hurst euless bedford i.s.d. employee benefits · pdf filen form. heb isd benefits. ... •...
TRANSCRIPT
Hurst Euless Bedford I.S.D.Employee Benefits2016 - 2017
Presented By: Karen Rose HEB ISD Benefits & Risk Manager
Contacts in the Benefit Office
Karen Rose• Benefits & Risk Manager• [email protected]
Maria Ortiz• Benefits Secretary• [email protected]• Ext. 2056 or 817-399-2056
Enrollment & PaperworkDue within 30 days of your Hire Date
Enroll Onlinewww.in-roll.com
•Your default login is your first initial of your first name followed by your last name and the last 4 digits of your social security number •Example: John Doe SSN
123-45-6789•Login ID: jdoe6789
•Your default password is the word “hebisd”
The following items must be turned in
to the benefits office:
• Employee Acknowledgement of the Alliance Direct Contracting Program
• Sick Leave Bank Enrollment/Declination Form
HEB ISD BENEFITSGUIDE
Please visit the Benefits web page for plan documents and more details on
each benefit.
This refers to the page
number in the Benefits Guide
Booklet
1
Login Pagewww.inrollplus.com/Login/Index
• As a new user you will need to register.• Complete the three required fields under the
New User heading.• Enter your Last Name, Last Four Digits of your SSN,
and your Date of Birth.
• Click Register and you will be directed to the screen to create your account.
• This will only be done once. Subsequent login will be done under the Returning User heading.
• Use the Video Tutorial and Chat features as necessary. The Chat feature will be available from 8:00 AM to 6:00 PM daily.
• Click the Español button on the top right to translate the whole site and videos to Spanish.
3
Annual Benefit Enrollment
Pages 4 – 7 contain information about our annual open enrollment
This information is for returning employees
Benefit Plan Year
September 1st through August 31st
is the benefit plan year.
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Effective Date of Insurance
Health InsuranceOption 1: Actively-at-work date (premium must be paid for the entire month)
Option 2: First of the month following the actively-at-work date – example: if you started work on August 11th ; your insurance will begin September 1st
All other benefits
First of the month following the actively-at-work date
If you started work in July: August 1st is your effective date
If you started work in August: September 1st
is your effective date
New Hires
30 Days
New hires must enroll in benefits within 30 days of their hire date.
Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Annual EnrollmentA
nnua
l En
rollm
ent • Typically held in July - August
• Opportunity to change benefit elections• Changes are not permitted during the plan
year unless you have a qualifying event
Retirement
All employees must contribute to Teacher Retirement System of
Texas instead of Social Security
Teacher Retirement System of Texas – 7.7%
of annual salary
This is an increase from 7.2% last year
TRS Insurance - .65% of annual salary
Mandatory active member contribution to TRS-Care (health
insurance for retirees)
TRS RetirementFor illustration purposes only! This information is not in your Benefit Guide
Benefits when you are eligible to retire: Average of 5 highest
salaries
Total # of years worked X 2.3% = % of salary you will
receive each year for the rest of your life
20 Years x 2.3% 46% of your salary = $25,30025 Years x 2.3% 57.5% of your salary = $31,62530 Years x 2.3% 69% of your salary = $37,95035 Years x 2.3% 80.5% of your salary = $44,27540 Years x 2.3% 92% of your salary = $46,55244 Years x 2.3% 100% of your salary = $55,000
Example: If you have an average salary of $55,000
Eligible Dependents
The employee is responsible for
notifying the Benefits Office when their
child no longer meets the dependent child
qualifications.
Spouse (including Common Law Spouse)
•A natural child•An adopted or a child who is lawfully placed for legal adoption•A stepchild•A foster child•A child under the legal guardianship of the employee
Child under the age of 26, who is one of the following: (They do nothave to be full time students.)
Disabled dependent children over the age of 26 are eligible for benefits if you can provide documentation of their disability.
Grandchildren are eligible for benefits if you can provide documentation that you are their legal guardian or that you claimed them as a dependent on your tax return.
Paychecks
Distributed by building Principal
Paid on the 20th of every month
During June, July & August paychecks are mailed directly to
your home address
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Example of a Paycheck For Illustration Purposes Only!! This information is not in your Benefit Guide
Annual Salary $54,500
*Assumes Single Filing; 0 Deductions on W4 Form
Deductions AmountMonthly Salary $4,541.66- Medicare 1.45% ($65.85)- TRS 7.7% ($349.71)- TRS Ins .65% ($29.52)- Federal Taxes (Amount Varies)* ($654.37)Total Bring Home Amount before you take out insurance premiums
$3,442.21
Leaves & Absences Full time employees will earn 5 local sick days & 5 personal days per school year• Days are prorated based on the actual
time employed
Medical certification (doctor’s note) must be provided if:• Employee is absent more than 4
consecutive days because of sickness self or sickness family
• There is a questionable pattern of absences
• The employee requests FMLA
Medical Leave/Maternity/FMLA contact: (Must notify me at least 30 days prior to the beginning of your leave!)• Karen Rose• Benefits & Risk Manager• 817.399.2075• [email protected]
Long Term Care
TRS offers a Long Term Care Plan
through Genworth Life Insurance Co.
Visit www.genworth.com/trsactivemember
If you are interested please call (866)
659-1970
Websites
Employee Benefits Web Site under www.hebisd.edu
Employee Access Center – change your address with HEB, look at paycheck stubs, etc.
Employee Benefits Facebook -”Like” our page www.facebook.com/hebbenefits
Employee Access Center App
App for your phone Allows you to view your
paychecks, leave balances, W2, employee directory and much more
To download the app: Search for “eFinance Plus
Employee” Type in “Hurst” as the school
district and then click on “Hurst-Euless-Bedford Independent SD
Follow the instructions to login to your account
Still working on a few bugs…
Changing Your Benefits
Benefits can only be changed during the middle of the plan year if you have a family status change AND you notify us within 30 days from the date the family status change occurred. Marriage
Divorce
Death Birth/Adoption
Loss of employment/benefits
Dependent lost eligibility
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Employee Acknowledgment of the Alliance Direct Contracting Program
Please sign the acknowledgement form stating that you understand you must see an in-network doctor!
For more information on the Alliance please refer to the Benefits Guide
If you are injured on the job, you must tell your
supervisor IMMEDIATELY!
Your school nurse will have
the Workers Comp forms to
complete.
If you need to seek medical treatment you must see an in-
network workers compensation doctor in order
for your medical expenses to be
paid.
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Sick Leave BankEVERYONE MUST COMPLETE AN
ENROLLMENT/DECLINATION FORM
Note: If you decline membership this year, you may enroll at a later date during open enrollment!
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Purpose
The purpose of the sick leave bank is to provide additional paid sick leave days for members of the bank who have exhausted all available paid leave (sick, personal, old state, vacation, etc) because of the catastrophic injury or illness of the employee or the employee’s immediate family member.
Sick Leave Bank Summary
Membership • Contribute 3 days of
local leave• This is a one time
contribution
Sick leave bank days available to use for:• Employee, spouse
child’s illness/injury• Parent receiving
hospice or end-of-life care
Maximum # of days that can be used: • employee’s illness – 30 days per school year• spouse or child’s illness – 30 days per school year; 60 days lifetime maximum• parent – 10 days per school year; 20 lifetime maximum
Sick Leave Bank Continued
Catastrophic illness/injury – Serious in nature (not a passing disorder or temporary ailment) Examples: cancer, heart disease,
multiple sclerosis, car accident with life threatening injuries, etc.
Illness/Injury must require that you will miss at least 20 work days
Sick Leave Bank Committee will approve/deny requests
Not Covered: Any procedure that could be
scheduled, without detriment to the employee’s health, at a time more compatible with the member’s work responsibilities are not covered
Example of Procedures Not Covered: maternity, knee surgery, hysterectomy, etc.
Employee Assistance Program (EAP)The Standardbda – Bensinger, DuPont & Assoc.
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What is an EAP?
An employee assistance program is a program which confidentially helps you in a time of need at no cost to you. The purpose of the program is to tackle your problems before these problems start to negatively affect your health and work performance. The program offers a variety of services ranging from family, health, and stress management to legal and financial counseling.
Who is Eligible to Receive Services
Employee
Spouse (Married or Divorced)
Significant Other / Partner
Children and Grandchildren (age 26 or
under)
Any household member, regardless
of age or relationship, residing
in employee’s home
The EAP Services Can Help With:
Child care & elder care
Alcohol & drug abuse
Life improvement
Difficulties in relationships
Stress & anxiety with
work or familyDepression Goal-setting Emotional
well-being
Financial & legal
concernsGrief & loss
Identity theft & fraud
resolutionOnline will
preparation
3 Sessions per incident or problem for assessment & counseling at no cost to the employee. Each
member of the employee’s household is
eligible for this service.
Health Insurance
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TRS ActiveCare Enrollment Guide
Please visit the Benefits website and download the Enrollment Guide!
More details about all our health plans.
www.trsactivecareaetna.com
This site gives you access to all of your health insurance resources in one place!
4 Health Plan Options
ActiveCare 1-HDActiveCare 2
ActiveCare Select
Scott & White HMO
What is TRS-ActiveCare?
Established and signed into law in 2001 (Chapter 1579, Texas Insurance Code)
A statewide health care benefits program for employees of school districts, charter schools, regional educational service centers and other educational districts
Law authorizes funding levels to help employees pay for coverage
1,127 districts/entities participate in TRS-ActiveCare (90% of eligible entities)
Plan Features ActiveCare 1-HD, ActiveCare 2, ActiveCare Select
Aetna Caremark is the Pharmacy vendor
ActiveCare 1HD & 2 are POS II Plans (Similar to PPO Plans) – you may see a doctor that is in or out of the network. If you stay in network you will have lower out-of-pocket costs!
ActiveCare Select is an EPO (Exclusive Provider Organization) – you must see a doctor that is in the network or the plan will not pay any benefits! There are NO OUT OF NETWORK Benefits!!! Make sure you review the list of providers in the network before you enroll in this plan!
No primary care physician (PCP) required; no referrals required to see a specialist
Plan Features HMO
Scott & White In order to enroll in the HMO plan, you must
work or reside in the HMO service plan area which includes: Denton, Collin, Tarrant, Dallas, and Rockwall counties.
You must see a doctor that is in the network or the plan will not pay any benefits! There are NO OUT OF NETWORK Benefits!!! Make sure you review the list of providers in the network before you enroll in this plan!
No primary care physician (PCP) required Referrals typically not needed to see a
specialist
Scott & White Service Area
Plan Overview (Network Level of Benefits)
ActiveCare 1-HD
ActiveCare 2
ActiveCare Select
Scott & WhiteHMO
Deductible $2,500 employee only$5,000 family
$1,000 individual$3,000 family
$1,200 individual$3,600 family
$1,000 individual$3,000 family
Maximum Out of Pocket (includes medical & prescription deductibles, copays and coinsurance)
$6,550 individual$13,100 family
$6,850 individual$13,700 family
$6,850 individual$13,700 family
$5,000 individual$10,000 family
Coinsurance 80% Plan pays20% Participant pays
80% Plan pays20% Participant pays
80% Plan pays20% Participant pays
80% Plan pays20% Participant pays
Office Visit Copay 20% after deductible $30 for primary$50 for specialist
$30 for primary$60 for specialist
$20 for primary-(first copay waived for a sick visit)
$50 for specialist
Primary means care provided by family practitioners, internists, OB/GYNs and pediatricians.
Family Deductible Illustration
ActiveCare 1-HD with a $5,000 family deductible• The family deductible may be met by one or more
people• Plan pays benefits once entire $5,000 is met – there
is no individual deductible to meet
ActiveCare 2 with a $1,000 individual deductible and a $3,000 family deductible• Plan pays benefits for an individual as his/her
deductible is met • Everyone helps to meet the family deductible, but
no one person pays more than the individual amount
Amy Ted Bob Sue Chris
Amy covers a spouse and three dependents
$5,000
Amy
$1,000
Ted
$800
Bob
$600
Sue
$400
Chris
$200
Preventive Benefits(Network Level of Benefits)
ActiveCare 1-HD
ActiveCare 2
ActiveCare Select
Scott & White HMO
Preventive Care Plan pays 100% (deductible waived)
Plan pays 100%(no copay required)
Plan pays 100%(no copay required)
Plan pays 100%(no copay required)
• 100% coverage for certain age and gender specific preventive care services when network providers are used
• Must be billed by provider as “preventive care”
• See page 17 for more details
Sample preventive care services:• Routine annual physicals* • Immunizations• Well-child care• Routine mammograms*• Routine colonoscopies• Bone density test• Screening for prostate cancer
*one per plan year
Plan Overview (Network Level of Benefits)
Benefits (continued)Services ActiveCare 1-HD ActiveCare 2 ActiveCare Select Scott & White HMO
Diagnostic Lab 20% after deductible
Quest FacilityPlan pays 100%
(deductible waived)
Quest FacilityPlan pays 100%
(deductible waived) 20% after deductibleOther Facility
20% after deductibleOther Facility
20% after deductible
High-tech Radiology(CT scan, MRI, nuclear medicine)
20% after deductible$100 copay per
service, plus 20% after deductible
$100 copay per service, plus 20% after deductible
20% after deductible
Outpatient Surgery 20% after deductible$150 copay
per visit, plus 20% after deductible
$150 copay per visit, plus 20%
after deductible
$150 copay per visit, plus 20%
after deductible
Plan Overview (Network Level of Benefits)
Benefits (continued)
Services ActiveCare 1-HD ActiveCare Select Scott & White HMO ActiveCare 2
Emergency Room(true emergency use)
20% after deductible
$150 copay, plus 20% after deductible
(copay waived if admitted)
$150 copay, plus 20% after deductible
(copay waived if admitted)
$150 copay, plus 20% after deductible
(copay waived if admitted)
Inpatient Hospital(facility charges)
Preauthorization required
20% after deductible
$150 copay per day, plus 20% after deductible
($750 max copay per admission)
$150 copay per day, plus 20% after deductible
($750 max copay per admission)
$150 copay per day, plus 20% after deductible
($750 max copay per admission)
Important NotesActiveCare 1-HD ActiveCare 2 ActiveCare Select Scott & White HMO
You must pay all of your deductible before insurance
will pay any benefits.You may see a provider in or out of the network.
You must see a provider in network or insurance will not pay any benefits
You must see a provider in network or insurance will
not pay any benefits
Deductible is waived for preventive visits and certain
preventive generic medications!
Provides the richest benefits, but also costs
the most!NO out of network
benefits!NO out of network
benefits!
“True Emergency” coverage for ER visit to
an out of network hospital
“True Emergency” coverage for ER visit to an out of
network hospital
If you have college kids attending college outside
of our area, they will need to come home to
go to the doctor.
If you have college kids attending college outside of our area, they will need to come home to go to the
doctor.
What is Teladoc?
Available only to those on TRS ActiveCare!! Not available for the HMO Plan!!
Teladoc’s board-certified doctors can resolve many of your medical issues, 24/7/365, via phone or online video consults from wherever you happen to be.
Imagine this…You wake up one morning with sudden cold-like symptoms: stuffy nose, cough, congestion. You have trouble getting an appointment with your existing doctor and you don’t want to miss time at work by sitting
in an urgent care or ER waiting room…so what do you do?
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You contact Teladoc…
Step 1: Contact Teladoc – online or by phone•Request a phone or
online video consult with doctor (avg. call back time is 16 minutes or you can schedule a time for the doctor to call you back)
Step 2: Talk with a doctor•Physician •Dermatologist•Behavioral Health
Provider
Step 3: Resolve your issue •The doctor will
recommend the right treatment and write a prescription if necessary
Step 4: Settle up • ActiveCare 2 – no
charge• Select - no charge • 1HD - $40 fee
What Issues can Teladoc handle?
Cold & flu symptoms Bronchitis Acne Ear infection Conjunctivitis Allergies
Pink eye Skin infection Insomnia Sinusitis Tonsillitis Fever
Counseling Moles & warts Laryngitis Pharyngitis And more!
Prescription Drug Benefits
Prescription Drug Benefits
Features ActiveCare 1-HD ActiveCare 2 ActiveCare Select Scott & White HMO
Drug Deductible(per person, per plan year)
Subject to plan year deductible
$0 for generic$200 per person
$0 for generic$200 per person
$0 for generic$100 per person
20% coinsuranceafter deductible
(Certain generic preventive drugs are available at no cost)
Retail Maintenance 90-Days Retail Mainten
ance 90-Days Retail 90-Days
Generic $20 $35 $45 $20 $35 $45 $3 $6Preferred Brand $40 $60 $105 $40 $60 $105 30% 30%Non-Preferred Brand $65 $90 $180 50% 50% 50% 50% 50%
Specialty Drugs$200 per fill (up to 31-day
supply)$450 per fill (32-day to 90-day
supply)
20% coinsurance per fill 20% coinsurance per fill
Retail Short-Term - (up to 31-day supply) Maintenance - (after first fill) up to 31-day supply at your local retail pharmacyMail Order and Retail-Plus - (up to 90-day supply)
ActiveCare 1-HD Enhanced Preventive Drug Coverage
Effective September 1, 2016, certain generic preventive drugs are available at no cost to participants enrolled in the ActiveCare 1-HD plan. The deductible and coinsurance do not apply to these generic medications. Please know this list is maintained by the Internal Revenue Service and may change from time to time.
EXAMPLES: Anticoagulants/Antiplatelets
(Blood Clots)
Anticonvulsants (Seizures)
Bowel Preparations
Cardiovascular Conditions (Heart) Antiarrhythmic Antianginal
Coronary Artery Disease (Cholesterol) Antihyperlipidemics
Diabetes Hypertension (High Blood
Pressure) Ace Inhibitors Beta Blockers Calcium Channel Blockers Diuretics
Mental Health Antidepressants Antipsychotics Obsessive Compulsive
Disorder
Osteoporosis (Bone Health) Preventive Care Services
Chemical Dependency Anti-Obesity Smoking Deterrents
Respiratory Disorders (Asthma)
Women’s Health Antiestrogens Contraceptives Prenatal Vitamins
Cost for Health Coverage
What Type of Funding is Provided for TRS-ActiveCare?
$150.00 (minimum) from the district
75.00 from the state of Texas
$225.00 Monthly funding
Monthly Premiums
ActiveCare1-HD
ActiveCare2
ActiveCare Select
Scott & WhiteHMO
Employee Only $116 $420 $259 $305.16
Employee & Spouse $689 $1,327 $922 $967.82
Employee & Children $390 $817 $554 $614.16
Employee & Family $1,006 $1,372 $1,136 $1,097.98
How to Search for Providers
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ActiveCare 1HD, 2 or Select
Visit www.trsactivecareaetna.com
Click on Find a Doctor or Facility (not yet enrolled)
In the search bar enter name, specialty, procedure or condition
Choose your Health Plan
ActiveCare 1-HD
ActiveCare Select – Make sure you choose Baylor Scott & White
Quality Alliance (DFW Region)
NOT ActiveCare Select
ActiveCare 2
List of Hospitals in Select Plan
Baylor Scott & White Medical Center (Grapevine, Irving, Trophy Club, etc.)
Baylor Emergency Medical Center (Colleyville, Keller, Mansfield, etc.)
Baylor All Saints – Ft. Worth Cook Children’s Medical Center Children’s Medical Center Methodist Southlake Hospital
Out of Network Hospitals:
Harris Methodist – HEBNorth Hills Hospital
Warning: Many of these hospitals don’t have in network ER doctors or Anesthesiologist
Urgent Care Facilities in Select Plan
Urgent Care Facilities: Concentra – Arlington, Ft. Worth, Irving Cook Children’s – Hurst, Ft. Worth, Southlake MedSpring Urgent Care – Keller, Irving Walk In Clinic inside of Walgreens
Out of Network Urgent Care
Facilities: Carenow
List Primary Care Providers within 10 miles of HEB ISD in Select Plan
Provider CityColleyville Family Medicine Colleyville
Dr. Eileen O’Brien Colleyville
Dr. Mohammad Uddin Colleyville
Dr. Kenneth LeCroy Colleyville
Baylor Family Medicine @ Riverside Grand Prairie
Baylor Family Medicine @ Grapevine Grapevine
Baylor Family Practice @ Keller Keller
Southlake Family Medicine Southlake
North Country Family Practice Southlake
No Primary Care Providers in the cities
of Hurst, Euless or Bedford!
Scott & White HMO
Visit www.trs.swhp.org
Click on Provider Information
Click on Browse providers online
Choose your Health Plan
Choose TRS-ActiveCare Participants Network and then search for your provider
List of Hospitals/Urgent Care Facilities in Scott & White HMO
Hospitals: Baylor Scott & White Medical Center (Grapevine, Irving, Trophy Club,
etc.) Baylor Emergency Medical Center (Colleyville, Keller, Mansfield, etc.) Baylor All Saints – Ft. Worth Methodist Medical Center – Dallas, Richardson, etc. Cook Children’s Medical Center Children’s Medical Center Texas Scottish Rite
Urgent Care Facilities: Concentra Cook Children’s – Hurst, Ft. Worth, Southlake Minute Clinic in CVS Pharmacy
Out of Network Hospitals:
Harris Methodist – HEBNorth Hills Hospital
Out of Network Urgent Care
Facilities: Carenow
List Primary Care Providers within 10 miles of HEB ISD in HMO Plan
Provider CityMedical Clinic of North Texas Bedford
Colleyville Family Medicine Colleyville
Mohammad Uddin Colleyville
Kenneth Lecroy Colleyville
Randall Hayes Euless
Baylor Family Medicine @ Riverside Grand Prairie
Loren Lasater Grapevine
Carlos Bazaldua Grapevine
Donald Frusher Hurst
Basanti Vrushab Hurst
Baylor Family Practice @ Keller Keller
Southlake Family Medicine Southlake
North Country Family Practice Southlake
Total Out of Pocket Amounts(In Network for Employee Only)
ActiveCare 1 - HD
ActiveCare 2
ActiveCare Select
Scott & WhiteHMO
Deductible (Medical) $2,500 $1,000 $1,200 $1,000
Deductible (Prescription) $0 $200 $200 $100Maximum Out of Pocket (co-ins & copays) $4,050 $5,650 $5,450 $3,900Subtotal Medical & Prescription Costs $6,550 $6,850 $6,850 $5,000
Annual Premium $1,392 $5,040 $3,108 $3,662Total Premium, Medical & Prescription Expenses $7,942 $11,890 $9,958 $8,662
1-HD vs. 2 = $3,648 savings in annual premiums
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Employee & SpouseActiveCare 1 - HD ActiveCare 2 ActiveCare Select Scott & White HMO
Deductible (Medical) $5,000 $2,000 $2,400 $2,000Deductible (Prescription) $0 $400 $400 $200Maximum Out of Pocket (co-ins & copays) $8,100 $11,300 $10,900 $7,800
Subtotal Medical & Prescription Costs $13,100 $13,700 $13,700 $10,000Annual Premium $8,268 $15,924 $11,064 $11,614
Total Premium, Medical & Prescription Expenses $21,368 $29,624 $24,764 $21,614
Employee & Child(ren) - Assumes 2 childrenActiveCare 1 - HD ActiveCare 2 ActiveCare Select Scott & White HMO
Deductible (Medical) $5,000 $3,000 $3,600 $3,000Deductible (Prescription) $0 $600 $600 $300Maximum Out of Pocket (co-ins & copays) $8,100 $10,100 $9,500 $6,700
Subtotal Medical & Prescription Costs $13,100 $13,700 $13,700 $10,000Annual Premium $4,680 $9,804 $6,648 $7,370
Total Premium, Medical & Prescription Expenses $17,780 $23,504 $20,348 $17,370
Employee & Family - Assumes 4 family membersActiveCare 1 - HD ActiveCare 2 ActiveCare Select Scott & White HMO
Deductible (Medical) $5,000 $3,000 $3,600 $3,000Deductible (Prescription) $0 $800 $800 $400Maximum Out of Pocket (co-ins & copays) $8,100 $9,900 $9,300 $6,600
Subtotal Medical & Prescription Costs $13,100 $13,700 $13,700 $10,000Annual Premium $12,072 $16,464 $13,632 $13,176
Total Premium, Medical & Prescription Expenses $25,172 $30,164 $27,332 $23,176
Application to Split Premium22
Married couples working for different participating entities may “Split” funds
OR
Married couples both working for HEB ISD may “Pool” funds
Family coverage and all want the same plan
Requires an Application to Split Premium form to be completed by both employees and both employers
No Application needed if the couple both work for HEB ISD
Split Premiums For Family CoverageThe rates in your guide are wrong…
Standard Funding TRS ActiveCare 1 -HD
TRS ActiveCare Select
Scott & White HMO
TRS ActiveCare2
Employee Only Premium $116.00 $259.00 $305.16 $420.00Employee & Child(ren) Premium $390.00 $554.00 $614.16 $817.00
Total Premium due $506.00 $813.00 $919.32 $1,237.00
Pooling Funds TRS ActiveCare 1-HD
TRS ActiveCare Select
Scott & White HMO
TRS ActiveCare 2
Employee & Family Total Premium $1,231.00 $1,361.00 $1,322.98 $1,597.00HEB Contribution for Employee A -$225.00 -$225.00 -$225.00 -$225.00HEB Contribution for Employee B -$225.00 -$225.00 -$225.00 -$225.00
Total Premium due $781.00 $911.00 $872.98 $1,147.00÷ 2 ÷ 2 ÷ 2 ÷ 2
Each employee pays $390.50 $455.50 $436.49 $573.50
Monthly Savings or (additional cost) ($275.00) ($98.00) $46.34 $90.00 Annual Savings or (additional cost) ($3,300.00) ($1,176.00) $556.08 $1,080.00
Health & Wellness Resources
23
Mobile apps and tools
• Find a network doctor
• Check your plan coverage
• Check on a claim• Show your ID card• Contact TRS-
ActiveCare Customer Service
Aetna Mobile
• Check a symptom• Look up a
condition• Find the right
doctor• Check on ER wait
times
iTriage
• 24/7/365 access to doctors by phone
• Get treatment for colds, allergies, ear infections and much more
Teladoc
• Schedule a lab appointment
• Find a lab near you• Check your results
MyQuest
Meet ALEX
Need help deciding which plan is right for you, Meet ALEX, your online benefits advisor. ALEX can: Help you understand and compare plans Explain health benefits terms -
without all the jargon Show you how deductibles, coinsurance
and out-of-pocket maximums work Walk you through estimating tax savings
with a health savings account (if you are considering the ActiveCare 1-HD plan)
To use the tool, visit www.myalex.com/trsactivecare/2016
6
May be used to compare 1-HD, 2 & Select! Not HMO
GAP InsuranceSPECIAL INSURANCE SERVICES (SIS)
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Gap Insurance
Gap insurance helps with out of pocket expenses one might incur due to a large deductible or high maximum out of pocket amounts.
You must be covered under a GROUP health plan in order to be eligible to enroll in the Gap plan.
2 Benefits: $1500 Inpatient & $1500 Outpatient
BenefitsInpatient Hospital Benefit• $1,500 per covered person per plan year
Outpatient Benefit• $1,500 per person per sickness/injury • Maximum of 3 occurrences per family per plan year• All expenses related to the treatment of the same or related sickness/injury will
accrue toward the outpatient benefit
How to file a claim:• Give your provider the Gap ID Card or• File a claim with SIS for reimbursement
Note: This plan will only reimburse you the amount the insurance carrier shows you owed to the provider.
Gap – Definition of Outpatient Services
The outpatient benefit does not cover a physician’s
office visit charge.
ER
Outpatient Surgery
Diagnostic testing (i.e.. X-rays, lab work, MRI, CT scans,
etc.)
Outpatient radiation/chemotherapy
Physical therapy
Chiropractic care
Durable medical equipment
Gap - Premiums
Under Age 40 Ages 40 - 49 Ages 50 & Above
Employee Only $26.89 $35.41 $74.37
Employee & Spouse $49.44 $65.05 $136.65
Employee & Children $64.64 $69.58 $128.15
Employee & Family $86.57 $98.44 $188.80
Dental InsuranceLINCOLN FINANCIAL
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DHMO PPO High PPO LowPreventive $5 Office Fee Plan Pays 100% Plan Pays 100%
Basic Fixed Co-Pays (see pg. 28)
Plan Pays 80%Deductible Applies
Plan Pays 70%Deductible Applies
Major Fixed Co-Pays(see pg. 28)
Plan Pays 50%Deductible Applies
Plan Pays 50%Deductible Applies
Orthodontics Fixed Co-Pays(see pg. 28)
Plans Pays 50% up to $1,000
Not Covered
Out of Network None; You must choose an in network provider (see page 26-27)
Yes Yes
Deductible Per Calendar Year None $50 Per Person$150 Family
$25 Per Person$75 Family
Annual Maximum Benefit(Maximum amount the insurance will pay per person per calendar year)
None $1,000 $750
Lincoln Financial Dental PPO & DHMO
PPO Plans MaxRewards
Both PPO Plans offer MaxRewards maximum rollover feature which will allow covered members to roll over a portion of their unused annual maximum into a MaxRewards Account Balance.
MaxRewards PPO High PPO Low
Eligible Range (Claim Threshold) $1 - $600 $1 - $300
Rollover Amount $250 per year $150 per yearRollover Amount with Preferred Provider $350 per year $200 per year
Maximum Rollover Account Balance $1,000 $750
30
Dental Premiums
DHMO PPO High PPO Low
Employee Only $13.91 $38.00 $25.00
Employee + 1 $26.42 $75.50 $51.50
Employee + Family $41.72 $114.50 $69.50
Vision PlanSUPERIOR VISION
31
Vision Plan
In Network Benefits
Examination (Once Every Plan Year) $10 copay
Material Copay (lenses & frames only, not contact lenses) $25 copay
Contact Lens Evaluation & Fitting (Once Every Plan Year)
$0 (standard)
$50 retail allowance (specialty)
Frames (Once Every Two Plan Years) $130 Allowance (20% discount off balance)
Contact Lenses (Once Every Plan Year)Up to $150
(Covered 100% if Medically Necessary)
Lenses (Once Every Plan Year)
•Single Vision, Bifocal, Trifocal Lenticular•Standard Scratch Coating
Covered in Full*Discounts on other types of
specialty lenses
PremiumsEmployee Only $6.10Employee + 1 $11.84Family $17.39
Disability InsuranceTHE STANDARD
32
The Standard Disability
Disability Income
Replaces a portion of your income when you are sick or injured and cannot work
Maximum Benefit Amount up to 2/3rds of your monthly earnings
Benefit Waiting Period 7, 14, 30, 60, 90, 180 days –
The period of time that you must be continuously disabled before benefits become payable. Benefits are not payable during the benefit waiting period!
First Day Hospital Benefit
If the insured employee is admitted as a hospital inpatient for at least four hours, the Benefit Waiting Period will be satisfied.
Benefits will become payable on the date of the hospitalization
This feature is included only on plans with Benefit Waiting Periods of 30 days or less 7 days
14 days
30 days
Disability Pre-Existing Conditions
Pre-existing Condition Exclusion:
•Any condition you had 90 days prior to the effective date of your insurance will
be considered pre-existing.
Pre-existing Condition Waiver:
•For the first 45 days of disability, The Standard will pay full benefits even if you
have a pre-existing condition
Annual Earnings
Monthly Earnings
Monthly Disability Benefit
Accident/Sickness Benefit Waiting PeriodCost Per Month
7 days 14 days 30 days 60 days 90 days 180 days
3,600 300 200 9.74 7.78 6.42 4.38 3.80 2.945,400 450 300 14.61 11.67 9.63 6.57 5.70 4.417,200 600 400 19.48 15.56 12.84 8.76 7.60 5.889,000 750 500 24.35 19.45 16.05 10.95 9.50 7.35
10,800 900 600 29.22 23.34 19.26 13.14 11.40 8.8212,600 1,050 700 34.09 27.23 22.47 15.33 13.30 10.2914,400 1,200 800 38.96 31.12 25.68 17.52 15.20 11.7616,200 1,350 900 43.83 35.01 28.89 19.71 17.10 13.2318,000 1,500 1,000 48.70 38.90 32.10 21.90 19.00 14.7019,800 1,650 1,100 53.57 42.79 35.31 24.09 20.90 16.1721,600 1,800 1,200 58.44 46.68 38.52 26.28 22.80 17.6423,400 1,950 1,300 63.31 50.57 41.73 28.47 24.70 19.1125,200 2,100 1,400 68.18 54.46 44.94 30.66 26.60 20.5827,000 2,250 1,500 73.05 58.35 48.15 32.85 28.50 22.0528,800 2,400 1,600 77.92 62.24 51.36 35.04 30.40 23.5230,600 2,550 1,700 82.79 66.13 54.57 37.23 32.30 24.9932,400 2,700 1,800 87.66 70.02 57.78 39.42 34.20 26.4634,200 2,850 1,900 92.53 73.91 60.99 41.61 36.10 27.9336,000 3,000 2,000 97.40 77.80 64.20 43.80 38.00 29.4037,800 3,150 2,100 102.27 81.69 67.41 45.99 39.90 30.8739,600 3,300 2,200 107.14 85.58 70.62 48.18 41.80 32.3441,400 3,450 2,300 112.01 89.47 73.83 50.37 43.70 33.8143,200 3,600 2,400 116.88 93.36 77.04 52.56 45.60 35.2845,000 3,750 2,500 121.75 97.25 80.25 54.75 47.50 36.7546,800 3,900 2,600 126.62 101.14 83.46 56.94 49.40 38.22
33
Disability ExamplesMaternity Benefits
$2600 Monthly BenefitOut for 6 weeks
30/30 Benefit Waiting Period
$2600 ÷ 30 days = $86 per day
7 days a week x 6 weeks = 42 days
42 days x $86 per day ≈ $3612
Knee Replacement Surgery$2000 Monthly Benefit
Out for 12 weeks30/30 vs. 60/60 Benefit Waiting Period
30/30$2000 ÷ 30 days = $66 per day
7 days a week x 12 weeks = 84 days
84 days x $66 per day ≈ $5544_________________________________
60/601st 8 weeks are unpaid
7 days a week x 4 weeks = 32 days
32 days x $66 per day ≈ $2112
If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first
day of inpatient confinement for Benefit Waiting Periods 7 days, 14 days, and 30 days.
Cancer PlanALLSTATE
37
Allstate
Pays actual doctor charges for Cancer related treatment
•Surgery, Radiation, Chemotherapy, Transportation,
Lodging, etc.
Pays benefits directly to you
Also covers 29 other specified diseases such as:•Lou Gehrig’s Disease, Muscular
Dystrophy, Multiple Sclerosis, Tuberculosis, Sickle Cell Anemia,
Bacterial Meningitis, Lyme Disease, Cystic Fibrosis, etc.
Policy is portable, which means if you leave the
district you can keep the plan at the same rate.
No evidence of insurability required at initial
enrollment for Low Plan•Pre-Existing Condition – Allstate
will not pay benefits for a pre-existing condition during the 1st
12 months
Allstate Cancer InsuranceBenefits Low Option High OptionAmbulance $100 $100Cancer Initial Diagnosis $2,000 $5,000Hospital Confinement $200 per day $200 per dayIntensive Care Unit $600 per day $600 per dayNon Local Transportation Coach Fare or .40/mileRadiation/Chemotherapy $10,000 $20,000Surgery Up to $3000 Up to $3000Wellness Benefit $100 per calendar yearPremiums Low Option High OptionEmployee Only $26.41 $40.33Employee & Child(ren) $37.28 $57.55Employee & Spouse $41.87 $63.24Employee & Family $52.72 $80.44
Group Term Life InsuranceLINCOLN FINANCIAL
42
Basic Life Insurance
HEB provides $5,000 Life Insurance upon the death of an employee
Term Life Insurance
Term Life Insurance for Employee
• Age Banded Rates – every 5 years when you are bumped to the next age bracket, your rates will increase
Term Life insurance for spouse and/or child(ren)
• Employee must choose term life insurance in order to choose term life insurance for spouse or child
• Spouse’s rates are based on the employee’s age
• Spouse’s coverage not to exceed ½ of employee’s coverage
Life Insurance
Maximum Benefits
• Employee - $500,000 not to exceed 5x annual salary
• Spouse - $75,000 not to exceed 50% of employee’s coverage
Guaranteed Coverage Amount For New Hires(no medical questions
required)
• Employee - $300,000 not to exceed 3x annual salary
• Spouse - $30,000
Term Life Insurance Premiums
Spouse Premiums
Employee Premiums
43
Child(ren) Life Insurance Rates
$5,000 per child - $.60 per month
$10,000 per child - $1.20 per month
Accidental Death & Dismemberment Life Insurance
46
Insurance that is payable in case death is ruled an accident
Examples:
AD&D Life Plan Accidental Death & Dismemberment
Family Coverage$100,000 = $3.30$500,000 = $16.50
Employee Only Coverage$100,000 = $2.40
$500,000 = $12.00
Benefit Employee Only Plan Family PlanAmount 1-10 times your
annual salary rounded to next higher $1000
• Spouse: 50% of the employee benefit, not to exceed $250,000 • Each Child: 15% of employee benefit, not to exceed $30,000 • Spouse + Each Child: Spouse 40% and Child 10% of the employee
benefit, not to exceed $30,000
Maximum Amount $500,000 $250,000Rate per $1,000 $.024 $.033
PrePaid Legal InsuranceLEGALEASE
48
What is PrePaid Legal?
The plan matches you up with an attorney
There are no deductibles
Benefits cover the attorney’s
time
Other costs, such as filing fees, are
not covered
LegalEASE offers employees a customized legal assistance plan that provides support and protection from unexpected personal legal issues.
Plan Benefits
Consumer
•Small Claims Court Representation
•Document Preparation•Promissory
Note•Simple
Affidavit
Estate Planning & Wills
•Simple Will•Living Will•Health Care
Power of Attorney
•Living Trust•Probate of
Small Estate
Family
•Divorce•Name Change•Adoption•Guardianship
Home
•Purchase of Primary Residence
•Sale of Primary Residence
•Refinancing
Criminal
•Traffic Defense•Misdemeanor
Defense
Other
•Civil Litigation Defense
•Foreclosure•Tax Audit•Financial
Planning & Coaching
•Office Consultation
•Telephone Advice
Individual $16.91Family $18.88
Premiums
50
Health Savings Accounts (HSA)HSA BANK
52
What is a Health Savings Account (HSA)?
An HSA, is a tax-advantaged account that you put money into to pay for current or future healthcare expenses
Tax free contributions
Unused funds roll over from year to year. There’s no “use it or lose it” penalty
Money in your account is invested
Money in your account is accessible as it is contributed. You do not have access upfront to all the money you are supposed to contribute to the account for the entire year like a Flexible Spending Account
EligibilityYou must be covered
by a qualified high deductible health
plan (HDHP) –ActiveCare 1HD
You cannot be enrolled in the GAP
PlanYou cannot be
enrolled in Medicare
You cannot be covered by other health insurance
You cannot be claimed as a
dependent on someone else's tax
return
You cannot be enrolled in a Flexible Spending Account
(FSA)
Maximum Contributions per Year
Age Under 55 Age 55+Individual Coverage $3,350 $4,350Family Coverage $6,750 $7,750
Funding your HSA:
Payroll deductions
Online transfers
Personal check
Eligible Medical Expenses
Note: You do not have to submit any
receipts to HSA Bank, save your bills and receipts for tax
purposes!
Expenses applied to your health plan
deductible
Dental Care Vision Care
Prescription drugs and medicines
How to Use Your HSA
Sign up for free internet banking
How to access your funds:•You can reimburse yourself for an expense paid
out-of-pocket or pay directly from your HSA account:•Debit Card•Checks – order checks from HSA bank for a fee•Online Transfers •Manual withdraw form - processing fee
Flexible Spending PlanTASC
55
Medical Reimbursement
Employee can pay for out-of-pocket medical expenses with before tax dollars • File claims for reimbursement• Use the debit card that is provided
Deductibles, co-insurance, co-pays, vision care, dental procedures, etc.
You must use it or lose it!!Plan year is September 1st
through August 31st. You must re-enroll every year.
Funds are front loaded (you have access to all the money on September 1st)
Maximum per year is $2,400 or $200 per month
Comparison of HSA & FSAQuestions Health Savings Account (HSA) Flexible Spending Account
(FSA)
Who qualifies as a participant?
All individuals under 65 who are participants in a qualified High Deductible Health Plan (HDHP).
A HDHP is TRS ActiveCare plan 1-HD
Non-Medicare enrolled persons
All employees (not required to be on District insurance to participate)
What is the maximum contribution per year? Individual - $3,350; over 55 - $4,350Family - $6,750; over 55 - $7,750 $2,400
Can I access the entire account at the start of the plan year?
No, money is available as it is contributed to the account
Yes, the total amount elected for the year is available to the employee on day one
Employee tax savings? Contributions are tax-free Contributions are tax-free
Does interest accrue on the account? Interest can be accrued Interest is NOT accrued
Can I roll unused dollars to next year?Yes. Funds may be carried over indefinitely throughout an account holder’s lifetime. Upon death, an account may be passed on to a surviving spouse.
No
What are qualified medical expenses on the plan?
Deductibles, coinsurance, prescriptions, includes dental and vision
Deductibles, coinsurance, prescriptions, includes dental and vision
Are claims substantiated? Only upon audit Yes. Receipts may be required.Can I use the money on non-medical qualified expenses?
Yes. The expense is subject to taxes and 10% tax penalty. (After age 65, no 10% penalty) No
Is there a “catch up” provision? Yes, individuals 55 and older may make additional contributions up to $1,000 per year. No
Portability Yes. It is owned by the account holder No
Subject to Cobra? No Yes
57
Dependent Day Care Reimbursement Plan
58
Dependent Day Care Reimbursement Plan
The plan allows you to set aside money on a pre-tax basis that you can use to cover certain costs associated with providing your dependent(s) with day care while you and your spouse are at work.
Any dependent under the age of 13 or any other dependent such as a parent or spouse can be covered
If you choose this plan you cannot claim the Federal Tax Credit.
Maximum contribution is $5,000 per year. You must use it or lose it.
Debit Card is provided and/or you can file claims for reimbursement.
Retirement Planning
60
Plan Administrators
403(b) Plan 457 PlanThe Omni Group877-544-6664
www.omni403b.com
TCG Administrators800-943-9179
www.tcgservices.com/documents/#/255/457b
What is a 403b or 457?
What is a 403(b)?A 403(b) plan is a retirement savings plan available for public education organizations. It has tax treatment similar to a 401(k) plan. Employee salary deferrals into a 403(b) plan are made before income tax is paid an allowed to grow tax-deferred until the money is taxed as income when withdrawn from the plan. 403(b) plans are also referred to as tax-sheltered annuity.
What is a 457?The 457 plan is a type of deferred-compensation retirement plan that is available for governmental employers. The employer provides the plan and the employee defers compensation into it on a pre-tax basis. For the most part the plan operates similarly to a 401(k) or 403(b) plan. The key difference is that there is no penalty for withdrawal before the age of 59½ (but subject to income tax).
Maximum Contributions for 2016:Annual Maximum - $18,000Over age 50 Catch-up - $6,000
Maximum Contributions for 2016:Annual Maximum - $18,000Over age 50 Catch-up - $6,000
Investment Options
You have 20 + companies to choose from with a variety of investment options available –Please visit www.trs.state.tx.usand select 403b Certification and click on View 403(b) Products List to see the list of fees charged by each company/product.
HEB ISD has selected 1 company to provide our employees with the 457 plan. TCG Administrators offers several investment options
403(b) Plan 457 Plan
How to Enroll
403(b) Plan 457 PlanHow to Enroll:Step 1: Set up your 403b
account with an approved vendor
Step 2: Complete the Salary Reduction Agreement with The Omni Group
How to Enroll:Complete the Salary Reduction Agreement with TCG Administrators
Enrollment or changes may be made anytime during the year
Effective Dates and Enrollment
Enrollment Due Date
Online enrollment and other forms must be completed and returned to the Benefits Office within 30 days of your hire date.
If you need help with your online enrollment, please call the Benefits Office to schedule an appointment!
Questions?