Login Process
Kempisd
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!
2024-2025 Enrollment Information
The 2024-2025 Section 125 Cafeteria Plan year begins 9/01/2024 and ends 8/31/2025. All benefits elected during the annual open enrollment will be effective 09/01/2024
Know Your Benefits! Below is the summary of benefits offered by KISD!
Medical Transport - 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 2/3% of your gross KISD 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 KISD.
Colonial Cancer – Benefits become payable to the employee once certain procedures have been conducted and/or diagnosis has been made.
Wellfleet Accident – Pays benefits for off the job accidents and related treatments. **$200 Wellness Benefit
Lincoln Group & Voluntary Life – Group Life Insurance that ends when employment is terminated from KISD. Coverage is also available for spouse and children.
UNUM Critical Illness – Guaranteed issue and pays a lump sum benefit if the insured is diagnosed with a covered critical illness. ** Wellness Benefit - $50
Delta Dental (NEW)– Coverage for preventive, basic, major, and orthodontia services. High and a Low plan available.
Superior Vision – Plan 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.
Health Savings Account - Participants in the TRS-ActiveCare HD health plan are eligible to contribute to a health savings account. A health savings account (HSA) provides tax benefits when used to pay for eligible out-of-pocket medical, dental, and vision expenses.
NBS Flexible Spending – Make sure to spend/claim the money in your current reimbursement account by August 31, 2024. Visit www.nbsbenefits.com to check account balances or request information.
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.
No matter how comprehensive your local in-network coverage may be, you still have
and
picked up by an
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
of
• 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
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.
Progressive Diseases
Amyotrophic Lateral Sclerosis (ALS)
Dementia (including Alzheimer’s Disease)
Functional Loss
Multiple Sclerosis (MS)
Parkinson’s Disease
Additional Critical Illnesses for your Children
Cerebral Palsy
Cleft Lip or Palate
Cystic Fibrosis
Down Syndrome
Spina Bifida
*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
Coma
Coronary Artery Disease (Major)
Coronary Artery Disease (Minor)
Heart Attack (Myocardial Infarction)
Invasive Cancer (includes all Breast Cancer)
Major Organ Failure Requiring Transplant
Non-Invasive Cancer
End Stage Renal (Kidney) Failure Stroke
Are wellness screenings covered?
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: $10,000
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.
How much does the coverage cost?
Option 3
including the anniversary/effective date.
Your rate is based on your insurance age, which is your age immediately prior to and 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.
Do my critical illness insurance benefits decrease with age?
Are there any exclusions or limitations?
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.
The limited benefits provided are a supplement to major medical coverage and are not a substitute for major medical coverage or other minimal essential coverage as required by federal law. Lack of minimal essential coverage may result in an additional tax payment being due.
This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form GCIP16-1 et al or contact your Unum representative.
© 2018 Unum Group. All rights reserved. Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries.
Underwritten by Unum Insurance Company, Portland, Maine AE-1226 FOR EMPLOYEES
Learn more about your annual Be Well Benefit
Your Unum plan pays a Be Well Benefit for one Be Well screening each year. With Unum’s Be Well Benefit, you and other covered family members can receive a valuable incentive for important tests and screenings. Many of these tests are routinely performed, so it’s easy to take advantage of this benefit.
Your Critical Illness Be Well benefit is $50.
Be Well screenings
• Annual exams by a physician including sports physicals and well-child visits
• Cancer screenings including pap smear, colonoscopy
• Cardiovascular function screenings
• Cholesterol and diabetes screenings
• Imaging studies, including chest X-ray, mammography
• Immunizations including HPV, MMR, tetanus, influenza
Each year, you can earn a valuable incentive just for taking care of your health. And so can each of your covered family members.
It’s easy to file a claim.
You can receive a benefit for tests that are performed after your initial coverage date. Follow these simple steps:
File your claim by mail or over the phone.
Simply call 1-800-635-5597 to learn more.
You will need to provide the following:
•First and last names of the employee and claimant (the employee might not be the claimant)
•Employee’s Social Security number or policy number
• Name and date of the test
•Name of physician and the facility where the test was performed.
For more information, please contact your HR representative.
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 Creut zfeldt-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 benef it 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 direc tly to you, unless you specify other wise.
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
Kemp Independent School District
Standard Insurance Company has developed this document to provide you with information about the optional insurance coverage you may select through the Kemp 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 the Kemp 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 $300 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
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 1-4: Maximum Benefit Period of 3 years for Sickness
If you become disabled before age 64, LTD benefits may continue during disability for 3 years. If you become disabled at age 64 or older, the benefit duration is determined by your age when disability begins:
Age Maximum Benefit Period
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 1-4: Maximum Benefit Period of To SSNRA for Accident
If you become disabled before age 62, LTD benefits may continue during disability until you reach age 65 or to the Social Security Normal Retirement Age (SSNRA) or 3 years 6 months, whichever is longest. 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 To SSNRA, or 3 years 6 months, whichever is longer
63 To SSNRA, or 3 years, whichever is longer
64 To SSNRA, or 2 years 6 months, whichever is longer
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 Limitation
A detailed description of the preexisting condition limitation is included in the Group Policy. If you have questions, please check with your human resources representative.
Preexisting Condition Period: The 180-day period just before your insurance becomes effective.
Exclusion Period: 12 months
Preexisting Condition Waiver
The Standard may pay benefits for up to 90 days 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 $300 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 $300 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.
Accident 7/ Sickness 7
Accident
14/ Sickness 14
Accident 30 / Sickness 30
Accident 90 / sickness 90
Keep smiling
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
and
hearing health services.
Benefit Highlights: DPO from Delta Dental
Plan Benefit Highlights for: Group Number:
Effective Date: 9/1/2024
Benefit Highlights: DPO from Delta Dental
per member / per family each calendar year Deductibles waived for Diagnostic & Preventive? Yes, for all Dentists Plan Benefit Highlights for: Group Number:
member each calendar year
& Preventive Services (D&P)
Exams, Cleanings, X-Rays, Sealants and Space Maintainers
Fillings, Simple Extractions, Posterior Composites and Denture Repair/Reline/Rebase
Crowns, Inlays, Onlays and Cast Restorations Prosthodontics
Effective Date: 9/1/2024
Vision Plan Benefits for Kemp ISD
Benefits through Superior Select Southwest Network
$55 retail Lenses (standard) per pair
in full
to $40 retail
to $45 retail
Lenses2
$65 retail Medically Necessary Contact Lenses Covered in full
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.
Kemp Independent School District provides this valuable benefit at no cost to you.
Full-Time Employees
Safeguard the most important people in your life.
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.
AT A GLANCE:
• A cash benefit of $15,000 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, such as losing a limb or your eyesight
• LifeKeys® services, which provide access to counseling, financial, and legal support
• TravelConnect® services, which give you and your family access to emergency medical assistance when you're on a trip 100+ miles from home
ADDITIONAL 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 70 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. TravelConnect® 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.
Voluntary
Term Life and AD&D Insurance
The Lincoln Term Life and AD&D Insurance Plan:
• Provides a cash benefit to your loved ones in the event of your death
• Provides an additional cash benefit to your loved ones if you die — or to you if you lose a limb or your eyesight — in a covered accident
• Features group rates for Kemp Independent School District employees
• Includes LifeKeys® services, which provide access to counseling, financial, and legal support services
• Also includes TravelConnect® services, which give you and your family access to emergency medical assistance when you’re on a trip 100+ miles from home
Full-Time Employees of Kemp Independent School District
Benefits At-A-Glance
Employee
Newly hired employee guaranteed coverage amount
Continuing employee guaranteed coverage annual increase amount
Maximum coverage amount
Minimum coverage amount
AD&D coverage amount
Spouse / Domestic Partner
Newly hired employee guaranteed coverage amount
Continuing employee guaranteed coverage annual increase amount
Maximum coverage amount
Minimum coverage amount
AD&D coverage amount
Dependent Children
6 months to age 26 guaranteed coverage amount
Age 14 days to 6 months guaranteed coverage amount
$150,000
Choice of $10,000 or $20,000
5 times your annual salary ($500,000 maximum in increments of $10,000)
$10,000
Equal to the life insurance amount chosen
$30,000
Choice of $5,000 or $10,000
50% of the employee coverage amount ($250,000 maximum in increments of $5,000)
$5,000
Equal to the life insurance amount chosen
$10,000
$250
What your benefits cover
Employee Coverage
Guaranteed Life and AD&D Insurance Coverage Amount
• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to $150,000 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 5 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 50% when you reach age 70
Spouse / Domestic Partner Coverage - You can secure term life and AD&D insurance for your spouse / domestic partner if you select coverage for yourself.
Guaranteed Life and AD&D Insurance Coverage Amount
• Initial Open Enrollment: When you are first offered this coverage, you can choose a coverage amount up to 50% of your coverage amount ($30,000 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 50% of your coverage amount ($250,000 maximum) for your spouse / domestic partner with evidence of insurability.
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
Additional Plan Benefits
Accelerated Death Benefit
Premium Waiver
Conversion
Portability
Seat Belt & Airbag
Common Carrier
Benefit Exclusions
Like any insurance, this term life and AD&D insurance policy does have exclusions.
For life insurance, a suicide exclusion may apply.
Included
Included
Included
Included
Included with AD&D
Included with AD&D
For AD&D, benefits will not be paid if death results from suicide, or death/dismemberment occurs while:
• Inflicting or attempting to inflict injury to one’s self
• Participating in a riot or as a result of war or act of war
• Serving as a member of the military, including the Reserves and National Guard
• Committing or attempting to commit a felony
• Deliberately inhaling gas (such as carbon monoxide) or using drugs other than those prescribed by a physician and administered as prescribed
• Flying in a non-commercial airplane or aircraft, such as a balloon or glider
• Driving while intoxicated (with a blood alcohol level of .08 grams or more per 100 milliliters of blood)
In addition, the 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.
Monthly Voluntary Life and AD&D Insurance Premium
Here’s how little you pay with group rates.
Group Rates for You
The estimated monthly premium for life and AD&D insurance is determined by multiplying the desired amount of coverage (in increments of $10,000) by the employee age-range premium factor.
Note: Rates are subject to change and can vary over time.
55
60
Group Rates for Your Spouse / Domestic Partner
The estimated monthly premium for life and AD&D insurance is determined by multiplying the desired amount of coverage (in increments of $5,000) by the employee age-range premium factor.
Note: Rates are subject to change and can vary over time.
Spouse / Domestic Partner | Monthly Premiums
Group Rates for Your Dependent Children
One affordable monthly premium covers all of your eligible dependent children.
Note: You must be an active Kemp Independent School District 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.
Life Insurance Highlights
For the employee
Flexible Premium Life Insurance to Age 121 Policy Form PRFNG-NI-10
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-plusispermanentlifeinsurancetoAttainedAge121 thatcanneverbecancelledaslongasyoupaythenecessarypremiums.Afterthe GuaranteedPeriod,thepremiumscanbelower,thesame,orhigherthantheTablePremium.Seethebrochureunder”PermanentCoverage”.
Health Savings Accounts
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.
How an HSA works:
• 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
What’s covered?
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.
Am I eligible for an HSA?
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.
2
3
How much can I contribute?
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
$8,300 $4,150 $7,750 $3,850 2024 2023
Catch-up contributions
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).
Triple tax savings
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
Visit www.hsabank.com orcallthe numberonthebackofyourdebit cardformoreinformation.
2
Earnings from interest and investments are tax-free.
3 Distributions are tax free when used for qualified medical expenses.
FLEXIBLE BENEFITS PLAN
Congratulations! Kemp 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……… $3,200.00 …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
HealthFSA andDCAP…… March 31 following plan year end
Mid-Year Terminations
FSA 30 days following termination date
DCAP…………………....……….30 days following plan year end
Orthodontic Reimbursement……….as paidper service contract or in full at time of banding Upfront payment……………….…………..… …allowed
AM I ELIGIBLE TO PARTICIPATE
Premium Only Account 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.
Health 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. Please note: If you contribute to this benefit, you cannot elect a Health Savings Account (HSA) Benefit.
NBS Welfare Benefit Service Center
(801) 532-4000 or 800-274-0503
Fax: 800-478-1528
service@nbsbenefits.com
Contact Person: Cathy Gunn 905 S Main Street Kemp, TX 75142 (903)498-1314 cathy.gunn@kempisd.org
Health Savings Account:
Flexible Benefits Plan Highlights
A Health Savings Account is a portable benefit which allows participants insured by a Qualified High Deductible Insurance Plan to save for deductibles and other expenses not covered under the Plan. If you participate in this benefit you cannot participate in the Health Flexible Spending Account benefit
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 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,
NBS Welfare Benefit Service Center
(801) 532-4000 or 800-274-0503
Fax: 800-478-1528
service@nbsbenefits.com
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: 6/7/2024
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
