2025 - 2026 Plan Year
MIDLAND ISD
BENEFIT GUIDE EFFECTIVE: 07/01/2025 - 06/30/2026 WWW.MYBENEFITSHUB.COM/MIDLANDISD
Table of Contents How to Enroll
4-5
Annual Benefit Enrollment
6-9
1. Annual Enrollment
6
2. Section 125 Cafeteria Plan Guidelines
7
3. Helpful Definitions
8
4. Eligibility Requirements
9
Hospital Indemnity
10
Telehealth
11
Vision
12-13
Disability
14
Life and AD&D
15-16
Individual Life
17
Cancer
18-19
Critical Illness
20-21
Accident
22-23
Emergency Medical Transportation
24
Flexible Spending Account (FSA)
25-26
Financial Wellness & ID Protection
27
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FLIP TO...
PG. 4
HOW TO ENROLL
PG. 6
SUMMARY PAGES
PG. 10
YOUR BENEFITS
Benefit Contact Information MIDLAND ISD BENEFITS Higginbotham Public Sector Call Center: (833) 738-4867 (800) 583-6908 www.mybenefitshub.com/midlandisd VISION EyeMed (888) 581-3648 eyemed.com/member
HOSPITAL INDEMNITY The Hartford Group #: VH1-681451 (866) 294-7987 www.thehartford.com DISABILITY The Hartford Group #: GLT-681451 (866) 294-7987 www.thehartford.com
INDIVIDUAL LIFE 5Star Life Insurance (866) 863-9753 www.5starlifeinsurance.com
CANCER Chubb (888) 499-0425
ACCIDENT The Hartford Group #: VAC-681451 (866) 294-7987 www.thehartford.com FINANCIAL WELLNESS & ID PROTECTION Experian Eilite Plan (855) 797-0052 www.experian.com
EMERGENCY MEDICAL TRANSPORTATION MASA (800) 423-3226 www.masamts.com
TELEHEALTH Recuro Health (855) 673-2876 www.recurohealth.com LIFE AND AD&D UNUM Basic Life Group #:682481 Voluntary Group Life Group #:682482 (866) 679-3054 www.unum.com CRITICAL ILLNESS UNUM Group #: 682480 (800) 635-5597 www.unum.com FLEXIBLE SPENDING ACCOUNT (FSA) NBS Group #: NBS400240 (855) 399-3035 www.nbsbenefits.com
Don’t Forget! •
Login and complete your benefit enrollment from 4/28/2025 - 5/21/2025
•
Enrollment assistance is available by calling Higginbotham Public Sector at (833) 453-1680.
•
REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator. 3
Mobile Enrollment Enrollment made easy with your smartphone or tablet. Text “BENEFITS” to (469) 669-0154 to opt into important text message*
Text “BENEFITS” to (469) 669-0154
enrollment reminders. Scan the QR code to go to your benefit website for: • Benefit Resources • Online Enrollment
OR SCAN
• Interactive Tools • And more! *Standard message rates may apply.
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Login Process 1
www.mybenefitshub.com/midlandisd
2
CLICK LOGIN
3
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.
4 5 5
Once confirmed, the Additional Security Verification page will list the contact options from your profile. Select either Text, Email, Call, or Ask Admin options to receive a code to complete the final verification step. Enter the code that you receive and click Verify. You can now complete your benefits enrollment!
Annual Benefit Enrollment
SUMMARY PAGES
Annual Enrollment Where can I find forms? For benefit summaries and claim forms, go to your benefit website: www.mybenefitshub.com/midlandisd. 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.
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.
How can I find a Network Provider? For benefit summaries and claim forms, go to the Midland ISD benefit website: www.mybenefitshub.com/midlandisd. Click on the benefit plan you need information on (i.e., Vision) and you can find provider search links under the Quick Links section.
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.
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. All new hire enrollment elections must be completed in the online enrollment system within the first 31 days If you do not receive your ID card, you can call the carrier’s customer service number to request another of benefit eligible employment. Failure to complete card. elections during this timeframe will result in the •
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
forfeiture of coverage. 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.
Q&A Who do I contact with Questions? For supplemental benefit questions, you can contact your Benefits Office or you can call Higginbotham Public Sector at (833) 453-1680 for assistance.
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Annual Benefit Enrollment
SUMMARY PAGES
Section 125 Cafeteria Plan Guidelines A Cafeteria plan enables you to save money by using pre-tax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment will become effective on the plan effective date and will remain in effect during the entire plan year.
Changes in benefit elections can occur only if you experience a qualifying event. You must present proof of a qualifying event to your Benefit Office within 31 days of your qualifying event and meet with your Benefits Office to complete and sign the necessary paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
CHANGES IN STATUS (CIS):
QUALIFYING EVENTS
Marital Status
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal separation is not recognized in all states).
Change in Number of Tax Dependents
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 Status of Employment Affecting Coverage Eligibility
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.
Gain/Loss of Dependents’ Eligibility Status
An event that causes an employee’s dependent to satisfy or cease to satisfy coverage requirements under an employer’s plan may include change in age, student, marital, employment or tax dependent status.
Judgment/ Decree/Order
If a judgment, decree, or order from a divorce, annulment or change in legal custody requires that you provide accident or health coverage for your dependent child (including a foster child who is your dependent), you may change your election to provide coverage for the dependent child. If the order requires that another individual (including your spouse and former spouse) covers the dependent child and provides coverage under that individual’s plan, you may change your election to revoke coverage only for that dependent child and only if the other individual actually provides the coverage.
Eligibility for Government Programs
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
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SUMMARY PAGES
Helpful Definitions Actively-at-Work
In-Network
You are performing your regular occupation for the employer on a full-time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel. If you will not be actively at work beginning 07/01/2025 please notify your benefits administrator.
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.
Annual Enrollment
Plan Year
The period during which existing employees are given the opportunity to enroll in or change their current elections.
July 1st through June 30th
Pre-Existing Conditions
Annual Deductible
Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).
The amount you pay each plan year before the plan begins to pay covered expenses.
Calendar Year July 1st through June 30th
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.
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Annual Benefit Enrollment
SUMMARY PAGES
Employee Eligibility Requirements
Dependent Eligibility Requirements
Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.
Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the district as both employees and dependents.
Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2025 benefits become effective on July 1, 2025, you must be actively-at-work on July 1, 2025 to be eligible for your new benefits.
PLAN
MAXIMUM AGE
Accident
Must be under age 26
Cancer
Through 24
Critical Illness
Must be under age 26
Dental
Must be under age 26
Dependent Care FSA
12 or younger or qualified individual unable to care for themselves & claimed as a dependent on your taxes
Individual Life
Issue through 25; Keep to 100
Healthcare FSA
Through 25 or IRS Tax Dependent
Medical
Must be under age 26
Hospital Indemnity Plan
Must be under age 26
Telehealth
Must be under age 26
Vision
Must be under age 26
Basic and Voluntary Life and AD&D
Must be under age 26
Medical Transportation
Must be under age 24
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 Benefits Office to request a continuation of coverage.
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Hospital Indemnity
EMPLOYEE BENEFITS
The Hartford
ABOUT HOSPITAL INDEMNITY This is an affordable supplemental plan that pays you should you be in patient 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/midlandisd
Hospital Indemnity (HI) insurance pays a cash benefit if you or an insured dependent (spouse or child) are confined in a hospital for a covered illness or injury. Even with the best primary health insurance plan, out-of-pocket costs from a hospital stay can add up. The benefits are paid in lump sum amounts to you, and can help offset expenses that primary health insurance doesn’t cover (like deductibles, coinsurance amounts or co- pays), or benefits can be used for any non-medical expenses (like housing costs, groceries, car expenses, etc.).
Hospital Indemnity Low
High
Employee Only
$23.48
$46.80
Employee and Spouse
$42.03
$83.76
Employee and Child(ren)
$41.36
$82.42
Employee and Family
$62.87
$125.28
COVERAGE INFORMATION
You have a choice of two hospital indemnity plans, which allows you the flexibility to enroll for the coverage that best meets your needs. To Learn more about Hospital Indemnity Insurance, visit www.thehartford.com/employeebenefits PLAN INFORMATION
LOW PLAN
HIGH PLAN
Coverage Type
On and off-job (24 hour)
On and off-job (24 hour)
Covered Events
Illness and injury
Illness and injury
HSA Compatible?
Yes
Yes
LOW PLAN
HIGH PLAN
BENEFITS HOSPITAL CARE
2
First Day Hospital Confinement
Up to 1 day per year
$1500
$3000
Daily Hospital Confinement (Day 2+)
Up to 90 days per year
$100
$200
Daily ICU Confinement (Day 1+)
Up to 30 days per year
$150
$250
Ability Assist® EAP2 – 24/7/365 access to help for financial, legal or emotional issues
Included
Included
HealthChampion
Included
Included
FEATURES SM2
– Administrative & clinical support following serious illness or injury
WHO IS ELIGIBLE?
You are eligible for this insurance if you are an active full-time employee who works at least 20 hours per week on a regularly scheduled basis, and are less than age 80. Your spouse and child(ren) are also eligible for coverage. Any child(ren) must be under age 26 (or under age None if a full-time student).
AM I GUARANTEED COVERAGE?
This insurance is guaranteed issue coverage – it is available without having to provide information about your or your family’s health. All you have to do is elect the coverage to become insured. 10
Telehealth
EMPLOYEE BENEFITS
Recuro Health
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/midlandisd Alongside your medical coverage is access to quality telehealth services through Recuro. Connect anytime day or night with a boardcertified doctor via your mobile device or computer. While Recuro 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 Telehealth: 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.
Recuro Behavioral Health: Managing stress or life changes can be overwhelming but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone or secure video. • Talk to a licensed counselor or psychiatrist from your home, office, or on the go! • Affordable, confidential online therapy for a variety of counseling needs.
Registration is Easy
Register with Recuro so you are ready to use this valuable service when and where you need it. • Online – www.recurohealth.com • Phone – 1.855.6RECURO • Mobile – download the Recuro mobile app to your smartphone or mobile device
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Vision Insurance
EMPLOYEE BENEFITS
EyeMed
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/midlandisd
Ready to live your best EyeMed life? 40 % OFF
additional complete pair of prescription eyeglasses
20 % OFF
non-covered items, including non-prescription sunglasses
Frequency
Once every plan year • Exam • Frame • Lens • Contact Lens
There’s so much more to your vision benefits than copays and coverage. Get ready to see the good stuff for yourself. Your network is the place to start See who you want, when you want. You have thousands of providers to choose from — independent eye doctors, your favorite retail stores, even online options. Keep your eyes open for extra discounts Members already save an average 76% off retail using their EyeMed benefits, 1 but our long list of special offers takes benefits even further. Remember, you’re never alone We’re always here to help you use your benefits like a pro. Stay in-the-know with text alerts or healthy vision resources from the experts. If it can make benefits easier for you, we do it. 1
Based on weighted average of sample transactions: EyeMed Insight network/$10 exam copay/$10 materials copay/$150 frame or contact lens allowance.
Create a member account at eyemed.com/member
Everything is right there in one spot. Check claims and benefits, see special offers and find an eye doctor — search for one with the hours, location and brands you want. For maximum mobility, try the EyeMed Members App (Google Play or App Store).
Log into eyemed.com/member to see all plans included with your benefits. EyeMed reserves the right to make changes to the products available on each tier. All providers are not required to carry all brands on all tiers. For current listing of brands by tier, call 866-939-3633. No benefits will be paid for services or materials connected with or charges arising from: medical or surgical treatment, services or supplies for the treatment of the eye, eyes or supporting structures; Refraction, when not provided as part of a Comprehensive Eye Examination; services provided as a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; any Vision Examination or any corrective Vision Materials required by a Policyholder as a condition of employment; safety eyewear; solutions, cleaning products or frame cases; non-prescription sunglasses plano (non-prescription) lenses; plano (non-prescription) contact lenses; two pair of glasses in lieu of bifocals; electronic vision devices; services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order; or lost or broken lenses, frames, glasses, or contact lenses that are replaced before the next Benefit Frequency when Vision Materials would next become available. Fees charged by a Provider for services other than a covered benefit and any local, state or Federal taxes must be paid in full by the Insured Person to the Provider. Such fees, taxes or materials are not covered under the Policy. Some provisions, benefits, exclusions or limitations listed herein may vary by state. Plan discounts cannot be combined with any other discounts or promotional offers. In certain states members may be required to pay the full retail rate and not the negotiated discount rate with certain participating providers. Please see online provider locator to determine which participating providers have agreed to the discounted rate. Underwritten by Fidelity Security Life Insurance Company® of Kansas City, Missouri, except in New York. Fidelity Security Life Policy number VC-146, form number M-9184. This is a snapshot of your benefits. The Certificate of Insurance is on file with your employer.
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Vision Insurance
EMPLOYEE BENEFITS
EyeMed
Insight network SCHEDULE OF BENEFITS VISION CARE SERVICES
EXAM SERVICES Exam Retinal Imaging CONTACT LENS FIT AND FOLLOW-UP Fit and Follow-up - Standard Fit and Follow-up - Premium FRAME Frame STANDARD PLASTIC LENSES Single Vision Bifocal Trifocal/Lenticular Progressive - Standard Progressive - Premium Tier 1 - 4 LENS OPTIONS Anti Reflective Coating - Standard Anti Reflective Coating - Premium Tier 1-2 Anti Reflective Coating - Premium Tier 3 Photochromic - Non-Glass Polycarbonate - Standard Polycarbonate - Std < 19 years of age Scratch Coating Tint UV Treatment All Other Lens Options CONTACT LENSES Contacts - Conventional Contacts - Disposable Contacts - Medically Necessary OTHER Hearing Care from Amplifon Network Lasik or PRK from U.S. Laser Network
IN-NETWORK MEMBER COST
OUT-OF-NETWORK MEMBER REIMBURSEMENT
$10 copay $0 copay
Up to $40 Up to $25
$0 copay; contact lens fit and two follow-up visits $0 copay; 10% off retail price, then apply $40 allowance
Up to $20 Up to $20
$0 copay; 20% off balance over $175 allowance
Up to $88
$0 copay $0 copay $0 copay $55 copay $85 - 215
Up to $30 Up to $50 Up to $70 Up to $50 Up to $50
$45 copay $57 - 68
Up to $23 Up to $23
$100 copay $75 $40 $0 copay $15 $15 $15 20% off retail price
Up to $23 Not covered Not covered Up to $20 Not covered Not covered Not covered Not covered
$0 copay; 15% off balance over $160 allowance $0 copay; 100% of balance over $160 allowance $0 copay; paid-in-full
Up to $80 Up to $80 Up to $300
Discounts on hearing aids; call 1.877.203.0675 15% off retail or 5% off promo price; call 1.800.988.4221
Not covered Not covered
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Disability Insurance
EMPLOYEE BENEFITS
The Hartford
ABOUT DISABILITY Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time. For full plan details, please visit your benefit website: www.mybenefitshub.com/midlandisd
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.
Elimination Period: 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.
Eligibility: You are eligible if you are an active employee who works at least 20 hours per week on a regularly scheduled basis.
Elimination Period Options: Injury 0 days/ Sickness 3 days first day hospital Injury 14 days/Sickness 14 days first day hospital Injury 30 days/Sickness 30 days first day hospital Injury 60 days/Sickness 60 days Injury 90 days/Sickness 90 days Injury 180 days/Sickness 180 days
The elimination period is the length of time you must be continuously disabled before you can receive benefits.
Enrollment: You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period. Effective Date: Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.
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.
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.
Once you have been disabled for 24 months, you must be prevented from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 60% or less of your pre-disability earnings.
Benefit Amount: You may purchase coverage that will pay you a monthly benefit of 30%, 40%, 50% or 60% of your monthly income, to a maximum of $7,500. Earnings are defined in The Hartford’s contract with your employer. Elimination Period 0/3 14/14 30/30 60/60 90/90 180/180
Disability—per $100 in coverage 30% 40% 50% of Salary of Salary of Salary $1.85 $2.24 $2.96 $1.48 $1.79 $2.35 $1.33 $1.60 $2.11 $1.03 $1.24 $1.65 $0.77 $0.94 $1.23 $0.59 $0.70 $0.93
Pre-Existing Condition Limitation: Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have been insured under this policy for 12 months before your disability begins. If your disability is a result of a preexisting condition, we will pay benefits for a maximum of 6 weeks.
60% of Salary $3.52 $2.80 $2.52 $1.94 $1.47 $1.11 14
Life and AD&D
EMPLOYEE BENEFITS
UNUM
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/midlandisd
How does it work?
Basic Life Insurance Plan Highlights
You keep coverage for a set period, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more. AD&D Insurance is also available, which can pay a benefit if you survive an accident but have certain serious injuries. It can pay an additional amount if you die from a covered accident.
Policy Number 682481
Who is eligible for this coverage? All actively employed employees working at least 30 hours each week for your employer in the U.S. What is the coverage amount? Your employer is providing you with $20,000 of term life insurance. You will also receive $20,000 of Accidental Death and Dismemberment insurance. Is it portable (can I keep it if I leave my employer)? If you retire, reduce your hours or leave your employer, you can continue coverage for yourself at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy - but they may be able to convert their term life policy to an individual life insurance policy. When is coverage effective? Please see your plan administrator for your effective date. What does my AD&D insurance pay for? The full benefit amount is paid for loss of: • Life • Both hands or both feet or sight of both eyes • One hand and one foot • One hand and the sight of one eye • Speech and hearing Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to 65 65% of original amount 70 50% of original amount Coverage may not be increased after a reduction.
Why Choose Unum?
Your employer is offering you this coverage at no cost to you.
What else is included?
A “Living” Benefit If you are diagnosed with a terminal illness with less than 12 months to live, you can request 75% of your life insurance benefit (up to $500,000) while you are still living. This amount will be taken out of the death benefit and may be taxable. Waiver of premium Your cost may be waived if you are totally disabled for a period. Portability You may be able to keep coverage if you leave the company, retire, or change the number of hours you work. Age Reduction Coverage amounts for Life and AD&D Insurance for you will reduce to 65% of the original amount when you reach age 65 and will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction.
Who can get Term Life coverage?
If you are actively at work at least 20 hours per week, you can receive coverage for: •
The policy provisions may vary or not be available in all states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage, please refer to www.mybenefitshub.com/midlandisd
You: A benefit amount of $20,000
Who can get Accidental Death & Dismemberment (AD&D) coverage? •
You: You can receive an AD&D benefit amount of $20,000.
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Life and AD&D
EMPLOYEE BENEFITS
UNUM
How much does the coverage cost? Term life Employee rate Spouse rate Age band per $1,000 per $1,000 <25 $0.052 $0.052 25-29 $0.062 $0.062 30-34 $0.083 $0.083 35-39 $0.093 $0.093 40-44 $0.104 $0.104 45-49 $0.155 $0.155 50-54 $0.238 $0.238 55-59 $0.445 $0.445 60-64 $0.683 $0.683 65-69 $1.315 $1.315 70-74 $2.133 $2.133 75+ $2.133 $2.133 Child life monthly rate is $0.17 per $1,000. One life premium covers all children.
Voluntary Life and AD&D Insurance Plan Highlights Policy Number 682482
Who is eligible for this coverage? All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children up to age 26 What are the Life/AD&D coverage amounts? • Employee: up to 7 times salary in increments of $10,000; not to exceed $700,000. • Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $50,000. • Child: up to 100% of employee coverage amount in increments of $1,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000. • Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself. Can I be denied coverage? • Current employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to $200,000 for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions. If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or before the enrollment deadline and will be required to answer health questions for any amount of coverage. • New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. When is coverage effective? Please see your plan administrator for your effective date. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness, or disorder, your dependent spouse and children: are confined in a hospital or similar institution; or are confined at home under the care of a physician for a sickness or injury. Exception: Infants are insured from live birth.
AD&D rate chart – you must purchase life coverage to purchase AD&D coverage Employee Employee & Family
AD&D Cost Per $1,000 Per $1,000
Monthly Cost $0.016 $0.024
Your Life rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date. Spouse Life rate is based on the Employee’s insurance age. Do my life insurance benefits decrease with age? Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 65 65% of original amount 70 50% of original amount Coverage may not be increased after a reduction. Is the coverage portable (can I keep it if I leave my employer)? If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy. Are there any life insurance exclusions or limitations? Life insurance benefits will not be paid for deaths caused by suicide within the first 24 months after the date your coverage becomes effective. If you increase or add coverage, these enhancements will not be paid for deaths caused by suicide within the first 24 months after you make these changes. Will my premiums be waived if I’m disabled? If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends. This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative.
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Individual Life Insurance
EMPLOYEE BENEFITS
5Star 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/midlandisd
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.
PROTECTION TO COUNT ON QUALITY OF LIFE Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following: • Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or • Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision
TERMINAL ILLNESS ACCELERATION OF BENEFITS Coverage that pays 30% (25% in CT and Ml) 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 23 years old
CONVENIENCE Easy payments through payroll deduction.
For further information and rates please visit www.mybenefitshub.com/midlandisd. *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 26 years old). $7.15 monthly for $10,000 coverage per child.
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Cancer Insurance
EMPLOYEE BENEFITS
Chubb
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/midlandisd
CORE PLAN FEATURES First Occurrence Benefit Radiation & Chemotherapy Benefit Surgical Benefit Transportation Benefit (Employee & Family) Lodging Benefit (Employee & Family) Hospital Confinement Hospital Intensive Care Confinement Wellness Benefit ADDITIONAL PLAN FEATURES Heart Attack & Stroke/Critical Illness Rider Anesthesia Hormone Therapy Ambulatory Surgical Facility Attending Physician Donor Benefit Home Health Care Hospice
PLAN 1 Diagnosis of Cancer Benefit: $5,000 Employee or Spouse; $7,500 Child(ren) & First Cancer Benefit: $100 paid upon receipt of first covered claim for Cancer; only 1 payment per certificate Radiation Therapy, Chemotherapy & Immunotherapy Benefit: maximum per covered person per 12-month period: $10,000 Up to $4,125 $100 per trip, maximum 12 trips per calendar year $100 per day, maximum 100 days per calendar year $200 per day - days 1 through 30; additional days: $400; max days per confinement: 31 $600 per day - days 1 through 30; additional days: $600; max days per confinement: 31 $50 per covered person, per calendar year / Follow-up test benefit amount: $100 PLAN 1 $5,000 Employee or Spouse; $7,500 Child(ren); Recurrence benefit: $2,500 Employee or Spouse; $3,750 Child(ren) General Anesthesia: 25% of Surgery Benefit $50 per calendar month; max months per calendar year: 12 Outpatient surgery facility service: $400 per day; max benefits per calendar year: 4 $50 per visit; max visits per confinement: 2; max visits per calendar year: 4 $200 per day of confinement, lifetime max donations: 2 $200 per day not to exceed the number of days confined; max days per calendar year: 30 $200 per day
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PLAN 2 Diagnosis of Cancer Benefit: $10,000 Employee or Spouse; $15,000 Child(ren) & First Cancer Benefit: $100 paid upon receipt of first covered claim for Cancer; only 1 payment per certificate Radiation Therapy, Chemotherapy & Immunotherapy Benefit: maximum per covered person per 12-month period: $20,000 Up to $4,125 $100 per trip, maximum 12 trips per calendar year $100 per day, maximum 100 days per calendar year $200 per day - days 1 through 30; additional days: $400; max days per confinement: 31 $600 per day - days 1 through 30; additional days: $600; max days per confinement: 31 $50 per covered person, per calendar year / Follow-up test benefit amount: $100 PLAN 2 $10,000 Employee or Spouse; $15,000 Child(ren); Recurrence benefit: $5,000 Employee or Spouse; $7,500 Child(ren) General Anesthesia: 25% of Surgery Benefit $50 per calendar month; max months per calendar year: 12 Outpatient surgery facility service: $400 per day; max benefits per calendar year: 4 $50 per visit; max visits per confinement: 2; max visits per calendar year: 4 $200 per day of confinement, lifetime max donations: 2 $200 per day not to exceed the number of days confined; max days per calendar year: 30 $200 per day
Cancer Insurance
EMPLOYEE BENEFITS
Chubb
Reconstructive Surgery Bone Marrow Transplant Stem Cell Transplant Drugs and Medicines Inpatient Drugs and Medicines Outpatient Blood and Plasma Ambulance - Ground Ambulance - Air Medical Equipment Prosthesis Hair Prosthesis Experimental Treatment PLAN PROVISIONS Pre-Existing Condition Limitation
Breast TRAM flap: $2,000; Breast TRAM flap: $2,000; Breast Reconstruction: $500; Breast Symmetry: Breast Reconstruction: $500; Breast Symmetry: $500; Facial Reconstruction: $500 $500; Facial Reconstruction: $500 First transplant: $6,000 / Additional transplant: First transplant: $12,000 / Additional transplant: 50% / Lifetime Maximum Transplant(s): 2 50% / Lifetime Maximum Transplant(s): 2 First transplant: $600 / Additional transplant: First transplant: $1,200 / Additional transplant: 50% / Lifetime Maximum Transplant(s): 2 50% / Lifetime Maximum Transplant(s): 2 $150 per day of confinement, maximum $150 per day of confinement, maximum confinements per calendar year: 6 confinements per calendar year: 6 Hormone Therapy Benefit: $50 per calendar Hormone Therapy Benefit: $50 per calendar month; max months per calendar year: 12 month; max months per calendar year: 12 $300 per transfusion; maximum transfusions $300 per transfusion; maximum transfusions per calendar year: 2 per calendar year: 2 $200 per trip, max trips per confinement: 2 $200 per trip, max trips per confinement: 2 $2,000 per trip, max trips per confinement: 2 $2,000 per trip, max trips per confinement: 2 $150 per piece of equipment; max pieces per $150 per piece of equipment; max pieces per calendar year: 2 calendar year: 2 Surgical: $1,000 per device; lifetime max benefit Surgical: $3,000 per device; lifetime max benefit $1,000; Non-Surgical Prosthesis Benefit: $100; $3,000; Non-Surgical Prosthesis Benefit: $300; lifetime maximum number of devices: 1 lifetime maximum number of devices: 1 $150 per hair piece, lifetime max: 1 $150 per hair piece, lifetime max: 1 Alternative Care Benefit: $75 per visit; max Alternative Care Benefit: $75 per visit; max visits per calendar year: 4 visits per calendar year: 4 PLAN 1 PLAN 2 12/12
If the Certificate replaced another Cancer Indemnity certificate or individual policy, Your coverage under the Certificate shall not limit or exclude coverage for a Pre-existing Condition or Waiting Period that would have been covered under the policy being replaced. Benefits payable for a Pre-existing Condition or during the Waiting Period will be the higher of the Continuity of Coverage Offered benefits that would have been payable under the terms of the prior coverage if it had remained (Describe Requirements) in force; or the benefits payable under the Certificate. Time periods applicable to Pre-existing Conditions and Waiting Periods will be waived to the extent that similar limitations or exclusions were satisfied under the coverage being replaced. Continuity of Coverage is only extended to the benefits provided under the Certificate. The Certificate may not include all the benefits provided under the prior coverage. No benefits will be paid for a date of diagnosis or treatment of cancer prior to the coverage effective date except where continuity of coverage applies. No benefits will be paid for services rendered by a member of the Immediate Family of a Covered Person. We will not pay benefits for other conditions or diseases, except losses due directly from Cancer or Skin Cancer. We will Policy Exclusions not pay Benefits for Cancer if the diagnosis or treatment of Cancer is received outside of the territorial limits of the United States and its possessions. Benefits will be payable if the Covered Person returns to the territorial limits of the United States and its possessions, and a Physician confirms the diagnosis or receives treatment. Waiver of Premium Included Conversion/Portability Portability MONTHLY PREMIUM PLAN 1 PLAN 2 Employee Only $18.14 $28.76 Employee & Spouse $34.68 $54.84 Employee & Child(ren) $23.48 $36.04 Employee & Family $41.32 $63.92 19
Critical Illness Insurance
EMPLOYEE BENEFITS
UNUM
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/midlandisd Critical Illness Age 18-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
$10,000 Plan $3.82 $4.82 $6.02 $8.02 $10.42 $13.52 $17.12 $23.12 $31.92 $46.12 $71.72 $105.52 $153.52 $247.04
$20,000 Plan $6.02 $8.02 $10.42 $14.42 $19.92 $25.42 $32.62 $44.62 $62.22 $90.62 $141.82 $209.42 $305.42 $492.42
$30,000 Plan $8.22 $11.22 $14.82 $20.82 $28.02 $37.32 $48.12 $66.12 $92.52 $135.12 $211.92 $313.32 $457.32 $737.82
Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness. Who is eligible for this coverage?
All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status). Your domestic partner is considered a spouse. What are the Critical The following coverage amounts are available. Illness coverage amounts? For you: Select one of the following Choice $10,000, $20,000 or $30,000 For your Spouse and Children: 100% of employee coverage amount. Can I be denied coverage? Coverage is guarantee issue. When is coverage effective? Are wellness Screenings covered?
Please see your Plan Administrator for your effective date of coverage. Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective. Each insured is eligible to receive one Be Well Benefit per calendar year. Be Well Benefit For you, your spouse and your children: $50 Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also include imaging studies, immunizations and annual examinations by a Physician. See certificate for details. 20
Critical Illness Insurance
EMPLOYEE BENEFITS
UNUM
What critical illness conditions are covered?
Covered Conditions* Critical Illnesses Coronary Artery Disease (major) Coronary Artery Disease (minor) End Stage Renal (Kidney) Failure Heart Attack (Myocardial Infarction) Major Organ Failure Requiring Transplant Stroke Cancer Invasive Cancer (including all Breast Cancer) Non-Invasive Cancer Skin Cancer Supplemental Critical Illnesses Benign Brain Tumor Coma Loss of Hearing Loss of Sight Loss of Speech Infectious Disease Occupational Human Immunodeficiency Virus (HIV) or Hepatitis Permanent Paralysis Progressive Diseases Amyotrophic Lateral Sclerosis (ALS) Dementia (including Alzheimer’s Disease) Functional Loss Multiple Sclerosis (MS) Parkinson’s Disease Additional Critical Illnesses for your Children Cerebral Palsy Cleft Lip or Palate Cystic Fibrosis Down Syndrome Spina Bifida
Percentage of Coverage Amount 50% 10% 100% 100% 100% 100% 100% 25% 500% 100% 100% 100% 100% 100% 25% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
*Please refer to the policy for complete definitions of covered conditions.
Pre-existing Conditions We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following: • a pre-existing condition; or • complications arising from treatment or surgery for, or medications taken for, a pre-existing condition. An insured has a pre-existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which: • medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period; • drugs or medications were taken, or prescribed to be taken during that period; or • symptoms existed.
The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective. Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the coverage effective date Pre-existing Condition requirements are not applicable to: • Children who are newly acquired after your Coverage Effective Date. Is the coverage portable (can I keep it if I leave my employer)? If your employment with your employer ends or you are no longer in an eligible group you can apply for ported coverage and pay the first premium within 31 days to continue coverage for yourself, your spouse and your children. If your spouse’s coverage ends as a result of your death, divorce or annulment, your spouse may elect to continue spouse and children coverage, as long as premium is paid as required. To file a claim call UNUM at 800-858-6843. 21
Accident Insurance
EMPLOYEE BENEFITS
The Hartford
ABOUT ACCIDENT Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you. For full plan details, please visit your benefit website: www.mybenefitshub.com/midlandisd
You have a choice of two accident plans, which allows you the flexibility to enroll for the coverage that best meets your needs. This insurance provides benefits when injuries, medical treatment and/or services occur as the result of a covered accident. Unless otherwise noted, the benefit amounts payable under each plan are the same for you and your dependent(s). To learn more about Accident insurance, visit thehartford.com/employeebenefits. PLAN INFORMATION Coverage Type BENEFITS EMERGENCY, HOSPITAL & TREATMENT CARE Accident Follow-Up Up to 3 visits per accident Acupuncture/Chiropractic Care/PT Up to 10 visits each per accident Ambulance – Air Once per accident Blood/Plasma/Platelets Once per accident Up to 30 days per accident while Child Care insured is confined Daily Hospital Confinement Up to 365 days per lifetime Daily ICU Confinement Up to 30 days per accident Diagnostic Exam Once per accident Emergency Dental Once per accident Emergency Room Once per accident Hospital Admission Once per accident Initial Physician Office Visit Once per accident Lodging Up to 30 nights per lifetime Medical Appliance Once per accident Rehabilitation Facility Up to 15 days per lifetime Transportation Up to 3 trips per accident Urgent Care Once per accident X-ray Once per accident
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Accident Low Option High Option Employee Only $8.18 $10.36 Employee and Spouse $12.95 $16.35 Employee and Child(ren) $13.92 $16.93 Employee and Family $21.83 $26.83 LOW PLAN On and off-job (24 hour) LOW PLAN
HIGH PLAN On and off-job (24 hour) HIGH PLAN
$50 $25 $1,500 $250
$50 $25 $1,500 $250
$25
$25
$100 $300 $200 Up to $150 $150 $500 $75 $100 $100 $50 $300 $50 $50
$200 $600 $200 Up to $150 $200 $1,000 $100 $100 $100 $150 $300 $50 $100
Accident Insurance
EMPLOYEE BENEFITS
The Hartford BENEFITS Cont’d.
LOW PLAN
HIGH PLAN
SPECIFIED INJURY & SURGERY Abdominal/Thoracic Surgery
Once per accident
$1,000
$1,000
Arthroscopic Surgery
Once per accident
250
250
Burn
Once per accident
Up to $10,000
Up to $10,000
Burn – Skin Graft
Once per accident for third degree burn(s)
25% of burn benefit
25% of burn benefit
Concussion
Up to 3 per year
$200
$200
Dislocation
Once per joint per lifetime
Up to $4,000
Up to $4,000
Eye Injury
Once per accident
$250
$250
Fracture
Once per bone per accident
Up to $6,000
Up to $6,000
Hernia Repair
Once per accident
$100
$100
Knee Cartilage
Once per accident
Up to $500
Up to $500
Laceration
Once per accident
Up to $400
Up to $400
Ruptured Disc
Once per accident
$500
$500
Tendon/Ligament/Rotator Cuff
Up to 2 per accident
750
750
$15,000
$30,000
CATASTROPHIC Accidental Death
Within 90 days; Spouse @ 50% and child @ 25%
Common Carrier Death
Within 90 days
3.33 times death benefit
3.33 times death benefit
Coma
Once per accident
Up to $5,000
Up to $5,000
Dismemberment
Once per accident
Up to $15,000
Up to $30,000
Paralysis
Once per accident
Up to $10,000
Up to $10,000
Prosthesis
Up to 2 per accident
Up to $1,000
Up to $1,000
Included
Included
FEATURES Ability Assist® EAP2 – 24/7/365 access to help for financial, legal or emotional issues
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Emergency Medical Transport
EMPLOYEE BENEFITS
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/midlandisd
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.
Emergent Plus Membership
Platinum Membership
Emergent Air Transportation
Emergent Ground Transportation
Non-Emergency InterFacility Transportation
Repatriation/Recuperation
Escort Transportation
Visitor Transportation
Return Transportation
Mortal Remains Transportation
Minor Return
Organ Retrieval/Organ Recipient Transportation
Vehicle Return
Pet Return
Worldwide Coverage
$14/month
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$39/month
Flexible Spending Account (FSA) NBS
EMPLOYEE BENEFITS
ABOUT FSA A Flexible Spending Account allows you to pay for eligible healthcare expenses with a pre-loaded debit card. You choose the amount to set aside from your paycheck every plan year, based on your employer’s annual plan limit. This money is use it or lose it within the plan year (unless your plan contains a $610 rollover or grace period provision). For full plan details, please visit your benefit website: www.mybenefitshub.com/midlandisd
Health Care FSA
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.
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 your plan year. Eligible expenses include: • Dental and vision expenses • Medical deductibles and coinsurance • Prescription copays • Hearing aids and batteries You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to a Health Savings Account (HSA).
Dependent Care FSA Guidelines • • •
How the Health Care FSAs Work
You can access the funds in your Health Care FSA two different ways: • Use your NBS Debit Card to pay for qualified expenses, doctor visits and prescription copays. • Pay out-of-pocket and submit your receipts for reimbursement: ∗ Fax – (844) 438-1496 ∗ Email – service@nbsbenefits.com ∗ Online – my.nbsbenefits.com ∗ Call for Account Balance: (855) 399-3035 ∗ Mail: PO Box 6980 West Jordan, UT 84084
•
Important FSA Rules •
•
Contact NBS • • • •
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 selfcare. The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
•
Hours of Operation: 6:00 AM – 6:00 PM MST, Mon-Fri Phone: (800) 274-0503 Email: service@nbsbenefits.com Mail: PO Box 6980 West Jordan, UT 84084
• •
Dependent Care FSA
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 25
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 $5,000 when filing jointly or head of household and $2,500 when married filing separately. You cannot change your election during the year unless you experience a Qualifying Life Event. 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 do not have to be enrolled in a medical plan to enroll in FSA Funds allocated to the HealthCare FSA, Limited Purpose FSA or Dependent Care FSA must be used during the plan year or are forfeited, this is known as the “use-it-or-lose-it” rule.
Flexible Spending Account (FSA) NBS
EMPLOYEE BENEFITS
Over-the-Counter Item Rule Reminder (OTC)
Health care reform legislation requires that certain over-the-counter (OTC) items require a prescription to qualify as an eligible Health Care FSA expense. You will only need to obtain a one-time prescription for the current plan year. You can continue to purchase your regular prescription medications with your FSA debit card. However, the FSA debit card may not be used as payment for an OTC item, even when accompanied by a prescription. Flexible Spending Accounts Account Type
Eligible Expenses
Annual Contribution Limits
Benefit
Health Care FSA
Most medical, dental and vision care expenses that are not covered by your health plan (such as copayments, coinsurance, deductibles, eyeglasses and doctor-prescribed over-thecounter medications)
$3,300
Saves on eligible expenses not covered by insurance, reduces your taxable income
Dependent Care FSA
Dependent care expenses (such as day care, after-school programs or elder care programs) so you and your spouse can work or attend school full-time
$5,000 single $2,500 if married and filing separate tax returns
Reduces your taxable income
FSAstore.Com
FSAstore.com offers thousands of FSA-eligible products and services to purchase using your FSA Debit Card or any major credit card. Competitive pricing and free shipping on orders over $50 can save you up to 40% using your FSA pretax dollars. Shop directly at FSAstore.com or have your physician submit prescriptions (when required). The FSAstore.com Services Channel allows you to search a database of more than 300,000 health care providers for nearby eligible services, such as acupuncture and chiropractic care. The FSAstore.com Learning Center focuses on answering common questions and keeping you informed about changes to your FSA benefits.
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Financial Wellness & ID Protection Experian
EMPLOYEE BENEFITS
ABOUT FINANCIAL WELLNESS & ID 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/midlandisd
Get help achieving financial wellness sooner with unique insights
Our Elite benefits plan features Digital Financial Manager—providing you tools to help manage your finances and credit profile in a single experience.
Digital Financial Manager
360o Financial Views Link all your accounts to stay on top of your daily spending with recommended budgets powered by AI and machine learning of past transactional behavior. Exclusive Credit Insights 50+ unique recommendations to help achieve financial goals sooner including activity, spending, budgeting, and VantageScore® improvements. Features to Help you With • Budgeting • Cash Flow • Spending • Net worth
Identity Protection for the Whole Family As identity theft continues to increase, an evolving suite of identity products helps you monitor any potential threats to your identity and alerts you if there are any areas of concern. You will also have access to proactive digital privacy tools that can help you keep passwords and other personal information.
Identity Theft Employee Employee and Family
$7.50 $14.00
An evolving suite of identity products to help you guard against the rising threat of fraud. Identity Restoration Experian® CreditLock Help getting back on track with support from an expert restoration Block fraudsters from using your information to get new credit and agent that will walk you through the process of reclaiming what’s act quickly to help prevent identity theft. Unlock it when you want rightfully yours. to apply for credit. Data Broker Removal Dark Web Monitoring If we detect any threats on the thousands of websites and millions Automatically reclaim exposed personal information from dangerous people finder sites to reduce your risk of identity theft of data points we scan, we’ll alert you so you can keep your family’s personal information safe. and potential fraud. Secure VPN Helps to prevent people and companies from seeing and collecting your data.
Password Manager Safely store and protect your logins and payment information in one place.
Over 30% of U.S. consumers ages 18- 44 reported experiencing identity theft in 2022 — U.S. Identity Theft: Adapting and Evolving, Ait-Novarica Group, July 2022 27
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2025 - 2026 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 Midland 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 Midland 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.
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