Provid great bene t choices to you and your family is just cial welfare of the people who make our district work so well.
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:
HOW DO I ENROLL?
Visit
1. Select "Log In" on the top right-hand corner.
2. Fill in your last name, date of birth, and the last four digits of your social security number, then click "Log In."
3. On the following page, enter the authentication code you'll receive this via text.
4.After entering the code, you'll be logged in. Proceed to review and sign off on acknowledgements, confirm your demographic information, and then make your elections for the new plan year.
•
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.
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?
Login Process
Llanoisd
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!
Employee Only
Premium: $445
District Pay: $445.00
Employee Cost: $0.00
Employee and Spouse Premium: $1,202.00 District Pay: $445.00
Employee and Child(ren)
Employee and Family
Premium: $522.00
District Pay: $445.00
Employee Cost: $77.00
Cost: $757.00 Premium: $1,358.00 District Pay: $445.00
Cost: $913.00
Premium: $757.00
District Pay: $445.00 Employee Cost: $312.00 Premium: $888.00 District Pay: $445.00
Premium: $1,513.00
District Pay: $445.00
Employee Cost: $1,068.00
Cost: $443.00
Premium: $1,723.00
District Pay: $445.00
Employee Cost: $1278.00
Premium: $460.00
District Pay: $445.00
Employee Cost: $15.00
$1,013.00
Pay: $445.00
Cost: $568.00
Premium: $1,242.00 District Pay: $445.00 Employee Cost: $797.00 Premium: $2,402.00 District Pay: $445.00
Premium: $782.00 District Pay: $445.00 Employee Cost: $337.00
Premium: $1,564.00
District Pay: $445.00
Cost: $1,957.00
$1,507.00 District Pay: $445.00 Employee Cost: $1,062.00
Employee Cost: $1,119.00 Premium: $2,841.00 District Pay: $445.00
Premium: $2,614.90 District Pay: $445.00 Employee Cost: $2,169.99
Learn the Terms.
• Premium: The monthly amount you pay for health care coverage.
• Deductible: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay.
• Copay: The set amount you pay for a covered service at the time you receive it. The amount can vary based on the service.
• Coinsurance: The portion you’re required to pay for services after you meet your deductible. It’s often a specified percentage of the costs; e.g., you pay 20% while the health care plan pays 80%.
• Out-of-Pocket Maximum: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket maximum, the plan pays 100% of allowable charges for covered services.
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
• 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
• Competitive Dividends paid on your entire HSA balance, so you can earn more
• 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
Membership in EECU is required - membership information available at 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 April 3, 2020 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.
Our free app gives you easy and secure on-the-go access to your EECU accounts. With our mobile banking app for iPhone and Android, you can:
•Check Balances
•View Transactions
•Pay Bills
•Transfer Funds
•Deposit Checks
•Set & Receive Card Activity & Fraud Alerts
Health Savings Account (HSA) Limits (Pre-tax contributions per calendar year)
Single coverage $4,150 Family Coverage: $8,300 Catch up contributions; $1,000
Term Life with Accidental Death & Dismemberment (AD&D) Insurance
How does it work?
You keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.
AD&D Insurance is also available, which can pay a benefit if you survive an accident but have certain serious injuries. It can pay an additional amount if you die from a covered accident.
Why Choose Unum?
Your employer is offering you this coverage at no cost to you.
What else is included?
A “Living” Benefit
If you are diagnosed with a terminal illness with less than 12 months to live, you can request 100% of your life insurance benefit (up to $250,000) while you are still living. This amount will be taken out of the death benefit and may be taxable.
Waiver of premium
Your cost may be waived if you are totally disabled for a period of time.
Portability
You may be able to keep coverage if you leave the company, retire or change the number of hours you work.
Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.
Work-life balance Employee Assistance Program
Get access to professional help for a range of personal and work-related issues, including counselor referrals, financial planning and legal support.
Worldwide emergency travel assistance
One phone call gets you and your family immediate help anywhere in the world, as long as you’re traveling 100 or more miles from home. However, a spouse traveling on business for his or her employer is not covered.
Who can get Term Life coverage?
Who can get Term Life coverage?
If you are actively at work at least 20 hours per week, you can receive coverage for:
If you are actively at work at least 20 hours per week, you can receive coverage for:
You: You can receive a benefit amount of $30,000. You can get up to $30,000 with no medical underwriting.
You: You can receive a benefit amount of $30,000. You can get up to $30,000 with no medical underwriting.
Who can get Accidental Death & Dismemberment (AD&D) coverage?
You: You can receive an AD&D benefit amount of $30,000.
No medical underwriting is required for AD&D coverage.
Actively at work
Eligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off.
Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage. Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage.
Exclusions and limitations
Life insurance benefits will not be paid for deaths that are caused by suicide occurring within 24 months after the effective date of coverage or the date that increases to existing coverage becomes effective. This exclusion standardly applies to all medically written amounts and contributory amounts that are funded by the employee including shared funding plans.
AD&D specific exclusions and limitations:
Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:
• Disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
• Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane
• War, declared or undeclared, or any act of war
• Active participation in a riot
• Committing or attempting to commit a crime under state or federal law
• The voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your doctor. This exclusion does not apply to you if the chemical substance is ethanol.
• Intoxication – “Being intoxicated” means your blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.
Delayed effective date of coverage
Employee: 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.
Age reduction
Coverage amounts for Life and AD&D Insurance for you will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction.
Termination of coverage
Your coverage under the policy ends on the earliest of:
• The date the policy or plan is cancelled
• The date you no longer are in an eligible group
• The date your eligible group is no longer covered
• The last day of the period for which you made any required contributions
• The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverage
Work-life balance Employee Assistance Program
The Work-life balance Employee Assistance Program, provided by HealthAdvocate, is available with select unum insurance offerings, Terms and availability of service are subjet to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.
Worldwide emergency travel assistance
Worldwide emergency travel assistance services, provided by Assist America, Inc., are available with select Unum insurance offerings. Terms and availability of service are subject to chance and prior notification requirements. Services are not valid after coverage terminates. Please contact your Unum representative for details.
This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative.
Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.
Underwritten by: Unum Life Insurance Company of America, Portland, Maine
Term Life and Accidental Death & Dismemberment (AD&D) Insurance
How does it work?
You choose the amount of coverage that’s right for you, and you keep coverage for a set period of time, or “term.” If you die during that term, the money can help your family pay for basic living expenses, final arrangements, tuition and more.
AD&D Insurance is also available, which pays a benefit if you survive an accident but have certain serious injuries. It pays an additional amount if you die from a covered accident.
Why is this coverage so valuable?
If you previously purchased coverage, you can increase it up to $150,000 to meet your growing needs — with no medical underwriting.
What else is included?
A ‘Living’ Benefit — If you are diagnosed with a terminal illness with less than 12 months to live, you can request 100% of your life insurance benefit (up to $250,000) while you are still living. This amount will be taken out of the death benefit, and may be taxable. These benefit payments may adversely affect the recipient’s eligibility for Medicaid or other government benefits or entitlements, and may be taxable. Recipients should consult their tax attorney or advisor before utilizing living benefit payments.
Waiver of premium — Your cost may be waived if you are totally disabled for a period of time.
Portability — You may be able to keep coverage if you leave the company, retire or change the number of hours you work. Employees or dependents who have a sickness or injury having a material effect on life expectancy at the time their group coverage ends are not eligible for portability.
Who can get Term Life coverage?
Who get Term Life coverage?
If you are actively at work at least 20 hours per week, you may apply for coverage for:
If you are actively at work at least 20 hours per week, you may apply for
Choose from $10,000 to $500,000 in $1,000 increments, up to 5 times your earnings. If you previously purchased coverage, you can increase it up to $150,000 with no medical underwriting. If you previously declined coverage, you may have to answer some health questions.
You: Choose from $10,000 to $500,000 in $1,000 increments, up to 5 times your earnings. If you previously purchased coverage, you can increase it up to $150,000 with no medical underwriting. If you previously declined coverage, you may have to answer some health questions.
Your spouse: Get up to $250,000 of coverage in $1,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.
Your spouse: Get up to $250,000 of coverage in $1,000 increments. Spouse coverage cannot exceed 100% of the coverage amount you purchase for yourself.
If you previously purchased coverage for your spouse, they can increase their coverage up to $50,000 with no medical underwriting, if eligible (see delayed effective date). If you previously declined spouse coverage, some health questions may be required.
If you previously purchased coverage for your spouse, they can increase their coverage up to $50,000 with no medical underwriting, if eligible (see delayed effective date). If you previously declined spouse coverage, some health questions may be required.
Your children: Get up to $10,000 of coverage in $1,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 26th birthday.
The maximum benefit for children live birth to 6 months is $1,000.
Your children: Get up to $10,000 of coverage in $1,000 increments if eligible (see delayed effective date). One policy covers all of your children until their 26th birthday.
Who can get Accidental Death & Dismemberment (AD&D) coverage?
The maximum benefit for children live birth to 6 months is $1,000.
You: Get up to $500,000 of AD&D coverage for yourself in $1,000 increments to a maximum of 5 times your earnings.
Your spouse: Get up to $250,000 of AD&D coverage for your spouse in $1,000 increments, if eligible (see delayed effective date).
Your children: Get up to $10,000 of coverage for your children in $1,000 increments if eligible (see delayed effective date).
No medical underwriting is required for AD&D coverage.
Calculate your costs
1. Enter the coverage amount you want.
2. Divide by the amount shown.
3. Multiply by the rate. Use the rate table (at right) to find the rate based on age. (Choose the age you will be when your coverage becomes effective on 09/01/2024. To determine your spouse rate, choose the age the spouse will be when coverage becomes effective on 09/01/2024.)
4. Enter your cost.
1. Enter the AD&D coverage amount you want.
2. Divide by the amount shown.
3. Multiply by the rate. Use the AD&D rate table (at right) to find the rate.
4. Enter your cost.
Exclusions and limitations
Actively at work
Eligible employees must be actively at work to apply for coverage. Being actively at work means on the day the employee applies for coverage, the individual must be working at one of his/her company’s business locations; or the individual must be working at a location where he/she is required to represent the company. If applying for coverage on a day that is not a scheduled workday, the employee will be considered actively at work as of his/her last scheduled workday. Employees are not considered actively at work if they are on a leave of absence or lay off.
An unmarried handicapped dependent child who becomes handicapped prior to the child’s attainment age of 26 may be eligible for benefits. Please see your plan administrator for details on eligibility. Employees must be U.S. citizens or legally authorized to work in the U.S. to receive coverage. Employees must be actively employed in the United States with the Employer to receive coverage. Employees must be insured under the plan for spouses and dependents to be eligible for coverage.
Exclusions and limitations
Life insurance benefits will not be paid for deaths caused by suicide occurring within 24 months after the effective date of coverage. The same applies for increased or additional benefits.
AD&D specific exclusions and limitations:
Accidental death and dismemberment benefits will not be paid for losses caused by, contributed to by, or resulting from:
• Disease of the body; diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
• Suicide, self-destruction while sane, intentionally self-inflicted injury while sane or self-inflicted injury while insane
• War, declared or undeclared, or any act of war
• Active participation in a riot
• Committing or attempting to commit a crime under state or federal law
• The voluntary use of any prescription or non-prescription drug, poison, fume or other chemical substance unless used according to the prescription or direction of your or your dependent’s doctor. This exclusion does not apply to you or your dependent if the chemical substance is ethanol.
• Intoxication – ‘Being intoxicated’ means your or your dependent’s blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state or jurisdiction where the accident occurred.
Delayed effective date of coverage
Insurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.
Delayed Effective Date: if your spouse or child has a serious injury, sickness, or disorder, or is confined, their coverage may not take effect. Payment of premium does not guarantee coverage. Please refer to your policy contract or see your plan administrator for an explanation of the delayed effective date provision that applies to your plan.
Age Reduction
Coverage amounts for Life and AD&D Insurance for you and your dependents will reduce to 50% of the original amount when you reach age 70. Coverage may not be increased after a reduction.
Termination of coverage
Your coverage and your dependents’ coverage under the policy ends on the earliest of:
• The date the policy or plan is cancelled
• The date you no longer are in an eligible group
• The date your eligible group is no longer covered
• The last day of the period for which you made any required contributions
• The last day you are actively employed (unless coverage is continued due to a covered layoff, leave of absence, injury or sickness), as described in the certificate of coverage
In addition, coverage for any one dependent will end on the earliest of:
• The date your coverage under a plan ends
• The date your dependent ceases to be an eligible dependent
• For a spouse, the date of a divorce or annulment
• For dependents, the date of your death
Unum will provide coverage for a payable claim that occurs while you and your dependents are covered under the policy or plan.
This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al or contact your Unum representative.
Life Planning Financial & Legal Resources services, provided by HealthAdvocate, are available with select Unum insurance offerings. Terms and availability of service are subject to change. Service provider does not provide legal advice; please consult your attorney for guidance. Services are not valid after coverage terminates. Please contact your Unum representative for details.
Unum complies with state civil union and domestic partner laws when applicable.
Underwritten by:
Unum Life Insurance Company of America, Portland, Maine
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ASKED & ANSWERED IS THIS COVERAGE HSA COMPATIBLE? If you (or any dependent(s)) currently participate in a Health Saving Account (HSA) or if you plan to do so in the future, you should be aware that the IRS limits the types of supplemental insurance you may have in addition to a HSA, while still maintaining the tax-exempt status of the HSA.
Eyetopia provides two vision benefits each eligibility period. You may have the opportunity to maximize your Eyetopia benefits by coordinating benefits with your Health Insurance coverage.
BENEFIT ONE 2 (choose either one of the following 2 options every 12 months):
1. Refractive Exam. One routine Vision Exam.
2. Coverage towards a medical eye exam copay or other services or materials. 2
BENEFIT TWO (choose only 1 of the following Vision Correction Options): Eyetopia provides you with 3 options for correcting your vision every 12 months.3
1.Prescription Lenses 4
CR-39 plastic single vision, bifocal, trifocal lenses
CR-39 plastic Progressive (no-line multi-focal) lenses that retail for up to $199.
CR-39 plastic Progressive (no-line multi-focal) lenses that retail for more than $199.
Polycarbonate material upgrade for child dependents (under age 26)
3.Refractive Surgery Option. 8 In lieu of spectacles or contact lenses. A $350.00 per eye allowance with contracted surgeons or a $75.00 per eye allowance with non-contracted surgeons toward the fees for refractive surgery care for the following procedures: LASIK, PRK, ICL or RLE. The member pays any amount exceeding the per eye allowance
The co-pay must be paid to the Participating Provider at the time of service.
When Health Insurance Carriers offer a comprehensive medical eye exam it creates an overlap in benefits for Eyetopia Members. If this occurs, the Member may choose another option under Benefit One as described, no co-pay is required to exercise these other options.
If your prescription has changed at least ½ diopter or your eye doctor recommends a change of lenses, you may select one of three vision correction options every 12 months.
Special Lens Materials and Non-covered Items: Ultra-light, premium PALs, rush service, service agreements, other special lens materials, oversize, other extras and any items not specifically mentioned above may be substituted provided the Member pays any amount exceeding the price of the covered benefit and the Participating Provider’s usual and customary fees for the upgrade at the time of service.
The Shaw Lens coverage includes a premium anti-reflective coating and an upgraded lens material. If the contact lens evaluation, fitting or dispensing service is performed and the Member decides to use their benefit toward an alternative vision correction option, the Member must pay the cost of the contact lens evaluation, fitting or dispensing service before another vision correction benefit option can be used.
Total maximum benefit allowance is $545.00. The Participating Provider must pre-authorize medical necessity. Non-covered Items and Exclusions – Facility fees, surgical procedures, medications and enhancements or treatments related to medical procedures.
3 4 .
Included Services and/or Eye Wear. Only those professional vision care services and/or vision correction options specifically referenced herein are included in the Eyetopia.
In-Network coverage is available through Participating Providers. Out of network services are not covered.
Rates
Employee Only: $0
Employee + 1: $7
Employee + Fam: $14
or
Educator Select Disability Insurance
How does it work?
This coverage provides a monthly benefit if you have a covered illness or injury and you can’t work for a few months — or even longer.
You’re generally considered disabled if you’re unable to do important parts of your job — and your income suffers as a result.
Why is this coverage so valuable?
You can use the money however you choose. It can help you pay for your rent or mortgage, groceries, out-of-pocket medical expenses and more.
What else is included?
Survivor Benefit
If you die while you’ve been disabled and receiving benefits for at least 180 days, your family could get a benefit equal to 3 months of your gross disability payment.
Waiver of premium
If you’re disabled and receiving benefit payments for 90 consecutive days , Unum waives your cost until you return to work.
. How much coverage can I get?
You*
You are eligible for coverage if you are an active employee in the United States working a minimum of 20 hours per week. Choose from $200 to $8,000 a month, in $100 increments not to exceed 662/3 of your monthly salary
The monthly benefit may be reduced or offset by other sources of income.
*See the Legal Disclosures for more information.
Benefit duration (BD)
This is the maximum length of time you can receive benefits while you’re disabled. You can receive benefits up to the Social Security (SS) normal retirement age.
Benefits will be paid for one month for disabilities caused by, contributed to by, or resulting from a pre-existing condition. See the disclosure section to learn more.
Educator Select Disability Insurance can replace part of your income if a disability keeps you out of work for a long period of time
Return to Work/Work Incentive Benefit
Unum supports efforts that enable a disabled employee to remain on the job or return to work as soon as possible. If you are disabled but working part time with monthly disability earnings of 20% or more of your indexed monthly earnings, during the first 12 months, the monthly benefit will not be reduced by any earnings until the gross disability payment plus your disability earnings, exceeds 100% of your indexed monthly earnings. The monthly benefit will then be reduced by that amount.
Elimination period (EP)
The elimination period is the number of days that must pass after a covered accident or illness before you can begin to receive benefits.
You may choose from the following elimination periods (injury/illness): 0/7**, 7/7**, 14/14**, 30/30, 60/60, or 180/180 days.**If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 14 days or less.)
Rehabilitation & Return to Work Assistance*
Unum has a vocational Rehabilitation and Return to Work Assistance program available to assist you in returning to work.
We will make the final determination of your eligibility for participation in the program, and will provide you with a written Rehabilitation and Return to Work Assistance plan developed specifically for you. This program may include, but is not limited to the following benefits:
•coordination with your Employer to assist your return to work;
•adaptive equipment or job accommodations to allow you to work;
• vocational evaluation to determine how your disability may impact your employment options;
• job placement services;
• resume preparation;
• job seeking skills training; or
• education and retraining expenses for a new occupation. If you are participating in a Rehabilitation and Return to Work Assistance program, we will also pay an additional disability benefit of 10% of your gross disability payment to a maximum of $1,000 per month. In addition, we will make monthly payments to you for 3 months following the date your disability ends, if we determine you are no longer disabled while:
• you are participating in a Rehabilitation and Return to Work Assistance program; and
• you are not able to find employment.
*If you return to work in your usual occupation as a result of a modification made by your Employer, Unum will reimburse you or your Employer for up to $1,000. The worksite modification benefit will be paid if Unum agrees to the modification in writing prior to its implementation. This benefit is available to you on a one time only basis.
Dependent Care Expense Benefit
If you are disabled and participating in Unum Rehabilitation and Return to Work Assistance program, Unum will pay a Dependent Care Expense Benefit when you are disabled and you provide satisfactory proof that you:
•are incurring expenses to provide care for a child under the age of 15;
•and/or start incurring expenses to provide care for a child age 15 or older or a family member who needs personal care assistance. The payment will be $350 per month per dependent, to a maximum of $1,000 per month for all dependent care expenses combined.
Pre-existing conditions
You have a pre-existing condition if:
• You received medical treatment, consultation, care or services including diagnostic measures for the condition, or took prescribed drugs or medicines for it in the 3 months just prior to your effective date of coverage; and
• The disability begins in the first 12 months after your effective date of coverage.
Exclusions and limitations
Active employee
You are considered in active employment, if on the day you apply for coverage, you are being paid regularly by your employer for the required minimum hours each week and you are performing the material and substantial duties of your regular occupation.
Delayed effective date of coverage
Insurance coverage will be delayed if you are not an active employee because of an injury, sickness, temporary layoff, or leave of absence on the date that insurance would otherwise become effective.
Benefit duration (BD)
The duration of your benefit payments is based on your age when your disability occurs. Your Long Term Disability benefits are payable while you continue to meet the definition of disability. Please refer to your plan document for the duration of benefits under this policy.
Definition of disability
You are considered disabled when Unum determines that:
•You are limited from performing the material and substantial duties of your regular occupation due to sickness or injury;
•You have a 20% or more loss of indexed monthly earnings due to the same sickness or injury; and
•during the elimination period you are unable to perform any of the material and substantial duties of your regular occupation.
After 24 months, you are considered disabled when Unum determines that due to the same sickness orinjury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.You must be under the regular care of a physician in order to be considered disabled.
The loss of a professional or occupational license or certification does not, in itself, constitute disability. “Substantial and material acts” means the important tasks, functions and operations that are generally required by employers from those engaged in your usual occupation and that cannot be reasonably omitted or modified.
Gainful occupation means an occupation that is or can be expected to provide you with an income within 12 months of your return to work, that exceeds 80% of your indexed monthly earnings if you are working or 60% of your indexed monthly earnings if you are not working.
Deductible sources of income
Your disability benefit may be reduced by deductible sources of income and any earnings you have while you are disabled, including such items as group disability benefits or other amounts you receive or are entitled to receive:
• Workers’ compensation or similar occupational benefit laws, including a temporary disability benefit under a workers’ compensation law
• State compulsory benefit laws
• Automobile liability insurance policy
• No fault motor vehicle plan
• Third-party settlements
• Other group insurance plans
• A group plan sponsored by your employer
• Governmental retirement system
• Salary continuation or sick leave plans, if applicable
• Retirement payments
• Social Security or similar governmental programs
Regardless of deductible sources of income, an employee who qualifies for disability benefits is guaranteed to receive a minimum benefit amount of 10% or $200 of the gross disability payment.
Exclusions and limitations
Benefits will not be paid for disabilities caused by, contributed to by, or resulting from:
• Intentionally self-inflicted injuries;
• Active participation in a riot;
• War, declared or undeclared or any act of war;
• Commission of or attempt to commit a felony;
• Loss of professional license, occupational license or certification; or
• Pre-existing conditions (See the disclosure section to learn more).
• War, declared or undeclared;
• Any period of incarceration while disabled
The loss of a professional or occupational license does not, in itself, constitute disability. Unum will not pay a benefit for any period of disability during which you are incarcerated. The lifetime cumulative maximum benefit for all disabilities due to mental illness is 24 months. Only 24 months of benefits will be paid for any combination of such disabilities even if the disabilities are not continuous and/or are not related. Payments can continue beyond 24 months only if you are confined to a hospital or institution as a result of the disability.
Termination of coverage
Your coverage under the policy ends on the earliest of the following:
• The date the policy or plan is cancelled
• The date you no longer are in an eligible group
• The date your eligible group is no longer covered
• The last day of the period for which you made any required contributions
• The last day you are in active employment except as provided under the covered layoff or leave of absence provision.
Unum will provide coverage for a payable claim that occurs while you are covered under the policy or plan. Unum’s LTD contracts standardly include a provision called the Social Security Claimant Advocacy Program. With this feature, claimants can receive expert advice and assistance from us regarding their Social Security Disability claim during the application and appeal process. Social Security advocacy services are provided by GENEX Services, LLC or Brown & Brown Absence Services Group. Referral to one of our advocacy partners is determined by Unum.
This information is not intended to be a complete description of the insurance coverage available. The policy or its provisions may vary or be unavailable in some states. The policy has exclusions and limitations which may affect any benefits payable. For complete details of coverage and availability, please refer to Policy Form C.FP-1 et al. or contact your Unum representative.
Underwritten by:
Unum Life Insurance Company of America, Portland, Maine
Accident Insurance can provide protection to help with the high cost of a covered accidental injury. From a simple physician’s office visit, to x-rays, ambulance transportation or an intensive care admission due to an accidental injury — unexpected expenses can add up.
How it works
CHOOSE the benefit options that best protect you and your family from a covered accident.
RECEIVE treatment for a covered accident.
FILE your claim online or mail it in. You'll receive a cash benefit to use however you wish.
Key features
Benefit funds are paid directly to you for expenses incurred as the result of a covered accident
You decide how to use the benefit funds—for medical and non-medical expenses
Multiple coverage options for your whole family
Cost-effective premiums with convenient payroll deduction
THE INSURANCE POLICY UNDER WHICH THIS CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS’ COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS’ COMPENSATION SYSTEM.
Summary of Benefits for Llano ISD
Spouse Coverage
Dependent Child(ren) Coverage
Continuation Coverage
Based on defined qualifying events defined in your certificate
Portability Coverage
Post-Accident Time Frame Requirement
Unless otherwise defined, confinement, stay, treatment, therapy, diagnosis, surgery, paralysis, dismemberment, death or prescription of covered items must occur within the defined number of days after a covered accident or for inpatient rehabilitation, if applicable to the plan, within the defined number of days after the date of discharge from the hospital
Hospital Benefits
Hospital Admission
Spouse benefit amounts are 100% of the insured’s benefit amount, unless otherwise stated.
Dependent child(ren) benefit amounts are 100% of the insured’s benefit amount, unless otherwise stated.
Coverage will be continued for 12 months following the date the insured ceased active employment.
Included, age 79 or younger
Pays only once per day, even if the confinement or observation long stay is the result of more than one injury. $500/5 days
Spouse benefit amounts are 100% of the insured’s benefit amount, unless otherwise stated.
Dependent child(ren) benefit amounts are 100% of the insured’s benefit amount, unless otherwise stated.
Coverage will be continued for 12 months following the date the insured ceased active employment.
Included, age 79 or younger
$1,000/5 days
Group Accident Insurance
Hospital Confinement Pays once per day
ICU Confinement Pays once per day
Initial Treatment Benefits
Observation Room Treatment Pays once per day
Emergency Room Treatment Pays once per day
Urgent Care Treatment Pays once per day
Physician’s Office Treatment Pays once per day
Diagnostic Benefits
X-ray
Major Diagnostic Exam
Therapy Benefits
Inpatient Rehabilitation
Physical Therapy
Extended Treatment
Coma and Paralysis Benefits
Coma
Must continue for at least 30 days before a benefit is payable. Pays once per covered accident.
Paralysis
Must continue for at least 60 days before a benefit is payable
Accidental Death Benefits
Accidental Death
Common Carrier Accidental Death
Dismemberment Benefits
Dismemberment - Single, Double, Finger/Toe
Dislocation Benefits
$100/365 days
$100/30 days
$50/5 days
$50/10 days
$50/10 days
$25/10 days
$100/5 days
$100/5 days
$50/60 days
$15/20 days
$15/20 days Benefits includes Chiropractic Therapy, Acupuncture Therapy
$5,000
Quadriplegia - $5,000 Paraplegia - $2,500
Insured - $25,000
Spouse - $25,000
Dependent Child(ren) - $25,000
Insured - $50,000
Spouse - $50,000
Dependent Child(ren) - $50,000
$500 to $10,000
Dislocation (open reduction) - based on joint involved $225 to $3,000
Dislocation (closed reduction) percentage1
Partial dislocation percentage1
Fracture Benefits
Fracture (open reduction) - based on bone involved
Fracture (closed reduction) percentage1
fracture percentage1
Laceration Benefits
Based on length of laceration
Inpatient Surgery Benefits
$200/365 days
$200/30 days
$100/5 days
$150/10 days
$150/10 days
$75/10 days
$200/5 days
$200/5 days
$100/60 days
$25/20 days
$25/20 days Benefits includes Chiropractic Therapy, Acupuncture Therapy
$10,000
Quadriplegia - $10,000
Paraplegia - $5,000
Insured - $50,000
Spouse - $50,000
Dependent Child(ren) - $50,000
Insured - $100,000
Spouse - $100,000
Dependent Child(ren) - $100,000
$1,250 to $25,000
$450 to $6,000
of
to $3,000 $450 to $6,000
$25 to $200/5 days
$50 to $400/5 days
Pays once per covered accident based on type of surgery $375 $750
General Anesthesia1
Group Accident Insurance
Outpatient Surgery Benefits
Tendon/ligament/rotator cuff/torn knee cartilagebased on type of surgery
Other miscellaneous surgery for repair
Exploratory Surgery
Brain Injury Benefits
Concussion
Severe Traumatic Brain Injury (TBI)
Severe Burn Benefits
2nd degree & 3rd degree Burns
Pays once per covered accident based on degree and size of burn
$200/5 days
$200/5 days
$200/2 days
$200/5 days
$1,250/5 days
$250 to $5,000
$400/5 days
$400/5 days
$400/2 days
$400/5 days
$2,500/5 days
$500 to $10,000
Skin Graft 1% of severe burn benefit amount 1% of severe burn benefit amount
Lodging and Travel Benefits
Transportation for treatment for the injured covered person by train, bus, coach or plane must be at least 100 miles from the covered person’s primary residence. Not payable if ambulance benefit is payable.
Non-Local Transportation
Family Lodging
Ambulance Benefits
Air Ambulance
Ground or Water Ambulance
Emergency Dental & Vision Treatment Benefits
$200/up to 3 round trips
$100/30 nights
$600/5 days
$200/5 days
Emergency dental extraction of a broken sound, natural tooth $50
Emergency repair of a broken sound, natural tooth with a crown
Eye surgery or removal of a foreign object
Appliance and Prosthesis Benefits
Wheelchair, motorized scooter, walker, walking boot, any other medical device used for mobility, including a brace, cane and crutches - based on type of appliance
Prosthesis
Pays once per covered accident, per plan year based on number of devices
Other Benefits
Auto & Home Modification
Blood/Plasma/Platelets
Epidural/Pain Management
Organized Sports Benefit Booster1
Post-Traumatic Stress Disorder (PTSD)
Prescription Drugs
Pays once per day
Accident Screening Benefit
Accident Screening1
$50/5 days
$500
$500/5 times
$300/5 days
$400/up to 3 round trips
$200/30 nights
$900/5 days
$300/5 days
$100/5 days
$1,500
$1,000/5 times
$400/5 days
$50/5 days $100/5 days
$5/3 days per month, up to 12 days per plan year
$50/1 per covered person, up to 4 per family. Additional screening tests included
$5/3 days per month, up to 12 days per plan year
$50/1 per covered person, up to 4 per family. Additional screening tests included
1 Spouse and/or dependent child(ren) benefit amount and/or percentage is the same as the insured’s benefit amount and/or percentage.
Group Accident Insurance
Group Accident Insurance
Fracture Benefits - If multiple fractures or chip fractures, if applicable to your plan, are suffered as the result of one covered accident, APL will not pay more than two times the greatest fracture benefit payable for an individual bone per covered accident for each covered person. No more than one fracture benefit per bone per covered accident will be paid for each covered person.
Laceration Benefits – Treatment for the laceration must occur within 14 days after the covered accident occurs. Benefits are payable when laceration is repaired with stitches by a physician as a result of a covered accident. Payable up to the defined number of days per plan year for each covered person. Payable only once per covered accident for each covered person, even if treatment is received for more than one laceration.
Inpatient Surgery Benefits
Inpatient Surgery Benefits – Surgery must be performed by a physician within the defined number of days after the covered accident occurs.
General Anesthesia – Inpatient surgery benefit must be payable and general anesthesia must be received during inpatient surgery for this benefit to be payable.
Outpatient Surgery Benefits
Outpatient Surgery Benefits - Surgery must be performed by a physician within the defined number of days after the covered accident occurs.
Exploratory Surgery - Exploratory arthroscopic surgery must be performed by a physician within the defined number of days after the covered accident occurs.
Brain Injury Benefits - Concussion must be diagnosed by a physician. A severe traumatic brain injury (TBI) must be diagnosed by a neurologist, if applicable to your plan. If both a concussion and a severe traumatic brain injury (TBI) occur in the same covered accident, only the highest benefit will be payable, if applicable to your plan.
Severe Burn Benefits
Severe Burn Benefits – No benefits will be paid if the degree and percentage of the body surface burned is not shown as a covered benefit.
Skin Graft – Severe burns benefit must be payable and skin graft treatment undergone for this benefit to be payable.
Lodging and Travel Benefits
Non-Local Transportation – Treatment in a hospital must be advised by a physician because treatment for an injury is not available locally. Payable only once per round trip for up to the defined number of round trip(s) per plan year for each covered person. This benefit is not payable on any day that an ambulance benefit is payable.
Family Lodging – Expense must be incurred for lodging by an adult family member accompanying a covered person who is confined away from the family member’s primary residence for treatment as the result of a covered accident. Payable up to the defined number of nights per plan year for each covered person. Payable only once per night, even if more than one family member accompanies the covered person; if the adult family member is providing care for the covered person or is acting as an advocate on the behalf of the covered person; and while the covered person is receiving treatment in a hospital that is advised by a physician because treatment for an injury is not available locally. Proof of the expense incurred for lodging, evidenced by a receipt, invoice or another appropriate document, must be submitted with the claim. Mileage is measured as the geographic distance from the family member’s primary residence to the facility at which the confinement occurs.
Ambulance Benefits – Ambulance transportation, to or from a hospital or between medical facilities, must occur within 168 hours after the covered accident.
Emergency Dental & Vision Treatment Benefits – Emergency dental work or vision work must occur within the defined number of days after the covered accident. Payable once per plan year for each covered person and only once per covered accident even if multiple teeth or eyes are affected. If more than one type of procedure is performed on the same day, only the highest emergency dental and vision treatment benefit will be payable.
Appliance and Prosthesis Benefits
Appliance – Medical appliance must be prescribed within the defined number of days after the covered accident occurs. Payable the defined number of days per plan year for each covered person. If more than one type of medical appliance is prescribed on the same day, only the highest appliance benefit will be payable.
Prosthesis – Prosthetic device, artificial limb or artificial eye must be prescribed by a physician and received within the defined number of days after the covered accident occurs.
Other Benefits
Auto & Home Modification – Residence and/or vehicle modification must occur within 365 days after the covered accident occurs.
Blood/Plasma/Platelets - Payable up to the defined number of days per plan year for each covered person. Transfusion of blood, plasma or platelets must be received during a surgery for which an inpatient surgery or outpatient surgery benefit is payable.
Epidural/Pain Management – Epidural injection, for treatment of an injury, must occur within the defined number of days after the covered accident occurs.
Group Accident Insurance
Organized Sports Benefit Booster – Pays an additional percentage only if a covered person suffers an injury for which a benefit is payable under the certificate and the injury occurred while the covered person was participating in an organized sport.
Post-Traumatic Stress Disorder (PTSD) – Must be under the active care of a physician or mental health professional for the treatment of PTSD.
Prescription Drugs – Drug must be prescribed by a physician or medical professional within 365 days after a covered accident occurs. Benefit will not be paid for any drug that is received or prescription that is filled while a covered person is confined in any medical facility.
Accident Screening Benefit – Service must be rendered by a physician while the covered person is not an inpatient in a hospital and while the covered person is covered under the policy. Covered tests are defined in your certificate.
Exclusions
APL will not pay benefits for a claim that is caused by, contributed to by, or resulting from any of the following: voluntary intoxication (as defined by the law of the jurisdiction in which such intoxication occurred) or while under the influence of any narcotic, drug or controlled substance, unless administered by or taken according to the instructions of a physician or medical professional; voluntary intoxication through use of poison, gas or fumes, whether by ingestion, injection, inhalation or absorption; committing or attempting to commit a felony, or active participation in a riot, insurrection or terrorist activity; intentional self-harm or attempting or committing suicide, whether sane or not; war or any act of war, whether declared or undeclared, or any act related to war while serving in the military forces or any auxiliary unit thereto (the pro-rata portion of any premium paid for any such covered person will be refunded upon receipt of your written request); any injury that occurs while a covered person is engaged in an illegal occupation or activity, or legally incarcerated in a penal or correctional institution; cosmetic surgery or other elective procedure that is not medically necessary, except for reconstructive surgery incidental to or following surgery for trauma to the affected body part; diagnosis or treatment received outside the United States, its territories or Canada, except for emergency care received within seven days of an injury; treatment provided at a facility, office or other location owned or operated by a covered person or family member; treatment of mental or nervous disorder(s) that is not a direct result of trauma sustained by a covered accident; any bacterial infection (except pyogenic infections which shall occur with and through an accidental cut or wound); operating, learning to operate, serving as a crew member of any aircraft or hot air balloon, including those which are not motor-driven, unless flying as a fare paying passenger; travel or flight in any aircraft or hot air balloon, including those which are not motor-driven, if it is being used for testing or experimental purposes, used by or for any military authority, or used for travel beyond the earth’s atmosphere; participation in any organized sport in a professional or semi-professional capacity; riding or driving an air, land or water vehicle in any organized and scheduled race, speed or endurance contest; participation in base jumping, bungee jumping, cliff jumping, kite surfing, kiteboarding, luging, parachuting, paragliding, parakiting, parasailing, ski jumping, skydiving, spelunking, tricking or wingsuit flying; or an on the job injury, if applicable to your plan. Additionally, no benefits will be paid for an injury that occurs prior to a covered person being covered under the certificate.
Termination of Coverage
Your coverage ends on the earliest of: the date you leave an eligible class under the certificate; any premium due date, if full payment for your coverage is not made within the grace period following the premium due date; the date the policy terminates and you have not elected coverage under the portability provision of the certificate; the last day of the month during which you attain the limiting age defined in your certificate. If dependent coverage is included in your plan, coverage for a dependent ends on the earliest of: your termination date; the last day of the month during which the dependent is no longer eligible for coverage due to a change to the policy; or the last day of the month during which a dependent no longer satisfies the definition of a dependent. Termination will not affect a claim that occurred while a covered person was covered by the policy.
2305 Lakeland Drive | Flowood, MS 39232 ampublic.com | 800.256.8606
If the accident 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.
This is not intended to be a complete description of the insurance coverage offered. While benefit amounts stated in this summary are specific to your coverage, other items may summarize our standard product features and not the specific features of your coverage. Provisions are provided in the certificate and this summary does not modify those provisions or the insurance in any way. This is not a contract. A certificate 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 certificate, the certificate will govern.
Underwritten by American Public Life Insurance Company | This is a brief description of the coverage. This product contains limitations and exclusions. For complete benefits and other provisions, please refer to the policy/certificate. This is not a Medicare supplement policy. 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, union 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 GAO21APL Series | Texas | Group Accident Insurance | Limited Benefit Group Accident
DID YOU KNOW?
are sent to the emergency room through ground or air ambulance every year * .
Insurance companies may not cover all air and ground ambulance expenses which can result in max in-network out-of-pocket** costs of:
$8,700 Individual $17,400 Family
Ground ambulance out-of-network transportation costs may be even higher than in-network since the No Surprises Act does not apply to ground ambulance at this time.
EMERGENT PLUS MEMBERSHIP BENEFITS
A MASA MTS Membership provides the ultimate peace of mind at an a ordablerateforemergencygroundand air transportation assistance expenses within the continental United States, Alaska, Hawaii, and while traveling in Canada, regardless of whether the provider is in or out of your group healthcare bene tsnetwork.Afterthe group health plan pays its portion, MASA works with providers to make certain our Members have no out-ofpocket expenses~ for emergency ambulance transportation assistance and other related services.
Emergency Air Ambulance Coverage1
MASA MTS covers out-of-pocket expenses associated with emergency air transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.
Emergency Ground Ambulance Coverage1
MASA MTS covers out-of-pocket expenses associated with emergency ground transportation to a medical facility for serious medical emergencies deemed medically necessary for you or your dependent family member.
Hospital to Hospital Ambulance Coverage1
MASA MTS covers out-of-pocket expenses that you or a dependent family member may incur for hospital transfers, due to a serious emergency, to the nearest and most appropriate medical facility when the current medical facility cannot provide the required level of specialized care by air ambulance to include medically equipped helicopter or xed-wingaircraft.
Repatriation to Hospital Near Home Coverage1
MASA MTS provides services and covers out-of-pocket expenses for the coordination of a Member’s nonemergency transportation by a medically equipped, air or ground ambulance in the event of hospitalization more than one hundred (100) miles from the Member’s home if the treating physician and MASA MTS’ Medical Director says it’s medically appropriate and possible to transfer the Member to a hospital nearer to home for continued care and recuperation.
Contact Your Representative, to learn more:
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 Llano 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
Cancer Treatment Center Evaluation or Consultation -1 per lifetime
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
$6,000
$1,000 per device
$100 per device
Level 3
Insured or Spouse:
$200 per day of hospital confinement, days 1-30; $400 per day of hospital confinement, days 31+
Eligible Dependent Child(ren):
$400 per day of hospital confinement, days 1-30; $800 per day of hospital confinement, days 31+
$400 per day surgery is performed
$40 per day of hospital confinement
$200 per day of hospital confinement, days 1-30; $400 per day of hospital confinement, days 31+
$200 per day
$200 per day
$200 per day
$200 per day; maximum of 365 days per lifetime
$200 per day of hospital confinement, days 1-30; $400 per day of hospital confinement, days 31+
Level 2
$750
$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
$500 per test; 2 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
$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
Maximum of 1 benefit per calendar year
Physical, Occupational, Speech, Audio Therapy and Psychotherapy
$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
$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 4 Level 4
Lump Sum Benefit
Maximum 1 per lifetime
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
Additional Rider(s)
Portability Amendment Rider
Insured or Spouse: $10,000 Eligible Dependent Child(ren): $15,000
$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.
Included
Insured or Spouse: $10,000 Eligible Dependent Child(ren): $15,000
$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.
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.
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.
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.
Group Cancer Insurance
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.
MEMBER INFORMATION
Providing Fast And Convenient Care
For Your Medical Needs…
COMMONLY TREATED CONDITIONS
• Allergies
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• Consulting for International and Domestic Travel
• AND MUCH MORE!
•Access to licensed, board-certified physicians
• Little or no time missed from work
•No crowded waiting rooms or appointment times
Activate your account online at www.1800MD.com or by calling member services at 1.800.530.8666. Once activated, you will need to setup your member profile and complete your electronic health record.
Health and pharmacy information must be completed before requesting a consultation.
Login to your account online or call member services at 1.800.530.8666 to request a consult anytime 24/7.
What
is 1.800MD?
1.800MD is a national telehealth company specializing in convenient, quality medical care. With board-certified physicians in all 50 states*, those in need can obtain diagnosis, treatment and a prescription, when necessary, through the convenience of a telephone and digital communications.
*Subjecttostateregulations.
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.
Can I get a consultation after hours or on weekends?
Yes. 1.800MD is available 24 hours a day, seven days a week and 365 days a year.
CONVENIENCE
Talk to a doctor any time, day or night, on the weekend or when traveling away from home. No inconvenience or hassle of traveling to the doctor’s office, urgent care or ER and waiting to be seen.
SAVES
MONEY
1.800MD reduces unnecessary doctor’s office and emergency room visits. Up to 70 percent of all urgent care and emergency room visits are unneeded, costly and can be handled with a 1.800MD telephone or video consultation.
QUALITY CARE
With an average of 15 years of internal medicine, family practice or pediatrics experience, you can rest assured each physician is properly licensed in your state, board-certified and verified by the National Physician Data Base and the American Medical Association.
CONTINUITY OF CARE
Real-time access to medical records, and the ability to send them to your primary care physi-cian or other providers.
WELLNESS AND PREVENTATIVE HEALTH TOOLS
The 1.800MD member portal contains information and tools to help you make informed health care decisions.
E-PRESCRIPTIONS
If a 1.800MD physician recommends medication as part of your treatment plan, the prescription will be digitally sent to the local pharmacy of your choice.
Advice
Provider Law Firm for any personal legal
Letters and Phone Calls on Your Behalf
Provider Lawyer
Contract and Document Review
pages each 24/7 Emergency Assistance
coverage depends on plan, such as: if you’re arrested or detained, if you’re seriously injured, if you’re served with a warrant, or if the state tries to take your child(ren).
Uncontested Name Change
Assistance*
Uncontested name change prepared by Provider Law Firm
Uncontested Adoption Representation*
Representation by your Provider Law Firm for uncontested adoption proceedings
Uncontested Separation/Divorce Representation*
Representation by your Provider Law Firm for uncontested legal separation, uncontested civil annulment and uncontested divorce proceedings
Document Preparation Standard Will Preparation
• Will preparation and annual reviews and updates for covered members
• Other documents available: Living Will,
Residential Loan Document Assistance
Mortgage documents (as required of the borrower by the lending institution) prepared by your Provider Law Firm for the purchase of your primary residence
Auto
Motor Vehicle Services assistance assistance for manslaughter, involuntary manslaughter, negligent homicide or vehicular homicide
• Up to 2.5 hours of help with driver’s license reinstatement and property damage collection assistance of
driver’s license and is driving a noncommercial motor vehicle
IRS
IRS Audit Legal Services
• One hour of consultation, advice or audit by the IRS
• If your case goes to trial, you’ll receive 46.5 hours of your Provider Law Firm’s services you enroll
25% Preferred Member Discount
You may continue to use your Provider Law Firm for legal situations that extend beyond plan coverage. The additional
standard hourly rates. Your Provider Law Firm will let you know when the 25% discount applies, and go over these fees
Your Plan Cover: LEGAL PLAN
Family Plan:
• The member
• The member’s spouse/ domestic partner
children under age 26 living at home
• Dependent children under age legal guardian
• Never married, dependent,
college students up to age 26
• Physically or mentally disabled children living at home
date of your membership. For detailed information about the legal services provided by the LegalShield contract, go to http://www.legalshield.com/info/legalplan. Business issues are not included; however, plans providing those services are available.
. See plan contract for
Download the free app from the App Store or Google Play.
Identity Consultation Services
As a member, you have unlimited access to identity consultation services provided by our licensed private investigators. The investigator will advise you on best practices for identity
Consultative services include:
Privacy and Security Best Practice
• Consult on best practices for the use and protection of your Social Security number and Personally Identifying Information (PII).
• Provide consultation on current trends, scams and schemes related to identity theft and fraud issues.
• online activities and consumer privacy.
• Provide the knowledge to help protect your identity and to inform you of your rights under federal and state laws.
• Help interpret and analyze your credit report and
• Consult on public record inquiries, background searches or credit freeze issues.
Event-Driven Consultation Support
• Lost/stolen wallet assistance
• Data Exposure/Data Breach
• Safeguards
• Monthly identity theft updates to help educate and protect
• Consultation services are limited to the solutions, best practices, legislation and established industry and organizational procedures in place in the or productive by our licensed private investigators.
Privacy Monitoring
Black Market Website Surveillance (Internet Monitoring)
Monitors global black-market websites, Internet Relay Chat (IRC), chat rooms, peer-to-peer sharing networks and social feeds or your PII, looking for matches of name, date of birth, Social Security number, email addresses (up to 10), phone numbers (up to 10), driver’s license number, passport number and medical ID numbers (up to 10).
Keeps track of a personal mailing address and sends an alert when a change of address has been requested through the United States Postal Service.
Social Media Monitoring
Monitors multiple social media accounts and content feeds for privacy and reputational risks. You will be alerted to privacy risks like the exposure of PII, including street address, date of birth or Social Security number, as well as reputational risks like foul language, drug and alcohol references, or discriminatory terms.
Security Monitoring
Black Market Website Surveillance (Internet Monitoring)
Monitors global black market websites, Internet Relay Chat (IRC), chat rooms, peer-to-peer sharing networks and social feeds for PII, looking for matches of Social Security number, credit card numbers (up to 10) and bank account numbers (up to 10).
Court Records Monitoring
Detects criminal activity that may be associated with your personal information, sending an alert when signs of potential criminal identity theft are recognized.
Credit Monitoring
Payday Loan Monitoring
Alerts you when your personal information is associated with short-term, payday or similar cash-advance loans.
Password Manager
IDShield Vault allows you to manage and generate passwords. With a browser plugin installed,
when browsing on the web and sync across devices to provide secure auto backup.
Employee Family Plan Coverage
Minor Identity Protection
(Formerly Safeguard for Minors - Family Plan only)
NEW!
New! High Risk Account Monitoring.
As a member, you have access to continuous credit monitoring through TransUnion. Monitoring can be accessed immediately via the member’s service portal dashboard on myidshield.com or through the free IDShield mobile app. Credit activity will be reported promptly to the member
Credit Inquiry Alerts
Allows parents/guardians of up to 10 dependents under the age of 18 to monitor for potentially fraudulent activity associated with their child’s SSN. Unauthorized names, aliases and addresses that become associated with a minor’s name and date of birth may be detected. The service monitors public records in all 50 States including: real estate data, new mover information, property and recorder of deed registration, county assessor/record data, internet job site providers, state occupational license data providers, voter information, public records/ court proceedings, bankruptcies, liens and judgements. Parents/ Guardians are provided a baseline scan, with
Dependent Identity Theft Protection
(Ages 18 to 26 - Family Plans only)
NEW!
New! Instant Hard Inquiry Alerts.
purposes of opening a new credit account. Alerts may also be triggered when a creditor requests a
account, a lease for a new apartment or even an application for a new mortgage. Inquiry alerts can be helpful in determining when an identity thief is opening a new account without your authorization.
Monthly Credit Score Tracker
You’ll receive a monthly credit score report from TransUnion that plots your score month-by-month on a graph, giving you the ability to see how your credit scores have changed over time, along with score factors that provide insight into what events may have caused your credit score to change.
If you have dependents between the ages of 1826, that either live at your home or are a full-time student and have never been married, they are still eligible for protection. Dependents who fall under this category will receive unlimited consultation and complete restoration by our licensed private investigators. Note that monitoring is not available for dependents in this category.
Identity Restoration
Our Licensed Private Investigators perform the bulk of the restoration work required to restore a member’s identity to pre-theft status.
IDShield Service Guarantee
We don’t give up until your identity is restored.
Note: Purchase of IDShield requires member to have a valid email address.
The following are excluded from the services: LEGAL REMEDY - Any stolen identity event where the victim is unable or unwilling to prosecute the person DISHONEST ACTS - Any dishonest, criminal, malicious or fraudulent acts, if the member(s) FINANCIAL LOSS - Membership services do not cover any purchases of retail goods or services online, by phone, by mail or direct. BUSINESS - A covered stolen identity event does not include business losses, including but not limited to the theft or unauthorized or illegal use of the victim’s business name, DBA or any other method of identifying the victim’s business activity. DORMANCY OR INACTIVITY - If the victim cannot or does not provide the items required to open a case, or having initiated restoration, if the victim fails to respond to or cooperate in activity facilitated for the purpose of ID restoration. INCURABLE – Because of the nature of the activity associated with identity theft, some issues cannot be resolved. For example, if a fraudulent act results in the victim’s name being improperly placed on a restoration services. IDShield plan members should consult their individual plans to determine availability of legal services.
Save with these incredible MEMBERPERKS
Your LegalShield and IDShield memberships are simply amazing. And in addition to the privileges that are already yours, we have added these MEMBERPERKS with hundreds of merchants and thousands of discounts. Members can access savings at both national and local companies on everyday purchases such as tickets, electronics, apparel, travel and more. Members have the opportunity to save, on average, over $2,000 per year. MEMBERPERKS can save you enough to pay for your membership for years to come!
RECEIVE EXCLUSIVE DISCOUNTS
Access your members-only discounts in categories such as:
“MEMBERPerks pays for my membership!” — Martha S.
“I saved 20% at Advance Auto and I also saved 30% on movie tickets on date night with my wife. This membership is it!”
— Andre E. cell phone monthly charge!”
— Paulette M.
Getting Started
To sign up, simply login at legalshield.com, click on the Resources tab, then click on MEMBERPERKS. If you don’t already have an account, follow the simple on-screen instructions to make an account with your personal or work email and LegalShield membership number.
Create Your Account
1. ACTIVATE your account by visiting accounts.legalshield.com/activate . (Tip: Your membership number can be found in the email welcoming you as a LegalShield Member.)
2. DOWNLOAD the mobile app.
3. SIGN IN by selecting “I am a member” and use the email and password you just created in step 1.
Identity Theft and Privacy Protection
Guarding your personal information is as EASY as 1-2-3!
Follow these steps to create your IDShield account.
1. Create an Account with LegalShield
Create your account at accounts.legalshield.com using your member number. If you already have a LegalShield account, simply sign-in.
2. Add Your Information to be Monitored
Select “Credit and Dark Web” from your IDShield Member Portal and create your identity protection account. Once you create your account you can add the personal information you want to monitor, including your social media accounts.
From the IDShield Member Portal you can also access your password manager, VPN Proxy One and anti-malware protection services provided by Trend Micro™. To download these services you will be asked to create a separate account with Trend Micro.
3. Download the IDShield Mobile App
After you create your identity protection account, download the IDShield mobile app and sign-in using your created login credentials.
If you have questions about setting up your account or forgot your member number, please call IDShield Member Services at 1-888-494-8519. IDShield Member Services is available 7 a.m.-7 p.m. CT, Monday-Friday.
life insurance highlights
For the employee
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! Llano 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
PlanYear:……………… September 1st through August 31st
Maximum Health FSA Limit……… Current IRS limit …See Code Section 125(i)(2) or current enrollment information
MaximumDependentCareLimit:……..……………..……..$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 60 days
Dependent Care (DCAP)..………………………….....…...60 days
Deadlines to Incur Expenses on Elected Funds
Health FSA October 30 following Plan Year End DCAP………………………...October 30 following Plan Year End
Deadlines to File for Reimbursement Run-outPeriod:………………………………… 75 days
Health FSA and DCAP November 14 following plan year end
Mid-Year Terminations
FSA ………………
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:
30 days following termination date DCAP……………
30 days following termination date
OrthodonticReimbursement……….aspaidper service contract or in full at time of banding Upfrontpayment……………….…………..…… allowed
AM I ELIGIBLE TO PARTICIPATE
If you work for the company, you will be eligible to join the Plan following your date of employment
You will enter the Plan on 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
A Health Savings Account is a portable benefit which allows participants insured by a Qualified High Deductible Insurance Plan to save for deductibles and other expenses not covered under the Plan. If you participate in this benefit you cannot participate in the Health Flexible Spending Account benefit
Dependent Care Flexible Spending Account:
The Dependent Care Flexible Spending Account (DCAP) enables you to pay for out-of-pocket, work-related dependent day-care cost. Please see the Summary Plan Description for the definition of eligible dependent. The law places limits on the amount of money that can be paid to you in a calendar year. Generally, your reimbursement may not exceed the lesser of: (a) $5,000 (if you are married filing a joint return or you are head of a household) or $2,500 (if you are married filing separate returns); (b) your taxable compensation; (c) your spouse’s actual or deemed earned income.
Flexible Benefits Plan Highlights
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
Updated: 6/10/2024
Llano Independent School District
ARE YOU AWARE OF YOUR 403(b) BENEFIT?
THE OPPORTUNITY
You have the opportunity to save for retirement by participating in your Employer’s 403(b) retirement plan. A 403(b) plan is a retirement plan for certain employees of public schools, tax-exempt organizations and ministries. We recommend that all employees visit our education page which can be found here: www.omni403b.com/Employees/Education WHY SAVE WITH 403(b)?
1. You do not pay income tax on allowable contributions until you begin making withdrawals from the plan, usually after your retirement.
2. Pre-tax investment gains in the plan are not taxed until distribution and eligible ROTH investment gains are tax free.
3. Generally, retirement assets can be carried from one employer to another.
New accounts may be opened with the following approved service providers.
•American Fund/Capital Guardian
•Americo Financial Life/Annuity
•Equitable (formerly AXA)
•Horace Mann Life Ins. Co.
•National Life Group (LSW)
•PlanMember Services Corp.
•ROTH - Equitable (formerly AXA)
•ROTH - PlanMember Services Corp.
•ROTH - Vanguard Fiduciary Trust Co.
•Security Benefit
•Thrivent Financial for Lutherans
•Vanguard Fiduciary Trust Co.
HOW CAN I PARTICIPATE?
Prior to contributing you must open an account with an investment provider authorized in the Plan, a list of which is available on the right. You may then complete a Salary Reduction Agreement (SRA) online at: www.omni403b.com/SRA
If you are already contributing to your Employer’s Plan and you want to change your contribution amount or investment provider, simply complete and submit a new SRA. Once we are in receipt of the newly completed SRA, we will notify your employer to begin contributions. HOW MUCH CAN I CONTRIBUTE ANNUALLY?
In 2024, you may contribute up to $23,000 if you are 49 years of age or below and up to $30,500 if you are 50 years of age and over. You may also be entitled to additional catch-up provisions like the 15 Year Service Catch-up. Please contact OMNI’s Customer Care Center at 877.544.6664 for further details.
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Click the link below for an investment professional to reach out to you.
Llano Independent School District Plan Detail Page
