Login Process
EustaceISD
On the login page, you will enter your Last Name, Date of Birth, and Last Four (4) of Social Security Number.
THEbenefitsHUB checks behind the scenes to confirm employment status.
Once confirmed, the Additional Security Verification page will list the contact options from your profile.
Select either Text, Email, Call, or Ask Admin options to get a code to complete the final verification step.
Enter the code that you receive and click Verify.
You can now complete your benefits enrollment!
2024 OPEN ENROLLMENT INFORMATION
The2024-2025 Section 125 Cafeteria Plan year begins 09/01/2024 and ends 08/31/2024. All benefits elected during the annual open enrollment will be effective 09/01/2024.
Know Your Benefits! Below is asummary of benefits offered through EISD.
Medical Transportation - MASA provides emergency transportation for ground, emergency air, and non-emergency hospital to hospital transportation anywhere in the US/Canada.
Standard Disability- Plan includes both short and long term disability coverage. Plan is designed to protect up to 66.66 percent of your gross EISD income.
Texas Life Permanent Life– Portable, permanent life insurance available for employees, their spouses and dependents. Employees can keep the coverage upon termination or retirement from EISD.
UNUM Term Life - Group term life insurance that ends when you terminate employment with EISD. Coverage is also available for spouses and dependent children.
UNUM Critical Illness - This benefit pays a lump sum if the insured is diagnosed with a critical illness
Colonial Cancer – pays benefits for internal cancer diagnosis. Guarantee issued, pre-existing conditions may apply.
Wellfleet Accident - Pays Benefits for off-the-job accidents. Includes physical/wellness reimbursement. $200 Wellness Benefit.
DeltaDental(NEW)-Coverage for preventative, basic, major and orthodontia services.
Superior Vision - Includes coverage for eye exams, materials (such as frames and lenses), and discounts for laser vision correction. The plan has a defined network of providers. Out of network benefits are available on a reimbursement basis only.
NBS Flexible Spending – NBS will be the new provider for Flexible Spending Account effective 9/1/2024 you will be receiving a new card. If you currently have an FSA card please spend your funds prior to 8/31/2024.
NBS Health Savings Account - (NEW) - An HSA is a personal savings account that can be used to pay for medical, dental, vision and other qualified expenses now or later in life. To contribute to an HSA, you must be enrolled in a qualified high deductible health plan. Your contributions are tax-deductible, but are limited annually.
The Ultimate Peace of Mind for Employees and Their Families
The Harrison’s Story
• Jim and his family were at a local festival when his daughter, Sara, suddenly began experiencing horrible abdominal and back pain, after a fall from earlier in the day.
• His wife, Heather, called 911 and Sara was transported to a local hospital, when it was decided that she needed to be flown to another hospital.
• Upon arrival, Sara underwent multiple procedures and her condition was stabilized.
• After further testing, it was discovered that Sara needed additional specialized treatment at another hospital requiring transport on a non-emergent basis.
Based on a true story. Names were changed to protect identities in compliance with HIPAA.
matter how
provider. A MASA Membership prepares you for the unexpected. ONLY MASA MTS provides you with:
• Coverage ANYWHERE in all 50 states and Canada whether at home or away
• Coverage for BOTH emergent ground ambulance and air ambulance transport REGARDLESS of the provider
• Non-emergent transport services, which are frequently covered inadequately by your insurance, if at all For more information, please contact your local MASA MTS representative or visit www.masamts.com
EMERGENCY TRANSPORTATION COSTS
MASA MTS is hereto protect its members andtheir families from the shortcomings of health insurance coverageby providingthem with comprehensivefinancial protectionfor lifesaving emergency transportation services, both at home and away fromhome.
Many American employers and employees believe that their health insurance policies cover most, if notall ambulance expenses Thetruth is, they DONOT!
Even after insurance payments for emergency transportation, you couldreceive a bill up to $5,000 for ground ambulanceand as high as $70,000 for air ambulance. The financial burdens for medical transportation costs are veryreal.
HOW MASA IS DIFFERENT
Across the US there are thousands of ground ambulance providers and hundreds of air ambulance carriers. ONLYMASA offers comprehensive coverage since MASA is a PAYERand not aPROVIDER!
ONLY MASA provides over 1.6million members with coverage for BOTH ground ambulance and air ambulance transport, REGARDLESS of which provider transports them.
Members are covered ANYWHEREin all50 states andCanada!
Additionally, MASA provides a repatriation benefit: if a member is hospitalized more than 100 miles from home, MASA can arrangeand pay to have them transported to a hospital closer to their place of residence.
Any Ground. Any Air. Anywhere.™
A MASA Membership prepares you for the unexpectedandgives you the peaceof mind to access vital emergency medical transportation no matter where you live, for a minimal monthlyfee.
• Onelow fee for the entire family
• NO deductibles
• NO health questions
• Easy claims process
For more information, pleasecontact Your Broker or MASA Representative
• Unlimitedlifetimemaximumbenefitwithnoage-relatedbenefitreductions
• Benefitspaidbasedonthescheduleofbenefitsprovidedforeachcoveredaccident
• WaiverofPremium:Premiumiswaivedfollowinga60-dayperiodofdisabilityduetoacovered accidentforaslongasthecoveredpersonremainsdisabled.
• Portabilityisincluded.
Closed/Non-SurgicalTreatment
Skull(exceptBonesofFaceorNose) Depressed $4,000.00
Hip,Thigh(Femur)
$4,000.00
Vertebrae,Bodyof(excludingVertebral Process) $4,000.00
Pelvis
Leg(Tibiaand/orFibula)
$4,000.00
$4,000.00
UpperArm(Humerus) $3,000.00
ShoulderBlade $3,000.00
Collarbone $3,000.00
UpperJaw,Maxilla(exceptAlveolarProcess) $2,500.00
LowerJaw,Mandible(exceptAlveolar Process)
VertebralProcess
Forearm(Ulnaand/orRadius)
Hand,Wrist(exceptFingers)
Kneecap
Foot(exceptToes)
Ankle
$2,500.00
$1,600.00
$1,600.00
$1,600.00
$1,600.00
$1,600.00
$1,600.00
Rib $300.00
Coccyx $300.00
Finger,Toe $300.00
EnhancementforOpen/SurgicalReduction
Dislocations
Closed/Non-SurgicalTreatment
Hip $4,000.00
Knee(otherthanKneecap) $2,250.00
Shoulder
$2,250.00
Kneecap $1,000.00
Ankleboneorbonesofthefoot $1,000.00
Elbow $1,000.00
Wrist $1,000.00
Boneorbonesofthehand
$1,000.00
Jawbone $1,000.00
Collarbone $1,000.00
Onetoeorfinger $300.00
EnhancementforOpen/SurgicalReduction
Lacerations
NoRepair
$50.00
Repair-upto2inches $50.00
Repair-over2inches,upto6inches $200.00
Repair-over6inches $400.00
Burns
2ndDegreeBurns
Atleast1%,butlessthan20%ofskinsurface $100.00
20%orgreaterofskinsurface $500.00
3rdDegreeBurns
Lessthan5%ofskinsurface $500.00
Atleast5%,butlessthan20%ofskinsurface $5,000.00
20%orgreaterofskinsurface $10,000.00
SkinGraft
DuetoBurns(%ofapplicableBurnbenefit) 50%
NotduetoBurns
Atleast1%,butlessthan20%ofskinsurface $100.00
20%orgreaterofskinsurface
ConcussionandOtherBrainInjuries
DentalBenefit
EyeInjuryBenefit
SurgeryBenefits
OutpatientSurgeryBenefit
FacilitiesotherthanPhysicianOfficeor EmergencyRoom
PhysicianOfficeorEmergencyRoom $300.00
InternalInjuriesSurgicalBenefits
OpenAbdominal&Thoracic
ExploratorywithoutRepair
Tendon/Ligament/RotatorCuffSurgicalBenefit
ExploratorywithoutRepair
TornKneeCartilageSurgeryBenefit
TornwithSurgicalRepair
ExploratorywithoutRepair $150.00
Diagnosisonlywithnosurgeryorrepair
RupturedDiscwithSurgicalRepair
AnesthesiaBenefit
GeneralAnesthesia
EpiduralorRegionalAnesthesia
LossofBothHands,orLossofBothFeet,orLossof OneHandandOneFoot
LossofOneHandorLossofOneFoot
PartialDismemberment
LossofOneorMoreFingersorToes
PartialAmputationofFingerorToe
CatastrophicBenefits
CatastrophicLoss
LossofSightinbotheyesorHearinginbothears
LossofSpeechorSightinoneeyeorHearingin oneear
EXCLUSIONS*
Inadditiontoanybenefit-specificexclusion,benefitswillnotbepaidforanylosswhich,directlyorindirectly,in wholeorinpart,iscausedbyorresultsfromanyofthefollowingunlesscoverageisspecificallyprovidedforby nameinthisCertificate:
1.Aninjuryincurredwhileworkingforpayorprofit;
2.Intentionallyself-inflictedinjury,suicide,oranyattemptorthreatwhilesaneorinsane;
3.Participatinginwaroranyactofwarwhetherdeclaredorundeclared;
4.Commissionorattempttocommitafelony;
5.Commissionoforactiveparticipationinariot,insurrection,orterroristactivity;
6.Engaginginanillegalactivityoroccupation;
7.Flightin,boarding,oralightingfromanaircraftoranycraftdesignedtoflyabovetheearth’ssurface,including anytravelbeyondtheearth’satmosphereexceptafare-payingpassengeronaregularlyscheduledcommercial orcharterairline;
8.Practicingfororparticipatinginanysemi-professionalorprofessionalcompetitiveathleticcontest,including officiatingorcoaching,forwhichthecoveredpersonreceivesanycompensationorremuneration;
9.Sickness,exceptforanybacterialinfectionresultingfromanaccidentalexternalcutorwoundoraccidental ingestionofcontaminatedfood;
10.Voluntaryingestionorinhalationofanynarcotic,drug,poison,gasorfumes,unlessprescribedortakenunder thedirectionofaphysicianandtakeninaccordancewiththeprescribeddosage;
11.Operatinganytypeofvehiclewhileundertheinfluenceofalcoholoranydrug,narcoticorotherintoxicant includinganyprescribeddrugforwhichthecoveredpersonhasbeenprovidedawrittenwarningagainst operatingavehiclewhiletakingit.Undertheinfluenceofalcohol,forpurposesofthisexclusion,means intoxicated,asdefinedbythelawoftheStateinwhichthecoveredaccidentoccurred;
12.Carethatisnotrecommendedandapprovedbyaphysician.
Critical Illness insurance provides financial protection by paying a lump sum benefit if you are diagnosed with a covered critical illness.
Who is eligible for this coverage?
What are the Critical Illness coverage amounts?
All employees in active employment in the United States working at least 20 hours per week and their eligible spouses and children (up to age 26 regardless of student or marital status).
The following coverage amounts are available.
For you: Select one of the following $10,000, $15,000 or $20,000
For your Spouse: 100% of employee coverage amount
For your Children: 50% of employee coverage amount
Can I be denied coverage?
When is coverage effective?
Coverage is guarantee issue.
Please see your Plan Administrator for your effective date of coverage.
Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.
Are wellness screenings covered?
Progressive Diseases
for your Children
*Please refer to the policy for complete definitions of covered conditions.
Covered Condition Benefit
The covered condition benefit is payable once per covered condition per insured.
Unum will pay a covered condition benefit for a different covered condition if: - the new covered condition is medically unrelated to the first covered condition; or - the dates of diagnosis are separated by more than 180 days.
Reoccurring Condition Benefit
We will pay the reoccurring condition benefit for the diagnosis of the same covered condition if the covered condition benefit was previously paid and the new date of diagnosis is more than 180 days after the prior date of diagnosis.
The benefit amount for any reoccurring condition benefit is 100% of the percentage of coverage amount for that condition.
The following Covered Conditions are eligible for a reoccurring condition benefit:
Benign Brain Tumor Heart Attack (Myocardial Infarction) Coma Invasive Cancer (includes all Breast Cancer)
Coronary Artery Disease (Major) Major Organ Failure Requiring Transplant
Coronary Artery Disease (Minor) Non-Invasive Cancer End Stage Renal (Kidney) Failure Stroke
Each insured is eligible to receive one Be Well Benefit per calendar year.
Be Well Benefit
For you, your spouse and your children: $50
If the employee’s Critical Illness Coverage Amount is: The Be Well Benefit Amount for you, your spouse and your children is:
Be Well Screenings include tests for the following: cholesterol and diabetes, cancer and cardiovascular function. They also include imaging studies, immunizations and annual examinations by a Physician. See certificate for details.
Do my critical illness insurance benefits decrease with age?
Are there any exclusions or limitations?
Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.
Spouse rate is based on your Spouse’s insurance age, which is their age immediately prior to and including the anniversary/effective date.
Critical Illness benefits do not decrease due to age.
We will not pay benefits for a claim that is caused by, contributed to by, or occurs as a result of any of the following:
- committing or attempting to commit a felony;
- being engaged in an illegal occupation or activity;
- injuring oneself intentionally or attempting or committing suicide, whether sane or not;
- active participation in a riot, insurrection, or terrorist activity. This does not include civil commotion or disorder, injury as an innocent bystander, or Injury for self-defense;
- participating in war or any act of war, whether declared or undeclared;
- combat or training for combat while serving in the armed forces of any nation or authority, including the National Guard, or similar government organizations;
- voluntary use of or treatment for voluntary use of any prescription or nonprescription drug, alcohol, poison, fume, or other chemical substance unless taken as prescribed or directed by the Insured’s Physician;
- being intoxicated; and
- a Date of Diagnosis that occurs while an Insured is legally incarcerated in a penal or correctional institution.
Additionally, no benefits will be paid for a Date of Diagnosis that occurs prior to the coverage effective date.
Is the coverage portable (can I keep it if I leave my employer)?
Pre-existing Conditions
We will not pay benefits for a claim when the covered loss occurs in the first 12 months following an insured’s coverage effective date and the covered loss is caused by, contributed to by, or occurs as a result of any of the following:
- a pre-existing condition; or
- complications arising from treatment or surgery for, or medications taken for, a pre-existing condition.
An insured has a pre-existing condition if, within the 3 months just prior to their coverage effective date, they have an injury or sickness, whether diagnosed or not, for which:
- medical treatment, consultation, care or services, or diagnostic measures were received or recommended to be received during that period;
- drugs or medications were taken, or prescribed to be taken during that period; or
- symptoms existed.
Pre-existing Condition requirements are not applicable to children who are newly acquired after your Coverage Effective Date.
The pre-existing condition provision applies to any Insured’s initial coverage and any increases in coverage. Coverage effective date refers to the date any initial coverage or increases in coverage become effective.
If your employment with your employer ends or you are no longer in an eligible group you can apply for ported coverage and pay the first premium within 31 days to continue coverage for yourself, your spouse and your children.
If your spouse’s coverage ends as a result of your death, divorce or annulment, your spouse may elect to continue spouse and children coverage, as long as premium is paid as required.
When does my coverage end?
If you choose to cancel coverage, it will end on the first of the month following the date you provide notification to your employer.
Otherwise, coverage ends on the earliest of:
- the date the policy is cancelled by your employer;
- the date you no longer are in an eligible group;
- the date your eligible group is no longer covered;
- the date of your death
- the last day of the period any required contributions are made;
- the last day you are in active employment.
If you choose to cancel your Spouse’s coverage, it will end on the first of the month following the date you provide notification to your employer.
Otherwise, your spouse’s coverage will end on the earliest of:
- the date your coverage ends;
- the date your spouse is no longer eligible for coverage;
- the date your spouse no longer meets the definition of a spouse;
- the date of your spouse’s death; or
- the date of divorce or annulment.
Your children’s coverage will end on the earliest of:
- the date your coverage ends;
- the date your children are no longer eligible for coverage; or
- the date your children no longer meet the definition of children.
Nearly everyone has experienced or knows somebody who has experienced a cancer diagnosis in their family. The good news is that cancer screenings and cancer-fighting technologies have gotten a lot better in recent years. However, with advanced technology come high costs. Major medical health insurance is a great start, but even with this essential safety net, cancer sufferers can still be hit with unexpected medical and non-medical expenses.
Cancer coverage from Colonial Life offers the protection you need to concentrate on what is most important — your care.
Features of Colonial Life’s Cancer Insurance:
1. Pays benefits to help with the cost of cancer screening and cancer treatment.
2. Provides benefits to help pay for the indirect costs associated with cancer, such as:
l Loss of wages or salary
l Deductibles and coinsurance
l Travel expenses to and from treatment centers
l Lodging and meals
l Child care
3. Pays regardless of any other insurance you have with other insurance companies.
4. Provides a cancer screening benefit that you can use even if you are never diagnosed with cancer.
5. Benefits paid directly to you unless you specify otherwise.
6. Flexible coverage options for employees and their families.
This is a brief description of some available benefits.
We will pay benefits if one of the following routine cancer screening tests is performed or if cancer is diagnosed while your coverage is in force.
Cancer Screening Benefit Tests
This benefit is payable once per calendar year per covered person.
l Pap Smear
l ThinPrep Pap Test1
l CA125 (Blood test for ovarian cancer)
l Mammography
l Breast Ultrasound
l CA 15-3 (Blood test for breast cancer)
l PSA (Blood test for prostate cancer)
l Chest X-ray
l Biopsy of Skin Lesion
l Colonoscopy
l Virtual Colonoscopy
l Hemoccult Stool Analysis
l Flexible Sigmoidoscopy
l CEA (Blood test for colon cancer)
l Bone Marrow Aspiration/Biopsy
l Thermography
l Serum Protein Electrophoresis (Blood test for Myeloma)
To file a claim for a covered cancer screening/wellness test, it is not necessary to complete a claim form. Call our toll-free Customer Service number, 1.800.325.4368, with the medical information
Inpatient Benefits
l Hospital and Hospital Intensive Care Unit Confinement
l Ambulance
l Private Full-Time Nursing Services
l Attending Physician
Treatment Benefits (In -or Outpatient)
l Radiation/Chemotherapy
l Antinausea Medication
l Blood/Plasma/Platelets/Immunoglobulins
l Experimental Treatment
l Hair Prosthesis/External Breast/Voice Box Prosthesis
l Supportive/Protective Care Drugs and Colony Stimulating Factors
l Bone Marrow Stem Cell Transplant
l Peripheral Stem Cell Transplant
Surgery Benefits
l Surgery Procedures (including skin cancer)
l Anesthesia (including skin cancer)
l Second Medical Opinion
l Reconstructive Surgery
l Prosthesis/Artificial Limb
l Outpatient Surgical Center
Transportation/Lodging Benefits
l Transportation
l Transportation for Companion
l Lodging
Extended Care Benefits
l Skilled Nursing Care Facility
l Hospice
l Home Health Care Service
Waiver of Premium
THIS IS A CANCER ONLY POLICY.
This policy has exclusions and limitations. For cost and complete details of the coverage, see your Colonial Life benefits counselor. Coverage may vary by state and may not be available in all states. Applicable to policy form GCAN-MP and certificate form GCAN-C (including state abbreviations where used, for example GCAN-C-TX.)
1ThinPrep is a registered trademark of Cytyc Corporation.
Group Cancer Insurance—
Initial
Diagnosis of Cancer Rider
The diagnosis of internal cancer can be an upsetting time. You do not need to add financial worry to what is already a very difficult situation. When you add an Initial Diagnosis of Cancer rider to your group cancer insurance coverage, you add a little more financial protection at the point you or an insured family member is diagnosed with internal cancer—a time before many medical costs are incurred.
Rider Benefits
This rider pays a lump sum benefit for the initial diagnosis of internal (not skin) cancer. Use the benefit any way you choose, such as to help pay for deductibles and coinsurance on your major medical insurance or settle any outstanding debts.
Rider Features
l Guaranteed renewable as long as your cancer insurance policy is in force.
l Covers the same family members as your cancer insurance policy.
l Pays benefits regardless of any other insurance you have with other insurance companies.
l Pays benefits directly to you, unless you specify otherwise.
This rider has exclusions and limitations. For cost and complete details of the coverage, see your Colonial Life benefits counselor. Coverage may vary by state and may not be available in all states. Applicable to rider form R-GCAN-Indx (including state abbreviations where used - for example: R-GCAN-Indx-TX).
Group Cancer Insurance—
Specified Disease Rider
When you add this rider to your group cancer insurance coverage, you add valuable coverage related to the following specified diseases.
Specified Diseases
•Adrenal Hypofunction (Addison’s Disease)
•Botulism
•Bubonic Plague
•Cerebral Palsy
•Cholera
•Cystic Fibrosis
•Diphtheria
• Encephalitis (including Encephalitis contracted from West Nile Virus)
•Huntington’s Chorea
•Legionnaires’ Disease
Rider Benefits
•Lou Gehrig’s Disease (Amyotrophic Lateral Sclerosis)
•Lyme Disease
•Malaria
•Meningitis (bacterial)
•Multiple Sclerosis
•Muscular Dystrophy
•Myasthenia Gravis
•Necrotizing Fasciitis
•Osteomyelitis
•Poliomyelitis
•Rabies
•Reye’s Syndrome
•Scleroderma
•Scarlet Fever
•Sickle Cell Anemia
•Systemic Lupus
•Tetanus
•Toxic Epidermal Necrolysis
•Toxic Shock Syndrome
•Tuberculosis (Mycobacterial)
•Tularemia
•Typhoid Fever
•Variant Creutzfeldt-Jakob
Disease (Mad Cow Disease)
•Yellow Fever
l Hospital Confinement –We will pay this benefit if you incur charges for and are confined to a hospital for treatment of one of the specified diseases listed above.
l Ambulance – We will pay this benefit if you incur charges for and use a professional ambulance to transport you, on the advice of a doctor, to or from a hospital where you are confined as an inpatient for the treatment of a specified disease listed above. Limit 2 one way trips per confinement.
l Attending Physician– We will pay this benefit if you incur charges for and use the services of an attending physician while confined to a hospital for the treatment of a specified disease listed above.
Rider Features
l Covers the same family members as your cancer insurance coverage.
l Pays benefits regardless of any other insurance you have with other insurance companies.
l Pays benefits directly to you, unless you specify otherwise.
This rider has exclusions and limitations. For cost and complete details of the coverage, see your Colonial Life benefits counselor. Coverage may vary by state and may not be available in all states. Applicable to Rider form R-GCAN-SpDis (including state abbreviation where used - for example: R-GCAN-SpDis-TX).
Voluntary Long Term Disability Insurance
Standard Insurance Company has developed this document to provide you with information about the optional insurance coverage you may select through the Eustace Independent School District. Written in non-technical language, this is not intended as a complete description of the coverage. If you have additional questions, please check with your human resources representative.
Employer Plan Effective Date
The group policy effective date is September 1, 2021.
Eligibility
To become insured, you must be:
• A regular employee of Eustace Independent School District, excluding temporary or seasonal employees, fulltime members of the armed forces, leased employees or independent contractors
• Actively at work at least 15 hours each week
• A citizen or resident of the United States or Canada
Employee Coverage Effective Date
Please contact your human resources representative for more information regarding the following requirements that must be satisfied for your insurance to become effective. You must satisfy:
• Eligibility requirements
• An eligibility waiting period of 0 days
• An evidence of insurability requirement, if applicable
• An active work requirement. This means that if you are not actively at work on the day before the scheduled effective date of insurance, your insurance will not become effective until the day after you complete one full day of active work as an eligible employee.
Benefit Amount
You may select a monthly benefit amount in $100 increments from $200 to $8,000; based on the tables and guidelines presented in the Rates section of these Coverage Highlights. The monthly benefit amount must not exceed 66 2/3 percent of your monthly earnings.
Benefits are payable for non-occupational disabilities only. Occupational disabilities are not covered.
Plan Maximum Monthly Benefit: 66 2/3 percent of predisability earnings
Plan Minimum Monthly Benefit: 10 percent of your LTD benefit before reduction by deductible income
Eustace Independent School District
Benefit Waiting Period and Maximum Benefit Period
The benefit waiting period is the period of time that you must be continuously disabled before benefits become payable. Benefits are not payable during the benefit waiting period. The maximum benefit period is the period for which benefits are payable. The benefit waiting period and maximum benefit period associated with your plan options are shown below:
Options 1-6: Maximum Benefit Period of 5 years for Sickness
If you become disabled before age 62, LTD benefits may continue during disability for 5 years. If you become disabled at age 62 or older, the benefit duration is determined by your age when disability begins:
62 3 years 6 months
63 3 years 64 2 years 6 months
65 2 years
66 1 year 9 months
67 1 year 6 months
68 1 year 3 months
69+ 1 year
Options 1-6: Maximum Benefit Period To Age 65 for Accident
If you become disabled before age 62, LTD benefits may continue during disability until you reach age 65. If you become disabled at age 62 or older, the benefit duration is determined by your age when disability begins:
Age Maximum Benefit Period
62 3 years 6 months
63 3 years
64 2 years 6 months
65 2 years
66 1 year 9 months
67 1 year 6 months
68 1 year 3 months
69+ 1 year
First Day Hospital Benefit
With this benefit, if an insured employee is admitted as a hospital inpatient for at least four hours during the benefit waiting period, the benefit waiting period will be satisfied. Benefits become payable on the date of hospitalization; the maximum benefit period also begins on that date. This feature is included only on LTD plans with benefit waiting periods of 30 days or less.
Preexisting Condition Exclusion
A general description of the preexisting condition exclusion is included in the Group Voluntary Long Term Disability Insurance for Educators and Administrators brochure. If you have questions, please check with your human resources representative.
Preexisting Condition Period: The 90-day period just before your insurance becomes effective Exclusion Period: 12 months
Preexisting
Condition Waiver
For the first 90 days of disability, The Standard will pay full benefits even if you have a preexisting condition. After 90 days, The Standard will continue benefits only if the preexisting condition exclusion does not apply.
Own Occupation Period
For the plan’s definition of disability, as described in your brochure, the own occupation period is the first 24 months for which LTD benefits are paid.
Any Occupation Period
The any occupation period begins at the end of the own occupation period and continues until the end of the maximum benefit period.
Other LTD Features
• Employee Assistance Program (EAP) – This program offers support, guidance and resources that can help an employee resolve personal issues and meet life’s challenges.
• Family Care Expense Adjustment – Disabled employees faced with the added expense of family care when returning to work may receive combined income from LTD benefits and work earnings in excess of 100 percent of indexed predisability earnings during the first 12 months immediately after a disabled employee’s return to work.
• Special Dismemberment Provision – If an employee suffers a lost as a result of an accident, the employee will be considered disabled for the applicable Minimum Benefit Period and can extend beyond the end of the Maximum Benefit Period
• Reasonable Accommodation Expense Benefit – Subject to The Standard’s prior approval, this benefit allows us to pay up to $25,000 of an employer’s expenses toward work-site modifications that result in a disabled employee’s return to work.
• Survivor Benefit – A Survivor Benefit may also be payable. This benefit can help to address a family’s financial need in the event of the employee’s death.
• Return to Work (RTW) Incentive – The Standard’s RTW Incentive is one of the most comprehensive in the employee benefits history. For the first 12 months after returning to work, the employee’s LTD benefit will not be reduced by work earnings until work earnings plus the LTD benefit exceed 100 percent of predisability earnings. After that period, only 50 percent of work earnings are deducted.
• Rehabilitation Plan Provision – Subject to The Standard’s prior approval, rehabilitation incentives may include training and education expense, family (child and elder) care expenses, and job-related and job search expenses.
When Benefits End
LTD benefits end automatically on the earliest of:
• The date you are no longer disabled
• The date your maximum benefit period ends
• The date you die
• The date benefits become payable under any other LTD plan under which you become insured through employment during a period of temporary recovery
• The date you fail to provide proof of continued disability and entitlement to benefits
Rates
Employees can select a monthly LTD benefit ranging from a minimum of $200 to a maximum amount based on how much they earn. Referencing the appropriate attached charts, follow these steps to find the monthly cost for your desired level of monthly LTD benefit and benefit waiting period:
1. Find the maximum LTD benefit by locating the amount of your earnings in either the Annual Earnings or Monthly Earnings column. The LTD benefit amount shown associated with these earnings is the maximum amount you can receive. If your earnings fall between two amounts, you must select the lower amount.
2. Select the desired monthly LTD benefit between the minimum of $200 and the determined maximum amount, making sure not to exceed the maximum for your earnings.
3. In the same row, select the desired benefit waiting period to see the monthly cost for that selection.
If you have questions regarding how to determine your monthly LTD benefit, the benefit waiting period, or the premium payment of your desired benefit, please contact your human resources representative.
Group Insurance Certificate
If you become insured, you will receive a group insurance certificate containing a detailed description of the insurance coverage. The information presented above is controlled by the group policy and does not modify it in any way. The controlling provisions are in the group policy issued by Standard Insurance Company.
Maximum Benefit Period: 5 Years for Sickness and To Age 65 for Accident
If your gross annual salary is at least: You are eligible for a maximum monthly benefit
Maximum Benefit Period: 5 Years for Sickness and To Age 65 for Accident (Continued)
If your gross annual salary is at least: You are eligible for a maximum monthly benefit
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DPO
Save with DPO
Visit a dentist in the DPO1 network to maximize your savings.2 These dentists have agreed to reduced fees, and you won’t get charged more than your expected share of the bill.3 Find a DPO dentist at deltadentalins.com.
Set up an online account
Get information about your plan, check benefits and eligibility information, find a network dentist and more. Sign up for an online account at deltadentalins.com
Check in without an ID card
You don’t need a Delta Dental ID card when you visit the dentist. Just provide your name, birth date and enrollee ID or Social Security number. If your family members are covered under your plan, they’ll need your information. Prefer to have an ID card? Simply log in to your account to view or print your card.
Coordinate dual coverage
If you’re covered under two plans, ask your dental office to include information about both plans with your claim — we’ll handle the rest.
Understand transition of care
Generally, multi-stage procedures are covered under your current plan only if treatment began after your plan’s effective date of coverage.4 Log in to your online account to find this date.
Get LASIK and hearing aid discounts
With access to QualSight and Amplifon Hearing Health Care5, you can receive significant savings on LASIK procedures and hearing aids. To take advantage of these discounts, call QualSight at 855-248-2020 and Amplifon at 888-779-1429.
1 In Texas, Delta Dental Insurance Company provides a dental provider organization (DPO) plan.
2 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-DPO dentist. Network dentists are paid contracted fees.
3 You are responsible for any applicable deductibles, coinsurance, amounts over annual or lifetime maximums and charges for non-covered services. Out-of-network dentists may bill the difference between their usual fee and Delta Dental’s maximum contract allowance.
4 Applies only to procedures covered under your plan. If you began treatment prior to your effective date of coverage, you or your prior carrier is responsible for any costs. Group- and state-specific exceptions may apply. If you are currently undergoing active orthodontic treatment, you may be eligible to continue treatment under this plan. Review your Evidence of Coverage, Summary Plan Description or Group Dental Service Contract for specific details about your plan.
5 Vision corrective services and Amplifon’s hearing health care services are not insured benefits. Delta Dental makes the vision corrective services program and hearing health care services program available to you to provide access to the preferred pricing for LASIK surgery and for hearing
and other hearing health services.
Benefit Highlights: DPO from Delta Dental
Effective Date: 9/1/2024
and Non-Surgical Periodontics
or
** Reimbursement is based on DPO contracted fees for DPO dentists, Premier contracted fees for
Benefit Highlights: DPO from Delta Dental
Deductibles waived for Diagnostic & Preventive? Yes, for all Dentists Plan Benefit Highlights for: Group Number:
Eustace Independent School District 22966 - Low Plan
$150
Effective Date: 9/1/2024
$150 per member / per family each calendar year
Per member each calendar year
D&P counts toward maximum? No, for all Dentists
Covered Services*
Diagnostic & Preventive Services (D&P)
Exams, Cleanings, X-Rays, Sealants and Space Maintainers
Basic Services
Fillings, Simple Extractions and Posterior Composites
Endodontics
Covered Not Covered Not Covered Root Canals
Periodontics Not Covered Not Covered Not Covered Surgical and Non-Surgical Periodontics
Oral Surgery
Major Services
Crowns, Inlays, Onlays and Cast Restorations
Prosthodontics
Bridges, Dentures and Denture
Not
For eligibility details, refer to the plan's Evidence/Certificate of Coverage (on file with your benefits administrator, plan sponsor or employer).
*Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s submitted fees.
** Reimbursement is based on DPO contracted fees for DPO dentists, Premier contracted fees for Premier dentists and program
for non-Delta Dental dentists.
This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company’s benefits representative.
Vision Plan Benefits for Eustace ISD
Benefits through Superior Select Southwest Network
Lenses (standard) per pair
Necessary Contact Lenses
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements
1Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay
2 Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglass lenses and frames benefit
Discount Features
Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Walmart Vision Center does not qualify for this additional discount because of Walmart’s “Always Low Prices” policy.
Disclaimer:
Who is eligible for this coverage?
What is the coverage amount?
Is it portable (can I keep it if I leave my employer)?
When is coverage effective?*
What does my AD&D insurance pay for?
Eustace Independent School District
Do my life insurance benefits decrease with age?
All actively employed employees working at least 20 hours each week for your employer in the U.S.
Your employer is providing you with $20,000 of term life insurance. You will also receive $20,000 of Accidental Death and Dismemberment insurance
If you retire, reduce your hours or leave your employer, you can continue coverage at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy.
Please see your plan administrator for your effective date.
The full benefit amount is paid for loss of:
- Life - Both hands or both feet or sight of both eyes - One hand and one foot - One hand and the sight of one eye - Speech and hearing
Coverage amounts will reduce according to the following schedule:
Age:
Insurance amount reduces to: 70 50% of original amount
Coverage may not be increased after a reduction.
*Delayed effective date of coverage
Insurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.
The policy provisions may vary or not be available in all states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage, please refer to Policy Form C.FP-1 et al or contact your Unum representative.
Underwritten by Unum Life Insurance Company of America, Portland, Maine © 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
EN-1771 (6-18) FOR EMPLOYEES
Who is eligible for this coverage?
What are the coverage amounts?
Eustace Independent School District Voluntary Life and AD&D Insurance Plan Highlights Policy Number 474650
All actively employed employees working at least 20 hours each week for your employer in the U.S. and their eligible spouses and children to age 26.
Employee: up to 5 times salary in increments of $10,000; not to exceed $500,000.
Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $250,000
Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000.
What are the AD&D coverage amounts?
Employee: up to 5 times salary in increments of $10,000; not to exceed $500.000.
Spouse: up to 100% of employee amount in increments of $5,000; not to exceed $250,000.
Child: up to 100% of employee coverage amount in increments of $2,000; not to exceed $10,000. The maximum death benefit for a child between the ages of live birth and six months is $1,000.
Note: You may purchase AD&D coverage for yourself regardless of whether you purchase term life coverage. In order to purchase life and AD&D coverage for your dependents, you must buy coverage for yourself.
Can I be denied coverage?
How do I apply?
When is coverage effective?
Current employees: If you and your eligible dependents are enrolled in the plan and wish to increase your life insurance coverage, you may apply on or before the enrollment deadline for any amount of additional coverage up to $150,000 for yourself and any amount of additional coverage up to $50,000 for your spouse. Any life insurance coverage over the guaranteed amount(s) will be subject to answers to health questions.
If you and your eligible dependents are not currently enrolled in the plan, you may apply for coverage on or before the enrollment deadline and will be required to answer health questions for any amount of coverage.
New employees: To apply for coverage, complete your enrollment within 31 days of your eligibility period. If you apply for coverage after 31 days, or if you choose coverage over the amount you are guaranteed, you will need to complete a medical questionnaire which you can get from your plan administrator. You may also be required to take certain medical tests at Unum’s expense.
Please see your plan administrator.
Please see your plan administrator for your effective date.
Insurance coverage will be delayed if you are not in active employment because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.
For your dependent spouse and children, insurance coverage will be delayed if that dependent is totally disabled on the date that insurance would otherwise be effective. Totally disabled means that as a result of an injury, sickness, or disorder, your dependent spouse and children: are confined in a hospital or similar institution; or are confined at
How much does the coverage cost?
home under the care of a physician for a sickness or injury. Exception: Infants are insured from live birth.
Term life
Do my life insurance benefits decrease with age?
Child life monthly rate is $0.36 per $2,000. One life premium covers all children.
AD&D rate chart
Is the coverage portable (can I keep it if I leave my employer)?
Are there any life insurance exclusions or limitations?
Will my premiums be waived if I’m disabled?
Your rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.
Spouse rate is based on your insurance age, which is your age immediately prior to and including the anniversary/effective date.
Coverage amounts will reduce according to the following schedule: Age: Insurance amount reduces to: 70 50% of original amount
Coverage may not be increased after a reduction.
If you retire, reduce your hours or leave your employer, you can continue coverage for yourself your spouse and your dependent children at the group rate. Portability is not available for people who have a medical condition that could shorten their life expectancy — but they may be able to convert their term life policy to an individual life insurance policy.
Life insurance benefits will not be paid for deaths caused by suicide within the first 24 months after the date your coverage becomes effective. If you increase or add coverage, these enhancements will not be paid for deaths caused by suicide within the first 24 months after you make these changes.
If you become disabled (as defined by your plan) and are no longer able to work, your life premium payments will be waived until your disability period ends.
What does my AD&D insurance pay for?
Are there any AD&D exclusions or limitations?
The full benefit amount is paid for loss of:
• life;
• both hands or both feet or sight of both eyes;
• one hand and one foot;
• one hand or one foot and the sight of one eye;
• speech and hearing.
Other losses may be covered as well. Please contact your plan administrator.
Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:
• disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM);
• suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane;
• war, declared or undeclared, or any act of war;
• active participation in a riot;
• committing or attempting to commit a crime under state or federal law;
• the voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol;
• intoxication – “being intoxicated” means you or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.
When does my coverage end?
You and your dependents’ coverage under the Summary of Benefits ends on the earliest of:
• the date the policy or plan is cancelled;
• the date you no longer are in an eligible group;
• the date your eligible group is no longer covered;
• the last day of the period for which you made any required contributions;
• the last day you are in active employment unless continued due to a covered layoff or leave of absence or due to an injury or sickness, as described in the certificate of coverage.
In addition, coverage for any one dependent will end on the earliest of:
• the date your coverage under a plan ends;
• the date your dependent ceases to be an eligible dependent;
• for a spouse, the date of a divorce or annulment;
• for dependent coverage, the date of your death.
Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.
• the date your dependent ceases to be an eligible dependent;
• for a spouse, the date of a divorce or annulment;
• for dependent coverage, the date of your death.
Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.
Life Insurance Highlights
For the employee
Flexible Premium Life Insurance to Age 121 Policy Form PRFNG-NI-10
For the eligible employees of EUSTACE ISD
Voluntary permanent life insurance can be an ideal complement to the group term and optional term your employer might provide. This voluntary universal life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term, on the other hand, typically are not portable if you change jobs and, even if you can keep them after you retire, usually cost more and decline in death benefit.
The policy, purelife-plus, is underwritten by Texas Life Insurance Company, and it has the following features:
• High Death Benefit. With one of the highest death benefits available at the worksite,1 purelife-plus gives your loved ones peace of mind.
• Minimal Cash Value. Designed to provide a high death benefit at a reasonable premium, purelife-plus provides peace of mind for you and your beneficiaries while freeing investment dollars to be directed toward such tax-favored retirement plans as 403(b), 457 and 401(k).
• Long Guarantees.2 Enjoy the assurance of a policy that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time.3
• Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, should you surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)
• Accelerated Death Benefit Due to Terminal Illness Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months, you will have the option to receive 92% of the death benefit, minus a $150 ($100 in Florida) administrative fee. This valuable living benefit gives you peace of mind knowing that, should you need it, you can take the large majority of your death benefit while still alive. (Conditions apply.) (Form ICC07-ULABR-07 or Form Series ULABR-07)
You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, children and grandchildren by answering just 3 questions: 4
During the last six months, has the proposed insured:
a. Been actively at work on a full time basis, performing usual duties?
b. Been absent from work due to illness or medical treatment for a period of more than five consecutive working days?
c. Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy, hormonal therapy for cancer, radiation therapy, dialysis treatment, or treatment for alcohol or drug abuse?
Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details.
1 Voluntary Whole and Universal Life Products, Eastbridge Consulting Group, December 2015
2 Guarantees are subject to product terms, exclusions and limitations and the insurer’s claims-paying ability and financial strength.
3After the guaranteed period, premiums may go down, stay the same, or go up.
4Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships. Accordingly, we will treat each party to a civil union or domestic partnership that is recognized and valid under applicable state law as a spouse. Coverage not available on children and grandchildren in Washington.
See the purelife-plus brochure for details.
PureLife-plusispermanentlifeinsurancetoAttainedAge121thatcanneverbecancelledaslongasyoupaythenecessarypremiums.Afterthe GuaranteedPeriod,thepremiumscanbelower,thesame,orhigher thantheTablePremium.Seethebrochureunder”PermanentCoverage”.
FLEXIBLE BENEFITS PLAN
Eustace Independent School District Employer ID NBS364168 PLAN HIGHLIGHTS
Login at: my.nbsbenefits.com
Congratulations! Eustace Independent School District has established a "Flexible Benefits Plan" to help you pay for your out-of-pocket medical expenses. The benefits you elect are paid for with a portion of your pay before Federal income or Social Security taxes are withheld. This means that you will save money by paying less taxes and have more money to spend. However, if you receive a reimbursement for an expense under the Plan, you cannot claim a Federal income tax credit or deduction on your return.
GENERAL PLAN INFORMATION
Plan Year:…………… September 1st through August 31st
Maximum Health FSA Limit… .…Current IRSlimit …See Code Section 125(i)(2) or current enrollment information
Maximum Dependent Care Limit:……..……………..……..$5,000
Carryover
If you have unused contributions in your Health Flexible Spending Account following the Plan run-out period, you may roll forward a limited dollar amount into the following plan year.
Health FSA Carryover…….Up to $500 following the Plan run-out Amounts exceeding $500 will be forfeited
Grace Period
If you have unused contributions in your Flexible Spending Accounts from the immediately preceding plan year, you may have a limited period to incur additional qualifying FSA and/or Dependent Care expenses.
Dependent Care (DCAP) ...…...75 days
Deadlines to Incur Expenses on Elected Funds
Health FSA August 31 Plan Year End
DCAP……………… November 14 following Plan Year End
Deadlines to File for Reimbursement
Run-out Period:………………………………… 90 days
Health FSA andDCAP…November 29 following plan year end
Mid-Year Terminations
FSA 30 days following termination date
DCAP……………… 30 days following termination date
Orthodontic Reimbursement……….as paidper service contract
or in full at time of banding Upfront payment……………….…………..……………..…allowed
AM I ELIGIBLE TO PARTICIPATE
Premium Only Plan and Dependent Care Spending Account
If you work 15 hours or more each week for the company, you will be eligible to join the Plan once you have satisfied the conditions for coverage under our group medical plan
You will enter the Plan on the day in which you meet the above eligibility requirements.
Flexible Spending Account
If you work 15 hours or more each week for the company, you will be eligible to join the Plan following your date of employment
You will enter the Plan on the first day of the month following the day in which you meet the above eligibility requirements.
Highly Compensated & Key Employees
Under the Internal Revenue Code, "highly compensated employees" and "key employees" generally are Participants who are officers, shareholders or highly paid If you fall within these categories, you may be limited in the benefits or election amounts that are available to you. Please refer to your Summary Plan Description or your HR Department for more information.
WHAT TYPE OF BENEFITS ARE AVAILABLE
Under our Plan, you can choose the following benefits. Each benefit allows you to save taxes at the same time because the amount you elect is set aside on a pre-tax basis.
Health Flexible Spending Account:
The Health Flexible Spending Account (FSA) enables you to pay for expenses allowed under Section 105 and 213(d) of the Internal Revenue Code which are not covered by our insured medical plan. Your Plan Maximum can be found in the General Plan Information section.
Dependent Care Flexible Spending Account:
The Dependent Care Flexible Spending Account (DCAP) enables you to pay for out-of-pocket, work-related dependent day-care cost. Please see the Summary Plan Description for the definition of eligible dependent. The law places limits on the amount of
NBS Welfare Benefit Service Center
(801) 532-4000 or 800-274-0503
Fax: 800-478-1528
service@nbsbenefits.com
Eustace Independent School District Flexible Benefits Plan
Plan Contact Person: Debra Meyners 320 FM316 South Eustace, TX 75124 (903)425-5125 dmeyners@eustaceisd.net
Flexible Benefits Plan Highlights
money that can be paid to you in a calendar year. Generally, your reimbursement may not exceed the lesser of: (a) $5,000 (if you are married filing a joint return or you are head of a household) or $2,500 (if you are married filing separate returns); (b) your taxable compensation; (c) your spouse’s actual or deemed earned income.
Premium Expense Plan:
A Premium Expense portion of the Plan allows you to use pre-tax dollars to pay for specific premiums under various insurance programs that we offer you.
Please note: Policies other than company sponsored policies (i.e. spouse's or dependents' individual policies etc.) may not be paid through the Flexible Benefits Plan. Furthermore, qualified longterm care insurance plans may not be paid through the Flexible Benefits Plan.
DETERMINING CONTRIBUTIONS
Before each Plan Year begins, you will select the benefits you want and how much of the contributions should go toward each benefit. It is very important that you make these choices carefully based on what you expect to spend on each covered benefit or expense during the Plan Year.
Generally, you cannot change the elections you have made after the beginning of the Plan Year. However, there are certain limited situations when you can change your elections if you have a “change in status”. Please refer to your Summary Plan Description for a change in status listing.
HOW DO I RECEIVE REIMBURSEMENTS
Participant Portal or Mobile App
During the course of the Plan Year, you may submit requests for reimbursement of expenses you have incurred. Expenses are considered “incurred” when the service is performed, not necessarily when it is paid for. Claims may be submitted through your online account or the NBS Mobile App.
In order to have the reimbursements made to you for qualifying Dependent Care expenses, you must provide a statement from the service provider including the name, address, date of service, the amount of expense and proof that the expense has been incurred. In most cases, the taxpayer identification number of the service provider will also be necessary.
Claims for reimbursement must be submitted in accordance with the timelines provided in the General Plan Information section.
NBS Smart Debit Card – FSA Pre-paid MasterCard
Your employer may sponsor the use of the NBS Smart Debit Card to access your Health FSA dollars. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.
Updated: 6/6/2024
NBS Welfare Benefit Service Center
(801) 532-4000 or 800-274-0503
Fax: 800-478-1528
service@nbsbenefits.com
What is a Dependent Care Assistance Program (DCAP)?
The Dependent Care Assistance Program (DCAP) allows you to use tax-free dollars to pay for child day care or elder day care expenses that you incur because you and your spouse are both gainfully employed.
To participate, determine the annual amount that you want to deduct from your paycheck before taxes. The maximum amount you can elect depends on your federal tax filing status ($5,000 if you are married and filing a joint return or if you are a single parent, $2,500 if you are married but filing separately).
Your annual amount will be divided by the number of pay periods in the plan year and that amount will be deducted from each paycheck.
Who is an eligible dependent?
You can use the DCAP for expenses incurred for:
• Your qualifying child who is age twelve or younger for whom you claim a dependency exemption on your income tax return.
• Your qualifying relative (e.g. a child over twelve, your parent, a spouse’s parent) who is physically or mentally incapable of caring for himself or herself and has the same principal place of abode as you for more than half of the year.
• Your spouse who is physically or mentally incapable of caring for himself or herself and has the same principal place of abode as you for more than half of the year.
Special Rule for Parents Who Are Divorced, Separated, or Living Apart
Only the custodial parent can claim expenses from the DCAP. The custodial parent is generally the parent with whom the child resides for the greater number of nights during the calendar year. Additionally, the custodial parent cannot be reimbursed from the DCAP for child-care expenses while the child lives with the non-custodial parent because such expenses are not incurred to enable the custodial parent to be gainfully employed.
What are eligible expenses for the DCAP?
The expenses which are eligible for reimbursement must have been incurred during the plan year and in connection with you and your spouse to remain gainfully employed.
Examples of eligible expenses:
• Before and After School and/or Extended Day Programs
• Daycare in your home or elsewhere so long as the dependent regularly spends at least 8 hours a day in your home.
• Base cost of day camps or similar programs.
Examples of ineligible expenses:
• Schooling for a child in kindergarten or above
• Babysitter while you go to the movies or out to eat
• Cost of overnight camps
What does it mean to be “gainfully employed”?
This means that you are working and earning an income (i.e. not doing volunteer work). You are not considered gainfully employed during paid vacation time or sick days. Gainful employment is determined on a daily basis.
If you are married, then your spouse would also need to be gainfully employed for your day care expenses to be eligible for reimbursement.
You are also considered gainfully employed if you are unemployed but actively looking for work, you are self-employed, you are physically or mentally not capable of self-care, or you are a full-time student (must attend for the number of hours that the school considers full-time, must have been a student for some part of each of 5 calendar months during the year, cannot be attending school only at night, does not include on-the-job training courses or correspondence schools).
What are some other important IRS regulations?
• You cannot be reimbursed for dependent care expenses that were paid to (1) one of your dependents, (2) your spouse, or (3) one of your children who is under the age of nineteen.
• In the event that you use a day care center that cares for more than six children, the center must be licensed.
• You must provide the day care provider’s Social Security Number/Tax Identification Number (EIN) on form 2441 when you file your taxes.
What are some other important IRS regulations?
The IRS allows you to take a tax credit for your dependent care expenses. The tax credit may provide you with a greater benefit than the DCAP if you are in a lower tax bracket. To determine whether the tax credit or the DCAP is best for you, you will need to review your individual tax circumstances. You cannot use the same expenses for both the tax credit and the DCAP, however, you may be able to coordinate the federal dependent care tax credit with participation in the DCAP for expenses not reimbursed through DCAP.
For more information, please call
How can an HSA help secure my retirement?
Contributing in a health savings account allows you to invest pre-tax dollars for your biggest retirement expense - HEALTHCARE.
You can continue to contribute year after year and withdrawals can be made at any time. Whether you withdraw the money tomorrow, five years from now, or in retirement, funds used for qualified healthcare expenses are always tax free.
What is a Health Savings Account (HSA)?
An HSA is a personal savings account that can be used to pay for medical, dental, vision and other qualified expenses now or later in life. To contribute to an HSA, you must be enrolled in a qualified highdeductible health plan. Your contributions are taxdeductible, but are limited annually. If your employer offers payroll deduction, you’ll see immediate tax savings on your contributions. You can use the money tax-free to pay for eligible expenses such as:
HSAs offer a triple tax advantage
1. CONTRIBUTE TAX-FREE. If your employer offers payroll deduction through a Cafeteria Plan, you may make contributions to your HSA on a pretax basis or you can contribute to your HSA post-tax and recognize the same tax savings by claiming the deduction when filing your annual taxes.
2. SPEND TAX-FREE. Eligible medical purchases can be made tax-free when you use your HSA. Make this easy by using your NBS Smart Card or online bill pay. You can also pay out-of-pocket for eligible medical expenses and then reimburse yourself from your HSA.
Spending is easy
Life’s not always flexible, but your money can be.
From baby care to pain relief, shop the largest selection of guaranteed HSA-eligible products with zero guesswork at HSA Store. Is your health need HSA-eligible? Find out using our comprehensive Eligibility List.
Get $10 off using code NBS1819.
Shop HSA Store at hsastore.com/nbs
3. EARN TAX-FREE. Unlike most savings accounts, interest earned on an HSA is not considered taxable income when the funds are used for eligible medical expenses. You can also invest HSA dollars and interest earned is tax-free.
When do you pay taxes on your HSA?
The only time you may pay taxes or penalties on your HSA funds is if you make a non-eligible purchase, or if you contribute more than the yearly maximum contribution limit. However, both circumstances can be corrected free of tax penalties by April 15th of the following calendar year.
Account access is easy
Get account information from our easy-to-use online portal and mobile app. See your account balance, contributions and account history in real time.
Our convenient NBS Smart Card allows you to avoid out-of-pocket expenses, cumbersome claim forms and reimbursement delays. You may also utilize the “pay a provider” option on our web portal.
Saving is easy
Since it is a savings account, you are encouraged to save more than you spend. Unlike FSA funds which are “use-it-or-lose-it,” your HSA balance rolls over from year-to-year and earns interest along the way. The account is portable, which means that if you ever leave your employer, you can take the HSA with you. It’s your money and your account.