We are pleased to offer a comprehensive, cost-effective benefits package intended to protect your well-being and financial health. This guide is intended to provide an overview and general information about your benefit options and to assist you in making enrollment decisions. To get the best value from your benefits plan, please take the time to evaluate your coverage options and determine which plans best meet the health care and financial needs of you and your family.
Please refer to the Summary Plan Descriptions for detailed information. This guide does not include all the terms, coverage, exclusions, limitations, and conditions of the plan document. However, if a discrepancy exists between this guide and the plan document, the plan document will govern. This guide does not imply a guarantee of employment or a continuation of benefits.
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices about your prescription drug coverage. Please see page 27 for more details.
BENEFITS ELIGIBILITY
You are eligible for benefits the first of the month after you have completed 60 continuous days of regular full-time employment. You may also enroll eligible dependents for benefits coverage. The cost to you for dependent coverage depends on the number of dependents you enroll and the particular plans you choose. When covering dependents, you must select the same plans for your dependents as you select for yourself.
ELIGIBLE EMPLOYEES
Regular, full-time employee
Average 30 or more hours per week
ELIGIBLE DEPENDENTS
Legal spouse
Children under 26 years of age
Unmarried, mentally or physically disabled children, regardless of age
PROOF OF DEPENDENT ELIGIBILITY
Evidence of Eligibility (EOE) is the proof of relationship documentation to establish a dependent’s eligibility for insurance coverage. When initially adding an eligible dependent to an insurance plan, EOE is required.
Child Your natural born child under age 261
Stepchild Your stepchild under age 261
Adopted Child Your legally adopted child under age 261
Foster Child Your foster child under age 261
Legal Guardian Your ward under the age of 261
Qualified Medical
Certificate of child naming you as the child’s parent
Birth Certificate of child naming your spouse as the child’s parent and Marriage Certificate for you and biological parent
Adoption Certificate or Adoption
Placement Agreement and Petition for Adoption
Placement Order and Affidavit of Foster Child
Government-Issued Birth Certificate for child, and court ordered document of legal custody
Order Qualified medical child support order Qualified Medical Child Support Order
1 Coverage may continue past the maximum age for a fully disabled dependent child.
ENROLLING IN BENEFITS
Benefit elections are made online using your Dayforce account. Failure to complete enrollment will result in waived coverage and you will not be able to enroll until the next Open Enrollment period.
QUALIFYING LIFE EVENTS
The Internal Revenue Service (IRS) provides strict regulations about changes to pretax elections after initial or annual enrollment. Your benefit elections remain in effect for the entire plan year (October 1 – September 30) and cannot be changed unless you experience a Qualifying Life Event (QLE). If you experience a QLE, you may make changes to your benefits within 30 days of the event. If the change request is not completed within 30 days of the event, you will not be able to change your elections until the next annual Open Enrollment period.
Examples of a QLE include:
Marriage, divorce, legal separation, or annulment
Birth, adoption, or placement for adoption of an eligible child
Death of a spouse or child
Change in your spouse’s employment that affects benefits eligibility
Change in your child’s eligibility for benefits (e.g., reaching the age limit, loss of coverage under Medicaid or CHIP)
Significant change in coverage or cost in your, your spouse’s, or child’s benefit plans
FMLA Leave, COBRA event, court judgment or decree
Becoming eligible for Medicare, Medicaid, or TRICARE
Receiving a Qualified Medical Child Support Order
Documentation of a QLE is required in order for you to make allowable changes to your benefits. If you are unsure if your event is a QLE, please contact Human Resources.
SECTION 125 AND PREMIUM PAYMENTS
It is your responsibility to review your earning statements and ensure the premium deductions for your elected benefits are correct. If you find a discrepancy, contact Human Resources immediately.
Premium payments are made through payroll deductions. IRS Section 125 allows you to pay health care (medical, dental, and vision) premiums on a pretax basis.
Contributions toward health care premiums are not subject to Social Security or Medicare taxes, nor are they subject to federal income or, where applicable, state and local income taxes.
Your taxable income is reduced accordingly. Pretax treatment therefore results in lower taxes and higher take-home pay.
Payroll deductions begin on the first pay date in the month in which your coverage begins.
MEDICAL COVERAGE
The medical plan options protect you and your family from major financial hardship in the event of illness or injury. You have a choice of three Preferred Provider Organization (PPO) plans:
Managed Choice Core Plan – provided by Aetna
Managed Choice Buy-Up Plan – provided by Aetna
Aetna Whole Health – Texas Health Plan – provided by Aetna Whole Health
– Texas Health
The PPO plans allow you the freedom to see any provider when you need care. When you use in-network providers, you receive benefits at a discounted network cost. You may pay more for services if you use out-of-network providers.
MEDICAL PLAN COMPARISON
In-network preventive care is covered at 100%.
In-network office visits, urgent care, and prescription medications are covered with a copay.
Most other in-network services are covered at the coinsurance level after you have met your deductible:
$4,000 individual deductible
$8,000 family deductible
Plan pays 70% after in-network deductible is met and 100% after in-network out-of-pocket maximum is reached:
$6,350 individual
$12,700 family
Utilizes the Aetna Open Access Managed Choice nationwide network of providers.
In-network preventive care is covered at 100%.
In-network office visits, urgent care, and prescription medications are covered with a copay.
Most other in-network services are covered at the coinsurance level after you have met your deductible:
$2,000 individual deductible
$4,000 family deductible
Plan pays 70% after in-network deductible is met and 100% after in-network out-of-pocket maximum is reached:
$6,350 individual
$12,700 family
Utilizes the Aetna Open Access Managed Choice nationwide network of providers.
In-network preventive care is covered at 100%.
In-network specialist visits, urgent care, and prescription medications are covered with a copay.
Most other in-network services are covered at the coinsurance level after you have met your deductible:
$1,000 individual deductible
$2,000 family deductible
Plan pays 100% after in-network deductible is met for all services subject to the deductible and 100% of all expenses after in-network out-of-pocket maximum is reached:
$2,500 individual
$5,000 family
Utilizes the Aetna Whole Health - Texas Health Aetna Select/OA Aetna Select/OA Elect Choice providers, including UT Southwestern, Cook Children’s Hospital, Texas Health Presbyterian Hospital, Children’s Medical Center of Dallas, and Methodist Health.
AETNA MANAGED CHOICE CORE PLAN
AETNA MANAGED CHOICE BUY-UP PLAN
AETNA WHOLE HEALTH –TEXAS HEALTH PLAN
MEDICAL BENEFITS SUMMARY
Retail Pharmacy
Up to 30-day supply
• Generic
• Preferred brand name
• Non-preferred generic/ brand name
Mail Order Pharmacy
Up to 90-day supply
• Generic
• Preferred brand name
• Non-preferred generic/ brand name
Specialty Medications
Up to 30-day supply
• Generic
• Preferred brand name
•
1 After deductible.
AVAILABILITY OF SUMMARY HEALTH INFORMATION
To help you make an informed choice and compare your options, a Summary of Benefits and Coverage (SBC) is available online in Dayforce or by contacting Human Resources for a printed copy.
TELEMEDICINE COVERAGE
Telemedicine lets you see and talk to a doctor from your mobile device or computer without an appointment and is a cost-effective alternative to an office visit or:
For non-emergency medical issues (especially as an alternative to the high cost of an emergency room or urgent care center)
When your doctor or pediatrician is not available on your schedule
When you are traveling and need medical care
When you need a prescription or refill
When it is not convenient to leave your home or work
WHEN TO USE TELEMEDICINE
COMMON CONDITIONS TREATED INCLUDE
Allergies Bronchitis Diarrhea Poison ivy
COST TO YOU
AETNA RESOURCES
AETNA ONLINE
Visit Aetna online for secure access to all of your account benefits and information.
Check the status of claims and your claim history
Locate in-network providers
Print or request an ID card
View and print Explanation of Benefits (EOB) forms
To get started, log on to www.aetna.com to register on the Aetna member website. Use the member information on your Aetna ID card to complete the registration process. If you have not yet received your medical ID card, you can use your social security number and date of birth to register.
AETNA HEALTH APP
The Aetna Health app can help you stay organized and in control of your health anytime, anywhere. Log in from your mobile device to access your account, including:
Pull up your ID card whenever you need it
See benefits and coverage details specific to your plan
Track spending and progress toward meeting your deductible
View and filter claims for your whole family
Find in-network providers near you and search by location or specialty
Compare cost estimates for doctor visits and procedures
Receive personalized recommendations to help improve your health Text AETNAHEALTHAPP to 90156 or search your device’s app store to download.
FIND A PROVIDER
Visit www.aetna.com/docfind Call 888-982-3862
Use the Open Access Managed Choice network (or Aetna Whole Health – Texas Health Aetna Select/OA Aetna Select/OA Elect Choice)
AETNA RESOURCES
PREVENTIVE CARE
Preventive check-ups and screenings can help find illnesses and medical problems early and improve the health of you and your family. Your health plan covers preventive care with no out-of-pocket costs like copays or coinsurance as long as you visit an in-network provider. Recommended preventive services include:
PREVENTIVE CARE CHECK-UPS AND SCREENINGS
Preventive immunizations (including flu shots)
Wellness and physical examinations
Blood pressure and cholesterol screenings
Well-woman exams and mammograms
Diabetes and obesity screening/counseling
Certain cancer screenings
DENTAL COVERAGE
Our dental plan helps you maintain good oral health through an affordable plan for preventive care, including regular checkups and other dental work. Coverage is provided through Aetna using the PDNII dental network.
DENTAL PREFERRED PROVIDER ORGANIZATION PLAN
The Dental Preferred Provider Organization (DPPO) plan allows the flexibility to select the provider of your choice, but benefits will be greater when you see an in-network provider. Out-of-network providers are paid at a percentage of the prevailing fee in their ZIP code.
DENTAL BENEFITS SUMMARY
FIND A DENTAL PROVIDER
To find an in-network dentist, visit www.aetna.com/docfind or call 888-982-3862 to speak with member services.
VISION COVERAGE
The vision plan through VSP Vision Care is designed to provide your basic eyewear needs and to preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes or 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.
VISION BENEFITS SUMMARY
• Single vision
• Lined bifocals
• Lined trifocals
• Standard progressive
• Premium progressive
• Custom progressive
• Retail
• Featured brands
Contacts In lieu of frames and lenses
• Elective
• Fitting and evaluation
1 Contact VSP for out-of-network plan details.
savings on amount over allowance
allowance
allowance
FLEXIBLE SPENDING ACCOUNTS
A Flexible Spending Account (FSA) allows you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. Our FSAs are administered by Higginbotham and are based on a calendar plan year (January 1 through December 31).
HEALTH CARE FSA
Set aside pretax dollars from each paycheck
Contribute up to $3,300 annually
Pay for eligible health care expenses such as office visit copays, deductible, prescription drugs, braces, dental, and eye care expenses
Available only if you do not have a Health Savings Account
HEALTH CARE FSA
DEPENDENT CARE FSA
Set aside pretax dollars from each paycheck
Contribute up to $7,500 annually
Use for child or dependent elder care expenses
Allows you and your spouse to work or attend school full time
Cannot be used to pay for dependent health care expenses
HIGGINBOTHAM BENEFITS DEBIT CARD
The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).
The Health Care FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. You may contribute up to $3,300 annually to a Health Care FSA and you are entitled to the full election from day one of the plan year. Eligible expenses include:
Dental and vision expenses
Medical deductibles and coinsurance
How the Health Care FSA Works
Prescription copays
Hearing aids and batteries
You can access the funds in your Health Care FSA two different ways:
Use your FSA debit card to pay for qualified expenses, doctor visits, and prescription copays.
Pay out-of-pocket and submit your receipts for reimbursement.
FLEXIBLE SPENDING ACCOUNTS
DEPENDENT CARE FSA
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for day care or baby sitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you must be a single parent or you and your spouse must be employed outside the home, disabled, or a full-time student.
Things to Consider Regarding the Dependent Care FSA
Overnight camps are not eligible for reimbursement (only day camps can be considered).
If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
IMPORTANT FSA RULES
The maximum per plan year you can contribute to a Health Care FSA is $3,300. The maximum per plan year you can contribute to a Dependent Care FSA is $7,500 when filing jointly or head of household and $3,750 when married filing separately.
The minimum per plan year you can contribute to a Health Care FSA or Dependent Care FSA is $100.
You cannot change your election during the year unless you experience a Qualifying Life Event.
Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
You may not contribute to a Health Care FSA if you also contribute to a Health Savings Account (HSA).
HIGGINBOTHAM PORTAL
The Higginbotham Portal provides information and resources to help you manage your FSAs.
Access plan documents, letters and notices, forms, account balances, contributions, and other plan information
Update your personal information
Utilize Section 125 tax calculators
Look up qualified expenses
Submit claims
Request a new or replacement Benefits Debit Card
Register on the Higginbotham Portal
Visit https://flexservices.higginbotham.net and click Get Started. Follow the instructions and scroll down to enter your information.
Enter your Employee ID, which is your Social Security number with no dashes or spaces.
Follow the prompts to navigate the site.
If you have any questions or concerns, contact Higginbotham:
Phone – 866-419-3519
Email – flexclaims @higginbotham.net
Fax – 866-419-3516
LIFE AND AD&D INSURANCE
Life and Accidental Death and Dismemberment (AD&D) insurance through Lincoln Financial Group are important parts of your financial security, especially if others depend on you for support. With Life insurance, your beneficiary(ies) can use the coverage to pay off your debts, such as credit cards, mortgages, and other final expenses. AD&D coverage provides specified benefits for a covered accidental bodily injury that causes dismemberment (e.g., the loss of a hand, foot, or eye). In the event that death occurs from an accident, 100% of the AD&D benefit would be payable to your beneficiary(ies).
BASIC LIFE AND AD&D
Basic Life and AD&D insurance are provided by The Fort Worth Zoo at no cost to you. You are automatically covered at one times your annual salary up to a maximum of $150,000
VOLUNTARY SUPPLEMENTAL LIFE AND AD&D
You may purchase additional Life and AD&D insurance for you and your eligible dependents. If you decline Voluntary Life and AD&D insurance when first eligible or if you elect coverage and wish to increase your benefit amount later, Evidence of Insurability (EOI) — proof of good health — may be required before coverage is approved.
You must elect Voluntary Life and AD&D insurance for yourself in order to elect coverage for your spouse or children. If you leave The Fort Worth Zoo, you may be able to take the insurance with you.
DESIGNATING A BENEFICIARY
A beneficiary is the person or entity you designate to receive the death benefits of your Life and AD&D insurance policy. You can name more than one beneficiary and you can change beneficiaries at any time. If you name more than one beneficiary, you must identify the share for each.
Increments of $10,000 up to five times annual earnings not to exceed $150,000
Guarantee Issue: $150,000
Increments of $5,000 up to $50,000 not to exceed 50% of employee coverage
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness while insured. The Fort Worth Zoo provides Short Term Disability (STD) and Long Term Disability (LTD) insurance at no cost to you through Lincoln Financial Group
SHORT TERM DISABILITY
STD coverage pays a percentage of your salary for up to 13 weeks if you are temporarily disabled and unable to work due to an illness, non-work-related injury or pregnancy. STD benefits are NOT payable if the disability is due to a job-related injury or illness.
LONG TERM DISABILITY
LTD insurance pays a percentage of your salary for a covered disability or injury that prevents you from working for more than 90 days. Benefits begin at the end of an elimination period and continue while you are disabled up to a maximum benefit duration.
Benefits begin on the 8th day of injury or illness
Receive 66.67% of your predisability earnings
$1,000 maximum weekly benefit
13-week maximum benefit period
Benefits begin on the 91st day of injury or illness
Receive 66.67% of your predisability earnings
$5,000 maximum monthly benefit
Maximum benefit period until you reach age 65 or Social Security Normal Retirement Age
Pre-Existing condition exclusion applies
LTD Pre-Existing Condition Exclusion
If you have a medical condition that begins before your coverage takes effect and you receive treatment for that condition within the three 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.
EMPLOYEE ASSISTANCE PROGRAM
Aetna’s Resources for Living EAP is a free, 24/7 counseling and support service available to you and your family, including children up to age 26 who are living away from home. The EAP serves as a point of early and confidential intervention for many problems and issues at home and work, such as:
Emotional Support – Get three counseling sessions per issue a year (e.g., grief, stress, family issues, etc.)
Daily Life Assistance – Get help for daily needs (e.g., child/elder care, special needs, pet care, home repair, etc.)
Legal and Financial Services – Get a free 30-minute consultation (e.g., law, estates, divorce, budgeting, credit issues, etc.)
Online and Additional Services – Access various resources and tools (e.g., discounts, chat therapy with counselors, identity theft services, MindCheck and myStrength tools for emotional health, etc.)
The Fort Worth Zoo wants to help you save for the future! Our 401(k) plan gives you the flexibility to save for retirement in a way that works best for you. If you are 21 years old or older, you can contribute to the plan on a pretax basis, lowering your taxable income now and paying taxes when you withdraw funds in retirement.
NEW THIS YEAR
Effective September 19, 2025, our 401(k) plan will offer a Roth 401(k) option in addition to the traditional pretax 401(k) option. With the new Roth 401(k) option, you can contribute to the plan with after-tax dollars, and qualified withdrawals in retirement are tax-free.
This option gives you greater flexibility in planning for your future. You may make pretax contributions, Roth 401(k) after-tax contributions, or a combination of both. You may adjust your contributions at any time.
In addition to your contributions, The Fort Worth Zoo may also, at its discretion, make an additional matching contribution to your retirement account.
To be eligible for the matching contribution, you must work a minimum of 1,000 hours during the plan year (January 1 – December 31) and be employed on the last day of the plan year (December 31).
FOR MORE INFORMATION
To begin participating, change your deferral rate, designate your beneficiary, or modify your investment options, go to www.empowermyretirement.com.
NOTE
The maximum amount you can contribute to your 401(k) account is determined by the IRS each year. It is your responsibility to ensure that applicable IRS maximums are not exceeded.
TIME OFF AND PERKS
PAID TIME OFF (PTO)
PTO is an all-purpose time-off bank used for scheduled and unscheduled absences. The PTO plan provides flexibility by combining traditional time off such as vacation, sick, and holiday leave into a single leave account. You begin accruing PTO hours on the first day of the pay period following your most recent hire date/ status change and according to the schedule below.
PTO SCHEDULE
PTO Sell Back
If you have been employed for a minimum of six (6) months and, at the time of the election (first day of the last pay period of the year), have at least eighty (80) hours of accrued PTO, then you are eligible once per calendar year to sell back forty (40) hours of PTO.
PTO Rollover
Your accrued unused PTO will continue to accumulate for use in future years.
ZOO ADMISSION
You will receive free admission to the Zoo as well as a family or guest membership. You also receive eight free general admission tickets per calendar year (after 60 days of continuous employment).
ZOO DISCOUNTS
You will receive discounts on tickets, food, merchandise, attractions, memberships, and education programs.
GLOSSARY OF TERMS
This glossary defines many commonly used terms, but is not a full list. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. Some of these terms also might not have exactly the same meaning when used in your policy or plan, and in any case, the policy or plan governs. (See your Summary of Benefits and Coverage for information on how to get a copy of your policy or plan document.)
HOW TO USE THIS GLOSSARY
Bold text indicates a term defined in this Glossary.
Refer to these terms if you need help understanding your benefits.
Allowed Amount – This is the maximum payment the plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance” or “negotiated rate.”
Appeal – A request that your health insurer or plan review a decision that denies a benefit or payment (either in whole or in part).
Balance Billing – When a provider bills you for the balance remaining on the bill that your plan does not cover. This amount is the difference between the actual billed amount and the allowed amount . For example, if the provider’s charge is $200 and the allowed amount is $110, the provider may bill you for the remaining $90. This happens most often when you see an out-of-network provider (non-preferred provider). A network provider (preferred provider) may not bill you for covered services.
Claim – A request for a benefit (including reimbursement of a health care expense) made by you or your health care provider to your health insurer or plan for items or services you think are covered.
Coinsurance – Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service. You generally pay coinsurance plus any deductibles you owe. (For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you have met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.)
Complications of Pregnancy – Conditions due to pregnancy, labor and delivery that require medical care to prevent serious harm to the health of the mother or the fetus. Morning sickness and a nonemergency Cesarean section generally are not complications of pregnancy.
Copayment – A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
Cost Sharing – Your share of costs for services that a plan covers that you must pay out of your own pocket (sometimes called “out-of-pocket costs”). Some examples of cost sharing are copayments, deductibles, and coinsurance. Family cost sharing is the share of cost for deductibles and outof-pocket costs you and your spouse and/or child(ren) must pay out of your own pocket. Other costs, including your premiums, penalties you may have to pay, or the cost of care a plan does not cover usually are not considered cost sharing.
GLOSSARY OF TERMS
Cost-Sharing Reductions – Discounts that reduce the amount you pay for certain services covered by an individual plan you buy through the Marketplace You may get a discount if your income is below a certain level, and you choose a Silver level health plan or if you are a member of a federally recognized tribe, which includes being a shareholder in an Alaska Native Claims Settlement Act corporation.
Deductible – An amount you could owe during a coverage period (usually one year) for covered health care services before your plan begins to pay. An overall deductible applies to all or almost all covered items and services. A plan with an overall deductible may also have separate deductibles that apply to specific services or groups of services. A plan may also have only separate deductibles. (For example, if your deductible is $1,000, your plan will not pay anything until you have met your $1,000 deductible for covered health care services subject to the deductible.)
Diagnostic Test – A test to figure out what your health problem is. For example, an X-ray can be a diagnostic test to see if you have a broken bone.
Durable Medical Equipment (DME) –Equipment and supplies ordered by a health care provider for everyday or extended use. DME may include oxygen equipment, wheelchairs, and crutches.
Emergency Medical Condition – An illness, injury, symptom (including severe pain) or condition severe enough to risk serious danger to your health if you did not get medical attention right away. If you did not get immediate medical attention, you could reasonably expect one of the following:
Your health would be put in serious danger
You would have serious problems with your bodily functions
You would have serious damage to any part or organ of your body.
Emergency Medical Transportation –Ambulance services for an emergency medical condition. Types of emergency medical transportation may include transportation by air, land, or sea. Your plan may not cover all types of emergency medical transportation, or may pay less for certain types.
Emergency Room Care/Emergency Services – Services to check for an emergency medical condition and treat you to keep an emergency medical condition from getting worse. These services may be provided in a licensed hospital’s emergency room or other place that provides care for emergency medical conditions
Excluded Services – Health care services that your plan does not pay for or cover.
Formulary – A list of drugs your plan covers. A formulary may include how much your share of the cost is for each drug. Your plan may put drugs in different cost sharing levels or tiers. For example, a formulary may include generic drug and brand name drug tiers and different cost sharing amounts will apply to each tier.
Grievance – A complaint that you communicate to your health insurer or plan
Habilitation Services – Health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in a variety of inpatient and/or outpatient settings.
Health Insurance – A contract that requires a health insurer to pay some or all of your health care costs in exchange for a premium. A health insurance contract may also be called a “policy” or “plan.”
Home Health Care – Health care services and supplies you get in your home under your doctor’s orders. Services may be provided by nurses, therapists, social workers, or other licensed health care providers. Home health care usually does not include help with non-medical tasks, such as cooking, cleaning, or driving.
GLOSSARY OF TERMS
Hospice Services – Services to provide comfort and support for persons in the last stages of a terminal illness and their families.
Hospitalization – Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. Some plans may consider an overnight stay for observation as outpatient care instead of inpatient care.
Hospital Outpatient Care – Care in a hospital that usually does not require an overnight stay.
Individual Responsibility Requirement – Sometimes called the “individual mandate,” the duty you may have to be enrolled in health coverage that provides minimum essential coverage. If you do not have minimum essential coverage, you may have to pay a penalty when you file your federal income tax return unless you qualify for a health coverage exemption.
In-Network Coinsurance – Your share (for example, 20%) of the allowed amount for covered health care services. Your share is usually lower for in- network covered services.
In-Network Copayment – A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health insurance or plan. In-network copayments usually are less than out-of-network copayments
Marketplace – A marketplace for health insurance where individuals, families, and small businesses can learn about their plan options; compare plans based on costs, benefits, and other important features; apply for and receive financial help with premiums and cost sharing based on income; and choose a plan and enroll in coverage. Also known as an “Exchange.” The Marketplace is run by the state in some states and by the federal government in others. In some states, the Marketplace also helps eligible consumers enroll in other programs, including Medicaid and the Children’s Health Insurance Program (CHIP). Available online, by phone, and in-person.
Maximum Out-of-pocket Limit – Yearly amount the federal government sets as the most each individual or family can be required to pay in cost sharing during the plan year for covered, in- network services. Applies to most types of health plans and insurance. This amount may be higher than the out-of-pocket limits stated for your plan.
Medically Necessary – Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease or its symptoms, including habilitation, and that meet accepted standards of medicine.
Minimum Essential Coverage – Health coverage that will meet the individual responsibility requirement . Minimum essential coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage.
Minimum Value Standard – A basic standard to measure the percent of permitted costs the plan covers. If you are offered an employer plan that pays for at least 60% of the total allowed costs of benefits, the plan offers minimum value and you may not qualify for premium tax credits and cost sharing reductions to buy a plan from the Marketplace
Network – The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.
Network Provider (Preferred Provider) –A provider who has a contract with your health insurer or plan who has agreed to provide services to members of a plan You will pay less if you see a provider in the network. Also called “preferred provider” or “participating provider.”
GLOSSARY OF TERMS
Orthotics and Prosthetics – Leg, arm, back, and neck braces; artificial legs, arms and eyes; and external breast prostheses after a mastectomy. These services include adjustment, repairs, and replacements required because of breakage, wear, loss, or a change in the patient’s physical condition.
Out-of-Network Coinsurance – Your share (for example, 40%) of the allowed amount for covered health care services to providers who do not contract with your health insurance or plan. Out-ofnetwork coinsurance usually costs you more than in-network coinsurance.
Out-of-Network Copayment – A fixed amount (for example, $30) you pay for covered health care services from providers who do not contract with your health insurance or plan. Out-of-network copayments usually are more than innetwork copayments
Out-of-Network Provider (NonPreferred Provider) – A provider who does not have a contract with your plan to provide services. If your plan covers out-of-network services, you will usually pay more to see an out-of-network provider than a preferred provider. Your policy will explain what those costs may be. May also be called “non-preferred” or “non-participating” instead of “out-ofnetwork provider.”
Out-of-Pocket Limit – The most you could pay during a coverage period (usually one year) for your share of the costs of covered services. After you meet this limit, the plan will usually pay 100% of the allowed amount . This limit helps you plan for health care costs. This limit never includes your premium, balancebilled charges, or health care your plan does not cover. Some plans do not count all of your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit.
Physician Services – Health care services a licensed medical physician, including an M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine), provides or coordinates.
Plan – Health coverage issued to you directly (individual plan) or through an employer, union, or other group sponsor (employer group plan) that provides coverage for certain health care costs. Also called “health insurance plan,” “policy,” “health insurance policy” or “ health insurance.”
Preauthorization – A decision by your health insurer or plan that a health care service, treatment plan, prescription drug , or durable medical equipment (DME) is medically necessary. Sometimes called prior authorization, prior approval, or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization is not a promise your health insurance or plan will cover the cost.
Premium – The amount that must be paid for your health insurance or plan You and/or your employer usually pay it monthly, quarterly, or yearly.
Premium Tax Credits – Financial help that lowers your taxes to help you and your family pay for private health insurance
You can get this help if you get health insurance through the Marketplace and your income is below a certain level. Advance payments of the tax credit can be used right away to lower your monthly premium costs.
Prescription Drug Coverage –
Coverage under a plan that helps pay for prescription drugs. If the plan’s formulary uses “tiers” (levels), prescription drugs are grouped together by type or cost. The amount you will pay in cost sharing will be different for each “tier” of covered prescription drugs
Prescription Drugs – Drugs and medications that by law require a prescription.
Preventive Care (Preventive Service) –
Routine health care, including screenings, check-ups, and patient counseling, to prevent or discover illness, disease, or other health problems.
Primary Care Physician – A physician, including an M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine), who provides or coordinates a range of health care services for you.
GLOSSARY OF TERMS
Primary Care Provider – A physician, including an M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law and the terms of the plan, who provides, coordinates, or helps you access a range of health care services.
Provider – An individual or facility that provides health care services. Some examples of a provider include a doctor, nurse, chiropractor, physician assistant, hospital, surgical center, skilled nursing facility, and rehabilitation center. The plan may require the provider to be licensed, certified, or accredited as required by state law.
Reconstructive Surgery – Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries, or medical conditions.
Referral – A written order from your primary care provider for you to see a specialist or get certain health care services. In many health maintenance organizations (HMOs), you need to get a referral before you can get health care services from anyone except your primary care provider. If you do not get a referral first, the plan may not pay for the services.
Rehabilitation Services – Health care services that help a person keep, get back, or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt, or disabled. These services may include physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation services in a variety of inpatient and/or outpatient settings.
Screening – A type of preventive care that includes tests or exams to detect the presence of something, usually performed when you have no symptoms, signs, or prevailing medical history of a disease or condition.
Skilled Nursing Care – Services performed or supervised by licensed nurses in your home or in a nursing home. Skilled nursing care is not the same as “skilled care services,” which are services performed by therapists or technicians (rather than licensed nurses) in your home or in a nursing home.
Specialist – A provider focusing on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions.
Specialty Drug – A type of prescription drug that, in general, requires special handling or ongoing monitoring and assessment by a health care professional, or is relatively difficult to dispense. Generally, specialty drugs are the most expensive drugs on a formulary
UCR (Usual, Customary and Reasonable) – The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount .
Urgent Care – Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care
LEGAL NOTICES
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998
In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully.
As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:
All stages of reconstruction of the breast on which the mastectomy was performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
Prostheses and treatment of physical complications of the mastectomy, including lymphedema.
Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
SPECIAL ENROLLMENT RIGHTS
This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.
Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP)
If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 30 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage).
If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance.
Marriage, Birth or Adoption
If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 30 days after the marriage, birth, or placement for adoption.
For More Information or Assistance
To request special enrollment or obtain more information, contact:
Fort Worth Zoo Human Resources 1989 Colonial Parkway Fort Worth, TX 76110 817-759-7227
LEGAL NOTICES
YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Fort Worth Zoo and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Fort Worth Zoo has determined that the prescription drug coverage offered by the Fort Worth Zoo medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage..
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Fort Worth Zoo at the phone number or address listed at the end of this section.
If you choose to enroll in a Medicare prescription drug plan and cancel your current Fort Worth Zoo prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.
If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.
For more information about this notice or your current prescription drug coverage:
Contact the Human Resources Department at 817-759-7227.
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
LEGAL NOTICES
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
Visit www.medicare.gov.
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
Call 1-800-MEDICARE (1-800-6334227). TTY users should call 877-4862048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www. socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
October 1, 2025
Fort Worth Zoo
Human Resources
1989 Colonial Parkway Fort Worth, TX 76110 817-759-7227
NOTICE OF HIPAA PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan – whether received in writing, in an electronic medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by Fort Worth Zoo, hereinafter referred to as the plan sponsor.
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer.
LEGAL NOTICES
You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask the Human Resources Department to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources Department.
Complaints: If you believe your privacy rights have been violated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer.
Fort Worth Zoo Human Resources 1989 Colonial Parkway Fort Worth, TX 76110 817-759-7227
Conclusion
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
LEGAL NOTICES
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272)
If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, 2025. Contact your State for more information on eligibility.
To see if any other States have added a premium assistance program since July 31, 2025, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
CONTINUATION OF COVERAGE RIGHTS UNDER COBRA
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the Fort Worth Zoo group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Fort Worth Zoo plan after you have left employment with the company. If you wish to elect COBRA coverage, contact your Human Resources Department for the applicable deadlines to elect coverage and pay the initial premium.
Plan Contact Information Fort Worth Zoo Human Resources 1989 Colonial Parkway Fort Worth, TX 76110 817-759-7227
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain outof-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-ofnetwork providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
LEGAL NOTICES
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an innetwork facility but are unexpectedly treated by an out-of-network provider. You are protected from balance billing for:
Emergency services – If you have an emergency medical condition and get emergency services from an outof- network provider or facility, the most the provider or facility may bill you is your plan’s in- network costsharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these innetwork facilities, out-of-network providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care out-ofnetwork. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-ofnetwork providers and facilities directly.
Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-ofnetwork services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/nosurprises for more information about your rights under federal law.
This brochure highlights the main features of the Fort Worth Zoo employee benefits program. It does not include all plan rules, details, limitations and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be an inconsistency between this brochure and the legal plan documents, the plan documents are the final authority. Fort Worth Zoo reserves the right to change or discontinue its employee benefits plans at anytime.
