We are pleased to offer you a comprehensive benefits package intended to protect your well-being and financial health. This guide is your chance to learn more about all of the benefits that are available to you and your eligible dependents beginning January 1, 2026.
To get the best value from your health care plan, please take the time to evaluate your coverage options and determine which plans best meet your health care and financial requirements. By being a wise consumer, you can support your health and maximize your health care dollars.
The enrollment decisions you make will remain in effect through December 31, 2026. All employees are required to reenroll in benefits each year as the current benefits will end at the end of the year. If you do not make elections, you will not have coverage for 2026
AVAILABILITY OF SUMMARY HEALTH INFORMATION
Our employee benefits program offers three medical plan coverage options. To help you make an informed choice and compare your options, a Summary of Benefits and Coverage is available at www.benefitsinhand.com or by calling 866-419-3518
TOTAL COMPENSATION
Hardin-Simmons appreciates and recognizes the talents you bring to our University every day. For this reason, we are pleased to offer a competitive benefits package providing financial security as well as health and welfare programs for you and your family. The value of the programs detailed in this guide is often referred to as your Hidden Paycheck. The total package includes:
Compensation
Benefits
Fully paid Life insurance, Short Term Disability (STD), and Long Term Disability (LTD)
Vacation/paid holidays
Sick leave
Performance and recognition
Development and career opportunities
Multiple discount opportunities
We encourage you to review this benefit guide to learn more about the features of your Hidden Paycheck. Hardin-Simmons is a special place made up of extraordinary people like you. Our total compensation and benefits package is an important component of our culture.
Thank you again for your service and dedication!
STAFF EXAMPLE: JOSEPH SMITH
FACULTY EXAMPLE: JANE SMITH
ELIGIBILITY
You are eligible for benefits if you are a covered, full-time employee. New employees must make benefit decisions during the first 30 days of employment. After the initial 30-day period, no changes can be made until Open Enrollment (OE) for pretax benefits, with the exception of the 403(b) retirement plan. Your coverage is effective the first day of the month following your date of hire, except employer-paid benefits that begin on the date of hire. You may also enroll eligible dependents for benefits coverage. Your cost for dependent coverage will vary depending on the plan you choose and whether you elect to cover your spouse, your children or both. When covering dependents, you and your dependents must be on the same plan.
Eligible dependents include:
Your legal spouse
Children under the age of 26 regardless of student, dependency or marital status
Children over the age of 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
QUALIFYING LIFE EVENTS
Once you elect your benefit options, they remain in effect for the entire plan year until the following OE. You may only change coverage during the plan year if you have a Qualifying Life Event (QLE), and you must do so within 31 days of the event. QLEs include:
Marriage, divorce, legal separation, or annulment
Birth, adoption, or placement for adoption of an eligible child
Death of your spouse or child
Change in your spouse’s employment status that affects benefits eligibility
Change in your child’s eligibility for benefits
Significant change in benefit plan coverage for you, your spouse, or your child
FMLA event, COBRA event, judgment, or decree
Becoming eligible for Medicare, Medicaid, or TRICARE
Receiving a Qualified Medical Child Support Order
If you have a QLE and want to request a midyear change, you must notify Human Resources and complete your election changes within 31 days following the event. Be prepared to provide documentation to support the QLE.
HOW TO ENROLL
To begin the enrollment process, go to www.benefitsinhand. com. First-time users follow steps 1-4. Returning users log in and start at step 5.
1. If this is your first time to log in, click on the New User Registration link. Once you register, you will just use your username and password to log in.
2. Enter your personal information and company identifier of HARDIN and click Next
3. Create a username (your work email address recommended) and password, then check the I agree to terms and conditions box before you click Finish
4. If you used an email address as your username, you will receive a validation email to that address. You may now log in to the system.
5. Click the Start Enrollment button to begin the enrollment process.
6. Confirm or update your personal information and click Save & Continue
7. Edit or add dependents who need to be covered on your benefits. Once all dependents are listed, click Save & Continue
8. Follow the steps on the screen for each benefit to make your selection. Please notice there is an option to decline coverage. If you wish to decline, click the Don’t want this benefit? button and select the reason for declining.
9. Once you have elected or declined all benefits, you will see a summary of your selections. Click the Click to Sign button. Your enrollment will not be complete until you click the Click to Sign button.
Do you have questions about your benefits or need help enrolling? Call or text the Employee Response Center (ERC) at 866-419-3518. Benefits experts are available to take your call or text Monday through Friday, 7:00 A.M. to 6:00 P.M. CT.
MEDICAL COVERAGE
Hardin-Simmons has a self-insured medical insurance program administered through Blue Cross Blue Shield of Texas (BCBSTX). Employees who are full-time (working at least 30 hours per week) have three options for medical insurance:
HDHP-HSA Plan – $4,000 deductible and pays 100% for medical expenses after the deductible is met. Pharmacy copayments apply until the $5,000 out-of-pocket maximum is met. Once the out-of-pocket limit is reached, all services are paid at 100% of covered charges.
Base PPO Plan – $5,000 deductible and 20% coinsurance up to the out-of-pocket maximum
Buy-Up PPO Plan – $2,000 deductible and 20% coinsurance up to the out-of-pocket maximum
All three plans use the BCBSTX BlueChoice network. Coverage begins the first day of the month following date of hire.
HIGH DEDUCTIBLE HEALTH PLAN
The High Deductible Health Plan (HDHP) allows you to choose any provider when you need care. However, in exchange for a lower per-paycheck cost, you must satisfy a higher deductible that applies to almost all health care expenses, including those for prescription drugs. Once your deductible has been met, innetwork medical expenses are paid at 100% and a copayment applies to pharmacy expenses. In-network preventive care is covered at 100% and the deductible does not apply. If you enroll in the HDHP, you may be able to open a Health Savings Account (HSA), which can be used to pay for out-ofpocket medical, dental and vision expenses.
PREFERRED PROVIDER ORGANIZATION
The two Preferred Provider Organization (PPO) plans offer the freedom to see any provider when you need care. When you use BlueChoice in-network providers, you receive benefits at the discounted network cost. If you use out-of-network providers, you will pay more for services.
PREFERRED LABS
Quest and LabCorp are the preferred providers for diagnostic lab and tests. Lab work not processed by LabCorp or Quest will be subject to deductible and coinsurance.
PHARMACY
All three medical plans include retail and mail order prescription services.
FIND AN IN-NETWORK PROVIDER
Call 800-521-2227
Visit www.bcbstx.com
BLUE ACCESS FOR MEMBERS WEBSITE
Blue Access for Members (BAM) is the secure BCBSTX member website where you can:
Check claim status or history
Confirm dependent eligibility Print Explanation of Benefits (EOB) forms
Locate in-network providers
Print or request an ID card
To get started, log on to www.bcbstx.com and use the information on your BCBSTX ID card to complete the registration process.
MOBILE APP
The BCBSTX mobile app can help you stay organized and in control of your health anytime, anywhere. Log in from your mobile device to access your BAM account, including:
Track account balances and deductibles
Access ID card information
Find doctors, dentists, and pharmacies
Text BCBSTX to 33633 or search your mobile device’s app store to download.
24/7 NURSELINE
Call 800-581-0368 for immediate access to registered nurses who can answer general health questions, make appointments with your doctor, and help determine where to go for immediate or emergency health care services. You can also access an audio library of more than 1,000 health-related topics in both English and Spanish.
BLUE365 DISCOUNT PROGRAM
Blue365 can help you save money on health and wellness products and services not covered by insurance. Sign up for Blue365 at www.blue365deals.com/bcbstx to receive weekly featured deals by email. Discounts include:
Davis Vision | Lasikplus – Eyewear And Lasik
Truhearing | Beltone – Hearing Aids And Tests
Philips Sonicare – Oral Care Products
Dental Solutions – Dental Discount Card
Jenny Craig | Sunbasket – Weight Loss And Nutrition
Reebok | Skechers – Work Footwear
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MEDICAL COVERAGE
MAKING THE MOST OF YOUR PRESCRIPTION DRUG COVERAGE
Our prescription drug program has a tiered structure:
Generics
Preferred Brand
Non-Preferred Brand
Specialty
Generally, how much you pay out-of-pocket for a prescription drug will be less if you choose a drug that is in a lower tier.
PHARMACY SERVICES
CVS Caremark manages our prescription benefits. To receive the best benefits, you can take your prescription to CVS or any other pharmacy in the network. Visit www.caremark.com or call 800-552-8159 to find a network pharmacy.
CVS/Caremark Mobile App – Download the mobile app to compare drug costs, request refills, track your prescriptions and find a network pharmacy.
INTERNATIONAL PRESCRIPTIONS
Your health plan offers a voluntary importation program that provides a 90-day supply of select brand-name medications at no cost after your first U.S. fill. Medications are shipped free from licensed pharmacies in Canada, the U.K., Australia, or New Zealand that meet or exceed U.S. FDA safety standards.
Maintenance medications are provided by CANARX (866893-6337), and specialty injectables or diabetic medications by ElectRx (855-353-2879). Look for enrollment details and the covered drug list after January 1.
STEP THERAPY
Step Therapy is designed to make sure you get safe, effective medication for your condition at the lowest possible cost for you and the plan. If your medication is initially denied, the pharmacy will reach out to your physician and your medication may be changed to a lower cost alternative. If your physician does not wish to change your prescription, a Prior Authorization review process can be initiated by your physician.
CAREMARK COST SAVER
Cost Saver makes sure you get the lowest possible cost for medications covered under your plan. All you have to do is present your CVS Caremark member ID card when you pick up your prescriptions and CVS Caremark will manage the rest for you by automatically applying the lowest available discount price.
Cost Saver benefits:
Best available prices for many commonly prescribed, nonspecialty generic drugs
Automatically applies your out-of-pocket costs to your deductible and out-of-pocket thresholds
Avoids wasted time shopping around for the best price
PRESCRIPTION REVIEWS
With rising drug costs, RxBenefits reviews prescriptions to ensure appropriate, cost-effective use. When a high-cost medication is prescribed, it may be reviewed or temporarily denied while the physician is contacted to consider lower-cost alternatives. If no change is made, the doctor can submit a prior authorization. Reviews typically take 24–72 hours, and quantity limits may apply based on plan guidelines.
GOODRX
Prescription drug prices are not regulated and can vary by more than $100 between pharmacies. GoodRx can provide price comparisons, coupons, discounts and savings tips. Go to www.goodrx.com to print coupons or show the coupon on your phone through the mobile app.
$4 PRESCRIPTIONS
Sometimes it costs less to purchase medication with cash, rather than with insurance. At Walmart, for example, some 30-day prescriptions are only $4, and 90-day prescriptions are $10. Other pharmacies offer great deals if you enroll in their Rx program. Some pharmacies charge membership fees, others do not.
MEDICAL COVERAGE
TRIA HEALTH PHARMACY MANAGEMENT
Hardin-Simmons partners with Tria Health to assist you and your family with medication management. The program consists of two components:
Help Desk – available to all employees
Pharmacy Advocate Program – available for patients with chronic conditions
TRIA HELP DESK
Most of us have medication-related questions from time to time. The Tria Help Desk provides access to clinical pharmacists for guidance about medications. Help is available 24/7/365 for questions such as:
I left my child’s cough syrup out when it was supposed to be refrigerated. Is it still safe to use?
Is it okay to mix cold medicine with my cholesterol medication?
My new diabetes medication is upsetting my stomach. Is that normal?
TRIA PHARMACY ADVOCATE PROGRAM
If you or a covered family member have one of the following conditions, you may be qualified to participate in the Pharmacy Advocate Program:
High blood pressure
High cholesterol
Diabetes
Asthma/COPD
Osteoporosis
Heart conditions
Depression
Multiple sclerosis
HIV
Hepatitis C
Rheumatoid arthritis
Tria pharmacists help you identify and resolve therapy problems as well as ensure medications are safe, affordable and effective. In addition, if you qualify, the program offers:
Free access to the Accu-Chek Connect System if you have diabetes, which includes a wireless blood glucose meter, testing strips and a mobile app designed to help you manage your diabetes better.
One-on-one consultations by phone with a pharmacist to review your medications, evaluate how well they work to treat your current condition(s) and make recommendations.
A summary of the care plan discussed and the same information shared with your physician.
To see if you qualify, visit www.triahealth.com or call 888-799-8742
HEALTH SAVINGS ACCOUNT
If you enroll in the HDHP medical plan, you may be eligible to open a Health Savings Account (HSA). An HSA is a personal savings account which you can use to pay qualified out-ofpocket medical expenses with pretax dollars. You own and control the money in your HSA. The money in your account (including interest and investment earnings) grows tax-free, and as long as the funds are used to pay for qualified medical expenses, they are spent tax-free.
Unlike a Flexible Spending Account (FSA), 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 each year. Since it is an individual account, if you change health plans or jobs, the balance is yours to keep.
HSA ELIGIBILITY
You are eligible to open and contribute to an HSA if you are:
Enrolled in an HSA-eligible HDHP
Not covered by another non-HDHP such as your spouse’s health plan or a Health Care Flexible Spending Account
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. Your HSA can be used for your expenses and those of your spouse and dependents, even if they are not covered by the HDHP.
NOTE
Contact Human Resources to set up your First Financial Bank HSA, which allows you to make contributions to your HSA via payroll deduction. The convenience of payroll deductions is available only through First Financial Bank. However, you may open an HSA account at any financial institution of your choosing.
MAXIMUM CONTRIBUTIONS
Your contributions to your HSA may not exceed the annual maximum amount established by the Internal Revenue Service. The annual contribution maximum is based on the coverage option you elect.
Individual – $4,400
Family (filing jointly) – $8,750
Employees age 55 and older are allowed to make an additional annual catch-up contribution of up to $1,000.
OPENING AN HSA
If you choose to enroll in the HDHP medical plan and you meet the eligibility requirements, you may enroll in the HSA administered by First Financial Bank
Once you are enrolled, you will receive a debit card from First Financial Bank to manage your HSA account reimbursements. Funds available for reimbursement are limited to the balance in your HSA. Visit www.ffin.com to view your account information.
You, NOT your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
HEALTH CARE SERVICES
Hardin-Simmons partners with HealthJoy to provide you with health care guidance and virtual medical consultations via the HealthJoy app — all for free!
TELEMEDICINE
HealthJoy provides 24/7/365 mobile app access to U.S. boardcertified doctors. While it does not replace your primary care physician, HealthJoy is a convenient and cost-effective option when you need care and:
Have a non-emergency issue and are considering an urgent care clinic or emergency room for treatment
Are on a business trip, vacation, or away from home
Need a short-term prescription refill
Your primary care physician is unavailable
GET THE CARE YOU NEED
HealthJoy doctors treat many medical conditions, including:
Cold and flu symptoms
Allergies
Bronchitis
Urinary tract infections
Respiratory infections
Sinus problems
Dermatology issues
Mental health concerns
With your consent, HealthJoy will provide information about your HealthJoy consult to your primary care physician. Request a consultation via the mobile app or call 877-500-3212 . Remember, it is free!
Do not use telemedicine for serious or life-threatening emergencies.
MDLIVE
Additional telemedicine services are available with your BCBSTX medical coverage through MDLIVE . Contact one of these providers anytime day or night if you need care and:
You are considering the emergency room or an urgent care clinic for a non-emergency issue
You are on vacation, a business trip, or away from home
You need a short-term prescription refill
CONCIERGE SERVICES
HealthJoy can help answer your health care questions and guide you through the complexities of your medical, dental, and vision plans. HealthJoy services are simple to use and available to you and your family through the mobile app.
HOW HEALTHJOY TAKES CARE OF YOU
Understand your insurance benefits – Receive guidance in understanding your benefits throughout the year.
Find a great doctor – Find the best doctors, dentists and eye care professionals in your area who meet your personal preferences and health care needs – they can even schedule appointments.
Save money on medical care – Get price comparisons before receiving care. Depending on the doctor, hospital, or facility, costs can vary by hundreds or thousands of dollars — even when in-network.
Pay less for prescriptions – Let HealthJoy compare medication prices and explore lower-cost options for you.
Get help with medical bills – Have your medical bills reviewed to make sure you are not overcharged.
HSA and FSA support – Get alerts for claims, deductibles, and more.
CONTACT HEALTHJOY
Call 877-500-3212
Download the HealthJoy app
CONTACT MDLIVE
Visit www.mdlive.com/bcbstx
Call 888-680-8646
MDLIVE COSTS
$40 copay on both PPO medical plans
$48 copay on the HDHP medical plan
DENTAL COVERAGE
Our dental plans help you maintain good dental health through affordable options for preventive care, including regular checkups and other dental work. Coverage is provided through BCBSTX using the BlueCare Dental PPO network.
DPPO PLANS
Our dental coverage options include a Low Plan, a High Plan, and a Preventive Plan. The High and Low plans offer coverage for preventive care, basic services such as fillings or simple extractions, and major procedures such as crowns and bridgework. The Preventive Plan offers preventive care and basic services, but no benefits for major services.
All three plans have in-network and out-of-network benefits. The Low Plan and the High Plan cover services at the 90th percentile of usual, customary and reasonable (UCR) fees of other dentists in the area. You are responsible for the difference between that amount and the charges billed by the dentist.
Out-of-network services under the Preventive plan are based on the network fee schedule. For this plan, you pay the difference between the billed charge and the network fee schedule, which is typically more than the UCR amount.
HOW TO FIND A DENTIST
VISION PLAN
The vision plan through BCBSTX using the EyeMed vision network is designed to provide your basic eyewear needs and to preserve your health and eyesight. In addition to identifying vision and eye problems, regular exams can detect certain medical issues such as diabetes or high cholesterol. You may seek care from any licensed optometrist, ophthalmologist, or optician, but plan benefits are better if you use an in-network provider.
FLEXIBLE SPENDING ACCOUNTS
FSAs allow you to pay for certain health, dental, vision, and dependent care expenses with pretax dollars, thereby saving you money by reducing your taxable income. There are three kinds of accounts:
Health Care FSA
Limited Purpose Health Care FSA
Dependent Care FSA
Hardin-Simmons’ FSAs are administered by Higginbotham
HEALTH CARE FSA
The Health Care FSA covers qualified medical, dental and vision expenses for you or your eligible dependents. You may contribute up to $3,400 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 an HDHP and contribute to an HSA.
LIMITED PURPOSE HEALTH CARE FSA
A Limited Purpose Health Care FSA is available if you enrolled in the HDHP medical plan and contribute to an HSA. You may contribute up to $3,400 annually to a Limited Purpose Health Care FSA and you are entitled to the full election from day one of your plan year. 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 (fillings, X-rays, and braces)
Vision care (eyeglasses, contact lenses and LASIK surgery)
HOW THE HEALTH CARE FSA AND LIMITED PURPOSE FSA WORK
You can access the funds in your Health Care or Limited Purpose FSA two different ways:
Use your Higginbotham Benefits Debit Card to pay for qualified expenses, doctor visits, and prescription copays.
Pay out-of-pocket and submit your receipts for reimbursement by fax, email, or online:
Fax – 866-419-3516
Email – flexclaims@higginbotham.net
Online – https://flexservices.higginbotham.net
BENEFITS DEBIT CARD
The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care or Limited Purpose Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).
DEPENDENT CARE FSA
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full time. You can use the account to pay for 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 must be a single parent or you and your spouse must be employed outside the home, disabled, or a full-time student.
THINGS TO CONSIDER REGARDING THE DEPENDENT CARE FSA
Overnight camps are not eligible for reimbursement (only day camps can be considered).
If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
You may request reimbursement for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
REMINDER
IMPORTANT FSA RULES
The maximum per plan year you can contribute to a Health Care or Limited Purpose Health Care FSA is $3,400. The maximum per plan year you can contribute to a Dependent Care FSA is $7,500 when filing jointly or head of household and $3,750 when married filing separately.
You cannot change your election during the year unless you experience a QLE.
You can continue to file claims incurred during the plan year (January 1 – December 31, 2026) for another 30 days (up until January 31, 2027).
Your Health Care or Limited Purpose FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
The IRS has amended the “use it or lose it” rule to allow you to carry over up to $680 in your Health Care FSA into the next plan year. The carryover rule does not apply to your Dependent Care FSA.
You cannot use your Higginbotham Benefits Card for dependent care expenses.
HIGGINBOTHAM PORTAL
The Higginbotham Portal provides information and resources to help you manage your FSAs.
Access plan documents, letters and notices, forms, account balances, contributions, and other plan information
Update your personal information
Look up qualified expenses
Submit claims
REGISTER ON THE HIGGINBOTHAM PORTAL
As you may know, we have a website available for online access to your FSA/HRA account. If you would like online access, please go to https://flexservices.higginbotham.net
To set up your online account, click Get Started. Follow the Instructions and scroll down to enter your information.
You will be asked for your name, ZIP code, and Social Security number
You will then be asked a few security questions
You will then be asked to create your password If you have any questions or concerns, please call 866-419-3519 or you can email flexclaims@higginbotham.net
EXAMPLES
Jennifer contributes $500 into her Health Care FSA for the plan year. On January 15, she receives a vision exam and contact lenses for a total charge of $200. She pays for the services and faxes her receipt, along with a claim form, to Higginbotham. She receives a reimbursement check for $200 within 24-72 hours, even though she has not yet accumulated the full $200 in her account.
Jack contributes $1,000 into his Health Care FSA for the plan year. He visits his dermatologist and uses his Higginbotham Benefits Debit Card to pay the $60 specialist. His card is swiped at the office check-out and he is given a receipt. He will not need to complete a claim form, nor will he have to submit his receipt.
HIGGINBOTHAM FLEX MOBILE APP
Easily access your Health Care or Limited Purpose FSA on your smartphone or tablet with the Higginbotham mobile app. Search for Higginbotham in your device’s app store and download it to:
View Accounts – Includes detailed account and balance information
Card Activity – Account information
SnapClaim – File a claim and upload receipt photos directly from your smartphone
Manage Subscriptions – Set up email notifications to keep up-to-date on all account and Health Care or Limited Purpose FSA debit card activity
Log in using the same username and password you use to log in to the Higginbotham Portal. If you have not registered on the portal, you can register on the app.
LIFE AND AD&D INSURANCE
LIFE AND AD&D COVERAGE
Life and Accidental Death and Dismemberment (AD&D) insurance through BCBSTX are 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).
BASIC LIFE AND AD&D
Basic Life and AD&D insurance is paid by Hardin-Simmons. The benefit amount is one times your annual salary up to $100,000. Benefits reduce by 35% of the original amount at age 70, and further reduce to 50% of the original amount at age 75. Benefits terminate at retirement.
DESIGNATING A BENEFICIARY
Designating a beneficiary ensures to whom your Life and AD&D insurance benefits are paid in case of your death. You can name more than one beneficiary, and you can change beneficiaries at any time. If you name more than one beneficiary, identify the share for each. Be sure all names are correct when you designate your beneficiaries.
VOLUNTARY LIFE AND AD&D
You may purchase additional Life and AD&D insurance for you and your eligible dependents. If you decline Voluntary Life and AD&D insurance when first eligible or if you elect coverage and wish to increase your benefit amount at a later date, Evidence of Insurability (EOI) — proof of good health — may be required before coverage is approved.
You must elect Voluntary coverage for yourself in order to elect coverage for your spouse or children. If you leave HardinSimmons, you may take the insurance with you by paying premiums directly to the insurance company.
VOLUNTARY LIFE AND AD&D
Employee
Spouse
Child(ren)
• Increments of $10,000 up to five times your annual salary not to exceed $500,000
• Guaranteed Issue $200,000
• Increments of $5,000 up to $500,000 not to exceed 100% of Employee coverage
• Guaranteed Issue $50,000
Maximum of $1,000 for children birth to six months; $10,000 for children six months to 26 years VOLUNTARY LIFE AND AD&D MONTHLY RATES PER $1,000
DISABILITY INSURANCE
Disability insurance is available for those unexpected situations that may keep you from performing the daily responsibilities of your job. These benefits are designed to help supplement your income when you are not able to continue working for a certain period of time due to illness or a non-occupational injury. Short Term Disability (STD) and Long Term Disability (LTD) coverage are provided to all full-time employees at no cost. STD and LTD coverages are provided through BCBSTX
SHORT TERM DISABILITY INSURANCE
STD covers a portion of your salary in the event you are unable to work due to a non-occupational injury or illness. Disability is defined as inability to perform the material and substantial duties of your regular occupation. Benefits begin after 14 days of disability.
SHORT TERM DISABILITY INSURANCE
Short Term Disability
Covers 66.67% of your base annual earnings up to a $1,000 maximum per week for 11 weeks. Benefit begins after 14 days of disability.
LONG TERM DISABILITY INSURANCE
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for more than 90 days.
NOTE: If you received medical treatment for a condition within three months prior to the effective date of LTD coverage and become disabled for that same condition within 12 months, no disability benefits are payable.
LONG TERM DISABILITY INSURANCE
Long Term Disability
Covers 60% of your base annual earnings to a $5,000 per month maximum. Benefit begins after 90 days of disability and payments will last for as long as you are disabled or until you reach your Social Security Normal Retirement Age, whichever is sooner.
IMPORTANT
This benefits package includes fixed indemnity policies, which are not health insurance.
A fixed indemnity policy may pay you a limited dollar amount if you are sick or hospitalized. You are still responsible for paying the cost of your care.
The payment you get is not based on the size of your medical bill.
There might be a limit on how much this policy will pay each year.
The policy is not a substitute for comprehensive health insurance.
Since these policies are not health insurance, it does not have to include most Federal consumer protections that apply to health insurance.
Looking for comprehensive health insurance?
Visit www.healthcare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.
To find out if you can get health insurance through your job, or a family member’s job, contact the employer.
Questions about these policies?
For questions or complaints about these policies, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners’ website (www.naic.org) under Insurance Departments.
If you have these policies through your job, or a family member’s job, contact the employer.
SUPPLEMENTAL POLICY
RenSecureHealth is a supplemental policy that pays a lump sum if you are diagnosed with any of 13,000+ covered conditions. RenSecureHealth pays cash benefits to help with health care expenses not covered by your major medical insurance or anything else you need on your road to recovery. Refer to the Certificate of Insurance for complete details.
COVERAGE OPTIONS
You may elect the Value plan. If you or an insured dependent is diagnosed with a covered condition, the payout will equal the amount you elected for the benefit category in which the covered condition falls.
Moderate Condition Benefit provides a $200 benefit for over 6,000 ICD10 procedures that include injuries or illnesses that likely require a short visit to the ER or urgent care such as simple fractures, lacerations, dehydration, and kidney stones.
Separation benefit is 14 days with unlimited payouts over policy life.
Severe Condition Benefit provides a $500 benefit for over 5,600 ICD10 procedures that include serious conditions that require more intensive medical treatment and attention such as compound fractures, appendicitis, pulmonary embolism, and torn anterior cruciate ligament (ACL).
Separation benefit is 30 days with unlimited payouts over policy life.
Catastrophic Condition Benefit provides a $1,000 benefit for over 1,300 ICD10 procedures that cover life-threatening conditions that require immediate medical intervention such as malignant lung cancer, heart attack, stroke, and major organ failure.
Separation benefit is 90 days with three payouts maximum of each of the 57 ICD10 condition categories over policy life.
BCBSTX WELLNESS PROGRAMS
If you are enrolled in a BCBSTX medical plan, you have access to these wellness programs.
WELL ONTARGET
Well onTarget provides the support you need to make healthy choices while rewarding you for your hard work. Use the online wellness portal and mobile app to access a suite of programs and tools.
Health Assessment – Answer a series of questions for a personal and confidential wellness report with tips for living your healthiest life. Your answers tailor your portal experience with programs designed to fit your needs and help you reach your wellness goals.
Self-Management Programs – Work at your own pace to reach your health goals with programs about nutrition, fitness, weight loss, smoking cessation, stress management, and more. Track your progress as you work through each program.
Online Wellness Challenges – Create personal challenges to meet your wellness goals.
Tools and Trackers – Use these resources to stay on course and make wellness fun. You can also access symptom checkers and health trackers to stay on track.
Fitness Tracking – Track your activity by syncing your fitness devices and apps.
Health and Wellness Content – Search a library of readerfriendly articles about conditions and medicines. Get started today by visiting www.wellontarget.com. Use the same login information as your BAM account or register on the Well onTarget site. Customer services is available by calling 877-806-9380.
FITNESS PROGRAM
The Fitness Program provides unlimited, affordable access to a nationwide network of more than 10,000 fitness locations. Visit a gym near your home, work, or while traveling. Program perks include:
No Long-Term Contracts – Membership is month-to-month with a choice of flexible plans from $19 to $99 per month. Studio classes are also available.
Convenient Payment – Pay monthly fees via automatic credit card or bank withdrawals.
Online Resources – Search online for convenient locations and track your visits.
Complementary and Alternative Medicine (CAM) – Find discounts through the Whole Health Living Choices Program, a network of 40,000 health and well-being providers such as acupuncturists, massage therapists, and personal trainers. Register online at www.whlchoices.com
Join the Fitness Program by calling 888-762 BLUE (2583) Monday through Friday between 7:00 a.m. and 7:00 p.m. CT.
LEARN MORE ABOUT THE BCBSTX WELLNESS PROGRAMS
Visit www.bcbstx.com and register for BAM then click the Wellness tab
Call 877-806-9380
Download the AlwaysOn Wellness app
EMPLOYEE ASSISTANCE PROGRAM
Hardin-Simmons provides access to the Work/Life Support Employee Assistance Program (EAP). Available through BCBSTX, this stand alone program is not tied to any other benefit and is available to all full-time employees of Hardin-Simmons University and their families.
An EAP provides you with confidential phone and online access to counselors and nurses. You may contact them regarding health care, work, family, personal, legal or financial issues. The EAP can help you cope with issues such as:
Before and after school childcare
Eldercare
Financial or legal issues
Marital problems
Identity theft and fraud resolution
Substance use and abuse
Mental or physical abuse
Grief and loss
Stress
Pet care
The staff will provide you and your eligible family members with confidential, comprehensive assessments of your concerns and will coordinate support services. You and your household members are eligible for up to five free face-to-face counseling visits (per issue). Educational materials and interactive tools related to health and wellness are also available online.
Full-time employees of Hardin-Simmons University and eligible immediate family members (e.g., dependent children, spouse) may apply for the Institutional Family Grant each semester. The tuition benefit is not guaranteed each semester and does require proof of eligibility of employee status and documentation to verify dependent eligibility prior to approval every semester. Employees and dependents are required to resubmit an application each semester prior to registration.
Contact Resources/Financial Aid Office for more information regarding the application process, eligibility criteria, and Financial Aid deadlines.
The HSU Personnel Handbook will have the most current policy for the Tuition Benefit (Institutional Family Grant) as it is subject to change pending Board of Trustee approval. The Personnel Handbook is located on HSU Central.
TEXAS WORKERS’ COMPENSATION
Coverage is provided to employees who experience workrelated injuries. Employees must report all work-related injuries immediately to Human Resources and to their immediate supervisor and/or vice president.
SICK LEAVE (FACULTY AND STAFF)
Full-time (40 hours per week) faculty/staff employees earn one day (8 hours) per month. Up to 65 days may be accumulated. Accruals will be prorated for full-time 30-hour per week staff, per Employee Handbook. (Employees must review the Employee Handbook regarding sick leave usage, FMLA, etc.).
VACATION LEAVE (STAFF ONLY)
Full-time (40 hour per week) staff employees earn 6.67 hours per month (10 days annually). Leave accruals begin on the first day of the first full month of employment.
Employees must review the Employee Handbook regarding vacation usage, rollover, etc. Accruals will be prorated for fulltime 30-hour per week staff, per Employee Handbook.
If an employee is approved to take vacation prior to earning the accrual, a Negative Vacation Acknowledgment Form must be signed by the employee and supervisor and submitted to Human Resources in advance.
Vacation accrual rates may vary depending on years of service.
HOLIDAYS
Staff employees follow this University holiday calendar:
January – Martin Luther King Jr.
March – Spring Break (2 days)
March/April – Good Friday
May – Memorial Day
June – Juneteenth
July – Independence Day/4th of July
September – Labor Day
October – Fall Break (one Friday in mid-late October)
November – Thanksgiving (3 days)
December – Christmas (dates determined annually)
Faculty employees follow the academic calendar each semester.
BEREAVEMENT LEAVE
Up to three days of Bereavement Leave may be approved in the event of the death of an immediate family member. Up to 10 days of Bereavement Leave may be approved in the event of the death of an employee’s spouse or child. Vacation must be used for any additional bereavement leave taken. Documentation must be submitted to Human Resources.
Employees must review the Employee Handbook regarding Bereavement Leave usage.
OTHER LEAVE
Employees must review the Employee Handbook regarding other leave types (e.g., jury duty).
EMPLOYEE BENEFITS
FAMILY MEDICAL LEAVE ACT (FMLA)
Employees must review the Employee Handbook regarding FMLA eligibility. Contact HR if you have any questions. Under the Family and Medical Leave Act, employees may take unpaid protected leave under certain circumstances. To be eligible for FMLA leave, an employee must have worked for at least 12 months and must have worked at least 1,250 hours (25 hours per week average) during the 12 months prior to the leave.
Faculty and Staff employees are required to use accrued sick and vacation time concurrently with FMLA leave.
Certification from a physician or other health care provider is required to support a request for leave because of a serious health condition. Employees may not perform work while on FMLA. A release to return to work is required before an employee suffering from a serious medical condition is permitted to return to work.
Basic Leave: Eligible employees are entitled to take up to 12 weeks of unpaid leave in a 12-month period for the birth or adoption of a child or to care for oneself or an eligible family member suffering from a serious health condition.
Military Family Leave: Eligible employees with a family member on a covered active duty are entitled to take up to 12 weeks of unpaid leave in a 12-month period for qualifying exigencies arising from active duty service.
The relevant 12-month period will be a rolling back period that is calculated by going back 12-months from the date a requested leave is to begin.
All employee benefits that operate on an accrual basis, such as sick and vacation days, will cease to accrue during an FMLA leave lasting more than 30 days. All group benefits such as major medical and hospitalization will continue during FMLA provided that the employee’s contributions/premiums continue to be paid during FMLA leave. Other benefit plans such as Retirement, Life insurance, Long Term Disability, etc. will be governed in accordance with the terms of each benefit plan.
FMLA must be requested as far in advance as possible. A minimum of 30 days prior to taking leave is required, except for emergency situations. Employees may obtain certification forms and more information from HR.
Aside from pre-existing limited activities permitted under the University’s Outside Employment policy, employees are prohibited from working while on leave.
Employees will not accrue sick (or vacation) leave when on unpaid status for a continuous 30 days or greater.
FMLA (and LOA) must be approved by HR.
BUSINESS CASUAL DRESS CODE
The University offers a business casual dress code throughout the year. The image portrayed should be one of professionalism, regardless of work area. Specifically, employees should be neat, clean and dress in good taste as a representative of the University. Good grooming and appropriate dress reflect employee pride, inspire confidence, and contribute to the corporate culture and reputation.
Supervisors cannot override University policy regarding dress code/any other policy without approval.
DIRECT DEPOSIT
Direct deposit is required for all employee paychecks. Earning statements are available online via Colleague Self-Service.
ADMISSION TO CAMPUS EVENTS
University employees receive free or discounted admission to many campus activities throughout the year. For example, passes are provided for regular season football, men’s basketball, women’s basketball, baseball, men’s soccer, women’s soccer, volleyball, softball, music and theatre performances, art exhibits, etc.
BOOKSTORE DISCOUNTS
Faculty and staff receive a 10% discount on items purchased at the HSU Bookstore.
SMOKE-FREE ENVIRONMENT
HSU offers a smoke-free environment for faculty, staff and students.
HSU BENEFITS COMMITTEE ON PHYSICAL AND FINANCIAL HEALTH
The University appoints a committee each year to review employee benefits. Recommendations to improve our benefits may be sent to HSU Benefits Committee on Physical and Financial Health members.
PHYSICAL THERAPY
The Hardin-Simmons University Physical Therapy department provides a physical therapy clinic to faculty, staff and their families in need of physical therapy services. The clinic is held most Fridays every semester from 10:30 a.m. – 12:30 p.m. The fee is $20 per visit after the initial evaluation. A doctor’s referral is required.
HSU TIMESHARES
Full-time employees of Hardin-Simmons University are eligible to rent the HSU condos/timeshares based on availability. Employees must review the Personnel Handbook for more details regarding company policies and procedures regarding rentals and use of the HSU condos/timeshares. The Personnel Handbook is located on HSU Central. Contact Human Resources at 325-670-1259 for more information regarding rental rates, availability, etc.
RETIREMENT
Hardin-Simmons University offers eligible employees the option to contribute to a 403(b) retirement plan. Contact Human Resources for more information.
Hardin-Simmons University Board of Trustees voted that effective October 2, 2024, eligible employees will also receive a dollar-for-dollar match on personal contributions up to 4% of salary.
Taking advantage of this new strategy in our retirement plan could have a tremendous impact o your retirement account. Contact Human Resources for more information regarding the matching component.
Part-time employees who are eligible to participate in the plan may contribute on their own, however, Hardin-Simmons does not provide matching funds. Contact Human Resources for details.
PLAN FEATURES
Eligible employees are immediately 100% vested. Early withdrawals (i.e., resignation) are subject to penalties and taxes. However, there are loan provisions. University employees may also participate in a Roth 403(b). A 457(b) plan is available to employees who want to tax-shelter additional money above the regular 403(b) legal limits. Employees must submit an enrollment form to Human Resources in order to receive the employer contribution.
IMPORTANT CONTACTS
IMPORTANT NOTICES
WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998
In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully.
As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:
All stages of reconstruction of the breast on which the mastectomy was performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
Prostheses and treatment of physical complications of the mastectomy, including lymphedema.
Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
SPECIAL ENROLLMENT RIGHTS
This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.
Loss of Other Coverage or Becoming Eligible for Medicaid
Program
or a state Children’s Health Insurance
(CHIP)
If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage).
If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance.
Marriage, Birth or Adoption
If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption.
For More Information or Assistance
To request special enrollment or obtain more information, contact:
Hardin-Simmons University Human Resources 2200 Hickory, Box 16030 Abilene, TX 79698 325-670-1259
YOUR PRESCRIPTION DRUG COVERAGE AND MEDICARE
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Company and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Company has determined that the prescription drug coverage offered by the Company medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is not considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Company at the phone number or address listed at the end of this section.
If you choose to enroll in a Medicare prescription drug plan and cancel your current Company prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.
If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.
For more information about this notice or your current prescription drug coverage: Contact the Human Resources Department at 325-670-1259.
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778.
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan – whether received in writing, in an electronic medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by Company, hereinafter referred to as the plan sponsor.
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer.
You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask the Human Resources Department to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources Department.
Complaints: If you believe your privacy rights have been violated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer.
Hardin-Simmons University
Human Resources
2200 Hickory, Box 16030
Abilene, TX 79698
325-670-1259
Conclusion
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, 2025. Contact your State for more information on eligibility.
To see if any other States have added a premium assistance program since July 31, 2025, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323 , Menu Option 4, Ext. 61565
TEXAS – MEDICAID
CONTINUATION OF COVERAGE RIGHTS UNDER COBRA
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the Company group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Company plan after you have left employment with the company. If you wish to elect COBRA coverage, contact your Human Resources Department for the applicable deadlines to elect coverage and pay the initial premium.
Plan Contact Information
Hardin-Simmons University Human Resources 2200 Hickory, Box 16030 Abilene, TX 79698 325-670-1259
YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
When you get emergency care or get treated by an out-ofnetwork provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-ofpocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care— like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
Emergency services – If you have an emergency medical condition and get emergency services from an out-ofnetwork provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, outof-network providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (costsharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/nosurprises for more information about your rights under federal law.
This brochure highlights the main features of the Hardin-Simmons University 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. Hardin-Simmons University reserves the right to change or discontinue its employee benefits plans anytime.
