Employee
Benefits Welcome To Your 2026-2027 Employee Benefits Program
Helpful Resources Welcome.................................................... 3
Flexible Spending Accounts...............19
Educator Disability Insurance.............31
How to Enroll............................................ 4
HSA and FSA Comparison..................21
Cancer Insurance..................................33
Eligibility.................................................... 6
Critical Illness Insurance.....................34
Qualifying Life Events.............................7
Qualified HSA and FSA Expenses........................................22
Life and AD&D Insurance...................... 8
Emergency Transport Services.........23
Identity Theft Protection..................... 37
Medical Coverage..................................10
Hospital Indemnity Insurance............25
Financial Planning.................................38
Pharmacy..................................................15
Telemedicine and Behavioral Health.................................26
Medical Gap Insurance........................39
Employee Assistance Program..........16 Health Savings Account....................... 17
Dental Coverage................................... 27 Vision Coverage....................................29
Important Contacts Wylie ISD Benefits
Dental
Higginbotham Public Sector 833-505-3768 wylieisd@hps.higginbotham.net
Life and AD&D
Chubb Policy Number: 100000205 888-499-0425 cwbspecialmarketservice@chubb.com
Medical
TRS ActiveCare Medical 866-355-5999 www.bcbstx.com/trsactivecare
Guardian Policy Number: 80541 877-814-8970 www.guardiananytime.com
Cancer
Chubb Policy Number: 100000205 888-499-0425 educatorclaims@chubb.com
Health Savings Account EECU 817-882-0800 www.eecu.org
Critical Illness
Emergency Transport Services
The Hartford Group # 6819647 866-547-4205 www.myhealthhub.app/thehartford
MASA Group # B2BWYISD 800-643-9023 www.masaaccess.com/member
Accident
Chubb Policy Number: 100000205 888-499-0425 cwbspecialmarketservice@chubb.com
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Vision
The Hartford Policy Number: GLT-681947 866-547-9124 www.myhealthhub.app/thehartford
ComPsych 800-964-3577 www.guidanceresources.com
Hospital Indemnity
Cigna Policy Number: 3345644 800-244-6224 https://my.cigna.com
Educator Disability
Employee Assistance Program
Accident Insurance...............................36
Cigna Policy Number: AI110660 800-754-3207 supphealthclaims@cigna.com
Identity Theft Protection
Aura 833-552-2131 https://my.aura.com/sign-in
Flexible Spending Accounts National Benefit Services Policy Number: NBS961442 800-274-0503 service@nbsbenefits.com
Medical Gap Insurance
Pan American Administered by: Administrative Concepts 888-346-9905 claims@acitpa.com
Pharmacy
Express Scripts 844-367-6108 express-scripts.com/trsactivecare
Prescription Drug Discounts Clever RX 800-873-1195 www.cleverrx.com/wylieisd
Financial Planning: 457(b) Plan TCG Services 800-943-9179 tcgservices.com
Telemedicine and Behavioral Health Recuro Health 855-673-2876 customerservice@recurohealth.com
Benefits Office
Wylie ISD 972-429-3046 brooke.rannebarger@wylieisd.net
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Welcome
We are pleased to offer a full benefits package to you and your eligible dependents. Read this guide to know what benefits are available to you. You may only enroll for or make changes to your benefits during Open Enrollment (OE) or when you have a Qualifying Life Event (QLE).
Availability Of Summary Health Information Your plan offers medical coverage options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage available by accessing www.mybenefitshub.com/wylieisd.
Your New Benefits Begin and End September 1, 2026 – August 31, 2027 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 for your prescription drug coverage. Please see Important Legal Notices for more details.
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How to Enroll Enrolling in benefits is simple through THEbenefitsHUB. 1.
Go to www.mybenefitshub.com/wylieisd or scan the QR code.
2.
Click Login.
3.
Enter your: • Last name
4.
• Date of birth
Benefits Questions?
• Social Security number (last four digits only)
Employee benefits can be complicated. The Higginbotham Public Sector benefits team is available to help you with the following:
Once confirmed, the Additional Security Verification page will list contact options. Select either the Text, Email, Call, or Ask Admin option to receive a code for completing final verification.
5.
Enter the code, and click Verify to begin your enrollment.
6.
Review your personal information and verify covered dependents. Contact your employer with any discrepancies.
7.
After dependent information is confirmed, you may select the benefits shown. To make your selections, click the drop-down list next to the plan name. Once the desired coverage amount is selected, your contribution amount will be displayed. Click Save & Continue. Repeat for each benefit. You may be asked to provide evidence of insurability for certain benefits.
8.
If enrolling in life insurance coverage, you must identify your beneficiary(ies). • Select your beneficiary designation. • Click Sign & Continue. • Review and confirm your information.
• Benefits • Eligibility • Claims and Billing Call or text 833-505-3768 Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you leave a message after 3:00 p.m. CT, your call or text will be returned the next business day. You can also email wylieisd@hps.higginbotham.net. Bilingual representatives are available.
Section 125 Cafeteria Plan Guidelines A cafeteria plan enables you to save money by using pretax 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 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 QLE. You must present proof of the QLE to your Benefits Office within 31 days of the event. Meeting with the Benefits Office to complete and sign the necessary paperwork is also required to make benefit election changes effective. Changes must be consistent with the QLE.
• Click Finished.
SCAN THE QR CODE TO ENROLL
4
• Enrollment
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How to Enroll Enrollment FAQs What if I miss the enrollment deadline?
When will I get my ID cards?
You may only enroll for or change your benefits during OE or if you have a QLE.
If the medical carrier provides ID cards and there is a plan change, new cards usually arrive within four weeks of your effective date. If there are no plan changes, a new card may not be issued.
Is there an age limit for dependents to be covered under my benefits? You may cover dependents up to age 26 on most benefit plans, but there are exceptions. See the Eligibility section for more details.
You may not need a card for dental and vision plans. Simply give your provider the insurance company’s name and phone number to verify benefits. You can also print a temporary card by visiting the insurance company’s website.
Where do I find benefit summaries and forms? Access www.mybenefitshub.com/wylieisd and click on the benefit plan you need (i.e., Dental). Forms and benefits information are under the Benefits and Form section.
Benefit questions? Ask your Benefits Office.
How do I find an in-network provider?
Call Higginbotham Public Sector at 833-505-3768 or email wylieisd@hps.higginbotham.net.
Access www.mybenefitshub.com/wylieisd and click on the benefit plan for the provider you need to find. Click on the Quick Links section to find provider search links.
Important Limitations and Exclusions Information The following limitations and exclusions may apply when obtaining coverage as a married couple or for your dependents.
Can I cover my family — a spouse or a dependent — as dependents on my benefits if we work for the same employer? Some benefits may not allow you to do this if you work for the same employer. Review the applicable plan documents, contact Higginbotham Public Sector, or contact the insurance carrier for spouse and dependent eligibility.
Are there FSA/HSA limitations for married couples? Yes, generally. 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 for specific types of FSAs. Contact the FSA and/or HSA provider before you enroll or reach out to your tax advisor for further guidance. 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 FSAs and an HSA as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Higginbotham Public Sector, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of your enrollment in spouse and/or dependent coverage, including enrollment in an FSA and HSA.
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Eligibility Who is Eligible for Benefits You are eligible for coverage if you are a regular, full-time employee. You may only enroll for coverage when:
About Your Coverage Effective Date You must be actively at work on the date your coverage becomes effective. Your coverage must be in effect for your spouse’s and eligible children’s coverage to take effect. See plan documents for specific details.
• You are a new hire • It is OE • You have a QLE See Important Limitations and Exclusions information.
New Hire
Employee
Dependent(s)
Who is Eligible
Who is Eligible
Who is Eligible
• A regular, full-time employee working an average of 20 hours per week
• A regular, full-time employee working an average of 20 hours per week
• Your legal spouse
When to Enroll
When to Enroll
• Enroll by the deadline given by Human Resources
• Enroll during OE or when you have a QLE
When Coverage Starts
When Coverage Starts
• Child(ren) over age 26 who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return
• Next first of the month after the date of hire
• You must be actively at work on the plan effective date for new benefits to be effective • QLE: Ask Human Resources
• Child(ren) under age 26 regardless of student, dependency, or marital status
When to Enroll • You must enroll the dependent(s) during OE or when you have a QLE • When covering dependents, you must enroll for and be on the same plans • Dependents cannot be double-covered by married spouses within the district as both employees and dependents
When Coverage Starts • Based on OE or QLE effective dates
Maximum Dependent Eligibility Age by Plan To Age 26
Medical/Dental/Medical Gap Supplement/Telemedicine/ Vision/Life/AD&D/Accident/Critical Illness/ Hospital Indemnity/Health Savings Account/ Flexible Spending Accounts, Cancer, Identity Theft Protection, Employee Assistance Programs
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Qualifying Life Events
You may only change coverage during the plan year if you have a Qualifying Life Event, such as:
Marriage
Birth
Divorce
Adoption
Legal separation
Placement for adoption
Annulment Death
FMLA leave, COBRA event, court judgment, or decree
Change in benefits eligibility
Becoming eligible for Medicare, Medicaid, or TRICARE Receiving a Qualified Medical Child Support Order
Death
Gain or loss of benefits coverage Change in employment status affecting benefits Significant change in cost of spouse’s coverage
You have 31 days from the event to notify Benefits Office and complete your changes. You may need to provide documents to verify the change.
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Life and AD&D Insurance Life and Accidental Death and Dismemberment (AD&D) insurance is important to your financial security, especially if others depend on you for support or vice versa. With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies).
Watch and learn more!
Basic Term Life and AD&D Basic Term Life and AD&D insurance are provided at no cost to you. You are automatically covered at $20,000 for each benefit.
Supplemental Term Life If you need more coverage than Basic Term Life and AD&D, you may buy Supplemental Term Life for yourself and your dependent(s). If you do not elect Supplemental Term Life insurance when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health.
Designating a Beneficiary A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. 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 how much each beneficiary will receive (e.g., 50% or 25%). The total must add up to 100%.
Chubb Voluntary Life: Guaranteed Issue Eligibility You may enroll up to the Guaranteed Issue amounts with no medical questions: • Employee – $350,000 • Spouse – $100,000 For employees with an existing Voluntary Life Insurance policy, Chubb provides Guaranteed Issue coverage up to the maximum policy limits.
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Life and AD&D Insurance Supplemental AD&D
Supplemental Term Life and AD&D Insurance
Supplemental AD&D coverage is separate and apart from your Basic and Supplemental Term Life insurance coverage. It provides benefits beyond your disability or life insurance for covered losses that are the result of an accidental injury or loss of life. The full amount of AD&D coverage you select is called the Full Amount and is equal to the benefit payable for the loss of life. You may enroll for up to $750,000 in Supplemental AD&D coverage without proof of good health.
Basic Life and AD&D Coverage Amount Employee
• $20,000
Supplemental Life Coverage Amount Employee
• Guaranteed Issue: $350,000 (no maximum age) • New Hire Guaranteed Issue: $350,000
Spouse
• Guaranteed Issue: $100,000 (no maximum age); includes legal spouse and domestic partner • New Hire Guaranteed Issue: $100,000
Child(ren)
• Live birth to age 26: $10,000 • New Hire Guaranteed Issue: $10,000
Monthly Supplemental Life Rates
Supplemental Coverage Highlights • Portable – keep your coverage. • Convertible – convert your coverage. • Accelerated Benefits Option – get a percentage your life insurance benefit if you (or your spouse) are diagnosed with a terminal illness or need Long Term Care. Some limitations and exclusions apply. See the plan documents for details.
$0 Included Programs and Services
Age
Employee Rates per $10,0001
<25
$0.440
25-29
$0.220
30-34
$0.530
35-39
$0.700
40-44
$0.970
45-49
$1.680
50-54
$2.830
55-59
$4.510
60-64
$6.900
65-69
$12.460
70+
$22.440
Child(ren) Rates per $10,0002 To age 26
These programs and services are included with your Life insurance plans:
$0.60
Monthly Supplemental AD&D Rates (Maximum Coverage: $750,000)
• Employee Assistance Program* (six in-person visits) • Travel Assistance* (pre-trip planning and emergency support) • Will Preparation* (other services available) • Air Bag Benefit (up to $5,000)
Employee
Spouse
Child(ren)
$0.20 per $10,000
$0.10 per $5,000
$0.20 per $10,000
1
Spouse rate is based on $5,000.
2
One premium covers all children.
• Child Care Expense Benefit (up to $12,000 max) • Child Education Benefit (up to $24,000 max) • Workplace Felonious Assault Benefit (up to $10,000 max) * With Supplemental Life only
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Medical Coverage Our medical plans protect you and your family from major financial hardship in the event of illness or injury. All TRS-Active participants may enroll in one of the following plans: • TRS-ActiveCare Primary • TRS-ActiveCare Primary+ • TRS-ActiveCare HD • The TRS-ActiveCare 2 plan is closed to new enrollments, but you may continue in the plan if you are a currently enrolled participant.
TRS-ActiveCare Primary and TRSActiveCare Primary+
Watch and learn more! TRS Region 10 Monthly Rates
TRS-ActiveCare Primary and TRS-ActiveCare Primary+ are physician-directed plans that require you to choose a primary care provider (PCP) who manages your care and provides referrals to specialists when needed. These plans feature low copays for doctor visits and generic prescriptions before meeting your deductible, as well as combined medical and pharmacy deductibles and out-of-pocket maximums. Both offer a broad statewide network without regional restrictions and provide flexibility for dependents living out of state to access out-of-network coverage. Prescription benefits also include coverage for specialty medications.
Monthly Premium
District Contribution
Employee Cost
$614.00
$275.00
$339.00
Employee and Spouse
$1,658.00
$275.00
$1,383.00
Employee and Child(ren)
$1,044.00
$275.00
$769.00
Employee and Family
$2,088.00
$275.00
$1,813.00
$722.00
$275.00
$447.00
Employee and Spouse
$1,878.00
$275.00
$1,603.00
Employee and Child(ren)
$1,228.00
$275.00
$953.00
Employee and Family
$2,383.00
$275.00
$2,108.00
Employee Only
$628.00
$275.00
$353.00
Employee and Spouse
$1,696.00
$275.00
$1,421.00
Employee and Child(ren)
$1,068.00
$275.00
$793.00
Employee and Family
$2,136.00
$275.00
$1,861.00
Employee Only
$1,013.00
$275.00
$738.00
Employee and Spouse
$2,402.00
$275.00
$2,127.00
Employee and Child(ren)
$1,507.00
$275.00
$1,232.00
Employee and Family
$2,841.00
$275.00
$2,566.00
ActiveCare Primary Employee Only
ActiveCare Primary+ Employee Only
ActiveCare HD
TRS-ActiveCare HD TRS-ActiveCare HD is a high-deductible plan that pairs with a Health Savings Account (HSA). You must meet your deductible before the plan begins to pay for most services. This plan does not require a PCP or referrals for specialist visits, offering more flexibility in choosing your care. It features a broad nationwide network, including coverage outside Texas, and also provides out-of-network benefits. Prescription coverage includes specialty medications, and the plan’s compatibility with an HSA allows you to save pretax dollars for medical expenses.
ActiveCare 2
Find an In-Network Provider Visit www.bcbstx.com/trsactivecare. Call 866-355-5999.
10
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Medical Coverage
TRS-ActiveCare
PLAN HIGHLIGHTS 2026-27
Except Arlington ISD TRS is committed to accessibility. If you have trouble accessing this content, contact TRS at WebAccessibility@trs.texas.gov to request an alternative format.
LEARN THE TERMS • PREMIUM: The monthly amount you pay for health care coverage. • DEDUCTIBLE: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay. • COPAY: The set amount you pay for a covered service at the time you receive it. The amount can vary based on the service. • COINSURANCE: The portion you’re required to pay for services after you meet your deductible. It’s often a specified percentage of the costs; e.g., you pay 20% while the health care plan pays 80%. • TIERING: Grouping doctors and facilities into tiers based on quality, cost and best practice clinical guidelines. This helps you compare choices. Tier 1 providers and facilities offer top performance and best value. You pay less when you choose Tier 1 and may pay more when you choose Tier 2. • OUT-OF-POCKET MAXIMUM: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket maximum, the plan pays 100% of allowable charges for covered services. Visit www.mybenefitshub.com/wylieisd for full plan details. RETURN TO TOC
765391.0226
11
2026-27 TRS-ActiveCare Plan Highlights Sept. 1, 2026 – A How to Calculate Your Monthly Premium
All TRS-ActiveCare participants have three plan options. E TRS-ActiveCare Primary • Lowest premium of the three available plans • Copays for doctor visits before you meet your deductible • Statewide network • Primary Care Provider referrals required to see specialists • Not compatible with a Health Savings Account • No out-of-network coverage
Total Monthly Premium Your Employer Contribution
Plan Summary
Your Premium Ask your Benefits Administrator for your district’s specific premiums.
Monthly Premiums
Total Premium Employee Only
Being Healthy is Easy • $0 preventive services • One-on-one health coaches • Weight loss programs and nutrition • TRS Virtual Health • Member Rewards is even better. Now you’ll get a check when you use Member Rewards and choose low-cost, highquality doctors and facilities – up to $599* per tax year. • Airrosti Remote Recovery gives you inhome virtual physical therapy to relieve
Employer Contribution
Your Premium
$614
TRS
• Highest premium • Copays for many • Lower deductible • Statewide netwo • Primary Care Pro • Not compatible w • No out-of-netwo
Total Premium $722
Employee and Spouse
$1,658
$1,878
Employee and Children
$1,044
$1,228
Employee and Family
$2,088
$2,383
Plan Features Type of Coverage Individual/Family Deductible Coinsurance Individual/Family Maximum Out of Pocket
In-Network Coverage Only
I
$2,500/$5,000 You pay 30% after deductible
Yo
$8,050/$16,100
PCP Required
Yes
Primary Care
$30 copay
Specialist
$70 copay
Doctor Visits
common aches and pains at no cost.* * Eligibility rules may apply.
See the Annual Enrollment Guide for more details.
Mental Health
Immediate Care Urgent Care
$50 copay
Emergency Care
You pay 30% after deductible
You
TRS Virtual Health-RediMD
$0 per medical consultation
$0
$12 per medical consultation
$12
TM
TRS Virtual Health-Teladoc
®
You have in-office and virtual benefits: Prescription Drugs • TRS-ActiveCare Primary Plan: $30 copay Drug Deductible Integrated with medical for office visits or $0 with Teladoc Generics (31-Day Supply/90-Day Supply) $15/$45 copay; $0 copay for certain generics • TRS-ActiveCare Primary+ Plan: $15 Preferred (Max does not apply if brand is You pay 30% after deductible copay for office visits or $0 with Teladoc selected and generic is available) • TRS-ActiveCare HD Plan: 30% You pay 50% after deductible Non-preferred coinsurance after deductible or $42 with Specialty (31-Day Max) You pay 30% after deductible; Teladoc Call 1-844-367-6108 to see if your specialty $0 if SaveOnSP eligible medication is covered by SaveOnSP. • TRS-ActiveCare 2 Plan: $20 copay for $25 copay for 31-day supply; Insulin Out-of-Pocket Costs Visit www.mybenefitshub.com/wylieisd for full plan details. office12 visits or $12 with Teladoc $75 for 61- to 90-day supply RETURN TO TOC
$200 deduct You pay You pay
Yo You pay
$2 $7
Aug. 31, 2027
Each includes a wide range of wellness benefits.
S-ActiveCare Primary+
m of the three available plans y services and drugs e than the HD and Primary plans ork ovider referrals required to see specialists with a Health Savings Account ork coverage
Employer Contribution
Your Premium
This plan is closed to new enrollees. Current TRS-ActiveCare 2 participants can stay enrolled.
TRS-ActiveCare HD
TRS-ActiveCare 2
• Higher premium of the three available plans • Must meet your deductible before plan pays for non-preventive care • Nationwide network with out-of-network coverage • No requirement for Primary Care Providers or referrals • Compatible with a Health Savings Account
Employer Contribution
Total Premium
Your Premium
• Closed to new enrollees • Current enrollees can choose to stay in the plan • Lower deductible • Copays for many services and drugs • Nationwide network with out-of-network coverage • No requirement for Primary Care Providers or referrals
Employer Contribution
Total Premium
$628
$1,013
$1,696
$2,402
$1,068
$1,507
$2,136
$2,841
Your Premium
In-Network Coverage Only
In-Network
Out-of-Network
In-Network
Out-of-Network
$1,200/$2,400
$3,400/$6,800
$6,800/$13,600
$1,000/$3,000
$2,000/$6,000
ou pay 20% after deductible
You pay 30% after deductible
You pay 50% after deductible
You pay 20% after deductible
You pay 40% after deductible
$6,900/$13,800
$8,300/$16,600
$20,500/$41,000
$7,900/$15,800
$23,700/$47,400
Yes
No
No
$15 copay
You pay 30% after deductible
You pay 50% after deductible
Tier 1: $20 copay Tier 2: $40 copay
You pay 40% after deductible
$70 copay
You pay 30% after deductible
You pay 50% after deductible
Tier 1: $55 copay Tier 2: $85 copay
You pay 40% after deductible
$50 copay
You pay 30% after deductible
You pay 50% after deductible
$50 copay
You pay 40% after deductible
You pay a $250 copay plus 20% after deductible
u pay 20% after deductible
You pay 30% after deductible
0 per medical consultation
$30 per medical consultation
$0 per medical consultation
$42 per medical consultation
$12 per medical consultation
2 per medical consultation
tible per participant (brand drugs only)
Integrated with medical
$200 brand deductible
You pay 20% after deductible; $0 coinsurance for certain generics
$20/$45 copay
25% after deductible ($100 max)/ 25% after deductible ($265 max)
You pay 25% after deductible
You pay 25% after deductible ($40 min/$80 max)/ You pay 25% after deductible ($105 min/$210 max)
ou pay 50% after deductible
You pay 50% after deductible
You pay 50% after deductible ($100 min/$200 max)/ You pay 50% after deductible ($215 min/$430 max)
20% after deductible ($500 max); $0 if SaveOnSP eligible
You pay 20% after deductible
You pay 30% after deductible ($200 min/$900 max); $0 if SaveOnSP eligible
$15/$45 copay
25 copay for 31-day supply; 75 for 61- to 90-day supply
You pay 25% after deductible $25 copay for 31-day supply; $75 for 61- to 90-day supply Visit www.mybenefitshub.com/wylieisd for full plan details. 13 RETURN TO TOC
Questions?
Call a Personal Health Guide at 1-866-355-5999 for help with medical services. Call Express Scripts® by Evernorth Pharmacy Benefit Services at 1-844-367-6108 for help with your pharmacy benefits.
Compare Prices for Common Medical Services Closed to new enrollees. Benefit
TRS-ActiveCare Primary
TRS-ActiveCare Primary+
In-Network Only
In-Network Only
Office/Independent Lab: You pay $0
Office/Independent Lab: You pay $0
TRS-ActiveCare HD In-Network
Out-of-Network
In-Network
Out-of-Network
Office/Independent Lab: You pay $0 You pay 30% after deductible
Diagnostic Labs
TRS-ActiveCare 2
You pay 50% after deductible
You pay 40% after deductible
Outpatient: You pay 30% after deductible
Outpatient: You pay 20% after deductible
You pay 30% after deductible
You pay 20% after deductible
You pay 30% after deductible
You pay 50% after deductible
You pay 20% after deductible + $100 copay per procedure
You pay 40% after deductible + $100 copay per procedure
You pay 30% after deductible
You pay 20% after deductible
You pay 30% after deductible
You pay 50% after deductible
You pay 20% after deductible ($150 facility copay per incident)
You pay 40% after deductible ($150 facility copay per incident)
(like childbirth, complex joint replacement and cardiac surgery)
You pay 30% after deductible
You pay 20% after deductible
You pay 30% after deductible
You pay 50% after deductible ($500 facility per day maximum)
You pay 20% after deductible ($150 facility copay per day)
You pay 40% after deductible ($500 facility copay per incident)
Freestanding Emergency Room
You pay $500 copay + 30% after deductible
You pay $500 copay + 20% after deductible
You pay $500 copay + 30% after deductible
You pay $500 copay + 50% after deductible
You pay $500 copay + 20% after deductible
You pay $500 copay + 40% after deductible
Facility: You pay 30% after deductible
Facility: You pay 20% after deductible
Facility: You pay 20% after deductible ($150 facility copay per day)
Professional Services: You pay $5,000 copay + 30% after deductible
Professional Services: You pay $5,000 copay + 20% after deductible
Professional Services: You pay $5,000 copay + 20% after deductible
Only covered if rendered at a BDC+ facility
Only covered if rendered at a BDC+ facility
Specialist: You pay $70 copay
Specialist: You pay $70 copay
You pay 30% after deductible
You pay 50% after deductible
PCP: $30 copay
PCP: $15 copay
Specialist: $70 copay
Specialist: $70 copay
You pay 30% after deductible
You pay 50% after deductible
High-Tech Imaging (like CT Scan, Mammogram and MRI)
Outpatient (like colonoscopy, cataract surgery and steroid injections)
Inpatient
Bariatric Surgery
Annual Vision Exam (one per plan year)
Annual Hearing Exam (one per plan year)
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Outpatient: You pay 20% after deductible
Not Covered
Not Covered
Not Covered
Only covered if rendered at a BDC+ facility Tier 1 Specialist: $55 copay Tier 2 Specialist: $85 copay
Tier 1 PCP: $20 copay Tier 2 PCP: $40 copay Tier 1 Specialist: $55 copay Tier 2 Specialist: $85 copay
Visit www.mybenefitshub.com/wylieisd for full plan details. RETURN TO TOC www.trs.texas.gov
You pay 40% after deductible
You pay 40% after deductible
Pharmacy Express Scripts TRS Pharmacy Benefits Manager
Contact Express Scripts
As part of your TRS medical plan coverage, you also have pharmacy benefits coverage through Express Scripts, our pharmacy benefits manager (PBM). This pharmacy benefits coverage is available ONLY to those enrolled in one of the TRS-ActiveCare medical plans.
Visit https://www.express-scripts.com/ trsactivecare. Call 844-367-6108.
Express Scripts helps you understand your pharmacy benefits and makes it convenient and affordable for you and your family to access the medications you need. New enrollees will be issued ID cards effective for the upcoming plan year. If you do not receive a card, or if yours is misplaced, you may download a temporary ID card. You can also contact the Express Scripts TRS-ActiveCare Customer Support team for assistance. Once your plan year deductible is met, you will pay the applicable copay or coinsurance for each prescription until your out-of-pocket maximum is reached. The Express Scripts website allows you to download a temporary ID card, check medication costs, and explore options for home delivery, specialty medications, and retail pharmacies. Please note that when utilizing prescription drug resources outside of Express Scripts, your prescription costs may not be applied toward your pharmacy coverage deductible or copays.
Prescription Drug Discounts Aside from the pharmacy benefits coverage included with your TRS medical plan, standalone prescription drug discount programs (which are not insurance) may help to lower your prescription costs. Such discount programs are available to anyone who is interested in saving money on their prescriptions.
Lower Your Prescription Costs With Clever RX Don’t overpay for your prescriptions. Clever RX gives you access to discounts on thousands of medications, and it is accepted at most pharmacies nationwide. Best of all – you can get up to 80% off prescription drugs!
Questions
Getting Started is Easy!
1.
• Group ID – 1085 • Member ID – 4014 Enter your ZIP code to find local
2. pharmacies with the best prices. 3.
Visit https://cleverrx.com/wylieisd.
Download the free Clever RX app and enter these numbers:
Click the voucher with the lowest price, closest location, and/or at your preferred pharmacy. Then present the voucher to the pharmacist when you pick up your prescription.
Call the Clever RX Help Line at 800-873-1195.
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Employee Assistance Program An Employee Assistance Program (EAP) helps you and family members cope with a variety of personal or work-related issues. Get confidential counseling and support services from licensed professionals at little or no cost to help with:
Relationships
Watch and learn more!
Work-life balance Stress and anxiety
Get 24/7 Support Visit www.guidanceresources.com. Web ID: CHUBB.
Grief and loss
Call 844-266-0712.
Childcare and eldercare resources
Download the GuidanceNow app.
Substance abuse Addiction And more
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Health Savings Account An HSA is more than a way to help you and your family cover health care costs – it is also a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs. A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule — you do not lose your money if you do not spend it in the calendar year — and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA Eligibility You are eligible to open and contribute to an HSA if you are: • Enrolled in an HSA-eligible High Deductible Health Plan (HDHP) • Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan • Not enrolled in a Health Care FSA, nor should your spouse be contributing towards a Health Care FSA
Watch and learn more!
• Not eligible to be claimed as a dependent on someone else’s tax return • Not enrolled in Medicare, Medicaid, or TRICARE • Not receiving Veterans Administration benefits You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered under your HDHP.
Having an HSA is a smart financial move!
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Health Savings Account Opening an HSA
Maximum HSA Contributions 2026 $4,400 Individual $8,750 Family If you are age 55 or older, you may make a yearly catchup contribution of up to $1,000 to your HSA. If you turn 55 at any time during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.
Important HSA Information • Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount. • You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit. • You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction.
HSA Contacts Visit www.eecu.org or download the mobile app to find a local financial center, check your balance, pay bills, and more. Call/Text 817-882-0800 for EECU member service. • Monday – Friday from 8:00 a.m. to 7:00 p.m. CT • Saturday 9:00 a.m. to 1:00 p.m. CT Call 800-333-9934 24/7 for lost or stolen cards.
Your HSA contributions may not exceed the annual maximum amount established by the IRS.
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Flexible Spending Accounts An FSA allows you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses.
Health Care FSA
Dependent Care FSA
The Health Care FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. Eligible expenses include:
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 daycare or babysitter 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 (and your spouse, if married) must be gainfully employed, looking for work, a full-time student, or incapable of self-care.
• 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 an HDHP and contribute to an HSA.
Dependent Care FSA Guidelines
Limited Purpose Health Care FSA A Limited Purpose Health Care FSA is available if you are enrolled in the HDHP medical plan and contribute to an HSA. You can use a Limited Purpose Health Care FSA to pay for eligible out-of-pocket dental and vision expenses only, such as: • Dental and orthodontia care (i.e., fillings, X-rays and braces) • Vision care (e.g., eyeglasses, contact lenses, and LASIK surgery)
• 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.
How the Health Care and Limited Purpose FSAs Work You can access the funds in your Health Care or Limited Purpose 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: • Call 855-399-3035. • Visit https://mynbsbenefits.com. • Email service@nbsbenefits.com. • Fax 844-438-1496. Note: You may file claims incurred during the plan year for another 90 days.
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Flexible Spending Accounts
Annual Maximum FSA Contributions Health Care FSA Limited Purpose FSA
Dependent Care FSA
Maximum
$3,400
$7,500 if filing jointly or head of household and $3,750 if married filing separately.
Carryover/Grace Period
No carryover; 60-day grace period
No carryover — use it or lose it.
2026
You are entitled to the full election from day one of the plan year.
FSAstore.com FSAstore.com offers thousands of FSA-eligible products and services to buy and save. Check it out! Watch and learn more!
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HSA and FSA Comparison Knowing the difference between an HSA and FSA can help you choose the best option for you and your family.
Health Savings Account
Flexible Spending Account
Internal Revenue Code
Section 223
Description
An FSA allows you to pay out-of-pocket An HSA is an actual bank account in your expenses tax-free for: name that allows you to save and pay for • copays, deductibles, and certain unreimbursed qualified medical expenses services not covered by medical plan tax-free. • qualifying dependent care
Employer Eligibility
A qualified HDHP
All employers
Contribution Source
You and/or your employer
You and/or your employer
Account Owner
Individual
Employer
Underlying Insurance Requirement
HDHP
None
Section 125
2026 Insurance Plan Minimum Deductible
• $1,700 single
N/A
• $3,400 family 2026 • $4,400 single
Maximum Contribution
$3,400
• $8,750 family • $1,000 age 55+ catch-up
Permissible Use of Funds
Use any way you wish. If used for nonqualified medical expenses, funds are subject to the current tax rate plus a 20% penalty.
Reimbursement for qualified medical expenses as defined in Section 213(d) of the Internal Revenue Code.
Cash-Outs of Unused Amounts (if no medical expenses)
Permitted, but subject to current tax rate plus 20% penalty (waived after age 65).
Not permitted
Year-to-year rollover of account balance?
Yes, it will roll over to use for subsequent year’s health coverage.
No. Access to some funds may be extended to 60 days due to the grace period.
Does the account earn interest?
Yes
No
Portable?
Yes, it is portable year-to-year and between jobs.
No
Flip to...
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HSA
19
FSA
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Qualified HSA and FSA Expenses
The products and services listed below are examples of medical expenses eligible for payment under your Health Care FSA or HSA.* This list is not all-inclusive; additional expenses may qualify, and the items listed are subject to change in accordance with IRS regulations. Please refer to IRS Publication 502 Medical and Dental Expenses at www.irs.gov for a complete description of eligible medical and dental expenses. Abdominal supports
Dermatologist
Operating room costs
Acupuncture
Diagnostic fees
Ophthalmologist/Optician/Optometrist
Ambulance
Eyeglasses
Orthopedic shoes
Anesthetist
Gynecologist
Orthopedist
Arch supports
Healing services
Osteopath
Artificial limbs
Hearing aids and batteries
Physician
Blood tests
Hospital bills
Postnatal treatments
Braces
Insulin treatment
Prenatal care
Cardiographs
Lab tests
Prescription medicines
Chiropractor
Metabolism tests
Psychiatrist
Crutches
Neurologist
Therapy equipment
Dental treatment
Nursing
Wheelchair
Dentures
Obstetrician
X-rays
* Excludes Dependent Care FSA.
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Emergency Transport Services Did you know that a ground ambulance ride can cost more than $1,200 and an air ambulance ride can cost up to $70,000? If you or a family member is in need of an emergency medical transport, your insurance coverage and Medicare may not cover all of the costs. After your medical crisis, contact MASA to negotiate with your medical plan provider and cover the balance on your medical transportation bills.
Watch and learn more!
MASA protects families against uncovered costs for emergency transportation and provides connections with care services. Employee Monthly Contributions Employee Only
$9.50
Employee and Family
$20.50
For More Information Visit www.masaaccess.com/member. Group # B2BWYISD. Call 800-643-9023.
Employee Monthly Contributions Employee Only
$9.50
Employee and Family
$20.50
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Emergency Transport Services Stay prepared with MASA Access Comprehensive coverage and care for emergency transport.
Our Emergent Premier membership plan includes: • Emergency Ground Ambulance Coverage1 Your out-of-pocket expenses for your emergency ground transportation to a medical facility are covered with MASA. • Emergency Air Ambulance Coverage1 Your out-of-pocket expenses for your emergency air transportation to a medical facility are covered with MASA. • Hospital to Hospital Ambulance Coverage1 When specialized care is required but not available at the initial emergency facility, your out-of-pocket expenses for the ground or air ambulance transfer to the nearest appropriate medical facility are covered with MASA. • Repatriation Near Home Coverage2 Should you need continued care and your care provider has approved moving you to a hospital nearer to your home, MASA coordinates and covers the expense for ambulance transportation to the approved medical facility.
MASA is coverage and care you can count on to protect you from the unexpected. With us, there is no “outof-network” ambulance. Just send us the bill when it arrives and we’ll work to ensure charges are covered. Plus, we’ll be there for you beyond your initial ride, with expert coordination services on call to manage complex transport needs during or after your emergency — such as transferring you and your loved ones home safely. Coverage territories 1
United States only.
2
United States and Canada only.
United States, Canada, Mexico, the Caribbean (excluding Cuba), the Bahamas and Bermuda. 3
Worldwide — contingent upon ten (10) day prior notice, some exclusions apply. 4
• Minor Return Transportation Coverage2 In the event your minor child traveling with you is left unattended due to your emergency transport, MASA coordinates services and covers expenses to return your child safely home. • Pet Return Transportation Coverage2 If you are traveling with your pets and an emergency occurs requiring your medical transport, MASA coordinates services and covers expenses for returning up to two pets to your home. • Sick While Away From Home Expense Protection3 Should you contract a communicable disease while traveling away from home, your out-of-pocket expenses are eased with MASA. • Post Admission Continued Care Transportation Coverage4 Should you need care in a rehabilitation facility, skilled nursing facility, long-term care facility, hospice, or at home after an emergency, your out-of-pocket expenses for transport are eased with MASA.
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Protect yourself, your family, and your family’s financial future with MASA.
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Hospital Indemnity Insurance The Hospital Indemnity plans help you with the high cost of medical care by paying you a cash benefit when you have an inpatient hospital stay. Unlike traditional insurance that pays a benefit to the hospital or doctor, these plans pay you directly. It is up to you how you want to use the cash benefit. These costs may include meals, travel, childcare or eldercare, deductibles, coinsurance, medication, or time away from work. See the plan documents for full details.
Watch and learn more!
Hospital Indemnity Insurance Low Plan
Medium Plan
High Plan
Hospital Admission Benefit Amount
$1,500 hospital / ICU $3,000
$3,000 hospital / ICU $6,000
$5,000 hospital / ICU $10,000
Hospital Admission Benefit
Hospital: 5 per calendar year ICU: 3 per calendar year
Hospital: 5 per calendar year ICU: 3 per calendar year
Hospital: 5 per calendar year ICU: 3 per calendar year
Daily Hospital Stay Benefit
$100 per day, maximum 30 days per calendar year
$200 per day, maximum 30 days per calendar year
$400 per day, maximum 30 days per calendar year
Daily Hospital ICU Benefit
$200 per day, maximum 30 days per calendar year
$400 per day, maximum 30 days per calendar year
$800 per day, maximum 30 days per calendar year
Observation Coverage Included
$500, 2 per calendar year for less than 20 hours
$500, 2 per calendar year for less than 20 hours
$500, 2 per calendar year for less than 20 hours
Newborn Care Admission (one time admission)
Newborn Nursery Benefit included / $500 per day, maximum days per confinement: 2
Newborn Care Stay Benefit
Newborn Nursery Benefit included / $500 per day, maximum days per confinement: 2
NICU Benefit
For a child who is admitted to the NICU, Chubb will pay the Hospital Admission benefit instead of the newborn nursery benefit
Pregnancy Coverage Included
Yes
Health Screening / Wellness Benefit
$50 per covered individual per calendar year (includes immunizations and physicals)
Are Benefits Determined by Policy Year or Calendar Year?
Calendar
Calendar
Calendar
HSA compatible?
Yes
Yes
Yes
Pre-existing Condition Limitation
None
None
None
Pre-existing Condition Period
None
None
None
Required number of hours confined for InPatient
Greater than 20 hours
Greater than 20 hours
Greater than 20 hours
Required number of hours confined for Observation Benefit
Less than 20 hours
Less than 20 hours
Less than 20 hours
Included
Included
Included
Conversion
Portability included
Portability included
Portability included
Portability
Included
Included
Included
Employee Only
$13.44
$27.48
$50.82
Employee and Spouse
$28.66
$58.56
$98.54
Employee and Child(ren)
$22.04
$45.02
$82.16
Employee and Family
$39.92
$81.52
$136.24
Waiver of Premium
Employee Monthly Contributions
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25
Telemedicine and Behavioral Health Alongside your medical coverage is access to quality telehealth services through Recuro. Connect anytime day or night with a board-certified 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
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, secure video, or Recuro app. • 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.
• Are on a business trip, vacation, or away from home • Are unable to see your primary care physician
All tiers under the Recuro Health plan are priced at a flat rate of $12 per month regardless of the level of service needed.
When to Use Telemedicine
Registration is Easy
At a cost that is the same or less than a visit to your physician, use telehealth services for minor conditions such as:
Register with Recuro so you are ready to use this valuable service when and where you need it.
• Sore throat
• Flu
• Headache
• Allergies
• Stomachache
• Fever
• Cold
• Urinary tract infections
Visit www.recurohealth.com. Call 855-673-2876. Download the Recuro app.
Do not use telemedicine for serious or lifethreatening emergencies.
Watch and learn more!
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Dental Coverage Our dental plans help you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work.
DPPO Plan Two levels of benefits are available with the DPPO plans: in-network and out-of-network. You may select any dental provider for care, but you will pay less and get the highest level of benefits with in-network providers. You could pay more if you use an out-of-network provider.
Watch and learn more!
Dental Benefits Summary Cigna Dental Choice Benefit Highlights
High Plan
Medium Plan
Low Plan
Reimbursement Levels • In-Network • Out-of-Network
Based on Contracted Fees Maximum Reimbursable Charge
Based on Contracted Fees Maximum Reimbursable Charge
Based on Contracted Fees Maximum Reimbursable Charge
Out-of-Pocket Maximum Applies to:
$1,450 Class I, II, and III expenses
$1,250 Class I, II, III, and IX expenses
$950 Class I, II, III, and IX expenses
Policy Year Deductible • Individual • Family
$50 $150
$50 $150
$50 $150
Employee Only
$57.17
$40.75
$27.46
Employee and Spouse
$123.71
$87.41
$54.94
Employee and Child(ren)
$113.74
$78.48
$49.34
Employee and Family
$199.52
$137.92
$92.97
Employee Monthly Contributions
How to Request a New ID Card You can request your dental id card by contacting Cigna directly at 800-244-6224. You can also go to www.mycigna.com and register/login to access your account. In addition, you can download the myCigna app on your smartphone and access your ID card on your phone.
Find an In-Network Provider Visit hcpdirectory.cigna.com. Call 800-244-6224. Download the MyCigna app.
Network Name: Total Cigna DPPO
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Dental Coverage In-Network:
Cigna Dental Choice
Total Cigna DPPO Network
Benefit Highlights
Out-of-Network:
See Non-Network Reimbursement
Plan Pays
You Pay
Plan Pays
You Pay
100% No deductible
No charge
100% No deductible
No charge
80% after deductible
20% after deductible
80% after deductible
20% after deductible
50% after deductible
50% after deductible
50% after deductible
50% after deductible
50% No deductible
50% No deductible
50% No deductible
50% No deductible
50% after deductible
50% after deductible
50% after deductible
50% after deductible
100% No deductible
No charge
100% No deductible
No charge
70% after deductible
30% after deductible
70% after deductible
30% after deductible
40% after deductible
60% after deductible
40% after deductible
60% after deductible
40% after deductible
60% after deductible
40% after deductible
60% after deductible
100% No deductible
No charge
100% No deductible
No charge
50% after deductible
50% after deductible
50% after deductible
50% after deductible
25% after deductible
75% after deductible
25% after deductible
75% after deductible
50% No deductible
50% No deductible
50% No deductible
50% No deductible
25% after deductible
75% after deductible
25% after deductible
75% after deductible
High Plan Class I: Diagnostic & Preventive
Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain
Class II: Basic Restorative
Restorative: fillings Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: dentures Denture Relines, Rebases and Adjustments
Class III: Major Restorative
Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Periodontics: minor and major Endodontics: minor and major
Class IV: Orthodontia
Coverage for Employee and All Dependents Lifetime Benefits Maximum: $1,000
Class IX: Implants
Medium Plan Class I: Diagnostic & Preventive
Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain (Note: This service is administrated at the in-network coinsurance level.)
Class II: Basic Restorative
Restorative: fillings Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: bridges, crowns and inlays Repairs: dentures Denture Relines, Rebases and Adjustments
Class III: Major Restorative
Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Endodontics: minor and major Periodontics: minor and major
Class IX: Implants
Low Plan Class I: Diagnostic & Preventive
Oral Evaluations Prophylaxis: routine cleanings X-rays: routine X-rays: non-routine Fluoride Application Sealants: per tooth Space Maintainers: non-orthodontic Emergency Care to Relieve Pain (Note: This service is administrated at the in-network coinsurance level.)
Class II: Basic Restorative
Restorative: fillings Oral Surgery: minor and major Anesthesia: general and IV sedation Repairs: bridges, crowns and inlays Repairs: dentures Denture Relines, Rebases and Adjustments
Class III: Major Restorative
Inlays and Onlays Prosthesis Over Implant Crowns: prefabricated stainless steel / resin Crowns: permanent cast and porcelain Bridges and Dentures Endodontics: minor and major Periodontics: minor and major
Class IV: Orthodontia
Coverage for Dependent Children to age 19 Lifetime Benefits Maximum: $1,000
Class IX: Implants
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Vision Coverage Our vision plans provide quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems. You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see in-network providers. Watch and learn more!
Vision Benefits Summary Low Plan
High Plan
Frame Benefit Frequency
Once every calendar year
Once every calendar year
Lenses Benefit Frequency
Once every calendar year
Once every calendar year
Contact Lenses Benefit Frequency
Once every calendar year
Once every calendar year
$10
$10
$15 $200 Covered in full after $39 copay
$15 $200 Covered in full after $39 copay
Single Vision Lenses (per pair)
Covered in full after $15 copay
Covered in full after $15 copay
Bifocal Lenses (per pair)
Covered in full after $15 copay
Covered in full after $15 copay
Trifocal Lenses (per pair)
Covered in full after $15 copay
Covered in full after $15 copay
Plan Features
In-Network Plan Features Exam Copay Materials Copay • Frame Allowance • Retinal Imaging
Materials
Standard Progressive Lenses (per pair) Polycarbonate Lenses
No
Yes
Covered in full for children
Covered in full for children and adults
$31.00
Covered in full
Lens Enhancements Standard Polycarbonate Lenses Progressive Lenses by Tier • Tier I (Basic) • Tier II (Medium) • Tier III (Enhanced)
$55 $95 - $105 $150 - $175
UV Coating
Tier 1 and 2 covered in full
$16
Covered in full
Scratch-Resistant Coating
$17
Covered in full
Tints (solid and gradient)
$15
Covered in full
Not covered
Not covered
Yes
Yes
Polarized Contacts (in lieu of glasses) Standard Contact Lens Allowance
$200
$200
Covered in full after copay
Covered in full after copay
Standard Contact Lens Fitting Allowance
Included in the contact lens allowance
Included in the contact lens allowance
Specialty Contact Lens Fitting Allowance
Included in the contact lens allowance
Included in the contact lens allowance
10% to 20% off
10% to 20% off
Medically Necessary Contact Lens Allowance
LASIK Benefit
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Vision Coverage Low Plan
High Plan
Exam Allowance
$39 maximum
$39 maximum
Frames Allowance
$46 maximum
$46 maximum
Retinal Imaging
Not covered
Not covered
Single Vision Lenses (Per Pair)
$23 maximum allowance
$23 maximum allowance
Bifocal Lenses (Per Pair)
$37 maximum allowance
$37 maximum allowance
Trifocal Lenses (Per Pair)
$49 maximum allowance
$49 maximum allowance
Standard Progressive Lenses (Per Pair)
No coverage
No coverage
Polycarbonate Lenses (Adult & Children)
No coverage
No coverage
Standard Polycarbonate Lenses
No coverage
No coverage
Progressive Lenses by Tier • Tier I (Basic) • Tier II (Medium) • Tier III (Enhanced)
No coverage
No coverage
UV Coating
N/A
N/A
Scratch-Resistant Coating
N/A
N/A
Tints (Solid and Gradient)
N/A
N/A
Standard Contact Lens Allowance
$100 maximum
$100 maximum
Medically Necessary Contact Lens Allowance
$210 maximum
$210 maximum
Standard Contact Lens Fitting Allowance
N/A
N/A
Specialty Contact Lens Fitting Allowance
N/A
N/A
Lasik Allowance
N/A
N/A
$6.44
$10.76
Out-Of-Network Plan Features
Materials
Lens Enhancements
Contacts & Lasik
Employee Monthly Contributions Employee Only Employee and Spouse
$11.26
$19.74
Employee and Child(ren)
$12.44
$21.76
Employee and Family
$17.64
$30.06
Plan Provisions • Benefits are determined by calendar year • Benefits cannot be utilized outside of the U.S.
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Find an In-Network Provider Visit www.guardiananytime.com. Call 877-814-8970.
Network Name: VSP Group Number: 00080541
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Educator Disability Insurance Educator Disability insurance combines features of short-term and long-term disability into one plan. Disability insurance protects part of your income if you are unable to work due to a covered accident, illness, or pregnancy. We offer Educator Disability insurance for you to purchase and allow you to choose the coverage amount and waiting period that best suits your needs.
Educator Disability FAQ
Educator Disability Benefits Begin The first number indicates the number of days you must be disabled due to Injury and the second number indicates the number of days you must be disabled due to Sickness.
What is disability insurance?
0/71 14/141 30/301 60/60 90/90
Percentage of Earnings You Receive
Up to 66 2/3%
Maximum Monthly Benefit Between
$200 and $8,000 Varies based on schedule selected and age at disability
Maximum Benefit Period Pre-existing Condition Exclusion
Elimination Period
35%
45%
55%
65%
0/7
$1.33
$1.71
$2.21
$2.72
14/14
$1.20
$1.54
$1.99
$2.45
30/30
$1.07
$1.38
$1.79
$2.20
60/60
$0.82
$1.05
$1.35
$1.67
90/90
$0.61
$0.78
$1.01
$1.25
If your elimination period is 30 days or less and you are confined to a hospital for 24 hours or more, the elimination period will be waived, and benefits will be payable from the first day of hospitalization. Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months. If your disability is a result of a pre-existing condition, benefits will be paid for a maximum of 4 weeks. 2
Disability insurance protects one of your most valuable assets: your paycheck. This insurance replaces part of your income if you are physically unable to work due to sickness or injury for an extended period of time. The Educator Disability plan is unique in that it includes both short- and long-term coverage in one convenient plan.
Does this plan have pre-existing condition limitations?
3/122
Monthly Rate per $100
1
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Yes. However, all plans will include pre-existing condition limitations that could impact you if you are a first-time enrollee in your employer’s disability plan (including your initial new hire enrollment). Review the plan documents for full details.
Will I get all of my disability benefit? Your disability benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as: • Social Security disability insurance • State teacher retirement disability plans • Workers’ Compensation • Other employer-based disability insurance coverage you may have • Unemployment benefits • Retirement benefits that your employer fully or partially pays for (such as a pension plan)
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Educator Disability Insurance What is the best way to choose which disability plan option to enroll in? Your disability plan selection should be a two-step approach. Step One:
Step Two:
Choose your elimination period or waiting period. This is how long you are disabled and unable to work before your benefit will begin. It will be displayed as two numbers, such as 0/7, 14/14, 60/60, etc.
Choose your benefit amount. This is the maximum amount of money you would get from the carrier on a monthly basis once your disability claim is approved by the carrier.
The first number indicates the number of days you must be disabled due to Injury and the second number indicates the number of days you must be disabled due to Sickness. When choosing your elimination period, determine how long you could go without a paycheck. Choose your elimination period based on your answer.
When choosing your monthly benefit, consider how much money you need to pay your monthly bills. Choose your monthly benefit amount based on your answer. Visit www.mybenefitshub.com/wylieisd for rates.
Note: Some plans will waive the elimination period if you choose 30/30 or other lesser option and you are confined as an inpatient to the hospital for a specific time period. For the 60and 90-day options, you must be continuously disabled for the full 60- or 90-day elimination period before benefits begin. No benefits are payable during this waiting period, which functions like a time-based deductible.
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File a Disability Claim Call 866-547-9124.
Policy Number: 681947
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Cancer Insurance Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living, and household upkeep. In addition to these nonmedical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance helps pay for these direct and indirect treatment costs so you can focus on your health.
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Cancer Insurance Low Plan
High Plan
Diagnosis of Cancer Benefit
$5,000 Employee or Spouse $7,500 Child(ren)
$10,000 Employee or Spouse $15,000 Child(ren)
Hospital Confinement Benefit
$100 Per Day – Days 1 through 30 Additional Days: $200 Maximum days per Confinement: 31
$100 Per Day – Days 1 through 30 Additional Days: $200 Maximum days per Confinement: 31
Hospital Confinement ICU Benefit
$200 Per Day – Days 1 through 30 Additional Days: $200 Maximum Days per Confinement: 31
$200 Per Day – Days 1 through 30 Additional Days: $200 Maximum Days per Confinement: 31
Medical Imaging Benefit
$500 per Imaging Study Maximum Studies per Calendar Year: 2
$500 per Imaging Study Maximum Studies per Calendar Year: 2
Attending Physician Benefit
$50 per Visit Maximum Visits per Confinement: 2 Maximum Visits per Calendar Year: 4
$50 per Visit Maximum Visits per Confinement: 2 Maximum Visits per Calendar Year: 4
Per Confinement: $150 Maximum Confinements per Calendar Year: 6
Per Confinement: $150 Maximum Confinements per Calendar Year: 6
Private Full-Time Nursing Services Benefit
$150 per Day Maximum Days per Confinement: 5
$150 per Day Maximum Days per Confinement: 5
Home Health Care Benefit
$100 per Day not to exceed the number of days confined Maximum Days per Calendar Year: 30
$100 per Day not to exceed the number of days confined Maximum Days per Calendar Year: 30
$100 per Day
$300 per Day
Employee Only
$10.24
$20.96
Employee and Spouse
$20.08
$40.58
Employee and Child(ren)
$12.00
$24.24
Employee and Family
$23.80
$47.08
Prescription Drug Inpatient Benefit
Hospice Care Benefit
Employee Monthly Contributions
Visit www.mybenefitshub.com/wylieisd for a complete list of benefits seen in the plan summary or certificate.
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Critical Illness Insurance Critical Illness insurance helps pay the cost of non-medical expenses related to a covered critical illness. The plan provides a lump-sum benefit payment to you upon first and second diagnosis of any covered critical illness. The benefit can help cover expenses such as lost income, out-of-town treatments, special diets, daily living, and household upkeep costs.
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Critical Illness Insurance Benefits Summary CRITICAL ILLNESS – The Hartford Coverage Amounts Employee Benefit Amount(s)
$10K, $20K, $30K
Spouse Benefit Amount Maximum
Based on Employee Amount or less
Child(ren) Benefit Amount Maximum
Coverage for enrolled children up to age 26 is included in the employee rate.
Covered Conditions Vascular Coronary Artery Disease
Minor 10%; Major 100%
Heart Attack
STEMI 100%; Non-STEMI 25%
Stroke
Mild 10%; Moderate 25%; Severe 100%
Cancer Invasive Cancer
100%
Benign Tumor
Early Diagnosis 10%; Advanced 100%
Carcinoma in Situ (Non-Invasive)
100%
Skin Cancer
$250 Annually
Neurological Advanced Stage Alzheimer’s Disease
100%
Amyotrophic Lateral Sclerosis (ALS)
100%
Parkinson’s Disease
100%
Blindness
100%
Loss of Hearing or Speech
100%
Other Specified Aneurysm
Minor 10%; Major 100%
Major Organ Failure
100%
End-stage Renal Disease
100%
Child Specified Cerebral Palsy
Early 10%; Advanced 100%
Cleft Lip, Cleft Palate
100%
Genetic Disorder
100%
Congenital Metabolic Disorder
100%
Congenital Heart Defect
100%
Genetic Disorder
100%
Structural Congenital Defect
100%
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Critical Illness Insurance CRITICAL ILLNESS – The Hartford Recurrence and Separation Period (CI and Cancer) Recurrence Period (Same Condition)
180 days
Wellness Benefit Health Screening/Wellness Benefit
$100 once per policy year per member
Plan Provisions Critical Illness coverage is generally designed to pay for new covered illnesses that occur after coverage begins. A pre-existing condition limitation allows the claims team to review prior medical history to determine whether the new illness is related to a condition that existed before coverage started.
Pre-existing Condition Limitations
Additional Information Ability Assist
3 face-to-face visits
Health Champion
Unlimited access to support for medical care, claims, and billing
Portable?
Yes
Employee and Spouse Rates are Calculated based on the Employee’s age at the time of issue Age
Monthly Rates per $1,000
Age
Monthly Rates per $1,000
<25
$0.30
55-59
$1.56
25-29
$0.36
60-64
$2.04
30-34
$0.44
65-69
$2.70
35-39
$0.54
70-74
$3.54
40-44
$0.70
75-79
$4.46
45-49
$1.00
80+
$5.38
50-54
$1.24
How to file a Critical Illness claim Visit https://www.myhealthhub.app/thehartford. Call 866-547-4205.
Group Number: 6819647
Accident Insurance Accident insurance provides affordable protection against a sudden, unforeseen accident. This benefit helps offset the direct and indirect expenses resulting from an accident such as copayments, deductible, ambulance, physical therapy, childcare, rent, and other costs not covered by traditional health plans. See the plan document for full details. Accident Insurance Benefit Ambulance • Ground • Water • Air
$500 $500 $2,000
Physician Office Visit (urgent care)
$400
Follow-up • Physician Office Visit • Follow-up Physical Therapy Visit
$125 $75
Diagnostic Exam (X-ray or lab)
$50
Emergency Care Treatment
$400
Admission • Hospital • ICU
$1,500 $1,500
Confinement • Hospital • ICU
$400 $600
Specific Sum Injuries Dislocations, ruptured discs, eye injuries, fractures, lacerations, concussions, etc. Sports Accident Benefit Accidental Death & Dismemberment
Based on the type of treatment received. See the plan document on the benefits portal. 50% of the qualified benefit
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Wellness Treatment Reimbursement per covered member
$50,000 - $100,000 $50
Employee Monthly Contributions Employee Only
$8.84
Employee and Spouse
$15.98
Employee and Child(ren)
$18.92
Employee and Family
$25.08
The amount of benefit paid for Dismemberment and Loss of Life is dependent on the type of loss. Spouse and Child benefit is 50% of the benefit shown. 1
Visit www.mybenefitshub.com/wylieisd for a complete list of benefits seen in the plan summary or certificate.
Watch and learn more!
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Identity Theft Protection Identity theft is one of the fastest-growing crimes in the country. Millions of people have their identity stolen each year. Protect yourself and restore your identity with coverage that includes: • Identity consultation and advice • Licensed private investigators • Identity and credit monitoring • Social media monitoring • Identity restoration • Threat and credit alerts • 24/7 emergency ID protection access • Mobile app
For More Information Employee Monthly Contributions
Visit my.aura.com/start. Call 833-552-2131.
Employee Only
$9.95
Employee and Family
$18.50
Download the Aura: Security & Protection app.
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Financial Planning
PROVIDER LOGO HERE
457(b) Retirement Plan A 457(b) plan can be a powerful tool to help you reach your investment goals and be financially secure in retirement.
How the Plan Works You are eligible to participate in the plan if you are a full-time employee, age 18 or older, and have 90 days of service with the district. You may contribute up to the IRS annual limits.
You decide how much you want to contribute, and you can change your contribution amount anytime. All changes are effective as soon as administratively feasible and remain in effect until you update or stop your contributions. You also decide how to invest the assets in your account.
2026 IRS Contribution Limits
To Enroll and Get More Information
• $24,500
Visit www.tcgservices.com/457b.
• $8,000 additional catch-up contribution (ages 50-59 and 64+)
Call 800-943-9179.
• $11,250 additional catch-up contribution (ages 60-63)
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Medical Gap Insurance Your Gap plan is administered by Administrative Concepts, Inc. (ACI), on behalf of Pan-American Accident & Health. Here’s how it comes together:
Coverage Details
1.
You’ll get an ID card for this plan, in addition to your regular Medical Plan ID card.
2.
When you visit a provider, show both your Medical Plan ID card and your Gap ID card.
3.
Your provider sends the Explanation of Benefits (EOB) from your major medical plan to ACI.
4.
ACI processes your claim.
Medical Gap Insurance
Submitting a Claim
Benefits
Per Person
Policy Maximum
$3,000/family (no limit)
Combined Inpatient and Outpatient I
Included separately
Inpatient Hospital
$1,500/family (no limit)
Outpatient I (DME included)
$1,500/family (no limit)
Ambulance Sublimit
$1,500/family (no limit)
Dr. Office Visits
Not Included
Policy Deductible
$0
Policy Coinsurance
100%
If your provider doesn’t bill your medical plan directly, you can file a Gap claim yourself. The process is quick and easy and helps ensure you receive the benefits you’re eligible for.
Monthly Premiums <40
40-50
51+
Employee Only
$32.82
$45.92
$80.56
What You’ll Need
Employee and Spouse
$61.40
$85.90
$151.26
Employee and Child(ren)
$59.56
$83.32
$146.72
Employee and Family
$94.38
$132.04
$232.52
1.
Your Medical Explanation of Benefits from your major medical carrier. This is the only document required.
2.
Optional, but helpful: a copy of your Medical Claim (HCFA or UB form) or an itemized bill from your provider. While not required, this extra paperwork can speed things up because it includes:
For Benefits, Eligibility, and Claims: Call 888-346-9905.
• Diagnosis
Email claims@acitpa.com.
• Place of service
Mail: Administrative Concepts, Inc. P.O. Box 4000 Collegeville, PA 19426
• Patient information • Services provided and their costs
Things to Know Claim submission instructions are printed on the back of your ID card. If you have questions, call ACI Customer Service at 888-346-9905. The member portal at www.acitpa.com only displays claims that have already been processed, so if you don’t see your claim, check with your provider to make sure your secondary insurance information is listed correctly.
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This brochure highlights the main features of the Wylie ISD 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. Wylie ISD reserves the right to change or discontinue its employee benefits plans at anytime.