Provid great bene t choices to you and your family is justcial welfare of the people who make our district work so well.
HOW DO I ENROLL?
Visit
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!
WHO IS ELIGIBLE?
insurance at full cost. •
WHO IS AN ELIGIBLE DEPENDENT?
Dependent children of any age who are disabled Children under your legal guardianship •
NEW HIRE ENROLLMENT
of the following month.
MID-YEAR CHANGES
or cancel coverage during the year if you have a qualifying change in the family or employment status that causes you to include:
Loss or gain of eligibility for other insurance (including
WHEN WILL I RECEIVE ID CARDS?
Everyone enrolled in Medical will receive a new Medical Card. ti rary ID card or give your provider the insurance company’s phonenumber to call and verify your coverage if you do not havean ID card at the time of service.
WHO DO I CONTACT WITH QUESTIONS?
830 606 5100
Login Process
LaGrangeISD
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!
La Grange ISD 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 $10,000 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
• Accident Plus - If you suffer an AD&D loss in an accident, you may also receive benefits for the following on top of your core AD&D benefits: coma, plegia, education, childcare, spouse training, and more.
• LifeKeys® services, which provide access to counseling, financial, and legalsupport
• TravelConnect® 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.
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 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. 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.
TRS contracts with HMOs in certain regions to bring participants in those areas additional options. HMOs set their own rates and premiums. They’re fully insured products who pay their own claims.
Blue Essentials - South Texas HMOSM Brought to you by TRS-ActiveCare
You can choose this plan if you live in one of these counties: Cameron, Hildalgo, Starr, Willacy
Blue Essentials - West Texas HMOSM Brought to you by TRS-ActiveCare
You can choose this plan if you live in one of these counties: Andrews, Armstrong, Bailey, Borden, Brewster, Briscoe, Callahan, Carson, Castro, Childress, Cochran, Coke, Coleman, Collingsworth, Comanche, Concho, Cottle, Crane, Crockett, Crosby, Dallam, Dawson, Deaf Smith, Dickens, Donley, Eastland, Ector, Fisher, Floyd, Gaines, Garza, Glasscock, Gray, Hale, Hall, Hansford, Hartley, Haskell, Hemphill, Hockley, Howard, Hutchinson, Irion, Jones, Kent, Kimble, King, Knox, Lamb, Lipscomb, Llano, Loving, Lubbock, Lynn, Martin, Mason, McCulloch, Menard, Midland, Mitchell, Moore, Motley, Nolan, Ochiltree, Oldham, Parmer, Pecos, Potter, Randall, Reagan, Reeves, Roberts, Runnels, San Saba, Schleicher, Scurry, Shackelford, Sherman, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terry, Throckmorton, Tom Green, Upton, Ward, Wheeler, Winkler, Yoakum
Health Savings Account – Fact Sheet
An EECU Health Savings Account (HSA) enables you to save and conveniently pay for qualified medical expenses while you earn tax-free interest and pay no monthly service fees.
Opening an HSA provides both immediate and long-term benefits. The money in your HSA is yours even if you change jobs, switch your health plan, or retire. Your unused HSA balance rolls over from year to year. And, best of all, HSAs allow for tax-free deposits, tax-free earnings and tax-free withdrawals (for qualified medical expenses).1 Also, after age 65, you can withdraw funds from your HSA penalty-free.1
Benefits
• Save money tax-free for healthcare expenses – contributions are not subject to federal income taxes and can be made by you, your employer or a third party1
• No monthly service fee – so you can save more
• Earn interest on your balance, paid monthly
• Free EECU HSA Debit Mastercard® to conveniently pay for your qualified healthcare expenses. (HSA checks are also available upon request.2)
• Free Online & Mobile Banking and Free Bill Pay & Mobile Deposit to manage your account from anywhere, at anytime
• Comprehensive service and support – to assist you in optimizing your healthcare saving and spending
• Federally insured by NCUA – to at least $250,000
Dividend Rates
$10,000 or more
Membership in EECU is required - membership information available at www.eecu.org
1 Contributions, investment earnings, and distributions are tax free for federal tax purposes if used to pay for qualified medical expenses, and may or may not be subject to state taxation. A list of Eligible Medical Expenses can be found in IRS Publication 502, http://www.irs.gov/pub/irs-pdf/p502.pdf As described in IRS publication 969, http://www.irs.gov/pub/irs-pdf/p969.pdf, certain over-the-counter medications (when prescribed by a doctor) are considered eligible medical expenses for HSA purposes. If an individual is 65 or older, there is no penalty to withdraw HSA funds. However, income taxes will apply if the distribution is not used for qualified medical expenses. For more information consult a tax adviser or your state department of revenue. All contributions and distributions are your responsibility and must be within IRS regulatory limits.
2 Call (817) 882-0800 or stop-by an EECU financial center to order standard checks at no charge (excludes shipping and handling) or order custom checks - prices vary.
3 Minimum opening deposit and balance of $.01 required. You will receive a Health Savings Account Agreement and Disclosures at enrollment. Please refer to those documents for complete terms and conditions. A free, no annual fee EECU HSA Debit Mastercard® will be sent to you separately. And, an EECU Health Savings Account Specialist is available to assist you with any questions you may have about your EECU HSA.
4 APY (Annual Percentage Yield) is accurate as of March 2, 2021 and is subject to change at any time. Average daily balance is required to earn the disclosed Annual Percentage Yield. Fees could reduce the earnings on the account. Dividend and interest is compounded daily and credited monthly. See Truth-In-Savings for Health Savings Account for more details.
Distributed by: Operating subsidiaries of Cigna Corporation. Insurance benefits are underwritten by Cigna Health and Life Insurance Company.
HOSPITAL CARE COVERAGE
SUMMARY OF BENEFITS
Prepared for: La Grange Independent School District
Hospital Care coverage provides a benefit according to the schedule below when a Covered Person incurs a Hospital stay resulting from a Covered Injury or Covered Illness See State Variations (marked by *) below.
Who Can Elect Coverage:
Eligibility for You, Your Spouse and Your Children will be considered by Your employer.
You: All active, Full-time Employees of the Employer who are regularly working in the United States a minimum of 20 hours per week and regularly residing in the United States and who are United States citizens or permanent resident aliens and their Spouse, Domestic Partner, or Civil Union Partner and Dependent Children who are United States citizens or permanent resident aliens and who are residing in the United States. You will be eligible for coverage the first of the month after 30 days from date of hire or Active Service.
Your Spouse:* Up to age 100, as long as you apply for and are approved for coverage yourself.
Your Child(ren): Birth to age 26; 26+ if disabled, as long as you apply for and are approved for coverage yourself.
Available Coverage:
The benefit amounts shown in this summary will be paid regardless of the actual expenses incurred and are paid on a per day basis unless otherwise specified. Benefits are only payable when all policy terms and conditions are met. Please read all the information in this summary to understand the terms, conditions, state variations, exclusions and limitations applicable to these benefits. See your Certificate of Insurance for more information.
Benefit Waiting Period:* None, unless otherwise stated. No benefits will be paid for a loss which occurs during the Benefit Waiting Period.
NOTE: This insurance is NOT a substitute for comprehensive or major medical insurance coverage.
Portability Feature:* You, your spouse, and child(ren) can continue 100% of your coverage at the time your coverage ends. You must be covered under the policy and be under the age of 100 in order to continue your coverage. Rates may change and all coverage ends at age 100. Applies to United States Citizens and Permanent Resident Aliens residing in the United States.
Employee’s Monthly Cost of Coverage:
Costs are subject to change. Actual per pay period premiums may differ slightly due to rounding.
NOTE: The following are some of the important policy provisions, terms and conditions that apply to benefits described in the policy. This is not a complete list. See your Certificate of Insurance for more information.
Benefit Amounts Payable: Benefits for all Covered Persons are payable at 100% of the Benefit Amounts shown, unless otherwise stated. Late applicants, if allowed under this plan, may be required to provide medical evidence of insurability.
Hospital Admission: Must be admitted as an Inpatient due to a Covered Injury or Covered Illness. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re-admission for the same Covered Injury or Covered Illness (including chronic conditions).
Hospital Chronic Condition Admission: Must be admitted as an Inpatient due to a covered chronic condition and treatment for a covered chronic condition must be provided by a specialist in that field of medicine. Excludes: treatment in an emergency room, provided on an outpatient basis, or for re-admission for the same Covered Injury or Covered Illness (including chronic conditions).
Hospital Stay: Must be admitted as an Inpatient and confined to the Hospital, due to a Covered Injury or Covered Illness, at the direction and under the care of a physician. If also eligible for the ICU Stay Benefit, only 1 benefit will be paid for the same Covered Injury or Covered Illness, whichever is greater. Hospital stays within 90 days for the same or a related Covered Injury or Covered Illness is considered one Hospital Stay.
Intensive Care Unit (ICU) Stay: Must be admitted as an Inpatient and confined in an ICU of a Hospital, due to a Covered Injury or Covered Illness, at the direction and under the care of a physician. If also eligible for the Hospital Stay Benefit, only 1 benefit will be paid for the same Covered Injury or Covered Illness, whichever is greater. ICU stays within 90 days for the same or a related Covered Injury or Covered Illness is considered one ICU stay.
Hospital Observation Stay: Must be receiving treatment for a Covered Injury or Covered Illness in a Hospital, including an observation room, or ambulatory surgical center, for more than 24 hours on a non-inpatient basis and a charge must be incurred. This benefit is not payable if a benefit is payable under the Hospital Stay Benefit or Hospital Intensive Care Unit Stay Benefit.
Newborn Nursery Care Admission and Newborn Nursery Care Stay: Must be admitted as an Inpatient and confined in a Hospital immediately following birth at the direction and under the care of a physician.
Common Exclusions and Limitations:
Exclusions:* In addition to any benefit-specific exclusion, benefits will not be paid for any Covered Injury or Covered Illness which is caused by or results from any of the following (unless otherwise provided for in the policy): • Intentionally self-inflicted injury, suicide or any attempted threat while sane or insane; • Commission or attempt to commit a felony or an assault; • Declared or undeclared war or act of war;• A Covered Injury or Covered Illness that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon our receipt of proof of service, we will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days;• Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage (excludes WA residents);• Operating any type of vehicle while under the influence of alcohol or any drug, narcotic or other intoxicant including any prescribed drug for which the Covered Person has been provided a written warning against operating a vehicle while taking it. “Under the influence of alcohol”, for purposes of this exclusion, means intoxicated, as defined by the law of the state in which the Covered Injury or Covered Illness occurred. (excludes WA residents);• Elective or cosmetic surgery. This does not include reconstructive, cosmetic surgery: a) incidental to or following surgery for trauma, infection or other disease of the involved part; or b) due to congenital disease or anomaly of a Covered Dependent child which has resulted in a functional defect;• Dental surgery, unless the surgery is the result of an accidental injury. In addition, benefits will n ot be paid for services or treatment rendered by a Physician, Nurse or any other person who is: employed or retained by the Subscriber or providing homeopathic, aroma-therapeutic or herbal therapeutic services or living in the Covered Person’s household or a parent, sibling, spouse or child of the Covered Person.
Important Definitions:
Covered Illness: A physical or mental disease or disorder including pregnancy and complications of pregnancy that results in a covered loss. A Covered Illness includes medically-necessary quarantine in a Hospital in conjunction with medically-necessary preventive treatment due to an identifiable exposure to a life-threatening contagious and infectious disease.
Covered Injury: Any bodily harm that results in a covered loss.
Covered Person: An eligible person, as defined in the Schedule of Benefits, who is enrolled and for whom Evidence of Insurability, where required, has been accepted by Us, required premium has been paid when due, and coverage under this Policy remains in force.
Elimination Period: The continuous period of time that must be satisfied before a benefit shown in the Schedule of Benefits is payable. An Elimination Period may be satisfied during the Policy’s Benefit Waiting Period.
Hospital:* An institution that is licensed as a hospital pursuant to applicable law; primarily and continuously engaged in providing medical care and treatment to sick and injured persons; managed under the supervision of a staff of physicians; provides 24-hour nursing services by or under the supervision of a graduate registered Nurse (R.N.); and has medical, diagnostic and treatment facilities with major surgical facilities on its premises, or available to it on a prearranged basis. The term Hospital does not include a clinic or facility for: (1) rehabilitation, convalescent, custodial, educational, hospice, or skilled nursing care; (2) the aged, drug addiction or alcoholism; or (3) a facility primarily or solely providing psychiatric services to mentally ill patients. The term Hospital also does not include a unit of a Hospital for rehabilitation, convalescent, custodial, educational, hospice, or skilled nursing care.
Policy Provisions:
When your coverage begins: Coverage begins on the later of the program’s effective date, the date you become eligible, the first of the month following the date your completed enrollment form is received or if evidence of insurability is required , the first of the month after we have approved you (or your dependent) for coverage in writing unless otherwise agreed upon by Cigna. Your coverage will not begin unless you are actively at work on the effective date. Coverage for Covered Persons will not begin on the effective date if the covered person is confined to a hospital, facility or at home; disabled or receiving disability benefits or unable to perform activities of daily living. Deferral of the effective date will not apply to the Newborn Nursery Care Admission and Stay Benefit.
When your coverage ends: Coverage for any Covered Person ends on the earliest of the date they are no longer eligible, the date the group policy is no longer in force, or the date for the last period for which required premiums are paid. For your Spouse and Dependent Child(ren), if applicable, coverage also ends when your coverage ends, when their premiums are not paid or when they are no longer eligible. (Under certain circumstances, your coverage may be continued if you stop working. Be sure to read the Continuation of Insurance provisions in your Certificate.)
30 Day Right To Examine Certificate: If a Covered Person is not satisfied with the Certificate for any reason, it may be returned to us within 30 days after receipt. We will return any premium that has been paid and the Certificate will be void as if it had never been issued.
*State Variations
For purposes of this brochure, wherever the term Spouse appears, it shall also include Domestic Partner registered under any state which legally recognizes Domestic Partnerships or Civil Unions. Spouse definition includes civil union partners in New Hampshire and Vermont. Hospital Stay, Hospital Intensive Care Unit (ICU) Stay, and Newborn Nursery Care Stay the number of days benefits are payable may differ for residents of ID. Hospital Stay Hospital Intensive Care Unit (ICU) Stay benefits will always be included for residents of ND. Hospital Intensive Care Unit (ICU) Stay Additional ICU Admission benefit is not available for residents of TX, NH. Hospital Stay benefits will always be included for residents of AK Observation Stay the Elimination Period is referred to as an Observation Period for residents of ID and ND. Elimination Period will not apply to residents ID and NH. Exclusions may vary for residents of MN, SC, SD, and WA. Newborn Nursery Care Admission and Stay Benefits are not available to residents in NH. Portability in TX, VT is referred to as Continuation due to loss of eligibility. VT residents are not subject to the age limit to continue coverage.
Series 1.0/1.1/1.2
THIS POLICY PAYS LIMITED BENEFITS ONLY. IT IS NOT COMPREHENSIVE HEALTH INSURANCE COVERAGE AND DOES NOT COVER ALL MEDICAL EXPENSES. THIS COVERAGE DOES NOT SATISFY THE “MINIMUM ESSENTIAL COVERAGE” OR INDIVIDUAL MANDATE REQUIREMENTS OF THE AFFORDABLE CARE ACT (ACA). THIS COVERAGE IS NOT MEDICAID OR MEDICARE SUPPLEMENT INSURANCE.
Product availability may vary by location and plan type and is subject to change. All group insurance policies may contain exclusions, limitations, reduction in benefits, and terms under which the policy may be continued in force or discontinued. For costs and details of coverage, review your plan documents. Policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation and are administered and insured by Cigna Health and Life Insurance Company (Bloomfield, CT). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
Terms and conditions of coverage for coverage are set forth in Group Policy No. HC110729. This is not intended as a complete description of the insurance coverage offered. This is not a contract. Please see your Plan Sponsor to obtain a copy of the Group Policy. If there are any differences between this summary and the Group Policy, the information in the Group Policy takes precedence. Product availability, benefits, riders, covered conditions, policy provisions and/or features may vary by state. Please keep this material as a reference.
Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (ii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.
Covers many preventive, basic, and majordental care services
Features group coveragefor La Grange ISDemployees
Allowsyou to choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist
Does not make you and your loved ones wait six months between routine cleanings
Calendar (Annual)
Deductible
Contracting Dentists Non-Contracting Dentists
Individual: $50
Family: $150
Waived for: Preventive
Individual: $50
Family: $150
Waived for: Preventive
Deductibles are combined for basicand majorContracting Dentists’ services. Deductibles are combined for basicand majorNon-Contracting Dentists’services.
Annual Maximum $750 $750
Annual Maximums are combined for preventive, basic, and major services.
Waiting Period This plan includes awaiting period if you do not enroll when it is first offered to you (known as a late entrant waiting period).
●12months for basic services
●12months for major services
Preventive Services
Routine oral exams
Bitewing X-rays
Full-mouth or panoramic X-rays
Other dental X-rays (including periapical films)
Routine cleanings
Fluoride treatments
Space maintainers for children
Sealants
Palliative treatment (including emergency relief of dental pain)
Basic Services
Problem focused exams
Consultations
Injections of antibiotics and other therapeutic medications
Fillings
Simple extractions
Biopsy and examination of oral tissue (including brush biopsy)
Periodontal maintenance procedures
Prefabricated stainless steel and resin crowns
Surgical extractions
Oral surgery
General anesthesia and I.V. s edation
Prosthetic repair and recementation services
Endodontics (including root canal treatment)
Non-surgical periodontal therapy
Periodontal surgery
Bridges
Full and partial dentures
Denture reline and rebase services
Crowns, inlays, onlays and related services
Implants & implant related services
To find a contracting dentist near you, visit www.LincolnFinancial.com/FindADentist .
This plan lets you choose any dentist you wish. However, your out-of-pocket costs are likely to be lower when you choose a contracting dentist. For example, if you need a crown…
…you pay a deductible (if applicable), then 60% of the remaining discounted fee for PPO members. This is known a s a PPO contracted fee.
… you pay a deductible (if applicable), then 60% of the maximum allowable charge (MAC) which is the maximum expense covered by the plan. You are responsible for the difference between the maximum allowable charge and the dentist’s billed charge.
With the Lincoln Dental Mobile App
Find a network dentist near you in minutes
Have an ID card on your phone
Customize the app to get details of your plan
Find out how much your plan covers for checkups and other services
Keep track of your claims Lincoln DentalConnect® Online Health Center
Determine the average cost of a dental procedure
Have your questions answered by a licensed dentist
Learn all about dental health for children, from baby’s first tooth to dental emergencies
Evaluate your risk for oral cancer, periodontal disease and tooth decay
Covered Family Members
When you choose coverage for yourself, you can also provide coverage for:
• Your spouse.
• Dependent children, up to age 26.
Benefit Exclusions
Like any coverage, this dental coverage doeshave some exclusions. The plan does not cover services started before coverage begins or after it ends. Benefits are limited to appropriate and necessary procedures listed in the summary plan description.Benefits are not payable for duplication of services. Covered expenses will not exceed the summary plan description’sallowances.
Plan benefits are not payable for a condition that is covered under Workers’ Compensation or a similar law; that occurs during the courseof employment or military service or involvement in an illegal occupation, felony, or riot; or that results from a self-inflicted injury. In certain situations, there may be more than one method of treating a dental condition. This summary plan description includes an alternative benefits provision that may reduce benefits to the lowestcost, generally effective, and necessary form of treatment. Certain conditions, such as age and frequency limitations, may impact your coverage. See the summary plan description for details. This plan includes continuation of coverage for employees with dental coverage from a previous employer. The member is required to complete the Continuity of Coverage form located on www.lfg.com. The form must be providedto us prior to the effective date to be eligible for continuation of coverage.
A complete list of benefit exclusions is included in the summary plan description.
This is not intended as a complete description of the coverage offered. Controlling provisions are provided in the summary plan description,and this summary does not modify coverage. A summary plan descriptionwill be made available to you that describes the benefits in greater detail. Refer to your summary plan descriptionfor your maximum benefit amounts.
Lincoln DentalConnect® health center Web content is provided by go2dental.com, Santa Clara, CA. Go2dental.com is not a Lincoln Financial Group® company. Coverage is subject to actual summary plan descriptionlanguage. Each independent company is solely responsible for its own obligations.
The Lincoln National Life Insurance Company (Fort Wayne, IN), does not conduct business in New York, nor is it licensed to do so. In New York, business is conducted by Lincoln Life & Annuity Company of New York (Syracuse NY). Both are Lincoln Financial Group Companies.
Dental Rate
Here’s how little you pay with grouprates.
As aLa Grange ISDemployee, you can take advantage of this dental coveragefor less than $0.49a day. Plus, you can add loved ones to the plan for just a little more.
Your
cost is itemizedbelow.
The Lincoln National Life Insurance Company
Please see prior page for product information.
High Option
The Lincoln DentalConnect®PPO Plan:
Covers many preventive, basic, and majordental care services
Also covers orthodontic treatment for children
Features group coveragefor La Grange ISDemployees
Allowsyou to choose any dentist you wish, though you can lower your out-of-pocket costs by selecting a contracting dentist
Does not make you and your loved ones wait six months between routine cleanings
Calendar (Annual)
Deductible
Benefits At-A-Glance
Contracting Dentists Non-Contracting Dentists
Individual: $50
Family: $150
Waived for: Preventive
Individual: $50
Family: $150
Waived for: Preventive
Deductibles are combined for basicand majorContracting Dentists’ services. Deductibles are combined for basicand majorNon-Contracting Dentists’services. Annual Maximum
Annual Maximums are combined for preventive, basic, and major services.
Orthodontic Coverage is available for dependent children.
Waiting Period This plan includes awaiting period if you do not enroll when it is first offered to you (known as a late entrant waiting period).
●12months for basic services
●12months for major services
●12months for orthodontic services
Preventive Services
Routine oral exams
Bitewing X-rays
Full-mouth or panoramic X-rays
Other dental X-rays (including periapical films)
Routine cleanings
Fluoride treatments
Space maintainers for children
Sealants
Palliative treatment (including emergency relief of dental pain)
Basic Services
Problem focused exams
Consultations
Injections of antibiotics and other therapeutic medications
Fillings
Simple extractions
Surgical extractions
Oral surgery
Biopsy and examination of oral tissue (including brush biopsy)
General anesthesia and I.V. sedation
Periodontal maintenance procedures
Major Services
Prefabricated stainless steel and resin crowns
Prosthetic repair and recementation services
Endodontics (including root canal treatment)
Non-surgical periodontal therapy
Periodontal surgery
Bridges
Full and partial dentures
Denture reline and rebase services
Crowns, inlays, onlays and related serv ices
Harmful habit appliances
Orthodontic exams
X-rays
Extractions
Study models
Appliances
To find a contracting dentist near you, visit www.LincolnFinancial.com/FindADentist .
This plan lets you choose any dentist you wish. However, your out-of-pocket costs are likely to be lower when you choose a contracting dentist. For example, if you need a crown…
…you pay a deductible (if applicable), then 50% of the remaining discounted fee for PPO members. This is known a s a PPO contracted fee.
… you pay a deductible (if applicable), then 50% of the usual and customary fee, which is the maximum expense covered by the plan. You are responsible for the difference between the usual and customary fee and the dentist’s billed charge.
With the Lincoln Dental Mobile App
Find a network dentist near you in minutes
Have an ID card on your phone
Customize the app to get details of your plan
Find out how much your plan covers for checkups and other services
Keep track of your claims Lincoln DentalConnect® Online
Health Center
Determine the average cost of a dental procedure
Have your questions answered by a licensed dentist
Learn all about dental health for children, from baby’s first tooth to dental emergencies
Evaluate your risk for oral cancer, periodontal disease and tooth decay
Covered Family Members
When you choose coverage for yourself, you can also provide coverage for:
• Your spouse.
• Dependent children, up to age 26.
Benefit Exclusions
Like any coverage, this dental coverage doeshave some exclusions. The plan does not cover services started before coverage begins or after it ends. Benefits are limited to appropriate and necessary procedures listed in the summary plan description.Benefits are not payable for duplication of services. Covered expenses will not exceed the summary plan description’susual and customary allowances. Plan benefits are not payable for a condition that is covered under Workers’ Compensation or a similar law; that occurs during the courseof employment or military service or involvement in an illegal occupation, felony, or riot; or that results from a self-inflicted injury.
The plan does not cover an orthodontia treatment plan started before coverage begins unless the member was receiving orthodontia benefits from the employer’s previous group dental summary plan description. In this case, Lincoln Financial will continue orthodontia benefits until the combined benefit paid by both policies is equal to this summary plan description’slifetime orthodontia maximum. Plan benefits are not payable if the orthodontic appliance was installed after the age of 19. In certain situations, there may be more than one method of treating a dental condition. This summary plan description includes an alternative benefits provision that may reduce benefits to the lowestcost, generally effective, and necessary form of treatment. Certain conditions, such as age and frequency limitations, may impact your coverage. See the summary plan description for details. This plan includes continuation of coverage for employees with dental coverage from a previous employer. The member is required to complete the Continuity of Coverage form located on www.lfg.com. The form must be providedto us prior to the effective date to be eligible for continuation of coverage.
A complete list of benefit exclusions is included in the summary plan description.
This is not intended as a complete description of the coverage offered. Controlling provisions are provided in the summary plan description,and this summary does not modify coverage. A summary plan descriptionwill be made available to you that describes the benefits in greater detail. Refer to your summary plan descriptionfor your maximum benefit amounts.
Lincoln DentalConnect® health center Web content is provided by go2dental.com, Santa Clara, CA. Go2dental.com is not a Lincoln Financial Group® company. Coverage is subject to actual summary plan descriptionlanguage. Each independent company is solely responsible for its own obligations.
The Lincoln National Life Insurance Company (Fort Wayne, IN), does not conduct business in New York, nor is it licensed to do so. In New York, business is conducted by Lincoln Life & Annuity Company of New York (Syracuse NY). Both are Lincoln Financial Group Companies.
Dental Rate
Here’s how little you pay with grouprates.
As aLa Grange ISDemployee, you can take advantage of this dental coveragefor less than $1.09a day. Plus, you can add loved ones to the plan for just a little more.
With MetLife, you’ll havea plan that providepayments in additionto any other insurancepayments youmay receive1. Here are just some ofthe covered events/services2 Covered Benefits – All benefits must relate
Dislocation Benefit (Closed) Lower Jaw
Dislocation
Broken
• Accidental Death Benefits Category:Thebenefit amount will be reduced by the amount ofany Accidental Dismemberment/Functional Loss/ParalysisBenefits and ModificationBenefitpaid for Injuries sustained by theCovered Person in the same Accidentfor which theAccidental Death Benefit is being paid.
• Accidental Death Common Carrier Benefit: “Common Carrier”:refers to airplanes,trains,buses,trolleys,subways and boats. Certain conditions apply.Seeyour DisclosureStatement or OutlineofCoverage/DisclosureDocumentfor specific details.
• LodgingBenefit:Thelodgingbenefitis notavailablein all states. It provides abenefit for a companionaccompanyinga covered insured whilehospitalized,provided thatlodgingis atleast 50 miles fromthe insured’s primary residence.
Please contactMetLife for detailed definitions andstatevariations ofcovered benefits.
Accident Insurance
This coverageincludes an Organized SportsActivity BenefitRider. Therider increases theamountpayable under the Certificatefor certain benefits by 25% for injuries resulting froman accidentthatoccurred whileparticipatingas a player in an organized sports activity. Therider sets forth terms, conditionsand limitations,includingthecovered persons to whomtherider applies.
Benefit Payment Example
Kathy’s daughter,Molly, was riding her biketo school On her way there shefell to the ground,was knockedunconscious,and was taken to the local emergency room (ER) by ambulance for treatment. The ER doctor diagnosed aconcussion and abroken tooth. He ordered aCT scan to check for facial fractures too,sinceMolly’s face was very swollen.Molly was released to her primary care physician for follow-uptreatment,and her dentistrepaired her broken tooth with acrown.Depending onher health insurance, Kathy’s out-of-pocketcosts couldrun into hundreds ofdollars to cover expenses likeinsuranceco-payments anddeductibles. MetLife Group AccidentInsurancepayments can beused to help cover theseunexpected costs.
Physician Follow-Up($75x 2)
Tooth (repaired by crown)
by
Benefit amount isbased on a sample MetLife plan design. Actual plan designand benefits may vary.
Questions & Answers
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 EnrollmentPeriod and to be actively at work for your coverageto be effective.
Q. How do I pay for my accident coverage?
A. Premiums will be paid through payroll deduction, so youdon’thaveto worry about writing acheck or missing apayment.
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 continueto pay your premiums to keep your coveragein force. Your coveragewill only end ifyoustop payingyour premiumor ifyour employer offers yousimilar coveragewith a different insurancecarrier
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.
1 Covered services/treatmentsmust be the result of a covered accident orsickness as definedin the group policy/certificate. SeeyourDisclosure Statement orOutline of Coverage/DisclosureDocument forfulldetails.
2 Availability of benefitsvaries by state. See yourDisclosure Statement orOutline of Coverage/Disclosure Document forstate variations.
3 Benefits and amountsare basedon sample MetLife plandesign. Plan designand planbenefits may vary.
4 Coverage is guaranteed provided(1)the employee is actively at work and (2)dependents to be covered are not subjectto medicalrestrictionsas set forth on the enrollment formand in the Certificate. Some statesrequire the insured to havemedicalcoverage Children may be covered to age26. There are benefit reductionsthat may beginat age 65.
[5 Eligibility forportabilitythrough the Continuationof Insurance with PremiumPayment provision may be subject to certain eligibilityrequirementsand limitations. For more information, contact yourMetLife representative ] Document forfulldetails. Covered Event3
No one is immune to identity theft.
Better Protect What Matters Most.
Identity theft can affect anyone—from infants to seniors. Each generation has habits that savvy criminals know how to exploit—resulting in over $43 billion lost to identity fraud in the U.S. in 2022. Take action with award-winning ID Watchdog identity theft protection.
Greater Peace of Mind
With ID Watchdog as an employee benefit, you have a more convenient and affordable way to help better protect and monitor your identity. You’ll be alerted to potentially suspicious activity and enjoy greater peace of mind knowing you don't have to face identity theft alone.
Why Choose ID Watchdog?
We scour billions of data points— public records, transaction records, social media and more—to search for signs of potential identity theft.
We've got you covered with lock features for added control over your credit report(s) to help keep identity thieves from opening new accounts in your name.
Awarded Best in Class Identity Protection Service
If you become a victim, you don’t have to face it alone. One of our certified resolution specialists will personally manage the case for you until your identity is restored.
Our family plan helps you better protect your loved ones with personalized accounts for adult family members, family alert sharing, and exclusive features for children.
ID Watchdog 1B
Powerful features for end-to-end support
Credit Report Lock | 1 Bureau
Blocked Inquiry Alerts | 1 Bureau
Financial Accounts Monitoring
Social Accounts Monitoring
Registered Sex Offender Reporting
Customizable Alert Options
National Provider ID Alerts
A child's identity can provide a blank slate for fraudsters
Credit Report Monitoring | 1 Bureau
Dark Web Monitoring
Data Breach Notifications
High-Risk Transactions Monitoring
Subprime Loan Monitoring
Public Records Monitoring
USPS Change of Address Monitoring
Credit Reports | 1 Bureau Monthly
VantageScore Credit Scores | 1 Bureau Monthly
Credit Score Tracker | 1 Bureau
What You Need to Know
Personalized Identity Restoration including Pre-Existing Conditions
Online Resolution Tracker
Up to $1M Identity Theft Insurance
Lost Wallet Vault & Assistance
Deceased Family Member Fraud
Remediation (Family Plan only)
Credit Freeze Assistance
Solicitation Reduction 5 4
Help better protect children with Equifax Child Credit Lock & Equifax Child Credit Monitoring PLUS features marked with this icon
The credit scores provided are based on the VantageScore 3.0 model. Any one-bureau VantageScore uses Equifax data. Third parties use many different types of credit scores and are likely to use a different type of credit score to assess your creditworthiness.
(1)Locking your Equifax credit report will prevent access to it by certain third parties. Locking your Equifax credit report will not prevent access to your credit report at any other credit reporting agency. Entities that may still have access to your Equifax credit report include: companies like ID Watchdog which provide you with access to your credit report or credit score, or monitor your credit report as part of a subscription or similar service; companies that provide you with a copy of your credit report or credit score, upon your request; federal, state, and local government agencies and courts in certain circumstances; companies using the information in connection with the underwriting of insurance, or for employment, tenant or background screening purposes; companies that have a current account or relationship with you, and collection agencies acting on behalf of those whom you owe; companies that authenticate a consumer’s identity for purposes other than granting credit, or for investigating or preventing actual or potential fraud; and companies that wish to make pre-approved offers of credit or insurance to you. To opt out of pre-approved offers, visit www.optoutprescreen.com (2)ThereisnoguaranteethatIDWatchdogisabletolocateandscanalldeepanddarkwebsiteswhereconsumers'personalinformationisatriskofbeing traded. (3)The monitored network does not cover all businesses or transactions. (4)The Identity Theft Insurance is underwritten and administered by American Bankers Insurance Company of Florida, an Assurant company. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions. Review the Summary of Benefits (www.idwatchdog.com/terms/insurance). (5)Applicable for enrolledfamilymembersonly.ToreviewIDWatchdogTerms&Conditions,gotoidwatchdog.com/terms.
BENEFITHIGHLIGHTSFOR:
LaGrangeIndependentSchoolDistrict
EDUCATOR DISABILITY INSURANCE OVERVIEW
What is Educator Disability Income Insurance?
Why do I need Disability Insurance Coverage?
Educator Disability insurance combines the features of a short-term and long-term disability plan into one policy. The coverage pays you a portion of your earnings if you cannot work because of a disabling illness or injury. The plan gives you the flexibility to choose a level of coverage to suit your need.
You have the opportunity to purchase Disability Insurance through your employer. This highlight sheet is an overview of your Disability Insurance. Once a group policy is issued to your employer, a certificate of insurance will be available to explain your coverage in detail.
More than half of all personal bankruptcies and mortgage foreclosures are a consequence of disability1
1 Facts from LIMRA, 2016 Disability Insurance Awareness Month
The average worker faces a 1 in 3 chance of suffering a job loss lasting 90 days or more due to a disability2
2Facts from LIMRA, 2016 Disability Insurance Awareness Month
Only 50% of American adults indicate they have enough savings to cover three months of living expenses in the event they’re not earning any income3
3Federal Reserve, Report on the Economic Well-Being of U.S. Households in 2018
ELIGIBILITY AND ENROLLMENT
Eligibility You are eligible if you are an active employee who works at least 18.75 hours per week on a regularly scheduled basis.
Enrollment You can enroll in coverage within 31 days of your date of hire or during your annual enrollment period.
Effective Date Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with your employer on the day your coverage takes effect.
Actively at Work You must be at work with your Employer on your regularly scheduled workday. On that day, you must be performing for wage or profit all of your regular duties in the usual way and for your usual number of hours. If school is not in session due to normal vacation or school break(s), Actively at Work shall mean you are able to report for work with your Employer, performing all of the regular duties of Your Occupation in the usual way for your usual number of hours as if school was in session.
FEATURES OFTHE PLAN
Benefit Amount You may purchase coverage that will pay you a monthly flat dollar benefit in $100 increments between $200 and $7,500 that cannot exceed 66 2/3% of your current monthly earnings. Earnings are defined in The Hartford’s contract with your employer.
Elimination Period You must be disabled for at least the number of days indicated by the elimination period that you select before you can receive a Disability benefit payment. The elimination period that you select consists of two numbers. The first number shows the number of days you must be disabled by an accident before your benefits can begin. The second number indicates the number of days you must be disabled by a sickness before your benefits can begin.
For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.
Maximum Benefit Duration Benefit Duration is the maximum time for which we pay benefits for disability resulting from sickness or injury. Depending on the schedule selected and the age at which disability occurs, the maximum duration may vary. Please see the applicable schedules below based on your election of the Premium benefit option.
Premium Option: For the Premium benefit option – the table below applies to disabilities resulting from sickness or injury
AgeDisabled
MaximumBenefitDuration
Priorto60 Toage65
Age60-64 60months
Age65-67 Toage70
Age68andover 24months
Mental Illness, Alcoholism and Substance Abuse, SelfReported or Subjective Illness: Duration You can receive benefit payments for Long-Term Disabilities resulting from mental illness, alcoholism and substance abuse or self-reported or subjective illness for a total of 24 months for all disability periods during your lifetime.
Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness, alcoholism and substance abuse does not count toward the 24 month lifetime limit.
Partial Disability Partial Disability is covered provided you have at least a 20% loss of earnings and duties of your job.
Other Important Benefits
Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or child under age 26, equal to three times your last monthly grossbenefit.
The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD benefits. Once you are covered you are eligible for services to provide assistance with child/elder care, substance abuse, family relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided through ComPsych®, a leading provider of employee assistance and work/life services.
Travel Assistance Program – Available 24/7, this program provides assistance to employees and their dependents who travel 100 miles from their home for 90 days or less. Services include pre-trip information, emergency medical assistance and emergency personal services.
Identity Theft Protection – An array of identity fraud support services to help victims restore their identity. Benefits include 24/7 access to an 800 number; direct contact with a certified caseworker who follows the case until it’s resolved; and a personalized fraud resolution kit with instructions and resources for ID theft victims.
Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow you to return to active full-timeemployment.
PROVISIONS OF THE PLAN
Definition of Disability Disability is defined as The Hartford’s contract with your employer. Typically, disability means that you cannot perform one or more of the essential duties of your occupation due to injury, sickness, pregnancy or other medical conditions covered by the insurance, and as a result, your current monthly earnings are 80% or less of your pre-disability earnings.
One you have been disabled for 24 months, you must be prevented from performing one or more essential duties of any occupation, and as a result, your monthly earnings are 66 2/3% or less of your pre-disability earnings.
Pre-Existing Condition Limitation
Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit payment will be limited, unless: You have been insured under this policy for 12 months before your disability begins.
If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 1 month.
Continuity of Coverage If you were insured under your district’s prior plan and not receiving benefits the day before this policy is effective, there will not be a loss in coverage and you will get credit for your prior carrier’s coverage.
Recurrent Disability What happens if I Recover but become Disabled again?
Periods of Recovery during the Elimination Period will not interrupt the Elimination Period, if the number of days You return to work as an Active Employee are less than one-half (1/2) the number of days of Your Elimination Period. Any day within such period of Recovery, will not count toward the Elimination Period.
Benefit Integration Your benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as:
• Social Security Disability Insurance
• State Teacher Retirement Disability Plans
• Workers’ Compensation
• Other employer-based disability insurance coverage you may have
• Unemployment benefits
• Retirement benefits that your employer fully or partially pays for (such as a pension plan)
Your plan includes a minimum benefit the greater of 10% of your elected benefit or $100.
General Exclusions You cannot receive Disability benefit payments for disabilities that are caused or contributed to by:
• War or act of war (declared or not)
• Military service for any country engaged in war or other armed conflict
• The commission of, or attempt to commit a felony
• An intentionally self-inflicted injury
• Any case where Your being engaged in an illegal occupation was a contributing cause to your disability
• You must be under the regular care of a physician to receive benefits
Termination Provisions Your coverage under the plan will end if:
• The group plan ends or is discontinued
• You voluntarily stop your coverage
• You are no longer eligible for coverage
• You do not make the required premium payment
• Your active employment stops, except as stated in the continuation provision in the policy
• Provides a cash benefit to your loved ones in the event of your death
• Features group rates for La Grange ISD 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 La Grange ISD
Benefits At-A-Glance
Employee
Newly hired employee guaranteed coverage amount
$200,000
Continuing employee guaranteed coverage annual increase amount Choice of $10,000 or $20,000
Maximum coverage amount 5 times your annual salary ($500,000 maximum in increments of $10,000)
Minimum coverage amount $10,000
Spouse
Newly hired employee guaranteed coverage amount
$50,000
Continuing employee guaranteed coverage annual increase amount Choice of $10,000 or $20,000
Maximum coverage amount
Minimum coverage amount
Dependent Children
6 months to age 26 guaranteed coverage amount
Age 1 day to 6 months guaranteed coverage amount
100% of the employee coverage amount ($500,000 maximum in increments of $10,000)
$10,000
$10,000
$1,000
What your benefits cover
Employee Coverage
Guaranteed Life Insurance Coverage Amount
• Newly Hired 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 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 Coverage - You can secure term life insurance for your spouse if you select coverage for yourself.
Guaranteed Life Insurance Coverage Amount
• Newly Hired 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 without providing evidence of insurability.
• Annual Limited Enrollment: If you are a continuing employee, you can increase the coverage amount for your spouse 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 100% of your coverage amount ($500,000 maximum) for your spouse 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 Included
Premium Waiver
Conversion
Included
Included
Portability Included
Benefit Exclusions
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.
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. TravelConnect® travel assistance services are provided by On Call International, Salem NH. On Call International must coordinate and provide all arrangements in order for eligible services to be covered ComPsych® and On Call International are not Lincoln Financial Group companies and Lincoln Financial Group does not administer these Services. Each independent company is solely responsible for its own obligations. Coverage is subject to contract language that contains specific terms, conditions, and limitations.
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.
Here’s how little you pay with grouprates.
Spouse | Monthly Premiums for Select
Life Insurance Coverage Amounts
Dependent Children Monthly Premium for
Please see prior page for product information.
$10,000
Group Rates for Your Dependent Children
One affordable monthly premium covers all of your eligible dependent children.
Note: You must be an active La Grange ISD employee to select coverage for a spouse and/or dependent children. To be eligible for coverage, a spouse 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.
The Lincoln National Life
Company Please see prior page for product information.
life insurance highlights
For the employee
purelife-plus
Voluntary permanent life insurance can be an ideal complement to the group term and optional term life insurance 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 life insurance may be portable if you change jobs, but even if you can keep them after you retire, they usually cost more and decline in death benefit.
The contract, 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, knowing there will be life insurance in force when you die.
• Refund of Premium. Unique in the marketplace, purelife-plus offers you a refund of 10 years’ premium, should you surrender the contract if the premium you pay when you buy the contract 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)
Additional Features
• 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. Enjoy the assurance of a contract that has a guaranteed death benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up). 2
You may apply for this permanent coverage, not only for yourself, but also for your spouse, children and grandchildren.3
QUICK QUESTIONS 3
You can qualify by answering just 3 questions – no exams or needles.
DURING THE LAST SIX MONTHS, HAS THE PROPOSED INSURED:
Been actively at work on a full time basis, performing usual duties?
Been absent from work due to illness or medical treatment for a period of more than 5 consecutive working days?
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, dialysis treatment, or treatment for alcohol or drug abuse?
PureLife-plus is a Flexible Premium Adjustable Life Insurance to Age 121. As with most life insurance products, Texas Life contracts and riders contain certain exclusions, limitations, exceptions, reductions of benefits, waiting periods and terms for keeping them in force. Please contact a Texas Life representative or see the Purelife-plus brochure for costs and complete details. Contract Form ICC18-PRFNG-NI-18, Form Series PRFNG-NI-18 or PRFNG-NI-20-OHIO.
1 Voluntary Whole and Universal Life Products, Eastbridge Consulting Group, December 2018
2 Guarantees are subject to product terms, limitations, exclusions, and the insurer’s claims paying ability and financial strength
3 Coverage not available on children in WA or on grandchildren in WA or MD. In MD, children must reside with the applicant to be eligible for coverage.
FLEXIBLE BENEFITS PLAN
Congratulations! La Grange Independent School District has established a "Flexible Benefits Plan" to help you pay for your out-of-pocket medical expenses. The benefits you elect are paid for with a portion of your pay before Federal income or Social Security taxes are withheld. This means that you will save money by paying less taxes and have more money to spend. However, if you receive a reimbursement for an expense under the Plan, you cannot claim a Federal income tax credit or deduction on your return.
GENERAL PLAN INFORMATION
Plan Year:…………… September 1st through August 31st
Maximum Health FSA Limit……… …Current IRSlimit …See Code Section 125(i)(2) or current enrollment information
Maximum Dependent Care Limit:……..……………..……..$5,000
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.
Health FSA …………………….....………….75days Dependent Care (DCAP)..………………………….....…...75 days
Deadlines to Incur Expenses on Elected Funds
Health FSA November 14 following Plan Year End DCAP…………… November 14 following Plan Year End
Deadlines to File for Reimbursement Run-out Period:………………………………… 90 days
Health FSA andDCAP… November 29 following plan year end
Mid-Year Terminations
FSA …………………………...90 days following termination date DCAP…………………....…… 90 days following termination date
Orthodontic Reimbursement……….as paidper service contract Upfront payment……………….…………..…… not allowed
AM I ELIGIBLE TO PARTICIPATE
If you work 20 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.
NBS Welfare Benefit Service Center (801) 532-4000 or 800-274-0503
Fax: 800-478-1528
service@nbsbenefits.com
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
Health Savings Account:
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
La Grange Independent School District Flexible Benefits Plan
Plan Contact Person: Jennifer Rebecek Jennifer Jaeger 560 North Monroe Street La Grange, TX 78945 (979) 968-7000 rebecekj@lgisd.net jaegerj@lgisd.net
Flexible Benefits Plan
compensation; (c) your spouse’s actual or deemed earned income.
Premium Expense Plan:
A Premium Expense portion of the Plan allows you to use pre-tax dollars to pay for specific premiums under various insurance programs that we offer you.
Please note: Policies other than company sponsored policies (i.e. spouse's or dependents' individual policies etc.) may not be paid through the Flexible Benefits Plan. Furthermore, qualified longterm care insurance plans may not be paid through the Flexible Benefits Plan.
DETERMINING CONTRIBUTIONS
Before each Plan Year begins, you will select the benefits you want and how much of the contributions should go toward each benefit. It is very important that you make these choices carefully based on what you expect to spend on each covered benefit or expense during the Plan Year.
Generally, you cannot change the elections you have made after the beginning of the Plan Year. However, there are certain limited situations when you can change your elections if you have a “change in status”. Please refer to your Summary Plan Description for a change in status listing.
HOW DO I RECEIVE REIMBURSEMENTS
Participant Portal or Mobile App
During the course of the Plan Year, you may submit requests for reimbursement of expenses you have incurred. Expenses are considered “incurred” when the service is performed, not necessarily when it is paid for. Claims may be submitted through your online account or the NBS Mobile App.
In order to have the reimbursements made to you for qualifying Dependent Care expenses, you must provide a statement from the service provider including the name, address, date of service, the amount of expense and proof that the expense has been incurred. In most cases, the taxpayer identification number of the service provider will also be necessary.
Claims for reimbursement must be submitted in accordance with the timelines provided in the General Plan Information section.
NBS Smart Debit Card – FSA Pre-paid MasterCard
Your employer may sponsor the use of the NBS Smart Debit Card to access your Health FSA dollars. You may use the card to pay merchants or service providers that accept credit cards, so there is no need to pay cash up front then wait for reimbursement.
NBS Welfare Benefit Service Center (801) 532-4000 or 800-274-0503
Fax: 800-478-1528
service@nbsbenefits.com
La Grange Independent School District Flexible Benefits Plan
Plan Contact Person: Jennifer Rebecek Jennifer Jaeger 560 North Monroe Street La Grange, TX 78945 (979) 968-7000 rebecekj@lgisd.net jaegerj@lgisd.net
La Grange Independent School District
Critical Illness Insurance
can pay money directly to you when you’re diagnosed with certain serious illnesses.
How does it work?
If you’re diagnosed with an illness that is covered by this insurance, you can receive a lump sum benefit payment. You can use the money however you want.
Why is this coverage so valuable?
• The money can help you pay out-of-pocket medical expenses, like co-pays and deductibles.
• You can use this coverage more than once. Even after you receive a payout for one illness, you’re still covered for the remaining conditions and for the reoccurrence of any critical illness with the exception of skin cancer. The reoccurrence benefit pays 100% of your coverage amount. Diagnoses must be at least 180 days apart or the conditions can’t be related to each other. What’s covered?
Critical illnesses
• Heart attack
• Stroke
• Major organ failure
• End-stage kidney failure
• Coronary artery disease Major (50%): Coronary artery bypass graft or valve replacement Minor (10%): Balloon angioplasty or stent placement
Cancer conditions
• Invasive cancer — all breast cancer is considered invasive
• Non-invasive cancer (25%)
• Skin cancer — $500
Progressive diseasesSupplemental conditions
• Amyotrophic Lateral Sclerosis (ALS)
• Dementia, including Alzheimer’s disease
• Multiple Sclerosis (MS)
• Parkinson’s disease
• Functional loss
• Loss of sight, hearing or speech
• Benign brain tumor
• Coma
• Permanent Paralysis
• Occupational HIV, Hepatitis B, C or D
• Infectious Diseases (25%)
Why should I buy coverage now?
• It’s more affordable when you buy it through your employer and the premiums are conveniently deducted from your paycheck.
• Coverage is portable. You may take the coverage with you if you leave the company or retire. You’ll be billed at home.
Be Well Benefit
Every year, each family member who has Critical Illness coverage can also receive $50 for getting a covered Be Well Benefit screening test, such as:
• Annual exams by a physician include sports physicals, wellchild visits, dental and vision exams
• Screenings for cancer, including pap smear, colonoscopy
• Cardiovascular function screenings
Who can get coverage?
• Screenings for cholesterol and diabetes
• Imaging studies, including chest X-ray, mammography
• Immunizations including HPV, MMR, tetanus, influenza
You: Choose $10,000, $20,000 or $30,000 of coverage with no medical questions if you apply during this enrollment.
Your spouse: Spouses can only get 100% of the employee coverage amount as long as you have purchased coverage for yourself.
Your children: Children from live birth to age 26 are automatically covered at no extra cost. Their coverage amount is 50% of yours. They are covered for all the same illnesses plus these specific childhood conditions: cerebral palsy, cleft lip or palate, cystic fibrosis, Down syndrome and spina bifida. The diagnosis must occur after the child’s coverage effective date. Active employment: You are considered in active employment if, on the day you apply for coverage, you are being paid regularly for the required minimum 18.75 hours each week and you are performing the material and substantial duties of your regular occupation. 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. New employees have a 0 day waiting period to be eligible for coverage. Please contact your plan administrator to confirm your eligibility date. If enrolling, and eligible for Medicare (age 65+; or disabled) the Guide to Health Insurance for People with Medicare is available at www.medicare.gov/media/9486. Please refer to the certificate for complete definitions about these covered conditions. Coverage may vary by state. See exclusions and limitations.
Monthly costs
Critical Illness Insurance benefit and cost
Your paycheck deduction will include the cost of coverage and the Be Well Benefit. Actual billed amounts may vary.
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 the result of any of the following: a Pre-existing Condition; or complications arising from treatment or surgery for, or medications taken for, a Preexisting Condition.
An Insured has a Pre-existing Condition if, within the 12 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.
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.
Pre-existing Condition requirements are not applicable to children who are newly acquired after your Coverage Effective Date.
Continuity of coverage
Monthly costs
We will provide coverage for an Insured if the Insured was covered by a similar prior policy on the day before the Policy Effective Date. Coverage is subject to payment of premium and all other terms of the certificate. If an employee is on a temporary Layoff or Leave of Absence on the Policy Effective Date of this certificate, we will consider your temporary Layoff or Leave of Absence to have started on that date and coverage will continue for the period provided temporary Layoff or Leave of Absence under Continuation of your Coverage During Extended Absences in the certificate. If you have not returned to Active Employment before any Insured’s Date of Diagnosis, any benefits payable will be limited to what would have been paid by the prior carrier.
If the Employer replaces a critical illness policy with this Policy, or the employee becomes insured due to a merger, acquisition or affiliation, and the prior carrier’s pre-existing condition requirement has been satisfied, the Pre-existing Condition requirement under this coverage will not apply. However, if the Unum certificate provides a higher level of coverage at the time it becomes effective, its Pre-existing Condition requirement will apply to any increase in coverage. If the prior carrier’s pre-existing condition requirement has not been satisfied, periods of coverage applicable to the prior carrier’s Pre-existing Condition will count towards satisfying the Pre-existing Condition requirement under this coverage.
Date of diagnosis must be after the coverage effective date.
Exclusions and 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.
End of employee coverage
If you choose to cancel your coverage your coverage ends on the first of the month following the date you provide notification to your employer. Otherwise, your coverage ends on the earliest of the: date this policy is canceled by Unum or your employer; date you are no longer in an eligible group; date your eligible group is no longer covered; date of your death; last day of the period any required premium contributions are made; or last day you are in active employment.
However, as long as premium is paid as required, coverage will continue in accordance with the Continuation of your Coverage during Absences provision or if you elect to continue coverage for you, your Spouse, and Children under Portability of Critical Illness Insurance.
Unum will provide coverage for a payable claim that occurs while you are covered under this certificate.
THIS INSURANCE PROVIDES LIMITED BENEFITS
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 imitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form GCIP16-1 or the Certificate Form GCIC16-1 or contact your Unum representative.
Comprehensive coverage and care for emergency transport.
Our Emergent Plus membership plan includes:
Emergency Ground Ambulance Coverage1
Your out-of-pocket expenses for your emergency ground transportation to a medical facility are covered with MASA.
Emergency Air Ambulance Coverage1
Your out-of-pocket expenses for your emergency air transportation to a medical facility are covered with MASA.
Hospital to Hospital Ambulance Coverage1
When specialized care is required but not available at the initial emergency facility, your out-of-pocket expenses for the ground or air ambulance transfer to the nearest appropriate medical facility are covered with MASA.
Repatriation Near Home Coverage1
Should you need continued care and your care provider has approved moving you to a hospital nearer to your home, MASA coordinates and covers the expense for ambulance transportation to the approved medical facility.
Did you know?
51.3 million emergency responses occur each year
MASA protects families against uncovered costs for emergency transportation and provides connections with care services.
Source: NEMSIS, National EMS Data Report, 2023
About MASA
MASA is coverage and care you can count on to protect you from the unexpected. With us, there is no “out-of-network” ambulance. Just send us the bill when it arrives and we’ll work to ensure charges are covered. Plus, we’ll be there for you beyond your initial ride, with expert coordination services on call to manage complex transport needs during or after your emergency — such as transferring you and your loved ones home safely.
Protect yourself, your family, and your family’s financial future with MASA.
Compare plans
Get emergency medical transportation coverage to protect what matters most.
With a MASA plan, you’ll have an additional layer of financial protection from the out-of-pocket costs of medical transportation. Explore the options below to compare the benefits offered in each plan.
Gain peace of mind and shield your finances knowing there’s a MASA plan best suited for your needs.
Group Cancer Insurance
How would cancer impact you and your family?
How it works
If you or a family member are diagnosed with cancer, APL’s Cancer Insurance may help cover the costs associated with the detection and treatment of cancer and help you be more financially prepared.
CHOOSE the benefit options that best protect you and your family.
RECEIVE treatment for a covered benefit.
FILE your claim online or mail it in.
Summary of Benefits for La Grange ISD
Spouse
Key features
Radiation Therapy, Chemotherapy, Immunotherapy
Experimental Treatments
Surgical and Anesthesia Benefits
Prescriptions, Transportation Benefits and more
Plus, multiple plan options to cover you, your spouse or your child(ren) with convenient payroll deduction
Experimental Treatment
Mastectomy
Prosthesis
Diagnostic Testing 1 test per calendar year
Follow-Up Diagnostic Testing 1 test per calendar year
in same manner and under the same maximums as any other benefit
in same manner and under the same maximums as any other benefit
Group Cancer Insurance
Medical Imaging
Surgical Benefit Rider
Surgical Operation
$500 per test; 1 test(s) per calendar year
Level 1
$30 unit dollar amount; Max $3,000 per operation
Anesthesia 25% of amount paid for covered surgery
Bone Marrow Transplant
Maximum per lifetime
Stem Cell Transplant
Maximum per lifetime
Prosthesis
Surgical implantation
Non-surgical (not hair piece)
1 device per site, per lifetime
Patient Care Benefit Rider
Hospital Confinement
Outpatient Facility
Attending Physician
Dread Disease
Extended Care Facility
Donor
Home Health Care
Hospice Care
US Government, Charity Hospital or HMO
Miscellaneous Benefit Rider
$6,000
$1,000 per device
$100 per device
Level 1
Insured or Spouse:
$100 per day of hospital confinement, days 1-30; $100 per day of hospital confinement, days 31+
Eligible Dependent Child(ren):
$200 per day of hospital confinement, days 1-30; $200 per day of hospital confinement, days 31+
$200 per day surgery is performed
$30 per day of hospital confinement
$100 per day of hospital confinement, days 1-30; $100 per day of hospital confinement, days 31+
$100 per day
$100 per day
$100 per day
$100 per day; maximum of 365 days per lifetime
$100 per day of hospital confinement, days 1-30; $100 per day of hospital confinement, days 31+
Level 1
Cancer Treatment Center Evaluation or Consultation -1 per lifetime Not Included
Evaluation or Consultation Travel and Lodging - 1 per lifetime Not Included
Second / Third Surgical Opinion Per diagnosis of cancer
Drugs and Medicine
Hair Piece (Wig) - 1 per lifetime
Transportation and Lodging
Transportation - maximum 12 trips per calendar year for all modes of transportation combined
Lodging - up to a maximum of 100 days per calendar year
Family Member Transportation and Lodging
Transportation - maximum 12 trips per calendar year for all modes of transportation combined
Lodging - up to a maximum of 100 days per calendar year
$300 / $300
$150 per inpatient confinement; $50 per outpatient prescription, maximum $150 per month
$150
actual coach fare or $0.40 per mile for travel by bus, plane or train; $0.40 per mile for travel by car; $50 per day for lodging
actual coach fare or $0.40 per mile for travel by bus, plane or train; $0.40 per mile for travel by car; $50 per day for lodging
$500 per test; 1 test(s) per calendar year
Level 3
$45 unit dollar amount; Max $4,500 per operation
of amount paid for covered surgery
$9,000
$2,000 per device
$200 per device
Level 4
Insured or Spouse:
$300 per day of hospital confinement, days 1-30; $600 per day of hospital confinement, days 31+
Eligible Dependent Child(ren):
$600 per day of hospital confinement, days 1-30; $1,200 per day of hospital confinement, days 31+
$600 per day surgery is performed
$50 per day of hospital confinement
$300 per day of hospital confinement, days 1-30; $600 per day of hospital confinement, days 31+
$300 per day
$300 per day
$300 per day
$300 per day; maximum of 365 days per lifetime
$200 per day of hospital confinement, days 1-30; $600 per day of hospital confinement, days 31+
Level 2
$750
$350
$300 / $300
$150 per inpatient confinement; $50 per outpatient prescription, maximum $150 per month
$150
actual coach fare or $0.75 per mile for travel by bus, plane or train; $0.75 per mile for travel by car; $100 per day for lodging
actual coach fare or $0.75 per mile for travel by bus, plane or train; $0.75 per mile for travel by car; $100 per day for lodging
Group Cancer Insurance
Blood, Plasma and Platelets
Ambulance
Maximum of 2 trips per hospital confinement for all modes of transportation combined
Inpatient Special Nursing Services
Outpatient Special Nursing Services
Medical Equipment
$300 per day
Ground: $200 per trip Air: $2,000 per trip
$150 per day of hospital confinement
$150 per day
Maximum of 1 benefit per calendar year Not Included
Physical, Occupational, Speech, Audio Therapy and Psychotherapy
$25 per visit; maximum of $1,000 per calendar year
$300 per day
Ground: $200 per trip Air: $2,000 per trip
$150 per day of hospital confinement
$150 per day
$150
$25 per visit; maximum of $1,000 per calendar year
Waiver of Premium Included Included
Internal Cancer First Occurrence Benefit Rider Level 1 Level 1
Lump Sum Benefit
Maximum 1 per lifetime
Insured or Spouse: $2,500 Eligible Dependent Child(ren): $3,750
Heart Attack/Stroke First Occurrence Benefit Rider Level 1 Level 1
Lump Sum Benefit Maximum 1 per lifetime Insured or Spouse: $2,500
Hospital Intensive Care Unit Benefit Rider
Intensive Care Unit
Maximum of 45 days per confinement for any combination of intensive care unit or step down unit
Step Down Unit
Maximum of 45 days per confinement for any combination of intensive care unit or step down unit
Increase in Coverage
$600 per day
$300 per day
Only available at annual renewal. Must be approved by APL and premium rates will be based upon the insured’s attained age. Subject to the Time Limit on Certain Defenses and Pre-Existing Condition provisions, as defined in the policy.
or Spouse: $2,500
or Spouse: $2,500
$600 per day
$300 per day
Only available at annual renewal. Must be approved by APL and premium rates will be based upon the insured’s attained age. Subject to the Time Limit on Certain Defenses and Pre-Existing Condition provisions, as defined in the policy.
Additional Rider(s)
Portability Amendment Rider Included Included
Group Cancer Insurance
Plan 1 - Monthly Premium*
Plan 2 - Monthly Premium*
*Total premium includes the Plan selected and any applicable rider premium. The premium and amount of benefits vary dependent upon the Plan selected at time of application.
Group Cancer Insurance
Refer to the Summary of Benefits for details specific to each plan.
Benefits are only payable following a diagnosis of cancer for a loss incurred for the treatment of cancer while covered under the policy. A charge must be incurred for benefits to be payable. All benefits are per covered person per calendar year, unless otherwise stated. When coverage terminates for loss incurred after the coverage termination date, APL’s obligation to pay benefits also terminates for a specified disease that manifested itself while the person was covered under the policy. All benefits are subject to the benefit maximums proposed.
A covered person means a person who is eligible for coverage under the certificate and for whom coverage is in force. An eligible dependent means your lawful spouse; your natural child, adopted child or stepchild who is under 26 years of age; a child who is under the age of 26 and/or for whom you are a party in a suit in which adoption of the child is sought; any child under the age of 26 for whom you provide medical support under an order issued under Chapter 154 of the Texas Family Code, or enforceable by a court in Texas; or grandchildren under the age of 26 if those grandchildren are the insured’s dependents for federal income tax purposes at the time application for coverage of the grandchild is made.
A hospital is not an institution, or part thereof, used as: a hospice unit, including any bed designated as a hospice or a swing bed; a convalescent home; a rest or nursing facility; a rehabilitative facility; an extended-care facility; a skilled nursing facility or facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction.
Cancer Plan Benefits
Radiation Therapy, Chemotherapy or Immunotherapy - Benefits are payable for actual charges, the amount actually paid by or on behalf of the covered person and accepted by the provider for services provided, up to the maximum benefit amount per 12-month period. The 12-month period begins on the first day covered radiation therapy, chemotherapy or immunotherapy is received. Chemotherapy and immunotherapy coverage will be limited to drugs only. Benefits not covered are defined in your certificate.
Hormone Therapy - Must be prescribed by a physician. This benefit covers drugs and medicine only. This benefit does not cover associated administrative processes, anti-nausea drugs, pain medicine, administration of anti-nausea drugs or pain medicine, or any drugs or medicines covered under the radiation therapy, chemotherapy or immunotherapy benefit.
Experimental Treatment - Must be prescribed by a physician for treatment of cancer the same as any other non-experimental treatment covered under the policy and any attached riders.
Mastectomy
Confinement
Payable following a mastectomy or lymph node dissection for the treatment of breast cancer.
Surgery
Payable when a mastectomy is performed on a covered person for a covered diagnosed cancer and surgery is performed in the hospital. Reconstructive surgery to the non-diseased breast must occur within a specified amount of time from the reconstructive surgery of the diseased breast, as determined to be appropriate by the covered person’s physician.
Prosthesis
Payable for mastectomy related prosthesis and treatment of physical complications, including lymphedemas, at all stages of mastectomy.
Ovarian/Cervical Cancer Screening
A charge must be incurred for the screening test. Payable without a diagnosis of cancer, but not payable for any test other than for the detection of ovarian and cervical cancer. Each of these tests are only payable annually, and second follow-up screening tests from an abnormal result are not covered under this benefit.
Prosthesis and Orthotic Device Benefit and Related Services
Covered benefits are limited to the most appropriate model of prosthetic device or orthotic device that adequately meets the medical needs of the covered person as determined by the covered person’s treating physician. The prosthesis benefit will include repair or replacement of a prosthetic device or orthotic device, unless the repair or replacement is necessitated by misuse by the covered person. Prosthetic related supplies such as special bras or ostomy pouches and supplies are not covered. Benefits for prosthesis in relation to a mastectomy will only be payable under the mastectomy prosthesis benefit. Benefits for a hair prosthesis is not covered under this benefit.
Limitations and Exclusions
No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date regardless of when specified disease was diagnosed. Loss must result from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The policy does not cover any other disease, sickness or incapacity which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer.
Pre-Existing Condition Exclusion
No benefits are payable for any loss incurred during the defined pre-existing condition exclusion period following the covered person’s effective date of the certificate as the result of a pre-existing condition. Pre-existing conditions specifically named or described as excluded in any part of the policy are never covered.
Group Cancer Insurance
Termination of Certificate
Insurance coverage under the certificate and any attached riders will end on the earliest of these dates: the date the policy terminates; the end of the grace period if the premium remains unpaid; the date insurance has ceased on all persons covered under the certificate; the end of the certificate month in which the policyholder requests to terminate the coverage; the date you no longer qualify as an insured; or the date of your death.
Termination of Coverage
Insurance coverage for a covered person under the certificate and any attached riders will end as follows: the date the policy terminates; the date the certificate terminates; the end of the grace period if the premium remains unpaid; the end of the certificate month in which the policyholder requests to terminate the coverage for an eligible dependent; the date a covered person no longer qualifies as an insured or eligible dependent; or the date of the covered person’s death. We may end the coverage of any covered person who submits a fraudulent claim.
Benefit Riders
All riders are part of the policy/certificate to which it is attached and are subject to all the provisions of the policy/certificate that are not in conflict with the provisions of the rider. A charge must be incurred for benefits to be payable, with the exception of the Internal Cancer First Occurrence Benefit Rider and the Heart Attack/Stroke First Occurrence Benefit Rider, if applicable to the plan. No benefits are payable for loss incurred during the defined pre-existing condition exclusion period following the covered person’s effective date of the rider as a result of a pre-existing condition, with the exception of the Hospital Intensive Care Unit Rider, if applicable to the plan.
Cancer Screening Benefit Rider
Diagnostic Testing - Must be a screening test that is generally medically recognized to detect internal cancer. Not payable for any test payable under the medical imaging benefit.
Follow-Up Diagnostic Testing - An abnormal result from a covered screening test must be received for an invasive screening test to be payable. For an invasive test involving an incision or surgery, this benefit will only be paid for a test that results in a negative diagnosis of cancer. For invasive tests that do not require an incision, this benefit will be paid regardless of the diagnosis.
Medical Imaging - CT, CAT, PET scan(s) or MRI must be requested by a physician and performed due to a diagnosis of cancer or treatment of cancer.
Limitations and Exclusions
No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment, as defined in the policy; or losses or medical expenses incurred prior to the covered person’s effective date of the rider.
Surgical Benefit Rider
Benefits are only payable for a loss incurred and treatment of a diagnosed cancer or skin cancer while covered under the rider.
Surgical Operation - Must be performed for a covered diagnosed cancer, skin cancer or for reconstructive surgery due to cancer. Pays the lesser of the surgical unit value assigned to the procedure multiplied by the unit dollar amount or the maximum per operation amount. Two or more surgical procedures performed through the same incision will be considered one operation and benefits will be limited to the most expensive procedure. Reconstructive surgery to the non-diseased breast to establish symmetry with a diseased breast must occur within 24 months of the reconstructive surgery of the diseased breast. Diagnostic surgeries that result in a negative diagnosis of cancer, surgeries required to implant a permanent prosthetic device or bone marrow transplant or stem cell transplant surgeries are not covered under this benefit
Anesthesia - Payable at 25% of the paid surgical benefit amount. Anesthesiologist services must be for the result of a covered surgery. Services of an anesthesiologist for bone marrow or stem cell transplants, skin cancer or surgical prosthesis implantation are not covered under this benefit.
Bone Marrow and Stem Cell Transplant - Payable in lieu of the surgical and the anesthesia benefits. If a bone marrow transplant and a stem cell transplant are performed on the same day, only the bone marrow transplant benefit will be payable.
Prosthesis - Surgically implanted prosthetic device must be prescribed by a physician as a direct result of surgery for cancer. Artificial limbs will be paid under the surgical implantation portion of this benefit. Temporary prosthetic devices used as tissue expanders are covered under the surgical benefit. Prosthetic related supplies and hair prosthesis are not covered under this benefit.
Limitations and Exclusions
No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date of this rider regardless of when a specified disease was diagnosed.
Patient Care Benefit Rider
Benefits are only payable for a loss incurred and treatment of a diagnosed specified disease while covered under the rider.
Hospital Confinement - Must be confined to a hospital for the treatment of a covered cancer or the treatment of a condition or disease directly caused by cancer or the treatment of cancer. Outpatient treatment or a stay of less than 18 hours in an observation unit or an emergency room is not covered.
Outpatient Facility - Facility fee must be charged and surgical procedure performed on an outpatient basis in a hospital or ambulatory surgical center. Surgical procedures for skin cancer are not covered under this benefit.
Group Cancer Insurance
Attending Physician - Services of a physician, other than a surgeon, must be required while confined in a hospital for the treatment of cancer.
Dread Disease - Must be confined in a hospital for treatment of a dread disease, as defined in the policy.
Extended Care Facility - Confinement in an extended care facility must be due to cancer, at the direction of a physician and begin within 14 days after a hospital confinement. Payable for up to the same number of days benefits were paid for the covered person’s preceding hospital confinement.
Donor - Expenses must be incurred for treatment of cancer on behalf of a covered person for a surgery due to organ transplant, bone marrow transplant or stem cell transplant. Blood donor expenses are not covered under this benefit. Donor may not be the same covered person for which expenses are incurred.
Home Health Care - Care required due to cancer must be in lieu of hospital confinement, prescribed by a physician, provided by a nurse or by a home health nurse’s aide under the supervision of a registered nurse and must begin within 14 days after a covered hospital confinement. Payable up to the same number of days benefits were paid for the covered person’s preceding hospital confinement. Caregiver may not be a member of your immediate family. Physical, speech, occupational or audio therapies or psychotherapy are not covered under this benefit. If the covered person qualifies for coverage under the hospice care benefit, the hospice care benefit will be paid in lieu of this benefit.
Hospice Care - Must be diagnosed by a physician as terminally ill, as defined in the policy, and require hospice care due to cancer. Care must be directed by a licensed hospice organization in the patient’s home or on an outpatient or short-term inpatient basis in a hospice facility.
U.S. Government Hospital / Charity Hospital / HMO - An itemized list of services must not be available due to confinement in a charity hospital, U.S. Government owned or operated hospital or coverage under a Health Maintenance Organization (HMO) or a Diagnostic Related Group (D.R.G.) where no charges are made to the covered person. If this option is elected, this benefit will be paid in lieu of any amounts payable under the rider, base policy, cancer screening benefit rider, surgical benefit rider and miscellaneous benefit rider (except for the transportation and lodging benefits), if applicable to the plan.
Limitations and Exclusions
No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date of the rider regardless of when a specified disease was diagnosed. The rider only pays for loss for cancer or dread disease resulting from definitive cancer treatment including direct extension, metastatic spread or recurrence. Proof must be submitted to support each claim. The rider also covers other conditions or diseases directly caused by cancer or the treatment of cancer. The rider does not cover any other disease, sickness or incapacity, which existed prior to the diagnosis of cancer, even though after contracting cancer it may have been complicated, aggravated or affected by cancer or the treatment of cancer except for conditions specifically provided in the dread disease benefit.
Miscellaneous Benefit Rider
Benefits are only payable for a loss incurred and treatment of a diagnosed cancer while covered under the rider.
Cancer Treatment Center Evaluation or Consultation - Treatment opinion must be obtained at a national cancer institute designated comprehensive cancer treatment center. If the comprehensive cancer treatment center is located more than 50 miles from the covered person’s place of residence, an evaluation or consultation travel or lodging benefit is also payable. This benefit is payable in lieu of the transportation and lodging benefit and family member transportation and lodging benefit listed in the rider.
Second/Third Surgical Opinion - Surgery must be recommended by an attending physician as treatment for a diagnosed cancer. Second and/ or third surgical opinion must be obtained from the consulting physician prior to surgery. Surgical opinions for reconstructive, skin cancer or prosthesis surgeries are not covered under this benefit.
Drugs and Medicine - Anti-nausea and pain medication must be prescribed by a physician and administered while receiving radiation therapy, chemotherapy, immunotherapy, a covered surgery, bone marrow transplant or stem cell transplant due to cancer. This benefit does not in include coverage for associated administrative charges or drugs or medicines covered under the radiation therapy, chemotherapy, immunotherapy or hormone therapy benefits.
Hair Piece (Wig) - Must be needed as a direct result of cancer or treatment of cancer.
Transportation and Lodging - Travel by a covered person to the hospital that provides radiation therapy, chemotherapy, immunotherapy, bone marrow transplant, stem cell transplant or surgery due to cancer must be by scheduled bus, plane, train or car and be within the United States or its territories. Hospital must be prescribed by a physician, be the nearest hospital which offers the specialized treatment and be at least 50 miles away from the covered person’s residence, using the most direct route. Proof of coach fare for bus, plane, train transportation must be provided or the per mile benefit will be paid. Travel by car will be paid at the stated rate per mile for up to 1,000 miles round trip. Benefits will be provided for only one mode of transportation per round trip. If treatment is received while confined in a hospital, benefits for transportation will be paid once per hospital confinement. Lodging for the covered person must be in a single room in a motel, hotel or other accommodation acceptable to APL. Benefit will only be paid on the days the covered person receives specialized treatment on an outpatient basis.
Family Member Transportation and Lodging - Travel must be for an adult family to be near a covered person who is receiving treatment in the hospital at least 50 miles away from the covered person’s residence, using the most direct route. If the family member travels by bus, plane or train, you will have the option to receive the coach fare benefits or the per mile benefit. Proof of coach fare for bus, plane, train transportation must be provided or the per mile benefit will be paid. Travel by car will be paid at the stated rate per mile for up to 1,000 miles round trip.
Group Cancer Insurance
Benefits will be provided for only one mode of transportation per round trip. If the covered person receives treatment while confined in a hospital, benefits for travel and/or lodging will be paid once per hospital confinement. If the family member and the covered person who is receiving treatment travel in the same car or lodge in the same room, benefits for travel and lodging will only be paid under the transportation and lodging benefit.
Blood, Plasma and Platelets - This benefit does not include coverage for any laboratory processes or colony stimulating factors.
Ambulance - Transportation must be by licensed air or ground ambulance to a hospital or from one medical facility to another. Must be admitted as an inpatient and confined in a hospital for at least 18 consecutive hours for the treatment of cancer. If both air and ground ambulance is required on the same day, only the highest benefit amount will be paid.
Inpatient Special Nursing Services - Full-time special nursing care for the treatment of cancer (other than that regularly furnished by a hospital), must be provided by a nurse and prescribed by a physician. Care must be for at least eight consecutive hours during a 24-hour period.
Outpatient Special Nursing Services - Outpatient full-time private duty nursing for the treatment of cancer at the covered person’s home must be provided by a nurse, prescribed by a physician and begin within 14 days following a hospital confinement for the treatment of cancer. Care must be for at least eight consecutive hours during a 24-hour period. Payable for up to the same number of days of the covered person’s preceding hospital confinement. If both inpatient special nursing services and outpatient special nursing services occur within the same 24hour period, only the inpatient special nursing services benefit will be paid.
Medical Equipment - Rental or purchase of medical equipment, as listed in the rider, must be prescribed by a physician for the treatment of cancer. This benefit will not be paid while the covered person is confined in a hospital.
Physical, Occupational, Speech, Audio Therapy or Psychotherapy - Must be advised by a physician as a result of cancer or treatment of cancer and performed by a licensed caregiver. If two or more therapies occur on the same day, only one benefit will be paid.
Waiver of Premium
You must remain disabled for 60 continuous days due to cancer and disability must occur while receiving treatment for such cancer. Proof of disability must be provided to APL. Proof includes, but is not limited to, a physician’s statement containing the date the cancer was diagnosed, the date disability due to cancer began, the expected date, if any, the disability will end and an employer’s statement with the last date of work and expected date of return, if known. Waiver of Premium will continue for as long as you remain disabled until the earliest of the following: the date you are no longer disabled; the date coverage ends according to the termination provisions in the certificate; or the date coverage ends according to the termination provisions in this rider. Proof of disability must be provided for each new period of disability.
Limitations and Exclusions
No benefits will be paid for any of the following: treatment by any program engaged in research that does not meet the definition of experimental treatment; or losses or medical expenses incurred prior to the covered person’s effective date of the rider regardless of when a specified disease was diagnosed.
Internal Cancer First Occurrence Benefit Rider
First diagnosis of internal cancer must be while the rider is in force. Internal cancer must be positively diagnosed by a legally licensed doctor of medicine certified by the American Board of Pathology or American Board of Osteopathic Pathology. Diagnosis must be made based on microscopic examination of fixed tissue or preparations from the hemic system (either during life or postmortem). Internal cancer does not include other conditions that may be considered pre-cancerous or having malignant potential as defined in your certificate. Benefits reduce 50% at age 70.
Limitations and Exclusions
No benefits will be paid for a diagnosis of internal cancer received outside the territorial limits of the United States or a metastasis to a new site of any cancer diagnosed prior to the covered person’s effective date, as this is not considered a first diagnosis of an internal cancer.
Heart Attack/Stroke First Occurrence Benefit Rider
First diagnosis of heart attack or stroke must be while the rider is in force. Heart attack must be diagnosed by a physician and treatment must occur within 72 hours of the onset of symptoms. Refer to your certificate for diagnosis not covered under this benefit. Benefits reduce 50% at age 70.
Limitations and Exclusions
No benefits will be paid for any loss caused by or resulting from an intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war; (If coverage is suspended for any covered person during a period of military service, APL will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request.); participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; or participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place).
Hospital Intensive Care Unit Rider
Benefits will not be paid for an ICU or step-down unit confinement that begins prior to the effective date of coverage. Refer to your certificate for confinement not covered under this benefit. Benefits reduce by 50% at age 70.
Group Cancer Insurance
Limitations and Exclusions
No benefits will be paid for any loss caused by or resulting from an intentionally self-inflicted bodily injury, suicide or attempted suicide, whether sane or insane; alcoholism or drug addiction; any act of war declared or undeclared, or any act related to war, or active service in the armed forces, or military service for any country at war; (If coverage is suspended for any covered person during a period of military service, APL will refund the pro-rata portion of any premium paid for any such covered person upon receipt of the policyholder’s written request.); participation in any activity or event while intoxicated or under the influence of any narcotic unless administered by a physician or taken according to the physician’s instructions; participation in, or attempting to participate in, a felony, riot or insurrection (a felony is defined by the law of the jurisdiction in which the activity takes place); for a newborn child born within the 10-month period following the effective date for confinements that begin within the first 30 days following the birth of such child; or for confinements caused by any heart condition during the first two years following the effective date of coverage when any heart condition was diagnosed or treated prior to the end of the 30-day period following the covered person’s effective date. The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date.
Benefit Rider(s) Termination of Coverage
Rider(s) will terminate and coverage will end for all covered persons on the earliest of any of the following: the end of the grace period if the premium for the rider remains unpaid; the date the policy or certificate to which the rider is attached terminates; the end of the certificate month in which APL receives a request from the policyholder to terminate the rider; the date of your death; if applicable to the plan, the date the lump sum benefit amount for the internal cancer first occurrence benefit rider has been paid for all covered persons under the rider; and if applicable to the plan, the date of covered person’s death or the date the lump sum benefit amount for the heart attack/stroke benefit rider has been paid for all covered persons under the rider. Coverage for an eligible dependent terminates under the rider when such person ceases to meet the definition of eligible dependent.
Additional Riders
Portability Rider
You may elect portability coverage when coverage ends under the policy for reasons other than non-payment of premium. The requirements for election of portability, election of dependent portability and termination of portability will be defined in rider attached to your certificate. When elected, APL will notify you of the amount of premium due, the frequency of the premium payments and the premium due dates.
If the cancer insurance premium is paid on a pre-tax basis, the benefit may be taxable. Please contact your tax or legal advisor regarding tax treatment of your policy benefits. Underwritten by American Public Life Insurance Company. This is a brief description of the coverage. This product contains Limitations, Exclusions and Waiting Periods. For complete benefits and other provisions, please refer to your policy/certificate. This coverage does not replace Workers’ Compensation Insurance. This product is inappropriate for people who are eligible for Medicaid coverage. This policy is considered an employee welfare benefit plan established and/or maintained by an association or employer intended to be covered by ERISA, and will be administered and enforced under ERISA. Group policies issued to governmental entities and municipalities may be exempt from ERISA guidelines. | Policy Form GC14APL Series | Texas | Limited Benefit Group Specified Disease Cancer Insurance | (10/22)
Frequently Asked Questions
What is 1-800MD?
1-800MD is an industry-leading telehealth company backed by a national network of board-certified, credentialed physicians throughout the United States. 1.800MD physicians diagnose illnesses, recommend treatment plans and prescribe medications, when deemed appropriate, for its members over the telephone or via secure bi-directional video and email.
How does 1-800MD improve quality of care?
Immediate access to medical attention can often resolve problems that, if left untreated, could eventually result in hospitalization. 1-800MD provides convenient, affordable access to healthcare at anytime and anywhere! 1-800MD provides 24/7/365 access to a physician without ever having to leave your home or office. No waiting for office visits! And, prescriptions, if needed and appropriate, are sent to the local pharmacy of your choice.
How does 1-800MD reduce health care costs?
1-800MD reduces unnecessary doctor’s office and emergency room visits and allow members alternatives to visiting their primary care physician for purely informational and other basic reasons. Data shows up to 70% of all doctor visits may be superfluous, costing billions of dollars and can be handled with a 1-800MD telephone or video consultation.
What about the doctors?
1-800MD uses a third-party credentialing agency to ensure that only the best providers are servicing our clients. The credentialing process is comprehensive and includes license verification, reference checks, and background checks. In fact, the process is fully in accordance with the American Association of Preferred Provider Organization (AAPPO) standards and is the same criteria used by hospitals to grant privileges.
Is there a minimum age requirement?
No, there is not a minimum age to consult with a 1-800MD physician. However, the physician’s ability to provide information or diagnose and treat is dependent on the nature of the symptoms and the patient’s ability to communicate his/her condition to the doctor.
I have a pre-existing condition. Will 1-800MD still accept me?
Absolutely! 1-800MD is not insurance. We do not deny access to quality care because of pre-existing conditions.
Frequently Asked Questions
Can I get a consultation after hours or on weekends?
Yes. 1-800MD services are available 24/7/365 throughout the United States. The physician will call the patient on the number that was provided generally within one hour (guaranteed within two).
Are there any restrictions on how many times I can use 1-800MD?
No. As a member, you have access to unlimited telephone consults anywhere, anytime. You only have to pay the nominal consult fee for each instance.
Are there any limitations as to what can be prescribed?
A 1-800MD physician has the ability (if medically appropriate) to prescribe a wide range of products.These include, but are not limited to, medications such as antibiotics and antihistamines. Our physicians do not prescribe medications regulated by the Drug EnforcementAgency or those that pose a potential for abuse or addiction. Also, 1-800MD physicians do not prescribe lifestyle drugs.
How are prescriptions filled?
If after consult with the physician, he/she determines that a prescription medication is indicated as part of your treatment,the doctor will electronically send the prescription to a local pharmacy of your choice.
Is Video Conferencing available?
Yes. The physician will schedule a convenient time, generally within 2 hours (guaranteed same day) to conduct the video consultation. Note, you must have a web camera and high-speed internet access to participate in a video consultation. Based on the presenting complaint or possibly state regulations, video consultations, when necessary, are suggested and initiated by the 1-800MD physician.
Are phone consultations allowed without an online Personal Medical History?
No. All active family members MUST complete a Personal Medical History form prior to receiving the first consultation.
