Medical – TRS Activecare
TeleMedicine – 1.800MD
Flexible Spending Account – NBS
Health Savings Account – HSAbank
Dental – MetLife
Vision – VSP
Disability – Lincoln
Group Life & AD&D – Lincoln
Permanent Life – 5 Star
Accident – MetLife
Hospital Indemnity - MetLife
Cancer – American Public
MASA Transport - MASA
Identity Theft – ID Watchdog
Retirement Plans – The Omni Group
Medical Insurance by TRS
BCISD contributes $395.00 a month toward plan election
See back for details; plan descriptions located on the TRS website.
Telehealth by 1800MD - FREE FOR ENTIRE FAMILY!
Provided to all eligible employees & their families by BCISD
Plan allows employees and household members access to a national network of licensed doctors that can diagnose, recommend treatment, and prescribe medication all over the phone 24/7/365 for non-emergencies.
Vision Insurance by VSP - FREE FOR EMPLOYEE!
BCISD contributes $5.98 a month
Members pay a co-pay for in-network benefits. Exam co-pay is $10.00 & materials co-pay is $25.00. Exams & lenses are covered innetwork once every 12 months. Additional frames may be purchased at a 20% discount. In-Network providers include Burnet Eye Care, Poole Eye Associates, Dr. Drinkard, Wal-Mart.
BCISD contributes $21.09 a month
Don’t wait until the deadline.
Complete today!
Low Option PPO is FREE to employee! Plan includes a $750 calendar year maximum; $50 deductible for individuals and $150 deductible for families. Class I expenses are paid at 100%; Class II expenses are paid at 60%; & Class III expenses are paid at 40%. Class IX & Orthodontia expenses are not covered. Plan includes contracted fees/max allowable charges.
High Option PPO - Plan includes a $1,500 calendar year maximum; $50 deductible for individuals and $150 deductible for families. Class 1 expenses are paid at 100%; Class II expenses are paid at 80%; Class III and IX expenses are paid at 50%. Orthodontia expenses are paid at 50% up to $1,000 (to age 19).
BCISD provides a $30,000 policy - FREE Group Term Life offers you an opportunity to purchase affordable term life insurance on a payroll deduction basis. Employees can also take additional voluntary life insurance. Rates are based on age / plan options. Employee Assistance Program through LifeKeys
Hospital Indemnity Plan by MetLife
Plan supplements your medical coverage by covering some of the additional expenses of a hospital stay; benefits paid directly to you.
Permanent Life Insurance by 5 Star
Plan provides a death benefit to age 100. Individual policies can be purchased on the employee, their spouse, children, grandchildren.
Plan protects one of your most valuable assets, your ability to earn a living. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury.
BCISD offers voluntary participation in 403(b) plans which are administered by The Omni Group. Contact the HR office for more details.
Flexible Spending Accounts by NBS
Allows an individual to set aside dollars pre-tax to pay for future health care &/or dependent care expenses on a “use it or lose it” basis. Medical reimbursement max is $3,050 plan year; dependent care reimbursement max is $5,000/plan year. NO fee to participate. Must re-enroll every year.
Allows an employee to accumulate pre-tax dollars in an account to assist with expenses for High Deductible (HD) health plans. Participant must be enrolled in an HD plan. Funds in this account DO roll over from year to year. Annual maximum for an individual is $3,850 and family maximum is $7,750. 55 years and older can contribute an additional $1,000 per year. $1.75 monthly fee deducted from participants account each month.
MASA provides medical emergency transportation solutions and covers your out of pocket medical transport cost when your insurance falls short. Zero out of pocket expenses for emergent air or ground transport, regardless of transport provider.
Benefits for hospital admission, ambulance, ER visits and more. Wellness visit benefit of $200 per enrollee.
Questions? We can help!
http:www.bcbstx.com/trsactivecare/coverage 2023/2024 Online Open Enrollment July 13th - August 11th
Benefits Information Night: August 1 All Staff and Spouses Welcome! 6:00 pm, CO Board Room
Enrollment Assistance: August 8 All Staff 11:00 am–2:00 pm, BHS Library Enroll Anytime, Anywhere; Research Plan Specifics: https://www.mybenefitshub.com/burnetcisd
Login Instructions: User Name: first 6 letters of last name, followed by the first letter of first name, then last 4 of social (i.e. darlinm1111) Password: full last name, followed by last four of social (i.e. darling1111)
To include dependents on any of your coverages through BCISD you must provide the dependents name, date of birth, and social security number.
Choose your benefits carefully. Several of the employee benefits plan contributions are made on a pre-tax basis and per IRS regulations, contribution amounts cannot be changed unless you experience a qualified life event. Qualifying life events include:
• Marriage, divorce, legal separation;
• Death of spouse or dependent;
• Birth or adoption of a child;
• Changes in employment for spouse or dependents;
• Significant cost or coverage changes;
You must submit your benefit change requests and include required documentation within 30 days of the event. Also note that per the IRS, only changes consistent with the life event are allowed.
New employees must enroll within 30 days of their hire date. If employees fail to enroll within the 30 days, all benefits will be waived.
Except for health insurance, plans will be effective on the first of the month following the date of hire. Health Insurance can be effective the date of hire or the first of the month following date of hire. Please be aware that if you choose date of hire as effective date for health insurance, you will be charged for the entire month.
Please carefully review your paycheck(s) to ensure all deductions are correct. If you find a discrepancy in your paycheck, please contact U.S. Employee Benefits or the BCISD benefits office as soon as possible to correct. Discrepancies must be communicated within 30 days from the effective date of the policy.
For contact information, claim forms, benefits guides and more, please visit the Burnet Consolidated ISD website at www.mybenefitshub.com/burnetcisd
Looking for care that fits your schedule? 1.800MD offers reliable, quality health care at your fingertips with a remarkable reputation.
1.800MD is a fast, convenient alternative to waiting days for an appointment or spending hours sitting in the doctor’s office, urgent care or ER. Whether it is 2 a.m. from your toddler’s room or 7 p.m. from your business trip destination, our telehealth solutions save you time and money while providing peace of mind.
Visits to the emergency room or urgent care are costly prices to pay when many visits can be handled by calling 1.800MD. As a low-cost alternative 1.800MD physicians treat many common conditions via phone or video consultations, reducing unnecessary doctor’s visits and saving you money.
With more than a decade of experience, 1.800MD provides individuals, families, employers and groups with best of class medical care 24/7/365. Available any time day or night, our board-certified physicians are equipped to diagnose, recommend treatment and prescribe medications while in the comfort of your home, office or business trip destination.
1.ACTIVATE ACCOUNT
Independently owned, 1.800MD focuses on customer satisfaction. Our member service representatives are available any time to assist you or answer any questions you may have.
1.800MD’s website and mobile app are extensions of our customer service commitment. They provide consumers with access to fast, convenient access to health care. Individual secure member portals contain information and tools to help make informed health care decisions.
Activate your account online at www.1800md.com or by calling 1.800.530.8666. Once activated, you will need to setup your member profile and complete your electronic health record.
2.REQUEST
Login to your account online or call member services at 1.800.530.8666 to request a consult anytime 24/7.
3.RECEIVE CARE
Receive diagnosis and treatment, giving you quality care and peace of mind where ever you are.
Q: What is 1.800MD?
A: With more than a decade of experience, 1.800MD is focused on providing individuals, families, employers and groups with convenient medical care, anywhere in the United States* at any time. You can rest assured that 1.800MD’s personalized telehealth solutions are unparalleled.
How does 1.800MD improve quality of care?
A: 1.800MD provides fast, convenient care for minor medical matters from the flu to allergies to urinary tract infections. With one of the largest networks of telemedicine physicians in the nation, 1.800MD’s board-certified physicians are equipped to diagnose, recommend treatment and prescribe medications from the comfort of your home, office or travel destination (within the United States, subject to state regulations) 24/7/365.
Q: How does 1.800MD reduce health care costs?
A: 1.800MD saves you money by diagnosing and treating common ailments through our telehealth solutions, thus reducing unnecessary doctor’s office and emergency room visits. Data shows up to 70 percent of all urgent care and emergency room visits are unneeded, costly and can be handled with a 1.800MD telephone or video consultation.
Q: What about the doctors?
A: 1.800MD has one of the largest networks of telemedicine physicians in the nation to ensure convenient care anywhere. A thorough review of medical licensure, training, education, work and malpractice history is performed every two years by a national third-party credentialing agency in accordance with the National Committee for Quality Assurance and the Utilization Review Accreditation Committee guidelines. With an average of 15 years of internal medicine, family practice or pediatrics experience, you can rest assured each physician is properly licensed in your state, board-certified and verified by the National Physician Data Base and the American Medical Association.
Q: Is there a minimum age requirement?
A: There is no minimum age to consult with a 1.800MD physician. However, the patient must have the ability to communicate his or her condition to the doctor to ensure the physician can properly diagnose and treat.
Q: I have a pre-existing condition. Will 1.800MD still accept me?
A: Absolutely! 1.800MD is not insurance. We do not deny access to quality care because of pre-existing conditions.
Q: Can I get a consultation after hours or on weekends?
A: Yes. 1.800MD is available 24 hours a day, seven days a week and 365 days a year.
Q: How are prescriptions filled?
A: If a 1.800MD physician recommends medication as part of your treatment plan, the prescription will be digitally sent to the local pharmacy of your choice.
Q: Are there any limitations as to what can be prescribed?
A: Yes. While a 1.800MD physician can prescribe appropriate medications to treat your condition such as antibiotics, antihistamines and maintenance medicines, our physicians do not prescribe lifestyle drugs, medications regulated by the Drug Enforcement Agency or those that pose a potential for abuse or addiction.
For all other questions, please contact us at 1 (800) 530-8666.
Our convenient NBS Smart Debit 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.
Get account information from our easy-to-use online portal and mobile app. You can submit claims online, and see your account balance, contributions, and account history in real time.
Expenses can be reimbursed from your health FSA if the expenses are for the diagnosis, cure, mitigation, treatment or prevention of disease and for treatments affecting any part or function of the body. The expenses must be primarily to alleviate or prevent a physical or mental defect or illness. Expenses solely for cosmetic reasons generally are not considered expenses for medical care. Also, expenses that are merely beneficial to your general health are not eligible.
The following list shows common examples of qualified medical expenses. Complete lists of eligible and non-eligible expenses can be found in IRS Publication 502, which can be ordered from the IRS by calling 1-800-TAX-FORM (1-800-829-3676) or by visiting www.irs.gov.
You can pay less in taxes and reduce your medical expenses simply by signing up for an FSA!
A Flexible Spending Account (FSA) lets you set aside a portion of your paycheck—before taxes— into an account to help you pay for medical expenses. An FSA is a planning tool with great tax benefits. With an FSA, you must use the account balance in full before the end of the plan year or it will be forfeited.
Two Types of FSAs. To take advantage of a health FSA, start by choosing an annual election amount. This amount will be available on day one of your plan year for eligible medical expenses. Payroll deductions will then be made throughout the plan year to fund your account. A dependent care FSA works differently than a health FSA. Dependent care FSA money only becomes available as it is contributed, and can only be used to pay expenses for the care of your dependents while you work. Both are pre-tax benefits your employer offers through a cafeteria plan. Choose one or both — whichever is right for you.
Reduces your taxable income. Your FSA contributions are deducted from your paycheck by your employer before taxes are withheld. These deductions lower your taxable income, which can save you money on income taxes.
Enrollment Consideration. After the enrollment period ends, you may increase, decrease or stop your contribution only when you experience a qualifying “change in status” event (e.g. marriage, divorce, employment change, dependent change) Be conservative in the total amount you elect to avoid forfeiting money at the end of the plan year.
What if I don’t use it all? You must use the account balance in full before the end of the plan year or it will be forfeited. This is known as the “use it or lose it” rule. Your employer may offer a grace period or a rollover to help if you miss the mark a little bit. Check your Summary Plan Description for specifics on your employer's plan, and make sure to plan carefully when you enroll.
• Acupuncture
• Addiction programs
• Adoption (medical expenses for baby birth)
• Alternative healer fees
• Ambulance
• Body scans
• Breast pumps
• Care for mentally handicapped
• Chiropractor
• Copayments
• Crutches
• Diabetes (insulin, glucose monitor)
• Eye patches
• Artificial teeth
• Copayments
• Deductible
• Dental work
• Fertility treatment
• First aid (e.g., bandages, gauze)
• Hearing aids & batteries
• Hypnosis (for treatment of illness)
• Incontinence products (e.g., Depends, Serene)
• Joint support bandages and hosiery
• Lab fees
• Menstrual Products*
• Monitoring device (blood pressure, cholesterol)
• Non-prescription medicines or drugs (vitamins/supplements without a prescription are not eligible)*
• Physical exams
• Pregnancy tests
• Prescription medicines or drugs
• Psychiatrist/psychologist (for mental illness)
• Physical therapy
• Speech therapy
• Vaccinations
• Vaporizers or humidifiers
• Weight loss program fees (if prescribed by physician)
• Wheelchair
• Dentures
• Orthodontia expenses
• Preventative care at dentist office
• Bridges, crown, etc.
• Braille - books & magazines
• Contact lenses
• Contact lens solutions
• Eye exams
• Personal hygiene (e.g., deodorant, soap, body powder, sanitary products. Does not include menstrual products)
• Addiction products**
• Cosmetic surgery**
• Cosmetics (e.g., makeup, lipstick, cotton swabs, cotton balls, baby oil)
• Counseling (e.g., marriage/family)
• Dental care - routine (e.g., toothpaste, toothbrushes, dental floss, antibacterial mouthwashes, fluoride rinses, teeth whitening/bleaching)**
• Exercise equipment**
• Haircare (e.g., hair color, shampoo, conditioner, brushes, hair loss products)
• Health club or fitness program fees**
• Homeopathic supplement or herbs**
• Household or domestic help
• Laser hair removal
• Massage therapy**
• Eyeglasses
*After January 1, 2020
• Laser surgery
• Office fees
• Guide dog and upkeep/ other animal aid
• Nutritional and dietary supplements (e.g., bars, milkshakes, power drinks, Pedialyte)**
• Skin care (e.g., moisturizing lotion, lip balm)
• Sleep aids (e.g., snoring strips)**
• Vitamins**
• Weight reduction aids (e.g., Slimfast, appetite suppressant)**
**Portions of these expenses may be eligible for reimbursement if they are recommended by a licensed medical professional as medically necessary for treatment of a specific medical condition.
Maximize your savings
A Health Savings Account, or HSA, is a tax-advantaged savings account you can use for healthcare expenses. Along with saving you money on taxes, HSAs can help you grow your nest egg for retirement.
• Contribute to your HSA by payroll deduction, online banking transfer or personal check.
• Pay for qualified medical expenses for yourself, your spouse and your dependents. Both current and past expenses are covered if they’re from after you opened your HSA.
• Use your HSA Bank Health Benefits Debit Card to pay directly, or pay out of pocket for reimbursement or to grow your HSA funds.
• Roll over any unused funds year to year. It’s your money — for life.
• Invest your HSA funds and potentially grow your savings.¹
You can use your HSA funds to pay for any IRS-qualified medical expenses, like doctor visits, hospital fees, prescriptions, dental exams, vision appointments, over-the-counter medications and more. Visit hsabank.com/QME for a full list.
You’re most likely eligible to open an HSA if:
• You have a qualified high-deductible health plan (HDHP).
• You’re not covered by any other non-HSA-compatible health plan, like Medicare Parts A and B.
• You’re not covered by TriCare.
• No one (other than your spouse) claims you as a dependent on their tax return.
The IRS limits how much you can contribute to your HSA every year. This includes contributions from your employer, spouse, parents and anyone else.2 Maximum contribution limit
You may be eligible to make a $1,000 HSA catch-up contribution if you’re:
• Over 55.
• An HSA accountholder.
• Not enrolled in Medicare (if you enroll mid-year, annual contributions are prorated).
A huge way that HSAs can benefit you is they let you save on taxes in three ways.
1 You don’t pay federal taxes on contributions to your HSA.3
2 Earnings from interest and investments are tax-free.
3
Distributions are tax free when used for qualified medical expenses.
¹ Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank. Investment losses which are replaced are subject to the annual contribution limits of the HSA.
2 HSA contributions in excess of IRS limits are subject to penalty and tax unless the excess and earnings are withdrawn prior to the tax filing deadline as explained in IRS Publication 969.
3 Federal tax savings are available regardless of your state. State tax laws may vary. Consult a tax professional for more information.
Metropolitan Life Insurance Company
Network: PDP Plus
The Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs. You get benefits for a wide range of covered services — both in and out of the network. The goal is to deliver affordable protection for a healthier smile and a healthier you.
Ortho applies to Child Only Child to age 19
The Preferred Dentist Program is designed to provide the dental coverage you need with the features you want. Like the freedom to visit the dentist of your choice – in or out of the network. .
If you receive in-network services, you will be responsible for any applicable deductibles, cost sharing, negotiated charges after benefit maximums are met, and costs for non-covered services. If you receive out-of-network services, you will be responsible for any applicable deductibles, cost sharing, charges in excess of the benefit maximum, charges in excess of the negotiated fee schedule amount or R&C Fee, and charges for non-covered services.
• Certain plan benefits are based on a percentage of the negotiated fee. This is the amount that participating dentists have agreed to accept as payment in full. If your plan benefits are based on a percentage of the Reasonable and Customary (R&C) charges, your out-of-pocket expenses may be more, since you will be responsible for paying any difference between the dentist's fee and your plan's payment for the approved service.
Take advantage of online self-service capabilities with MyBenefits.
• Check the status of your claims
• Locate a participating PDP dentist
• Access MetLife’s Oral Health Library
• Elect to view your Explanation of Benefits online
If you are not already registered, just go to www.metlife.com/mybenefits and follow the easy registration instructions.
High
• Dependent children up to age 19. Age limitations may vary by state. Please see your Plan description for complete details. In the event of a conflict with this summary, the terms of the certificate will govern.
• All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia.
• Benefits for the initial placement will not exceed 20% of the Lifetime Maximum Benefit Amount for Orthodontia. Periodic follow-up visits will be payable on a monthly basis during the scheduled course of the orthodontic treatment. Allowable expenses for the initial placement, periodic follow-up visits and procedures performed in connection with the orthodontic treatment, are all subject to the Orthodontia coinsurance level and Lifetime Maximum Benefit Amount as defined in the Plan Summary.
• Orthodontic benefits end at cancellation of coverage
*Alternate Benefits: Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pretreatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plan’s reimbursement for those services, and your out-of-pocket expense. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment.
The service categories and plan limitations shown above represent an overview of your Plan of Benefits. This document presents many services within each category, but is not a complete description of the Plan. Please see your Plan description/Insurance certificate for complete details. In the event of a conflict with this summary, the terms of your insurance certificate will govern.
*Alternate Benefits: Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pretreatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plan’s reimbursement for those services, and your out-of-pocket expense. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment.
The service categories and plan limitations shown above represent an overview of your Plan of Benefits. This document presents many services within each category, but is not a complete description of the Plan. Please see your Plan description/Insurance certificate for complete details. In the event of a conflict with this summary, the terms of your insurance certificate will govern.
1. Services which are not Dentally Necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which We deem experimental in nature;
2. Services for which You would not be required to pay in the absence of Dental Insurance;
3. Services or supplies received by You or Your Dependent before the Dental Insurance starts for that person;
4. Services which are primarily cosmetic (For residents of Texas, see notice page section in your certificate).
5.Services which are neither performed nor prescribed by a Dentist except for those services of a licensed dental hygienist which are supervised and billed by a Dentist and which are for:
• scaling and polishing of teeth; or
• fluoride treatments.
For NY Sitused Groups, this exclusion does not apply.
6.Services or appliances which restore or alter occlusion or vertical dimension.
7. Restoration of tooth structure damaged by attrition, abrasion or erosion.
8. Restorations or appliances used for the purpose of periodontal splinting.
9. Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco.
10 Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss.
11 Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work.
12 Missed appointments.
13.Services
• covered under any workers’ compensation or occupational disease law;
• covered under any employer liability law;
• for which the employer of the person receiving such services is not required to pay; or
• received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital. For North Carolina and Virginia Sitused Groups, this exclusion does not apply.
14.Services paid under any worker’s compensation, occupational disease or employer liability law as follows:
• for persons who are covered in North Carolina for the treatment of an Occupational Injury or Sickness which are paid under the North Carolina Workers’ Compensation Act only to the extent such services are the liability of the employee, employer or workers’ compensation insurance carrier according to a final adjudication under the North Carolina Workers’ Compensation Act or an order of the North Carolina Industrial Commission approving a settlement agreement under the North Carolina Workers’ compensation Act;
• or for persons who are not covered in North Carolina, services paid or payable under any workers compensation or occupational disease law. This exclusion only applies for North Carolina Sitused Groups
15.Services:
• for which the employer of the person receiving such services is required to pay; or
• received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital. This exclusion only applies for North Carolina Sitused Groups
16.Services covered under any workers' compensation, occupational disease or employer liability law for which the employee/or Dependent received benefits under that law. This exclusion only applies for Virginia Sitused Groups
17.Services:
• for which the employer of the person receiving such services is not required to pay; or
• received at a facility maintained by the policyholder, labor union, mutual benefit association, or VA hospital. This exclusion only applies for Virginia Sitused Groups.
18.Services covered under other coverage provided by the Employer.
19 Temporary or provisional restorations.
20 Temporary or provisional appliances.
21 Prescription drugs.
22.Services for which the submitted documentation indicates a poor prognosis.
23 The following when charged by the Dentist on a separate basis:
• claim form completion;
• infection control such as gloves, masks, and sterilization of supplies; or
• local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.
24 Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food.
For NY Sitused Groups, this exclusion does not apply.
25 Caries susceptibility tests.
26 Other fixed Denture prosthetic services not described elsewhere in this certificate.
27 Precision attachments, except when the precision attachment is related to implant prosthetics.
28 Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it.
29 Fixed and removable appliances for correction of harmful habits.1
30 Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards.1
31 Diagnosis and treatment of temporomandibular joint (TMJ) disorders. This exclusion does not apply to residents of Minnesota.1
32 Orthodontic services or appliances. 1
33. Repair or replacement of an orthodontic device.1
34. Duplicate prosthetic devices or appliances.
35
Replacement of a lost or stolen appliance, Cast Restoration, or Denture.
36 Intra and extraoral photographic images.
37 Services or supplies furnished as a result of a referral prohibited by Section 1-302 of the Maryland Health Occupations Article. A prohibited referral is one in which a Health Care Practitioner refers You to a Health Care Entity in which the Health Care Practitioner or Health Care Practitioner’s immediate family or both own a Beneficial Interest or have a Compensation Agreement. For the purposes of this exclusion, the terms “Referral”, “Health Care Practitioner” , “Health Care Entity”, “Beneficial Interest” and Compensation Agreement have the same meaning as provided in Section 1-301 of the Maryland Health Occupations Article.
This exclusion only applies for Maryland Sitused Groups
1Some of these exclusions may not apply. Please see your Certificate of Insurance.
Who is a participating dentist?
A participating, or network, dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for covered services provided to plan members, subject to any deductibles, copayments, cost sharing and benefit maximums. Negotiated fees typically range from 30-45% below the average fees charged in a dentist’s community for the same or substantially similar services.*
In addition to the standard MetLife network, your employer may provide you with access to a select network of dental providers that may be unique to your employer’s dental program. When visiting these providers, you may receive a better benefit, have lower out-of-pocket costs and/or have access to care at facilities at your worksite. Please sign into MyBenefits for more details.
* Based on internal analysis by MetLife. Negotiated fees refer to the fees that participating dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. Savings from enrolling in a dental benefits plan will depend on various factors, including the cost of the plan, how often members visit a dentist and the cost of services rendered. Negotiated fees are subject to change.
How do I find a participating dentist?
There are thousands of general dentists and specialists to choose from nationwide so you are sure to find one that meets your needs. You can receive a list of these participating dentists online at www.metlife.com/dental or call 1-800-275-4638 to have a list faxed or mailed to you.
What services are covered by my plan?
Please see your Certificate of Insurance for a list of covered services.
May I choose a non-participating dentist?
Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating (out-of-network) dentist, your out-of-pocket costs may be greater than your out-of-pocket costs when visiting an in-network dentist.
Can my dentist apply for participation in the network?
Yes. If your current dentist does not participate in the network and you would like to encourage him or her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.* The website and phone number are for use by dental professionals only.
* Due to contractual requirements, MetLife is prevented from soliciting certain providers.
How are claims processed?
Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive email alerts when a claim has been processed. If you need a claim form, visit www.metlife.com/dental or request one by calling 1-800-275-4638.
Can I get an estimate of what my out-of-pocket expenses will be before receiving a service?
Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. The estimate helps you prepare for the cost of dental services. We recommend that you request a pre-treatment estimate for services in excess of $300. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment.
Yes. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (collect) when outside the U.S. to receive immediate care until you can see your dentist. Coverage will be considered under your out-of-network benefits.** Please remember to hold on to all receipts to submit a dental claim.
*International Dental Travel Assistance services are administered by AXA Assistance USA, Inc. (AXA Assistance). AXA Assistance provides dental referral services only. AXA Assistance is not affiliated with MetLife and any of its affiliates, and the services they provide are separate and apart from the benefits provided by MetLife. Referral services are not available in all locations.How does MetLife coordinate benefits with other insurance plans?
Coordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. These rules determine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan.
Do I need an ID card?
No, You do not need to present an ID card to confirm that you are eligible. You should notify your dentist that you are enrolled in a MetLife Dental Plan. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system.
Do my dependents have to visit the same dentist that I select?
No. You and your dependents each have the freedom to choose any dentist.
If I do not enroll during my initial enrollment period can I still purchase Dental Insurance at a later date?
Yes, employees who do not elect coverage during enrollment period may still elect coverage later. Dental coverage would be subject to the following waiting periods.
• No waiting period on Preventive Services
• 6 months on Basic Restorative (Fillings)
• 12 months on all other Basic Services
• 24 months on Major Services
• 24 months on Orthodontia Services (if applicable)
Like most group benefits programs, MetLife group benefits programs contain certain exclusions, waiting periods, reductions and terms for keeping them in force. The certificate of insurance sets forth the plan terms and provisions, including the exclusions and limitations.
YOUR VSP VISION BENEFITS SUMMARY
BURNET CONSOLIDATED SCHOOL DISTRICT and VSP provide you with an affordable vision plan.
PROVIDER NETWORK: VSP Advantage
WELLVISION EXAM
YOUR COVERAGE WITH A VSP PROVIDER
Focuses on your eyes and overall wellness
Retinal screening for members with diabetes
ESSENTIAL MEDICAL EYE CARE
Additional exams and services beyond routine care to treat immediate issues from pink eye to sudden changes in vision or to monitor ongoing conditions such as dry eye, diabetic eye disease, glaucoma, and more.
Coordination with your medical coverage may apply. Ask your VSP doctor for details.
PRESCRIPTION GLASSES
FRAME
LENSES
LENS ENHANCEMENTS
CONTACTS (INSTEAD OF GLASSES)
$145 featured frame brands allowance
$125 frame allowance
20% savings on the amount over your allowance
$125 Walmart®/Sam's Club® frame allowance
$65 Costco® frame allowance
Single vision, lined bifocal, and lined trifocal lenses
Impact-resistant lenses for dependent children
Standard progressive lenses
Premium progressive lenses
Custom progressive lenses
Average savings of 20-25% on other lens enhancements
$120 allowance for contacts and contact lens exam (fitting and evaluation)
15% savings on a contact lens exam (fitting and evaluation)
Glasses and Sunglasses
EXTRA SAVINGS
$10
$0 per screening
$20 per exam
Every 12 months
Available as needed
$25
Included in Prescription Glasses
Included in Prescription Glasses
$0
$95 - $105
$150 - $175
Every 12 months
Every 12 months
Every 12 months
Every 12 months $0
Extra $20 to spend on featured frame brands. Go to vsp.com/offers for details.
20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of your last WellVision Exam.
Routine Retinal Screening
No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam
Laser Vision Correction
Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities
YOUR COVERAGE WITH OUT-OF-NETWORK PROVIDERS
Get the most out of your benefits and greater savings with a VSP network doctor. Call Member Services for out-of-network plan details. Coverage with a retail chain may be different or not apply. Log in to vsp.com to check your benefits for eligibility and to confirm in-network locations based on your plan type. VSP guarantees coverage from VSP network providers only. Coverage information is subject to change. In the event of a conflict between this information and your organization s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business.
Log in to vsp.com to find an in-network provider based on your plan type.
*Only available to VSP members with applicable plan benefits. Frame brands and promotions are subject to change. Savings based on doctor s retail price and vary by plan and purchase selection; average savings determined after benefits are applied. Ask your VSP network doctor for more details.
Classification: Restricted
EFFECTIVE DATE: 09/01/2022 22
©2022 Vision Service Plan. All rights reserved. VSP, VSP Vision Care for life, Eyeconic, and WellVision Exam are registered trademarks. Flexon is a registered trademark of Marchon Eyewear, Inc. All other brands or marks are the property of their respective owners.
The Lincoln Shortterm Disability Insurance Plan:
• Provides a cash benefit when you are out of work for up to 24 weeks due to injury, illness, surgery, or recovery from childbirth
• Provides a partial cash benefit if you can only do part of your job or work part time
• Features group rates for Burnet CISD employees
• Offers a fast, no-hassle claims process
Short-term Disability
Weekly benefit amount
60% of your weekly salary, limited to $1,400 per week
Sickness elimination period 14 days
Accident elimination period 14 days
First day hospitalization 0 days
Maximum coverage period 24 weeks
Sickness Elimination Period
• You must be out of work for 14 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 15.
Accident Elimination Period
• You must be out of work for 14 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 15.
First Day Hospitalization
• The elimination period is reduced if you are hospitalized due to an illness or accidental injury. You can begin collecting benefits on the first day of hospitalization.
• If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months.
• Your short-term disability benefits can coordinate with income from other sources, such as continued income or sick pay from your employer, during your disability.
• This allows you to receive up to 100% of your pre-disability income.
• When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.
Like any insurance, this short-term disability insurance policy does have some exclusions. You will not receive benefits if:
• Your disability is the result of a self-inflicted injury or act of war
• You are not under the regular care of a doctor when you request disability benefits
Your benefits may be reduced if you are eligible to receive benefits from:
• A state disability plan or similar compulsory benefit act or law
• A retirement plan
• Social Security
• Any form of employment
• Workers’ Compensation
A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.
Your estimated monthly premium is determined by multiplying your monthly salary amount (up to $10,111) by your age-range premium rate. If your monthly salary exceeds $10,111, multiply $10,111 by your premiumrate.
The Lincoln Shortterm Disability Insurance Plan:
• Provides a cash benefit when you are out of work for up to 22 weeks due to injury, illness, surgery, or recovery from childbirth
• Provides a partial cash benefit if you can only do part of your job or work part time
• Features group rates for Burnet CISD employees
• Offers a fast, no-hassle claims process
Short-term Disability
Weekly benefit amount
60% of your weekly salary, limited to $1,400 per week
Sickness elimination period 30 days
Accident elimination period 30 days
First day hospitalization 0 days
Maximum coverage period 22 weeks
Sickness Elimination Period
• You must be out of work for 30 days due to an illness before you can collect disability benefits. You can begin collecting benefits on day 31.
Accident Elimination Period
• You must be out of work for 30 days due to an accidental injury before you can collect disability benefits. You can begin collecting benefits on day 31.
First Day Hospitalization
• The elimination period is reduced if you are hospitalized due to an illness or accidental injury. You can begin collecting benefits on the first day of hospitalization.
• If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months.
• Your short-term disability benefits can coordinate with income from other sources, such as continued income or sick pay from your employer, during your disability.
• This allows you to receive up to 100% of your pre-disability income.
• When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.
Like any insurance, this short-term disability insurance policy does have some exclusions. You will not receive benefits if:
• Your disability is the result of a self-inflicted injury or act of war
• You are not under the regular care of a doctor when you request disability benefits
Your benefits may be reduced if you are eligible to receive benefits from:
• A state disability plan or similar compulsory benefit act or law
• A retirement plan
• Social Security
• Any form of employment
• Workers’ Compensation
A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.
Your estimated monthly premium is determined by multiplying your monthly salary amount (up to $10,111) by your age-range premium rate. If yourmonthly salary exceeds $10,111, multiply $10,111 by your premiumrate.
The Lincoln Long-term Disability Insurance
Advantage Plan:
• Provides a cash benefit after you are out of work for 90 days or more due to injury, illness, or surgery
• Features group rates for Burnet CISD employees
• Includes EmployeeConnectSM services, which give you and your family confidential access to counselors as well as personal, legal, and financial assistance
Long-term Disability
Monthly benefit amount
Elimination period
Coverage period for your occupation
Maximum coverage period
Elimination Period
60% of your monthly salary, limited to $6,000 per month
90 days
24 months
Up to age 65 or Social Security
Normal Retirement Age (SSNRA), whichever is later
• This is the number of days you must be disabled before you can collect disability benefits.
• The 90-day elimination period can be met through either total disability (out of work entirely) or partial disability (working with a reduced schedule or performing different types of duties).
• This is the coverage period for the trade or profession in which you were employed at the time of your disability (also known as your own occupation).
• You may be eligible to continue receiving benefits if your disability prohibits you from any employment for which you are reasonably suited through your training, education, and experience. In this case, your benefits are extended through the end of your maximum coverage period (benefit duration).
• This is the total amount of time you can collect disability benefits (also known as the benefit duration).
• Benefits are limited to 24 months for mental illness; 24 months for substance abuse.
• If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months.
Like any insurance, this long-term disability insurance policy does have some exclusions. You will not receive benefits if:
• Your disability is the result of a self-inflicted injury or act of war
• You are not under the regular care of a doctor when you request disability benefits
• Your disability occurs while you are committing a felony or participating in a riot
• Your disability occurs while you are imprisoned for committing a felony
• When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.
• Your disability occurs while you are residing outside of the United States or Canada for more than 12 consecutive months for a purpose other than work
Your benefits may be reduced if you are eligible to receive benefits from:
• A state disability plan or similar compulsory benefit act or law
• A retirement plan
• Social Security
• Any form of employment
• Workers’ Compensation
• Salary continuance
• Sick leave
A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.
Here’s how little you pay with grouprates.
Your estimated monthly premium is determined by multiplying your monthly salary amount (up to $10,000) by your age-range premium rate. If your monthly salary exceeds $10,000, multiply $10,000 by your premiumrate.
The Lincoln Long-term Disability Insurance
Advantage Plan:
• Provides a cash benefit after you are out of work for 180 days or more due to injury, illness, or surgery
• Features group rates for Burnet CISD employees
• Includes EmployeeConnectSM services, which give you and your family confidential access to counselors as well as personal, legal, and financial assistance
Long-term Disability
Monthly benefit amount
Elimination period
Coverage period for your occupation
Maximum coverage period
Elimination Period
60% of your monthly salary, limited to $6,000 per month
180 days
24 months
Up to age 65 or Social Security
Normal Retirement Age (SSNRA), whichever is later
• This is the number of days you must be disabled before you can collect disability benefits.
• The 180-day elimination period can be met through either total disability (out of work entirely) or partial disability (working with a reduced schedule or performing different types of duties).
• This is the coverage period for the trade or profession in which you were employed at the time of your disability (also known as your own occupation).
• You may be eligible to continue receiving benefits if your disability prohibits you from any employment for which you are reasonably suited through your training, education, and experience. In this case, your benefits are extended through the end of your maximum coverage period (benefit duration).
Maximum Coverage Period
• This is the total amount of time you can collect disability benefits (also known as the benefit duration).
• Benefits are limited to 24 months for mental illness; 24 months for substance abuse.
• If you have a medical condition that begins before your coverage takes effect, and you receive treatment for this condition within the 3 months leading up to your coverage start date, you may not be eligible for benefits for that condition until you have been covered by the plan for 12 months.
Like any insurance, this long-term disability insurance policy does have some exclusions. You will not receive benefits if:
• Your disability is the result of a self-inflicted injury or act of war
• You are not under the regular care of a doctor when you request disability benefits
• Your disability occurs while you are committing a felony or participating in a riot
• Your disability occurs while you are imprisoned for committing a felony
• When you are first offered this coverage (and during approved open enrollment periods), you can take advantage of this important coverage with no health examination.
• Your disability occurs while you are residing outside of the United States or Canada for more than 12 consecutive months for a purpose other than work
Your benefits may be reduced if you are eligible to receive benefits from:
• A state disability plan or similar compulsory benefit act or law
• A retirement plan
• Social Security
• Any form of employment
• Workers’ Compensation
• Salary continuance
• Sick leave
A complete list of benefit exclusions and reductions is included in the policy. State restrictions may apply to this plan.
Here’s how little you pay with grouprates.
Your estimated monthly premium is determined by multiplying your monthly salary amount (up to $10,000) by your age-range premium rate. If your monthly salary exceeds $10,000, multiply $10,000 by your premiumrate.
Think about what your loved ones may face after you’re gone. Term life insurance can help them in so many ways, like covering everyday expenses, paying off debt, and protecting savings. AD&D provides even more coverage if you die or suffer a covered loss in an accident.
• A cash benefit of $30,000 to your loved ones in the event of your death, plus a matching cash benefit if you die in an accident
• A cash benefit to you if you suffer a covered loss in an accident, suchas losing a limb or your eyesight
• LifeKeys® services, which provide access to counseling, financial, and legalsupport
• TravelConnectSM services, which give you and your family access to emergency medical assistance when you're on a trip 100+ miles from home
You also have the option to increase your cash benefit by securing additional coverage at affordable group rates. See the enclosed life insurance information for details.
Conversion: You can convert your group term life coverage to an individual life insurance policy without providing evidence of insurability if you lose coverage due to leaving your job or for another reason outlined in the plan contract. AD&D benefits cannot be converted.
Benefit Reduction: Coverage amounts begin to reduce at age 65 and benefits terminate at retirement. See the plan certificate for details.
For complete benefit descriptions, limitations, and exclusions, refer to the certificate of coverage.
This is not intended as a complete description of the insurance coverage offered. Controlling provisions are provided in the policy, and this summary does not modify those provisions or the insurance in any way. This is not a binding contract. A certificate of coverage will be made available to you that describes the benefits in greater detail. Refer to your certificate for your maximum benefit amounts. Should there be a difference between this summary and the contract, the contract will govern.
LifeKeys® services are provided by ComPsych® Corporation, Chicago, IL. ComPsych®, EstateGuidance® and GuidanceResources® are registered trademarks of ComPsych® Corporation. TravelConnectSM services are provided by On Call International, Salem, NH. ComPsych® and On Call International are not Lincoln Financial Group® companies. Coverage is subject to actual contract language. Each independent company is solely responsible for its own obligations.
Insurance products (policy series GL1101) are issued by The Lincoln National Life Insurance Company (Fort Wayne, IN), which does not solicit business in New York, nor is it licensed to do so. Product availability and/or features may vary by state. Limitations and exclusions apply. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations. Limitations and exclusions apply.
Burnet CISD provides this valuable benefit at no cost to you.
The Lincoln Term Life Insurance Plan:
• Provides a cash benefit to your loved ones in the event of your death
• Features group rates for Burnet CISD employees
• Includes LifeKeys® services, which provide access to counseling, financial, and legal support services
• Also includes TravelConnect SM services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home
Employee
Newly hired employee guaranteed coverage amount $200,000
Continuing employee guaranteed coverage annual increase amount
Maximum coverage amount
Choice of $10,000 or $20,000
7 times your annual salary ($500,000 maximum in increments of $10,000)
Minimum coverage amount $10,000
Spouse / Domestic Partner
Newly hired employee guaranteed coverage amount $50,000
Continuing employee guaranteed coverage annual increase amount
Maximum coverage amount
Choice of $5,000 or $10,000
100% of the employee coverage amount ($500,000 maximum in increments of $5,000)
Minimum coverage amount $5,000
Dependent Children
6 months to age 26 guaranteed coverage amount $10,000
Age 1 day to 6 months guaranteed coverage amount $1,000
Employee Coverage
Guaranteed Life Insurance Coverage Amount
• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $200,000 without providing evidence of insurability.
• Annual Limited Enrollment: If you are a continuing employee, you can increase your coverage amount by $10,000 or $20,000 without providing evidence of insurability . If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability.
• If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.
• You can increase this amount by up to $20,000 during the next limited open enrollment period.
Maximum Life Insurance Coverage Amount
• You can choose a coverage amount up to 7 times your annual salary ($500,000 maximum) with evidence of insurability. See the Evidence of Insurability page for details.
• Your coverage amount will reduce by 35% when you reach age 65; an additional 15% of the original amount when you reach age 70; and an additional 25% of the original amount when you reach age 75
Spouse / Domestic Partner Coverage - You can secure term life insurance for your spouse / domestic partner if you select coverage for yourself.
Guaranteed Life Insurance Coverage Amount
• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to 100% of your coverage amount ($50,000 maximum) for your spouse / domestic partner without providing evidence of insurability.
• Annual Limited Enrollment: If you are a continuing employee, you can increase the coverage amount for your spouse / domestic partner by $5,000 or $10,000 without providing evidence of insurability. If you submitted evidence of insurability in the past and were declined for medical reasons, you may be required to submit evidence of insurability.
• If you decline this coverage now and wish to enroll later, evidence of insurability may be required and may be at your own expense.
• You can increase this amount by up to $10,000 during the next limited open enrollment period.
Maximum Life Insurance Coverage Amount
• You can choose a coverage amount up to 100% of your coverage amount ($500,000 maximum) for your spouse / domestic partner with evidence of insurability.
• Coverage amounts are reduced by 35% when an employee reaches age 65, an additional 15% when an employee reaches age 70, and an additional 25% when an employee reaches age 75.
Dependent Children Coverage - You can secure term life insurance for your dependent children when you choose coverage for yourself.
Guaranteed Life Insurance Coverage Options: $10,000
Accelerated Death Benefit Included
Premium Waiver Included
Conversion Included
Portability Included
Like any insurance, this term life insurance policy does have exclusions. A suicide exclusion may apply. A complete list of benefit exclusions is included in the policy. State variations apply.
The estimated monthly premium for life insurance is determined by multiplying the desired amount of coverage (in increments of $10,000) by the employee age-range premium rate.
$ X = $
coverage amount premium rate monthly premium
Note: Rates are subject to change and can vary over time.
The estimated monthly premium for life insurance is determined by multiplying the desired amount of coverage (in increments of $5,000) by the employee age-range premium rate.
$ X = $
coverage amount premium rate monthly premium
Note: Rates are subject to change and can vary over time.
One affordable monthly premium covers all of your eligible dependent children.
Note: You must be an active Burnet CISD employee to select coverage for a spouse / domestic partner and/or dependent children. To be eligible for coverage, a spouse / domestic partner or dependent child cannot be confined to a health care facility or unable to perform the typical activities of a healthy person of the same age and gender.
• Provides a cash benefit to your loved ones if you die in an accident
• Provides a cash benefit to you if you suffer a covered loss in an accident
• Features group rates for Burnet CISD employees
• Includes LifeKeys® services, which provide access to counseling, financial, and legal support
• Also includes TravelConnectSM services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home
This coverage provides a cash benefit to the beneficiary/beneficiaries you name if you die in an accident, or to you if you suffer a covered loss in an accident, such as losing a limb or your eyesight
Maximum coverage amount
Up to 10 times your annual salary ($500,000 maximum) in $10,000 increments
Minimum coverage amount $10,000
Your employee AD&D coverage amount will reduce by 35% when you reach age 65, an additional 15% of the original amount when you reach age 70, and an additional 25% of the original amount when you reach age 75 Benefits end when you retire
As an alternative, you can secure AD&D insurance for yourself, your spouse / domestic partner, and dependent children by selecting family coverage. The amount of AD&D insurance for family members is equal to a percentage of your AD&D coverage amount. The payout percentage is based on family structure who makes up your immediate family when a loss occurs.
Spouse / Domestic Partner coverage percentage
Child(ren) coverage percentage
50% of the employee coverage amount when the family is made up of only the spouse / domestic partner and the employee.
10% of the employee coverage amount when the family is made up of only dependent children and the employee.
Spouse / Domestic Partner & Child(ren) coverage percentage
Spouse: 50% of the employee coverage amount when the family is made up of dependent children, the spouse / domestic partner, and the employee
Child(ren): 10% of the employee coverage amount when the family is made up of dependent children, the spouse / domestic partner, and the employee.
The spouse / domestic partner AD&D coverage amount will reduce by 35% when you reach age 65, an additional 15% of the original amount when you reach age 70, and an additional 25% of the original amount when you reach age 75. Benefits end when you retire.
Note:
Like any insurance, this AD&D insurance policy does have exclusions. Benefits will not be paid if death results from suicide, or death/dismemberment occurs while:
• Intentionally inflicting or attempting to inflict injury to one’s self
• Participating in a war, act of war, or riot
• Serving on full-time active duty in the armed forces of any state or country (this does not include duty of 30 days or less training in the Reserves or National Guard)
• Flying on any non-commercial airplane or aircraft, such as a hot air balloon or glider (see the contract for details and exceptions)
• Flying on a commercial airline or aircraft as a pilot or crewmember
• Committing or attempting to commit a felony
• Deliberately inhaling gas (such as carbon monoxide) or using drugs other than those taken as prescribed by a licensed physician
• Driving while intoxicated, impaired, or under the influence of drugs
In addition, this AD&D insurance policy does not cover sickness or disease, including the medical and surgical treatment of a disease.
A complete list of benefit exclusions is included in the policy. State variations apply.
The estimated monthly premium for AD&D insurance is determined by multiplying the desired amount of coverage (in increments of $10,000) by the premium rate. See table at right for select coverage amounts.
$ X 0.0000250 = $
coverage amount premium rate monthly premium
Note: Rates are subject to change and can vary over time.
The estimated monthly premium for AD&D insurance is determined by multiplying the desired amount of employee coverage (in increments of $10,000) by the family premium rate. See table at right for select premium amounts.
$ X 0.0000400 = $
coverage amount premium rate monthly premium
Note: Rates are subject to change and can vary over time.
Protection Plan with Terminal Illness
Term Life Insurance to age 100
Nearly 85% of people said they thought most people need life insurance.
Yet only 59% said that they have coverage themselves.
And 33% wish their spouse or partner had more life insurance.*
With several options to choose from, select the coverage that best meets the needs of your family.
Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL).
Coverage continues with no loss of benefits or increase in cost if you terminate employment after the first premium is paid. We simply bill you directly.
You can get coverage for your spouse and financially dependent children 14 days through 23 years old, even if you don’t elect coverage on yourself. No matter what the future brings, you and your family are protected.
Easy payment through payroll deduction.
Benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following:
• Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or
• Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision.
Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two-year contestability period and/or under investigation. This coverage has no war or terrorism exclusions.
Quality of Life not available ages 66-70. Quality of Life benefits not available for children. Child life coverage availabe only on children and grandchildren of employee (age on application date 14 days through 23 years). $4.98 monthly for $10,000 coverage and $9.97 monthly for $20,000 of coverage per child.
Benefits that may help cover costs such as those not covered by your medical plan.
With MetLife, you’ll have a choice of Single plan (called the “High Plan”) that provide payments in addition to any other insurance payments you may receive1. Here are just some of the covered events/services2
ADF# AI2166.19
• Accidental Death Benefits Category: The benefit amount will be reduced by the amount of any Accidental Dismemberment/Functional Loss/Paralysis Benefits and Modification Benefit paid for Injuries sustained by the Covered Person in the same Accident for which the Accidental Death Benefit is being paid.
• Accidental Death Common Carrier Benefit: “Common Carrier”: refers to airplanes, trains, buses, trolleys, subways and boats. Certain conditions apply. See your Disclosure Statement or Outline of Coverage/Disclosure Document for specific details.
• Lodging Benefit: The lodging benefit is not available in all states. It provides a benefit for a companion accompanying a covered insured while hospitalized, provided that lodging is at least 50 miles from the insured’s primary residence
Kathy’s daughter, Molly, was riding her bike to school On her way there she fell to the ground, was knocked unconscious, and was taken to the local emergency room (ER) by ambulance for treatment. The ER doctor diagnosed a concussion and a broken tooth. He ordered a CT scan to check for facial fractures too, since Molly’s face was very swollen. Molly was released to her primary care physician for follow-up treatment, and her dentist repaired her broken tooth with a crown. Depending on her health insurance, Kathy’s out-of-pocket costs could run into hundreds of dollars to cover expenses like insurance co-payments and deductibles. MetLife Group Accident Insurance payments can be used to help cover these unexpected costs.
Benefit amount is based on a sample MetLife plan design. Actual plan design and benefits may vary.
Q. Who is eligible to enroll for this accident coverage?
A. You are eligible to enroll yourself and your eligible family members!4 You need to enroll during your Enrollment Period and to be actively at work for your coverage to be effective.
Q. How do I pay for my accident coverage?
A. Premiums will be paid through payroll deduction, so you don’t have to worry about writing a check or missing a payment.
Q. What happens if my employment status changes? Can I take my coverage with me?
A. Yes, you can take your coverage with you.5 You will need to continue to pay your premiums to keep your coverage in force. Your coverage will only end if you stop paying your premium or if your employer offers you similar coverage with a different insurance carrier
Q. Who do I call for assistance?
A. Contact a MetLife Customer Service Representative at Monday through Friday from 8:00 a.m. to 8:00 p.m., EST
Coverage to help with unexpected expenses, such as hospitalization expenses that may not be covered under your medical plan.
With MetLife, you’ll have a choice of two comprehensive plans (called the “Low Plan” and the “High Plan”) which provide lump sum cash payments for covered events regardless of any other payments you may receive from your medical plan. Here are just some of the covered benefits/servicesB when an accident or illness puts you in the hospital. A
Please contact MetLife for detailed definitions and state variations of covered benefits.
In most states there is an Elimination Period for Routine Childbirth where benefits are not payable for the first ten months of coverage
1. If the Admission Benefit is payable for a Confinement, the Confinement Benefit will begin to be payable the day after Admission.
The example below assumes Susan sought treatment at a group policyholder-designated facility and is therefore eligible for additional payment under the Benefit Supplement Rider. Susan has chest pains at home, and after contacting her doctor, she is instructed to head to her local hospital. Upon arrival, the doctor examines Susan and advises that she requires immediate admission to the Intensive Care Unit for further evaluation and treatment. After two days in the Intensive Care Unit, Susan moves to a standard room and spends two additional days recovering in the hospital. Susan was released to her primary care physician for follow-up treatment and observation Her primary doctor is now keeping a close watch over Susan’s overall health. Depending on her health insurance, Susan’s out-of-pocket costs could run into hundreds of dollars to cover expenses like insurance co-payments and deductibles. MetLife Group Hospital Indemnity Insurance payments can help cover these unexpected costs or in any other way Susan sees fit.
Benefit amount is based on a sample MetLife plan design. Plan design and plan benefits may vary
Q. How do I enroll?
A. Enroll for coverage at mybenefits.metlife.com
Q. Who is eligible to enroll for this Hospital Indemnity coverage?
A. You are eligible to enroll yourself and your eligible family members. C You need to enroll during your Enrollment Period and be actively at work for your coverage to be effective. Dependents to be enrolled may not be subject to a medical restriction as set forth in the Certificate. Some states require the insured to have medical coverage
Q. How do I pay for my Hospital Indemnity coverage?
A. Premiums will be paid through payroll deduction, so you don’t have to worry about writing a check or missing a payment.
Q. What happens if my employment status changes? Can I take my coverage with me?
A. Yes, you can take your coverage with you. You will need to continue to pay your premiums to keep your coverage in force. Your coverage will only end if you stop paying your premium or if your employer cancels the group policy and offers you similar coverage with a different insurance carrier. D
Q. What is the coverage effective date?
A. The coverage effective date is 01/01/2023.
Q. Who do I call for assistance?
A. Please call MetLife directly at 1-800-GET-MET8 (1-800-438-6388) and talk with a benefits consultant. Or visit our website: www.mybenefits.metlife.com
A Hospital does not include certain facilities such as nursing homes, convalescent care or extended care facilities. See your Disclosure Statement or Outline of Coverage/Disclosure Document for full details.
B Covered services/treatments must be the result of an accident or sickness as defined in the group policy/certificate. There is a pre-existing exclusion for covered sicknesses. See your Disclosure Statement or Outline of Coverage/Disclosure Document for more details
C Coverage is guaranteed provided
(1) the employee is actively at work and
(2) dependents to be covered are not subject to medical restrictions as set forth on the enrollment form and in the Certificate. Some states require the insured to have medical coverage Additional restrictions may apply to dependents serving in the armed forces or living overseas.”
D Eligibility for portability through the Continuation of Insurance with Premium Payment provision may be subject to certain eligibility requirements and limitations. For more information, contact your MetLife representative
METLIFE'S HOSPITAL INDEMNITY INSURANCE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. The policy is not intended to be a substitute for medical coverage and certain states may require the insured to have medical coverage to enroll for the coverage The policy or its provisions may vary or be unavailable in some states. Prior hospital confinement may be required to receive certain benefits. There may be a preexisting condition limitation for hospital sickness benefits. MetLife’s Hospital Indemnity Insurance may be subject to benefit reductions that begin at age 65. Like most group accident and health insurance policies, policies offered by MetLife may contain certain exclusions, limitations and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX, GPNP13-HI, GPNP16-HI or GPNP12-AX-PASG, or contact MetLife. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. In certain states, availability of MetLife’s Group Hospital Indemnity Insurance is pending regulatory approval.
No matter what, MASA MTS has you covered!
What is Covered?
Only MASA MTS for Employees can provide you with complete protection.
Americans today suffer from a false sense of security that their medical coverage will pay for all costs associated with emergency or critical care transport. The reality is that a majority of Americans are only partially covered for these high costs.
Most healthcare policies will only pay based off of the “Usual and Customary Charges” leaving you with the remainder of the bill.
You face the possibility that your medical coverage will deny the claim leaving you responsible for the ENTIRE bill
We provide medical emergency transportation solutions AND cover your out of pocket medical transport cost when your insurance falls short.
“All I had to do was send the bill which was never paid by TriCare for Life --- and the rest is history. When MASA received that bill, it was paid and all amounts owed satisfied.” --- MASA Member, 2015
• NO health questions
• NO age limits
• NO claim forms
• NO deductibles
• NO provider network limitations
• NO dollar limits on emergency transport costs
OVER 15 MILLION IDENTITIES WERE STOLEN IN 2013.
You may already be a victim of identity theft without knowing it. Now what?
Victims may discover the problem when they are denied credit or employment, are contacted by police, or receive unknown bills.
» Identity theft victims su er an average loss of over $6,000 and spend 30 0 hours repairing the damage on their own.
» e value is in the identity, not the bank account.
Armed with your personal information, thieves can:
» Drain your savings and retirement accounts.
» Open credit cards or loans in your name.
» Commit tax fraud in your name.
» Use your name when arrested for a crime.
Millions of identities face a greater risk for ID theft because they have been stolen from major outlets including:
» e Home Depot ® 56+ million
» Target ® 40 million
» Medical Centers/Hospitals 6.8 million
» Google Gmail™ Accounts 5 million
» JP Morgan Chase Bank 76 million
We monitor identities in real time to identify potential fraud instantly —as it is occurring—even failed attempts. New accounts can be detected at the instant of application. We also monitor and alert on high-risk transactions like password resets, fund transfers, and more!
Sophisticated algorithms spider the Internet black market, phishing sites, command and control networks, compromised machines, forums, and chat rooms to determine if personal data has been compromised.
ID Watchdog is the ONLY ID eft Protection vendor to o er Physician NPI Monitoring. is emerging threat involves “ghost practices” submitting high-dollar Medicare and Medicaid claims in a physician’s name, costing thousands to resolve.
ID Watchdog works directly with alternative credit bureaus that service the underbanked to expand the monitoring of payday loans.
Working with our alternative credit bureau partners, ID Watchdog is the first and only ID eft Protection provider to expand its fraud detection network to include monitoring of auto pawn, buy-here-pay-here auto, rent-to-own transactions, sub-prime utility and cell phone accounts, and sub-prime collections.
We monitor the National Change of Address Registry and public records databases with more than 11.6 billion consumer records in an attempt to identify identity theft.
Utilizing our deferred authentication technology ID Watchdog is the only vendor to activate ALL of your monitoring on day 1 without any additional action, ensuring you are protected the day your benefi ts start.
A secure digital vault to store wallet contents, and, in the event a wallet is lost or stolen, assistance with cancelling and replacing its content.
Assistance with setting credit bureau fraud alerts, and reminders when the fraud alerts expire— securing your credit file to help prevent ID theft.
A dedicated Certified Identity eft Risk Management (CITRMS) professional will work with you to assess your identity theft situation and move forward with a fully managed resolution.
$1M in expense reimbursement insurance, providing protection from the financial damages of identity theft including lost wages, travel expenses, fraudulent fund transfers and legal defense.
ID Watchdog enables you to opt in or out of the National Do Not Call Registry, Pre-Approved Credit O ers, and Junk Mail or Email.
ID Watchdog creates this report to surface any pre-existing conditions going back 30 years or more.
100% Resolution Guarantee:
ID Watchdog will not stop working on an employee’s case until their identity is completely restored to its pre-theft level. ID Watchdog has never failed to restore an identity.
ID Watchdog o ers di erent levels of identity theft protection to fit your needs. We o er the best value and guarantee 100% resolution services should you become a victim.
•American Fund/Capital Guardian
•Athene Annuity and Life (Aviva)
•Equitable (formerly AXA)
•Fidelity Management Trust
•GWN/Employee Deposit Acct
•Horace Mann Life Ins. Co.
•Industrial Alliance - (Sec.Ben.)
•Invesco OppenheimerFunds
•National Life Group (LSW)
•PFS Investments
•ROTH - Fidelity Management Trust
•ROTH - Primerica Financial Services
