Employee Benefit Guide

Transcription

Duncanville
Independent School District
Employee Beneﬁt Guide
EFFECTIVE 09/01/2015 - 08/31/2016
www.mybenefitshub.com/duncanvilleisd
Table of Contents
1
2
3-5
6-9
10
11
12-14
Contact Information
Online Benefit Enrollment
Employee Guide to Enroll in Benefits
TRS-ActiveCare and Scott & White HMO
American Public Life MEDlink®
MDLIVE Telehealth
15
16-17
18
19-20
21
22
VSP Vision
The Hartford Disability
American Public Life Cancer
Loyal American Accident
Loyal American Critical Illness
Unum Term Life/AD&D
Cigna Dental
Texas Life Permanent Life
23
HSA Bank Health Savings Accounts
24
25-26 NBS Flexible Spending Accounts
LegalShield Identity Theft and Legal
Protection
403 (b) 457
28
29-31 Online Enrollment Instructions
27
Benefit Contact Information
Refer to this list when you need to contact one of your benefit providers. For general information please contact your
Benefits Department, Financial Benefit Services or log on to www.mybenefitshub.com/duncanvilleisd.
Program
Duncanville ISD Benefits
Medical
Pharmacy
MEDlink® GAP
Telehealth
Dental
Vision
Critical Illness
Disability
Cancer
Accident
Term Life/AD&D
Vendor
Phone Number
Financial Benefit Services
(800) 583-6908
Aetna
(800) 222-9205
www.trsactivecareaetna.com
Scott & White HMO
(800) 321-7947
trs.swhp.org
CVS Caremark
American Public Life
Group #15668
MDLIVE
Cigna
Group #3336999
VSP
Group #30020362
Loyal American
Group #1575
(800) 222-9205 Opt 2 www.caremark.com/trsactivecare
800) 256-8606
www.ampublic.com
(888) 365-1663
www.consultmdlive.com
(800) 244-6224
www.mycigna.com
(800) 877-7195
www.vsp.com
(800) 366-8354
The Hartford Group #395320
(800) 583-6908
File a Claim
(866) 278-2655
Group #15668
Loyal American
Group #1575
Unum
Group #469014
Website/Email
(800) 256-8606
www.thehartfordatwork.com
www.ampublic.com
(800) 366-8354
(800) 583-6908
www.unum.com
Permanent Life
Texas Life
(800) 283-9233
www.texaslife.com
Health Savings Accounts
HSA Bank
(800) 357-6246
www.hsabank.com
National Benefit Services
(800) 274-0503
www.nbsbenefits.com
(800) 654-7757
www.legalshield.com
(800) 274-0503
www.nbsbenefits.com
Voya
(972) 225-1524
www.voya.com
Flexible Spending Accounts
Identity Theft and Legal
Protection
Retirement Planning 403(b)
457
LegalShield
Group #47012
Page 1
Plan Year 9/1/2015 - 8/31/2016
Annual Benefit Enrollment
Mandat
ory
Enrollm
ent
For All
Duncanville ISD Enrollment is from
7/27/2015 through 8/31/2015
Duncan
ville ISD
Employ
ees!
Benefit Updates - What’s New:
Enrollment is MANDATORY for all Duncanville ISD
employees, so if you do not login and elect coverage,
you and your family members will not be enrolled in
the 2015—2016 plan year. You are also responsible
for updating your profile information: home address,
email, and phone numbers.
During enrollment ensure that you provide ALL
dependent information including: social security
numbers, date of birth, student status, and mark
whether your child is disabled.
TRS is now offering an HMO plan, Scott & White
Health Plan (SWHP). Under SWHP you must use
providers who belong to the SWHP network. For more
information visit https://trs.swhp.org/ or call
(800) 321-7947.
If you are currently participating in a Health Care or
Dependent Care FSA, you MUST re-elect a new
reimbursement amount every year. The new IRS
maximum for FSA Health Care reimbursement is now
$2,550 annually or $212.50 per month.
Reminder! Cancer Insurance is enrolled on a Guarantee
Issue basis (no health questions asked). However,
benefits aren’t payable during the first year of coverage
for a pre-existing condition.
Reminder! MDLIVE Telehealth provides FREE over the
phone consultations for minor illnesses with a doctor.
Sinus Infection or a child with a cold? No problem, call
today!
Unum is the NEW Voluntary Term Life and AD&D
provider. Guarantee Issue (GI) is available meaning no
health questions asked. GI amounts are $200K for
employees and $50K for spouses. As long as you elect
coverage this year, you can increase your life insurance up
to the GI every year!
Don’t Forget!
Due to the Affordable Care Act (ACA), every employee is required to login and complete the enrollment process,
even if you are declining benefits.
Enrollment assistance is available by calling Financial Benefit Services at 866-914-5202 to speak to a live
representative. Asistencia de inscripción está disponible llamando al 866.914.5202 Financial Benefit Services para
hablar con un representante.
FBS has expanded our call center hours to better meet your needs. Monday—Friday 10:00 A.M.—7:00 P.M.
July 27th—August 31st. іSe habla Espanol!
Duncanville ISD Employee Benefits HUB: www.mybenefitshub.com/duncanvilleisd
Benefit Information Access / Online Enrollment Access / FBS Contact Information
Page 2
Changing Your Benefits
A Cafeteria Plan enables you to save money by using pre-tax dollars
to pay for eligible group insurance premiums sponsored and offered
by your employer. Enrollment is automatic unless you decline this
benefit. Elections made during annual enrollment will become
effective on the plan effective date and will remain in effect during
the entire plan year.
Changes in benefit elections can occur only if you experience
qualifying event. You must present proof of a qualifying event to your
benefits office within 30 days of your qualifying event. You must also
meet with your benefits office to complete and sign the necessary
paperwork in order to make a benefit election change. Benefit changes must be consistent with the qualifying event.
Changes In Status
(CIS):
Marital Status
Qualifying Events
A change in marital status includes marriage, death of a spouse, divorce or annulment (legal
separation is not recognized in all states).
A change in number of dependents includes the following: birth, adoption and placement for
Change in Number of Tax
adoption. You can add existing dependents not previously enrolled whenever a dependent
Dependents
gains eligibility as a result of a valid change in status event.
Change in Status of
Employment Affecting
Coverage Eligibility
Change in employment status of the employee, or a spouse or dependent of the employee,
that affects the individual's eligibility under an employer's plan includes commencement or
termination of employment.
An event that causes an employee's dependent to satisfy or cease to satisfy coverage
Gain/Loss of Dependents'
requirements under an employer's plan may include change in age, student, marital,
Eligibility Status
employment or tax dependent status.
If a judgment, decree, or order from a divorce, annulment or change in legal custody requires
that you provide accident or health coverage for your dependent child ( including a foster
child who is your dependent), you may change your election to provide coverage for the
Judgment/Decree/Order dependent child. If the order requires that another individual (including your spouse and
former spouse) covers the dependent child and provides coverage under that individual's
plan, you may change your election to revoke coverage only for that dependent child and
only if the other individual actually provides the coverage.
Eligibility for Government
Gain or loss of Medicare/Medicaid coverage may trigger a permitted election change.
Programs
Retro-Terminations
A retro-termination or termination that happened in the past, will not be approved. ONLY
future date terminations will be accepted.
Enrollment in Medicare means that an employee is no longer eligible to contribute to a
Enrollment in Medicare
Health Savings Account (HSA). However, if you already have one you can continue to use
and HSA contributions
your funds.
Page 3
Annual Enrollment
During your annual enrollment period, you have the opportunity to review, change or continue benefit elections each
year. Changes are not permitted during the plan year unless a Section 125 qualifying event occurs.

Changes, additions or drops may be made only during the annual enrollment period without a qualifying event.

Employees must review their personal information and verify that dependents they wish to provide coverage for are
included in the dependent profile. Additionally, you must notify your employer of any discrepancy in personal and/or
benefit information.

Employees must confirm on each benefit screen (medical, dental, vision, etc.) that each dependent to be covered is
selected in order to be included in the coverage for that particular benefit.
New Hire Enrollment
All new hire enrollment elections must be completed in the online enrollment system within the first 30 days of benefit
eligibility employment. Failure to complete elections during this timeframe will result in the forfeiture of coverage.
Employee can elect to have their medical coverage begin on their date of hire or the first of the month following their
date of hire. Supplemental benefits will always begin the first of the month following or coincident with (if hired on the
first) the date of hire.
Q&A
Who do I contact with Questions?
For supplemental benefit questions, you can contact your Benefits/HR
department or you can call Financial Benefit Services at 866-914-5202 for
assistance.
Where can I find forms?
For benefit summaries and claim forms, go to your school district’s benefit website:
www.mybenefitshub.com/duncanvilleisd. Click on the benefit plan you need information on (i.e., dental) and you can
find the forms you need under the Benefits and Forms section.
How can I find a Network Provider?
For benefit summaries and claim forms, go to your school district’s benefit website:
www.mybenefitshub.com/duncanvilleisd. Click on the benefit plan you need information on (i.e., dental) and you can
find provider search links under the Quick Links section.
When will I receive ID cards?
If the insurance carrier provides ID cards, you can expect to receive those 3-4 weeks after your effective date. For most
dental and vision plans, you can login to the carrier website and print a temporary ID card or simply give your provider the
insurance company’s phone number and they can call and verify your coverage if you do not have an ID card at that time.
If you do not receive your ID card, you can call the carrier’s customer service number to request another card.
Page 4
Employee Eligibility Requirements
Supplemental Benefits: Eligible employees must work 30
or more regularly scheduled hours each work week.
Eligible employees must be actively at work on the plan
effective date for new benefits to be effective, meaning
you are physically capable of performing the functions of
your job on the first day of work concurrent with the plan
effective date. For example, if your 2015 benefits become
effective on September 1, 2015, you must
be actively-at-work on September 1, 2015 to be eligible for
your new benefits.
Dependent Eligibility Requirements
Dependent Eligibility: You can cover eligible dependent children under a benefit that offer dependent coverage,
provided you participate in the same benefit, up to the maximum age listed below.
Plan
Carrier
Maximum Age
TRS Medical
Aetna and Scott & White HMO
26
MEDlink®
26
Dental
Cigna
26
Vision
VSP
25
Critical Illness
Loyal American
25
Cancer
26
Accident
Loyal American
25
Term Life/AD&D
Unum
26
Permanent Life
Texas Life
25
Health Savings Accounts
HSA Bank
26 (benefits terminate at the end of the
plan year following the birthday)
26 (benefits terminate at the end of the
plan year following the birthday)
Telehealth
MDLIVE
26
Identity Theft and Legal Protection
LegalShield
18 (23 if Full-Time Student)
!
If your dependent is disabled, coverage can continue past the
maximum age under certain plans. If you have a disabled
dependent who is reaching an ineligible age, you must provide a
physician’s statement confirming your dependent’s disability.
Contact your HR/Benefit Administrator to request a continuation
of coverage.
Page 5
2015–2016 TRS-ActiveCare Plan Highlights
Effective September 1, 2015 through August 31, 2016 | Network Level of Benefits*
ActiveCare 1-HD
Type of Service
ActiveCare Select or ActiveCare
Select – Aetna Whole Health
ActiveCare 2
(Baptist Health System and HealthTexas
Medical Group; Baylor Scott & White Quality
Alliance; Memorial Hermann Accountable
Care Network; Seton Health Alliance)
Deductible
(per plan year)
$2,500 employee only
$5,000 employee and spouse; employee
and child(ren); employee and family
$1,200 individual
$3,600 family
$1,000 individual
$3,000 family
Out-of-Pocket Maximum
(per plan year; does include medical deductible/
any medical copays/coinsurance/any prescription
drug deductible and applicable copays/coinsurance)
$6,450 employee only
$12,900 employee and spouse; employee
and child(ren); employee and family
$6,600 individual
$13,200 family
$6,600 individual
$13,200 family
80%
20%
80%
20%
80%
20%
Office Visit Copay
Participant pays
20% after deductible
$30 copay for primary
$60 copay for specialist
Diagnostic Lab
Participant pays
Plan pays 100% (deductible waived) if
performed at a Quest facility; 20% after
deductible at other facility
Plan pays 100% (deductible waived) if
performed at a Quest facility; 20% after
deductible at other facility
Preventive Care
See reverse side for a list of services
Plan pays 100%
Plan pays 100%
Plan pays 100%
Teladoc® Physician Services
$40 consultation fee (applies to deductible
and out-of-pocket maximum)
Plan pays 100%
Plan pays 100%
High-Tech Radiology
(CT scan, MRI, nuclear medicine)
Participant pays
$100 copay plus 20% after deductible
Inpatient Hospital
(preauthorization required)
(facility charges)
Participant pays
$150 copay per day plus 20% after deductible
($750 maximum copay per admission)
$150 copay per day plus 20% after deductible
($750 maximum copay per admission;
$2,250 maximum copay per plan year)
Emergency Room
(true emergency use)
Participant pays
(copay waived if admitted)
(copay waived if admitted)
Outpatient Surgery
Participant pays
$150 copay per visit plus 20% after deductible
$150 copay per visit plus 20% after deductible
Bariatric Surgery
Physician charges (only covered if performed at an
IOQ facility)
Participant pays
$5,000 copay plus 20% after deductible
Not covered
$5,000 copay (does not apply to out-of-pocket
maximum) plus 20% after deductible
Prescription Drugs
Drug deductible (per plan year)
Subject to plan year deductible
$0 for generic drugs
$200 per person for brand-name drugs
$0 for generic drugs
$200 per person for brand-name drugs
Retail Short-Term
(up to a 31-day supply)
Participant pays
• Generic copay
• Brand copay (preferred list)
• Brand copay (non-preferred list)
$20
$40***
50% coinsurance
$20
$40***
$65***
Retail Maintenance
(after first fill; up to a 31-day supply)
Participant pays
• Generic copay
$25
$50***
50% coinsurance
$25
$50***
$80***
Mail Order and Retail-Plus
(up to a 90-day supply)
Participant pays
• Generic copay
$45
$105***
50% coinsurance
$45
$105***
$180***
Specialty Drugs
Participant pays
20% coinsurance per fill
$200 per fill (up to 31-day supply)
$450 per fill (32- to 90-day supply)
Coinsurance
Plan pays (up to allowable amount)
Participant pays (after deductible)
Page 6
2015–2016 TRS-ActiveCare Plan Highlights
TRS-ActiveCare Plans – Preventive Care
Network Benefits
When Using Network Providers
(Provider must bill services as “preventive care”)
Preventive Care Services
ActiveCare 1-HD
ActiveCare Select or
ActiveCare Select – Aetna
Whole Health
ActiveCare 2 Network
(Baptist Health System and
HealthTexas Medical Group; Baylor
& White Quality Alliance; Memorial
Hermann Accountable Care Network;
Seton Health Alliance)
Evidence−based items or services that have in effect a rating of “A”
or “B” in the current recommendations of the United States Preventive
Services Task Force (USPSTF).
Immunizations recommended by the Advisory Committee on Immunization
Practices of the Centers for Disease Control and Prevention (CDC) with
respect to the individual involved.
Evidence−informed preventive care and screenings provided for in the
comprehensive guidelines supported by the Health Resources and Services
Administration (HRSA) for infants, children and adolescents. Additional
preventive care and screenings for women, not described above, as
provided for in comprehensive guidelines supported by the HRSA.
For purposes of this benefit, the current recommendations of the USPSTF
regarding breast cancer screening and mammography and prevention
will be considered the most current (other than those issued in or around
November 2009).
The preventive care services described above may change as
USPSTF, CDC and HRSA guidelines are modified.
Examples of covered services included are routine annual physicals (one
per year); immunizations; well-child care; breastfeeding support, services
and supplies; cancer screening mammograms; bone density test;
screening for prostate cancer and colorectal cancer (including routine
colonoscopies); smoking cessation counseling services and healthy diet
counseling; and obesity screening/counseling.
Examples of covered services for women with reproductive capacity
are female sterilization procedures and specified FDA-approved
contraception methods with a written prescription by a health
care practitioner, including cervical caps, diaphragms, implantable
contraceptives, intra-uterine devices, injectables, transdermal
contraceptives and vaginal contraceptive devices. Prescription
contraceptives for women are covered under the pharmacy benefits
administered by Caremark. To determine if a specific contraceptive
drug or device is included in this benefit, contact Customer Service at
1-800-222-9205. The list may change as FDA guidelines are modified.
Plan pays 100% (deductible waived)
Plan pays 100% (deductible waived;
no copay required)
Plan pays 100% (deductible waived;
no copay required)
Annual Vision Examination
(one per plan year; performed by an opthalmologist or optometrist using
calibrated instruments)
Participant pays
After deductible, plan pays 80%;
participant pays 20%
Annual Hearing Examination
Participant pays
After deductible, plan pays 80%;
participant pays 20%
Note: Covered services under this benefit must be billed by the provider as “preventive care.” If you receive preventive services from a non-network provider, you will be
responsible for any applicable deductible and coinsurance under the ActiveCare 1-HD and ActiveCare 2. There is no coverage for non-network services under the ActiveCare
Select plan or ActiveCare Select – Aetna Whole Health.
A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *Illustrates benefits when network providers are used. For some plans non-network benefits are also available; there is no coverage for
non-network benefits under the Aetna Select Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for
this balance bill amount, which maybe considerable. **Includes prescription drug coinsurance ***If the patient obtains a brand-name drug when a generic equivalent is available, the patient will be responsible for the generic copayment
plus the cost difference between the brand-name drug and the generic drug.
TRS-ActiveCare is administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered
by Caremark.
Page 7
Scott & White Health Plan
Summary of Benefits for TRS-ActiveCare
Plan Provisions
Annual Deductible
Annual out-of-pocket
maximum (including medical and pre-
scription co-pays and co-insurance)
Lifetime Paid Benefit Maximum
Fully Covered Health Care Services
Co-Payment
$800 Individual/
$2,400 Family
LiveWell! Condition Guidance
and Wellness Programs
No Charge
Well Child Care Annual Physicals
No Charge
Immunizations (age appropriate)
No Charge
Outpatient Services
Primary Care
Specialty Care
Pre-Natal Care
Inpatient Delivery
Inpatient Services
Overnight hospital stay: includes
all medical services including
semi-private room or intensive care
Diagnostic &
Therapeutic Services
Physical and Speech Therapy
Equipment and Supplies
Ambulance and Helicopter
$40 co-pay and 20% of charges
after deductible
Emergency Room
$150 co-pay and 20% of charges
after deductible
$55 co-pay
Specialty Medications
Co-Payment
Tier 2 (Preferred)
$20 co-pay
Tier 3 (Premium preferred)
$50 co-pay
Tier 4 (Non-preferred)
50% after deductible3
Maternity Care
$20 co-pay
Urgent Care Facility
Co-Payment
Diagnostic/Radiology
Procedures
Outpatient Surgery
No Charge — go to
trs.swhp.org
20% after deductible1
Allergy Serum & Injections
1-877-505-7947
Tier 1
Other Outpatient Services
Eye Exam (one annually)
Co-Payment
After Hours Primary Care Clinics
Co-Payment
No Charge
$50 co-pay
LiveWell! Online Services
None
No Charge
Home Health Care Visit
LiveWell! Nurse On Call
(excludes deductible)
Standard Lab and X-ray
Co-Payment
Worldwide Emergency Care
$5,000 Individual/
$10,000 Family
Preventive Services
Home Health Services
Prescription Drugs
Annual Benefit Maximum
No Charge
Deductible
$150 co-pay and 20% of
charges after deductible
Ask a SWHP Pharmacy
representative how to
save money on your
prescriptions.
Co-Payment
No Charge
Preferred Generic4
$150 per day2 and
20% of charges
after deductible
Co-Payment
$150 per day2 and
20% of charges
after deductible
$50 co-pay
$100
Does not apply to generic drugs
Co-Payment
Unlimited
Maintenance Quantity
Retail Quantity
(Up to a 34-day supply)
SWHP Pharmacies Only
(Up to a 90-day supply)
$3 co-pay
$6 co-pay
Preferred Brand
Non-preferred
Non-formulary
Greater of $50 or
Not available
Mail Order
Online Refills
1-800-707-3477
trs.swhp.org
Includes other services, treatments, or procedures received at time of office visit.
$750 maximum co-payment per admission and 20% after deductible.
3
Tier 4 co-payment does not count toward out-of-pocket maximum.
4
If a brand name drug is dispensed when a generic is available, 50% co-pay applies.
1
2
Co-Payment
Diabetic Supplies and Equipment
Same as DME or Rx,
as appropriate
Durable Medical Equipment/
Prosthetics
trs.swhp.org
Page 8
Duncanville ISD
Plan Year September 1, 2015 - August 31, 2016
TRS Medical Insurance
Rates include $245 district contribution.
Monthly (12 pay)
Employee Only
Employee + Spouse
Employee + Children
Employee + Family
ActiveCare 1-HD
ActiveCare Select
ActiveCare 2
Scott & White HMO
$96
$669
$370
$986
$228
$877
$517
$1,086
$369
$1,233
$747
$1,276
$258.60
$890.62
$553.30
$1,014.76
Semi-Monthly (24 pay)
Employee Only
Employee + Spouse
Employee + Children
Employee + Family
ActiveCare 1-HD
ActiveCare Select
ActiveCare 2
Scott & White HMO
$48
$334.00
$185
$493
$114
$438.50
$258.50
$543
$184.50
$616.50
$373.50
$638
$129.30
$445.31
$276.65
$507.38
18 pay
Employee Only
Employee + Spouse
Employee + Children
Employee + Family
ActiveCare 1-HD
ActiveCare Select
ActiveCare 2
Scott & White HMO
$64
$446
$246.67
$657.33
$152
$584.67
$344.67
$724
$246
$822
$498
$850.67
$172.40
$593.75
$368.87
$676.51
*Please note the rates above are per paycheck and after the district has contributed.
Split Rates (Employee + Family)
ActiveCare 1 - HD
ActiveCare Select
ActiveCare 2
Scott & White HMO
Employee + Family
$370.50
$420.50
$515.50
$384.88
Employee works for Duncanville ISD and their spouse works at another school offering TRS-AcitveCare Medical.
Pooled Rates (Employee + Family)
$741.00
$841.00
$1,031.00
Employee + Family
Both employee and their spouse works for Duncanville ISD.
Page 9
$769.76
APL MEDlink® - Duncanville ISD Group #15668
MEDlink
Gap
- Medical
Group
# 15668
MEDlink®
IV Supplemental Limited
Benefit
Expense Insurance
is designed to help supplement your employer’s major medical insurance plan and
can help cover some of your out-of-pocket expenses. The available plan options are based on enrollment in TRS ActiveCare 1HD medical plan. You are not
This
offset
out-of-pocket
you experience
due to deductible
and coinsurance
for plan,
an in-patient
eligible
forsupplemental
MEDlink® IV ifcoverage
any of thehelps
following
apply:
You (or yourcosts
dependents)
are not covered
under the school’s
major medical
covered by
hospital
stay.
You
are
not
eligible
for
MEDLink
if
any
of
the
following
apply:
employees
(or
dependents)
who
aren’t
covered
TRS-Care (retiree plan), Medicare, Medicaid, have a Medical Savings Accounts (an actively-funded HSA) or are non-residents of the United
States,
undernot
theactively
school’s
medical
anyone
by TRS-Care (retiree plan), Medicare, Medicaid, or Medical Savings
Employees
at major
work on
the planplan,
effective
datecovered
are not eligible.
Accounts, employees who have a Health Savings Account that is be ng actively funded, non-residents of the US, employees not
actively at work on the plan effective date.
Summary of Benefits*
Enhanced Plan Base Policy
Option 1
Base Policy
Option 2
Option 1
Option 2
Maximum In-Hospital Benefits
$1,500 per Covered Person per Confinement.
In-Hospital Ambulance Benefit
Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a
Covered Person is Confined as an Inpatient. Limited to one trip per day.
Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation
$0 per Covered Person per Confinement
where a Covered Person is Confined as an Inpatient. Limited to one trip per day.
The Pre-Existing Period is 12 months prior to the effective date of coverage. This product has a Pre-Existing
Condition Limitation. The Pre-Existing Condition Limitation will apply only if the Covered Person is subject to a
$0 per Covered Person per Confinement
Pre-Existing Condition Limitation under the Other Medical Plan. Therefore, any Pre-Existing Condition Limitation
applied to the Major Medical plan would, in effect, limit coverage under this plan.
Maximum In-Hospital Benefits
In-Hospital
Deductible
In-Hospital
Ambulance Benefit
Pre-Existing Period
In-Hospital Deductible
$2,500 per Covered Person per Confinement.
$1,500 per Covered Person per Confinement. $2,500 per Covered Person per Confinement.
The Pre-Existing Period is 12 months prior to the effective date of coverage. This product has
a Pre-Existing Condition Limitation. The Pre-Existing Condition Limitation will apply only if
the
Covered
subject
to a Pre-Existing
ConditionServices
Limitation under the Other Medical
$500 per
CoveredPerson
Person is
per
Occurrence
for Covered Outpatient
Plan. Therefore, any Pre-Existing Condition Limitation applied to the Major Medical plan
Up to $350 per trip for ground transportation or up to $1,000 per trip for air transportation where a
would,
in effect,
limit
underLimited
this plan.
Covered
Person
resides
lesscoverage
than 18 hours.
to one trip per day.
Outpatient Benefit Rider
Pre-Existing
PeriodBenefits
Maximum
Outpatient
Outpatient Ambulance Benefit
Outpatient Deductible
Outpatient Benefit Rider
$0 per Covered Person Per Occurrence
Covered Outpatient Services
Maximum Outpatient Benefits
Hospital Emergency Room
$500 per Covered Person per Occurrence for Covered Outpatient Services
Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Up to $350
perUrgent
trip forCare
ground
or up
$1,000Year.
per trip
for airof
transportation
Maximum
of three
visits transportation
per Covered Person
perto
Calendar
Maximum
six Urgent Care visits
perwhere
Calendar
Year for all
Covered
Persons
PayableLimited
up to thetoMaximum
a Covered
Person
resides
lesscombined.
than 18 hours.
one trip Outpatient
per day. Benefit, subject to
the Outpatient Benefit Deductible, as shown above.
Outpatient
Surgery
Outpatient
Surgery inPerson
Hospital
Outpatient
Facility or Freestanding Outpatient Surgery Center. Payable up to the
Outpatient
Deductible
$0 per Covered
Per
Occurrence
Maximum Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Covered
Outpatient ServicesDiagnostic Testing in a Hospital Outpatient Facility or MRI Facility. Payable up to the Maximum Outpatient
Diagnostic
Testing
Benefit,
subject
to the
the Outpatient
Deductible,
as shown
Payable
up to
MaximumBenefit
Outpatient
Benefit,
subjectabove.
to the Outpatient Benefit
HospitalTreatment
Emergency
Outpatient
forRoom
a
Deductible,
as
shown
above.
Maximum of 60 days of treatment per Covered Person per Calendar Year. Payable up to the Maximum
Serious Mental Illness in a
Outpatient Benefit, subject to the Outpatient Benefit Deductible, as shown above.
Hospital Outpatient Facility
Maximum of three Urgent Care visits per Covered Person per Calendar Year. Maximum of six
Outpatient Ambulance Benefit
Urgent Care visits per Calendar Year for all Covered Persons combined. Payable up to the
Benefit Rider
Physician Outpatient Treatment
Benefit Rider
Outpatient Surgery
$25 per visit; Maximum of four visits per Covered Person per Calendar Year and eight visits per Calendar Year or
Outpatient Surgery in Hospital Outpatient Facility or Freestanding Outpatient Surgery
all Covered Persons combined for treatment in a Hospital Outpatient Facility, Freestanding Emergency Care
Center, Payable up to the Maximum Outpatient Benefit, subject to the Outpatient Benefit
Clinic, Urgent Care Facility/Clinic, or Physician Office
Deductible, as shown above.
Testing in a Hospital Outpatient
Facility
or MRI Facility.
Payable up
the
Total
Semi-Monthly
Premiums
bytoPlan**
Total Monthly PremiumsDiagnostic
by Plan**
Diagnostic Testing
Age 18 +
Option 1
Option 2
Age 18 +
Option 1
Option 2
Outpatient
EmployeeTreatment for a Serious
$33.60 Maximum$40.44
Employee
$16.80
$20.22
of 60 days of treatment per
Covered Person per Calendar
Year. Payable
up to the
Mental Illness in a Hospital
Employee & Spouse
$38.86
$46.72
EmployeeFacility
& Spouse
$77.72
$93.45
Outpatient
Employee & Child
$60.66
$72.29
Employee & Family
$104.68
Monthly
$125.20
Age 18+
Employee & Child
Premiums by
Plan & Family
Employee
Option 1
$30.33
$36.14
$52.34
$62.60
Option 2
*The premium and amount of benefits
vary dependent upon the $40.44
option selected.
Employee
$33.60
**Total premium includes the policy and riders of the option selected.
Employee & Spouse
$77.72
& Child
$60.66
Must be used in conjunction Employee
with brochure
APSB-22132 series.
To view click here
Employee & Family
$104.68
This product is inappropriate for people who are eligible for Medicaid coverage.
$93.45
$72.29
$125.20
This is a general overview of your plan benefits. Additional details on covered expenses, limitations and exclusions are included in the summary plan
description located on the Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd.
Underwritten by American Public Life Insurance Company
APESB-448
Page 10
This is a general overview of your plan benefits.
Additional details on covered expenses,
24/7/365 on-demand access to
affordable, quality healthcare.
Anytime, Anywhere.
MDLIVE offers 24/7/365 on-demand access to a
national network of board-certified doctors and
pediatricians that can diagnose, recommend
treatment, and prescribe medication. Get
the care you need, when you need it.
What can be treated?
When should I use MDLIVE?
If you’re considering the ER or urgent care for a non-emergency
medical issue
Your primary care physician is not available
At home, traveling, or at work
24/7/365, even holidays!
Pediatric Care related to:
Cold & Flu
Constipation
Ear Infection
Fever
Nausea & Vomiting
Pink Eye
And More!
Allergies
Asthma
Bronchitis
Cold and Flu
Ear Infections
Joint Aches and Pain
Respiratory Infection
Sinus Problems
And More!
Who are our providers?
Are children eligible?
Our providers practice primary care,
pediatrics, family and emergency
medicine, and have incorporated
MDLIVE into their practice to provide
convenient access to quality
care.
Yes. MDLIVE has local pediatricians
on-call 24/7/365.
However, a parent or guardian
must be present during registration
and any consultations involving
minors.
Call us at (888) 365-1663 or visit us at consultmdlive.com
Disclaimers: MDLIVE does not replace the primary care physician. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE
does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of
services. For complete terms of use visit www.mdlive.com/pages/terms.html 010113
Page 11
Cigna Dental-High & Low - Group #3336999
Network: Total Cigna Dental Choice
Duncanville ISD offers 2 PPO options listed below. YOU DON’T NEED AN ID CARD TO VISIT A PPO DENTIST! Tell the dentist
Cigna’s group number is #3336999.
Coverage Type
High Dental Plan
Negotiated InNetwork
Out-of Network
Coverage Type
Low MAC Dental Plan
Negotiated InOut-of Network
Network
Class I100% of Negotiated
100% of R&C
Preventive &
Fee**
Fee**
Diagnostic
Class II-Basic 80% of Negotiated
80% of R&C Fee**
Restorative
Fee*
Class III-Major 50% of Negotiated
50% of R&C Fee**
Restorative
Fee*
Class IV50% of Negotiated
50% of R&C Fee**
Orthodontia
Fee*
Deductible†
In-Network
Out-of Network
Individual
$50.00
$50.00
Family
$150.00
$150.00
Annual Max
In-Network
Out-of Network
Benefit
Per Person
$1,500.00
$1,500.00
Orthodontia
Lifetime
In-Network
Out-of Network
Maximum
Per Person
$1,000.00
$1,000.00
Class I100% of Negotiated 100% of Maximum
Preventive &
Fee*
Allowable Charge
Diagnostic
Class II-Basic 80% of Negotiated 80% of Maximum
Restorative
Fee*
Allowable Charge
Class III-Major 50% of Negotiated 50% of Maximum
Restorative
Fee*
Allowable Charge
Class IV50% of Negotiated 50% of Maximum
Orthodontia
Fee*
Allowable Charge
Deductible†
In-Network
Out-of Network
Individual
$50.00
$50.00
Family
$150.00
$150.00
Annual Max
In-Network
Out-of Network
Benefit
Per Person
$1,000.00
$1,000.00
Orthodontia
Lifetime
In-Network
Out-of Network
Maximum
Per Person
$1,000.00
$1,000.00
High Option PPO Plan Gives you the freedom to choose
any dentist. In-network benefit percentages are 100% for
preventive, 80% for Basic, 50% for Major and 50% for Ortho
Services. Out-of-Network charges are paid based on usual,
reasonable and customary fees. There is a $50 deductible,
$1,500 calendar year maximum and $1,000 lifetime
maximum benefit for Ortho (only available to children under
age 19).
Low Option PPO Plan Benefits are based on contracted fees innetwork. In-network benefit percentages are 100% for
preventive, 80% for basic, and major and 50% for Ortho Services.
Out-of-Network charges are paid based on the maximum
allowable charge (participant will be balance billed for any
amount charged over the fee schedule). There is a $50
deductible, $1,000 calendar year maximum and $1,000 lifetime
maximum benefit for Ortho (only available to children under age
19).
!
*Negotiated Fee refers to the fees that participating PDP dentists have agreed to accept as payment in full, subject to any copayments, deductibles, cost
sharing and benefits maximums.
**R&C Fee refers to the Reasonable and Customary (R&C) charge, which is based on the lowest of (1) the dentist’s actual charge, (2) the dentist’s usual charge
for the same or similar services, or (3) the charge of most dentists in the same geographic area for the same or similar services as determined by Cigna.
†Applies only to Class II & III services
Rates
Tier
Monthly
Semi-Monthly
High Plan
Low Plan
High Plan Low Plan
EE Only
$49.60
$31.78
$24.80
EE + Spouse
$64.26
$48.40
EE + Child(ren)
$73.44
EE + Family
$124.82
18 Pay
High Plan
Low Plan
$15.89
$33.07
$21.19
$32.13
$24.20
$42.84
$32.27
$55.30
$36.72
$27.65
$48.96
$36.87
$94.04
$62.41
$47.02
$83.21
$62.69
This is a general overview of your plan benefits. Additional details on covered expenses, limitations and exclusions are included in the
summary plan description located on the Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd.
Page 12
Cigna Dental-DHMO - Group #3336999
DHMO Plan
This plan provides dental benefits through a network of participating primary and specialty care dentists. Participants pay copay amounts for covered services. All covered services must be provided by the member’s Primary Care Dentist. Specialty care
dentists require a referral and approval. Please refer to the schedule of benefits for full plan details. If terms of this summary
and the schedule of benefits differs, the schedule of benefits governs.
Tier
Monthly Rates
Semi-Monthly Rates
18 Pay Rates
EE Only
$14.68
$7.34
$9.79
EE + Spouse
$19.46
$9.73
$12.97
EE + Child(ren)
$22.26
$11.13
$14.84
EE + Family
$37.82
$18.91
$25.21
!
Cigna Provider Search Tips
PPO Provider Search:
To search for a Cigna PPO provider, choose this plan option:
DHMO Provider Search:
To search for a Cigna DHMO provider, choose this plan option:
PLEA
You
SE N
will
OTE!
have
selec
to
taP
rima
Care
ry
Den
tist w
enro
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ile
lling
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is
plan
.
Page 13
Dental-DHMO - Group # 3336999 - For a Complete Fee Schedule please visit www.mybenefitshub.com/duncanvillesd
Code
D0120
D0150
D0210
D0274
D0330
D1110
D1120
D1351
D2140
D2330
D2391
D2750
D2751
D3220
D3330
D4260
D4341
D4381
D4910
D5110
D5120
D5211
D5212
D6241
D6750
D7140
D7210
D7220
D7240
D8070
D8080
D8090
D9110
D9310
Service
Diagnostic Treatment
Periodic Oral Evaluation
Comprehensive Oral Evaluation - New or Established Patient
X-Rays Intraoral - Complete Series (including Bitewings) (Limit 1 Every 3 Years)
X-Rays (Bitewings) - Four Films
X-Rays (Panoramic Film) (Limit 1 Every 3 Years)
Preventive Services
Prophylaxis - Adult (Limit 2 per Calendar Year)
Prophylaxis - Child (Limit 2 per Calendar Year)
Sealant—Per Tooth
Restorative Services
Amalgam - One Surface, Primary or Permanent
Resin-Based Composite - 1 Surface, Anterior
Resin-Based Composite - 1 Surface, Posterior
Crowns
Crown - Porcelain Fused to High Noble Metal
Crown - Porcelain Fused to Predominantly Base Metal
Endodontics
Pulpotomy - Removal of Pulp, Not Part of a Root Cana
Molar Root Canal - Permanent Tooth (Excluding Final Restoration)
Periodontics
Osseous Surgery – 4 or More Teeth per Quadrant
Periodontal Scaling and Root Planing – 4 or More Teeth per Quadrant (Limit 4
Quadrants per Consecutive 12 Months)
Localized Delivery of Antimicrobial Agents per Tooth - By Report
Periodontal Maintenancee (Limited to 2 per Calendar Year) (Only Covered after
Active Therapy)
Prosthodontics
Full Upper Denture
Full Lower Denture
Upper Partial Denture – Resin Base (Including Clasps, Rests and Teeth)
Lower Partial Denture – Resin Base (Including Clasps, Rests and Teeth)
Crowns/Fixed Bridges
Pontic - Porcelain Fused to Predominantly Base Metal
Crown - Porcelain Fused to High Noble Metal
Oral Surgery
Extraction, Erupted Tooth or Exposed Root - Elevation and/or Forceps Removal
Surgical Removal of Erupted Tooth - Removal of Bone and/or Section of Tooth
Removal of Impacted Tooth - Soft Tissue
Removal of Impacted Tooth - Completely Bony
Orthodontics
Comprehensive Orthodontic Treatment of Transitional Dentition - Banding
Comprehensive Orthodontic Treatment of Adolescent Dentition - Banding
Comprehensive Orthodontic Treatment of Adult Dentition - Banding
Adjunctive General Service
Palliative (Emergency) Treatment of Dental Pain - Minor Procedure
Consultation (Diagnostic Service Provided by Dentist or Physician Other than
Requesting Dentist or Physician)
Office Visit Fee - Per Visit
Copayment
$0.00
$0.00
$0.00
$0.00
$0.00
$5.00
$5.00
$11.00
$0.00
$0.00
$45.00
$320.00
$400.00
$68.00
$335.00
$400.00
$83.00
$45.00
$50.00
$400.00
$400.00
$300.00
$300.00
$400.00
$320.00
$12.00
$50.00
$43.00
$115.00
$500.00
$515.00
$515.00
$0.00
$0.00
$5.00
Page 14
VSP Vision - Group #30020362
Vision Plan:
Members pay a co-pay for in-network benefits. Out-of-network vision services are reimbursed up to a certain dollar amount
for covered expenses. The in-network exam co-pay is $10.00 and the materials co-pay is $10.00.Exams and lenses (within plan
allowance) are covered in-network with a co-pay, once every 12 months. Frames are covered (within plan allowance) every 24
months.
CO-PAYS
Vision Plan Benefits
Benefits
In-Network
Out-of-Network
Exam
Frames
Contact Lens fitting
Contact Lenses
Covered in full
$130 retail allowance
Covered in full
$130 retail allowance
Up to $45 retail
Up to $70 retail
Not Covered
Up to $105 retail
Lenses (standard) per pair
Single Vision
Lined Bifocal
Covered in full
Covered in full
Up to $30 retail
Up to $50 retail
Lined Trifocal
Progressive
Covered in full
See Co-Pays
Up to $65 retail
Up to $50 retail
ASE
E
L
P
TE!
O
N
Exam
$10
Materials₁
$10
Contact Lens Fitting
$25
Standard Progressive Lenses
$55
Premium Progressive Lenses
$95-$105
Custom Progressive Lenses
$150-$175
SERVICES/FREQUENCY
Exam
Frame
12 months
24 months
Contact Lens Fitting
12 months
Lenses
Contact Lenses
12 months
12 months
de
ovi
r
p
t
u
s no rds. Yo
e
o
d
a
n
VSP er ID c r visio
b
u
m
a
yo
me
are
tell
r
y
l
u
p
yo
.
si m
der
i
ber
v
o
m
r
e
p
m
VSP
!
Rates
Monthly
Semi-Monthly
18 Pay
EE Only
EE + Spouse
EE+ Child(ren)
EE + Family
$7.58
$15.16
$16.22
$25.92
$3.79
$7.58
$8.11
$12.96
$5.05
$10.11
$10.81
$17.28
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements.
₁ Materials co-pay applies to lenses & frames only, not contact lenses.
₂Contact lenses are in lieu of eyeglass lenses and frames benefits
Page 15
The Hartford Disability - Group #395320
Disability is designed to provide a monthly income to an individual that is disabled due to an accident or illness. There are different
plans available with benefits becoming available from the 1st day of disability to as late as the 180th day. Benefits can be payable
to age 65 if disability occurs prior to age 65. All new or increases in coverage are subject to pre-existing condition exclusions.
Pre-existing Conditions
Your policy limits the benefits you can receive for a disability caused by a pre-existing condition. In general, if you were diagnosed
or received care for a disabling condition within the 3 consecutive months just prior to the effective date of this policy, your benefit
payment will be limited, unless: You have not received treatment for the disabling condition within 3 months, while insured under
this policy, before the disability begins, or You have been insured under this policy for 12 months before your disability begins. You
may also be covered if you have already satisfied the pre-existing condition requirement of your previous insurer. If your disability
is a result of a pre-existing condition we will pay benefits for a maximum of 4 weeks.
Benefit Reductions
Your benefit payments may be reduced by other income you receive or are eligible to receive due to your disability, such as:
 Social Security Disability Insurance (please see www.mybenefitshub.com/burnetcisd for exceptions)
 Workers' Compensation
 Other employer-based Insurance coverage you may have
 Unemployment benefits
 Settlements or judgments for income loss
 Retirement benefits that your employer fully or partially pays for (such as a pension plan.)
Your benefit payments will not be reduced by certain kinds of other income, such as:
 Retirement benefits if you were already receiving them before you became disabled
 Retirement benefits that are funded by your after-tax contributions
 Your personal savings, investment, IRAs or Keoghs
 Profit-sharing
 Most personal disability policies
 Social Security increases
Coverage goes into effect subject to the terms and conditions of the policy. You must satisfy the definition of Actively at Work with
your employer on the day your coverage takes effect.
Exclusions
You cannot receive Disability benefit payments for disabilities that are caused or contributed to by:
 War or act of war (declared or not)
 Military service for any country engaged in war or other armed conflict
 The commission of, or attempt to commit a felony
 An intentionally self-inflicted injury
 Any case where your being engaged in an illegal occupation was a contributing cause to your disability
 You must be under the regular care of a physician to receive benefits.
Mental Illness, Alcoholism and Substance Abuse


You can receive benefit payments for Long-Term Disabilities resulting from mental illness, alcoholism and substance abuse for
a total of 24 months for all disability periods during your lifetime.
Any period of time that you are confined in a hospital or other facility licensed to provide medical care for mental illness,
alcoholism and substance abuse does not count toward the 24 month lifetime limit.
Page 16
The Hartford Disability - Group #395320
Additional Benefits
 Workplace Modification provides for reasonable modifications made to a workplace to accommodate your disability and allow
you to return to active full-time employment.
 Survivor Benefit - If you die while receiving disability benefits, a benefit will be paid to your spouse or child(ren) under age 25,
equal to three times the last monthly gross benefit.
 The Hartford's Ability Assist service is included as a part of your group Long Term Disability (LTD) insurance program. You have
access to Ability Assist services both prior to a disability and after you’ve been approved for an LTD claim and are receiving LTD
benefits. Once you are covered you are eligible for services to provide assistance with child/elder care, substance abuse, family
relationships and more. In addition, LTD claimants and their immediate family members receive confidential services to assist
them with the unique emotional, financial and legal issues that may result from a disability. Ability Assist services are provided
through ComPsych®, a leading provider of employee assistance and work/life services.
 Waiver of Premium – Once your disability claim is approved
and you have satisfied your elimination period, your
For the Premium benefit option – the table below applies to
coverage premiums will be waived.
disabilities resulting from sickness or injury:
 Travel Assistance Program – Available 24/7, this program
Premium Option Coverage
provides assistance to employees and their dependents
Age Disabled
Benefits Payable
who travel 100 miles from their home for 90 days or
less. Services include pre-trip information, emergency
Prior to Age 63 To Normal Retirement Age or 48 months if greater
medical assistance and emergency personal services.
Age 63
To Normal Retirement Age or 42 months if greater
 Identity Theft Protection – An array of identity fraud
Age 64
36 months
support services to help victims restore their identity.
Age
65
30 months
Benefits include 24/7 access to an 800 number; direct
Age 66
27 months
contact with a certified caseworker who follows the case
until it’s resolved; and a personalized fraud resolution kit
Age 67
24 months
with instructions and resources for ID theft victims.
Age 68
21 months
Age 69 & older
18 months
Monthly Premiums
Accident / Sickness Elimination Period
Annual
Earnings
Monthly
Earnings
Monthly Disability
Benefit
0/3 day*
14 day*
30 day*
60 day
90 day
180 day
$3,600
$300
$200
$8.12
$6.32
$5.36
$3.48
$3.00
$2.28
$9,000
$750
$500
$20.30
$15.80
$13.40
$8.70
$7.50
$5.70
$18,000
$1,500
$1,000
$40.60
$31.60
$26.80
$17.40
$15.00
$11.40
$27,000
$2,250
$1,500
$60.90
$47.40
$40.20
$26.10
$22.50
$17.10
$36,000
$3,000
$2,000
$81.20
$63.20
$53.60
$34.80
$30.00
$22.80
$45,000
$3,750
$2,500
$101.50
$79.00
$67.00
$43.50
$37.50
$28.50
$54,000
$4,500
$3,000
$121.80
$94.80
$80.40
$52.20
$45.00
$34.20
$63,000
$5,250
$3,500
$142.10
$110.60
$93.80
$60.90
$52.50
$39.90
$72,000
$6,000
$4,000
$162.40
$126.40
$107.20
$69.60
$60.00
$45.60
*For those employees electing an elimination period of 30 days or less, if you are confined to a hospital for 24 hours or more due to a disability, the elimination period
will be waived, & benefits will be payable from the first day of disability.
Page 17
APL GC-13 Limited Benefit Group Cancer Indemnity Insurance
Over 1.7 million new cases of cancer will be diagnosed this year.1 Many major medical insurance policies do not cover all of the
expenses related to the treatment of cancer, which could leave you and your family with unexpected financial expenses. The plan
options below can help offset some of the expenses associated with a diagnosis of cancer.
Summary of Benefits*
Cancer Treatment Benefits—Base Policy
Option 1
Option 2
$15,000
$20,000
$50 per treatment
$50 per treatment
Radiation Therapy, Chemotherapy or Immunotherapy
Maximum per 12-month period
Hormone Therapy
Maximum of 12 treatments per Calendar Year
Experimental Treatment
Paid in the same manner and under the same maximums as any other benefit
Waiver of Premium
Waive Premium
Internal Cancer First Occurrence Benefit Rider
Lump Sum Benefit
Maximum 1 per Covered Person per lifetime
$5,000
$10,000
Lump Sum for Eligible Dependent Children
$7,500
$15,000
Lump Sum Benefit
$5,000
$10,000
Lump Sum for Eligible Dependent Children
$7,500
$15,000
Heart Attack/Stroke First Occurrence Benefit Rider
Monthly Premiums**
Option 1
Option 2
Individual
$13.66
$23.00
Individual & Spouse
$29.48
$49.94
1 Parent Family
$15.70
$26.50
2 Parent Family
$31.52
$53.48
*Premium and amount of benefits provided vary dependent upon the option selected at time of application.
**Total premium includes the policy and riders of the option selected.
Must be used in conjunction with brochure APSB-22273 series. To view click here
This product is inappropriate for people who are eligible for Medicaid coverage.
This is a general overview of your plan benefits. Additional details on covered expenses, limitations and exclusions are included in the summary plan
description located on the Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd
1. American Cancer Society: Cancer Facts and Figures 2014, pg. 1.
Underwritten by American Public Life Insurance Company
APESB-448
Page 18
Loyal American Accident - Group #1575
Plan pays benefit amounts for covered medical expenses as a result of an accident, directly to you! Coverage is available
for ages 18-64 and is portable, you can choose to keep your benefit even if you leave the district or retire.
F
n’t
Do
!
et
org
ur
o yo
t
efer
d
ys r
a
w
taile
Al
r de
o
f
cy
d
poli
s an
term
ns.
ditio
con
Monthly Premiums
Available for Issue Ages 18-64
Individual
Single Parent
Insured + Spouse
Family
$12.70
$20.40
$19.50
$27.20
Did
You
This
Kno
w?
polic
y do
es n
pay
ot
for l
o
s
ses
resu
lting
from
sickn
ess,
only
accid
ent.
Summary of Benefits
Ambulance
Ground Ambulance Benefit: Loyal American will pay this benefit if you require transportation by a licensed
professional ambulance company to or from a hospital or between medical facilities within 90 days for injuries
sustained after a covered accident. Payable once per accident.
Air Ambulance Benefit: Loyal American will pay this benefit if you require transportation by a license professional
air ambulance company to or from a hospital or between medical facilities within 48 hours for injuries sustained
after a covered accident. Payable once per accident.
Indemnity Benefits
Emergency Room Treatment Benefit: Loyal American will pay this benefit if you received hospital emergency
room treatment within 72 hours of injuries sustained in a covered accident and for which charges are submitted.
Plan Pays
$150
$600
Insured/
Spouse:
$150
Child: $75
Accident Follow-Up Treatment Benefit: Loyal American will pay this benefit for three additional treatments of
injuries sustained in a covered accident over and above emergency treatment administered during the first 72
$50 per visit
hours following the accident. Treatment must begin within 30 days of the covered accident and must be within
the 6 month period following the covered accident.
Blood, Plasma, Platelets Benefit: Loyal American will pay this benefit if you require transfusion, administration,
cross matching, typing and processing of blood, plasma or platelets when administered within 90 days for injuries
$100
sustained in a covered accident. Payable once per accident.
Hospital Benefits
Initial Accident Hospitalization Benefit: Loyal American will pay this benefit if hospital confinement is required
$500
within six (6) months for injuries sustained in a covered accident. Payable once per accident.
Hospital Confinement Benefit: Loyal American will pay this benefit for a maximum of 180 days per confinement.*
$200 per
if you require confinement in a hospital or in a hospital intensive care unit– sub acute within six (6) months for
day
injuries sustained in a covered accident.
Intensive Care
Hospital Intensive Care Unit Confinement Benefit: Loyal American will pay this benefit for a maximum of 15 days
per confinement* if you are confined in a hospital intensive care unit within 30 days because of injuries received
$400 per
in a covered accident.
day
*Confinements separated by less than 90 days will be considered as the same period of confinement.
The policy is guaranteed renewable.
Page 19
Loyal American Accident - Group #1575
Summary of Benefits (cont’d)
Plan Pays
Physical Therapy
Physical Therapy Benefit: Loyal American will pay this benefit, not to exceed five treatments per accident,
for services prescribed by a doctor and rendered by a licensed physical therapist. Physical therapy must be
for injuries sustained in a covered accident and must start within 60 days after the accident. Treatment must
be completed within 6 months after the accident.
Prostheses Benefit: Loyal American will pay this benefit if a doctor prescribes the use of a prosthetic device
due to the loss of a hand, foot or sight of an eye in a covered accident. The prosthetic must be received
within 1 year of the covered accident. This benefit is payable once per accident and is not payable for
hearing aids, dental aids, false teeth or for cosmetic prosthesis (e.g. hair wigs). We will not pay for joint
replacement (e.g. artificial hip or knee).
Appliance Benefit: Loyal American will pay this benefit if a doctor advises you to use a medical appliance as
an aid to personal locomotion within 90 days as a result of injuries sustained in a covered accident. Benefits
are payable for crutches, wheelchairs, braces, etc. Benefits are payable for crutches and wheelchairs once
per accident.
Family Lodging & Transportation
Family Lodging Benefit: Loyal American will pay this benefit for a maximum of 30 days per accident, during
the time you are confined in a hospital, for one motel/hotel room for a family member to accompany you if
injuries sustained in a covered accident require hospital confinement, and if the hospital and motel/hotel
are more than 100 miles from your residence.
Transportation Benefit: Loyal American will pay this benefit for a maximum of three trips per calendar year
if you require special treatment and confinement in a hospital located more than 100 miles from your
residence or site of the accident for injuries sustained in a covered accident.
Accidental Death
$50 per treatment
1 prosthetic device/
artificial limb: $100
More than 1: $500
$50
$100 per day
$300
Plan Pays
Accidental Death* Benefit - This policy will pay the following benefit for death if it is the result of injuries sustained in a covered
accident. Death must occur within 90 days of a covered accident.
Common-Carrier– You must be a fare paying passenger on a common-carrier. Common-carrier
vehicles are limited to commercial airplanes, trains, buses, trolleys, subways, ferries and boats that
operate on a regular scheduled basis between predetermined points or cities. Taxies and privately
chartered vehicles are not included.
Insured: $100,000
Spouse: $50,000
Child: $15,000
Other Accidents– Other Accidents are those not classified as common-carrier and are not specifically
excluded in the limitations and exclusions section of the policy.
Insured: $25,000
Spouse: $10,000
Child: $5,000
Dismemberment
Accidental Dismemberment* Benefit– This policy will pay a percentage of the Accidental Death-Other Accidents Benefit for the
selected plan.
*Death or dismemberment must occur within 90 days of the accident. Only the highest single benefit will be paid for accidental dismemberment.
Both arms and both legs
Two arms or legs
Sight of two eyes, hands or feet
Sight of one eye, hand foot, arm or leg
One or more fingers and/or one or more toes
100%
50%
50%
20%
5%
Page 20
Loyal American Critical Illness - Group #1575
Most of us are not financially prepared for a medical crisis caused by a critical illness within our family. Out of pocket expenses
(deductibles, co-payments etc.) can deplete our savings, home equity and retirement funds. Major medical insurance does not
cover many non-medical expenses. The issue age for Loyal American’s Critical Illness plan is ages 18-69. Application is required for
enrollment outside of the Guarantee Issue period.
PLEA
SE N
Coverage Options




Coverage amounts from $5,000 to $50,000.
You may apply for Individual, Single Parent Family or Two Parent Family coverage.
Two Parent Family rates include automatic spouse coverage at 50% of employee’s
selected coverage.
Single Parent & Two Parent Family rates include automatic child coverage at 10% of
employee’s selected coverage.
Benefits






OTE!
Plea
se r e
fer t
o the
polic
y for
f
ull
term
s and
cond
ition
s.
Optional rider available for First Occurrence, Additional Occurrence or Reoccurrence of
Cancer.
First Occurrence Benefit for the employee is 100% of benefit face amount (each insured
person is limited to the payment of only one 1st Occurrence Benefit.)
For each Additional Occurrence or Reoccurrence (after 180 days past the last covered occurrence) of a covered critical illness,
the benefit Is 50% of the original benefit face amount which varies for the employee, spouse & children.
Angioplasty or First Coronary Artery Bypass Surgery Benefit Is 25% of insured’s First Occurrence Benefit (any First Occurrence
Benefit amount payable for heart attack will be reduced, dollar for dollar, by any amounts previously paid for either
Angioplasty or Coronary Artery Bypass Surgery. We will not pay any amount for Angioplasty or Coronary Artery Bypass
Surgery if we have already paid the full First Occurrence Benefit for Heart Attack. We will not pay a partial First Occurrence
Benefit for more than (1) Angioplasty nor more than (1) Coronary Artery Bypass Surgery per insured person.)
Annual Health Screening Benefit of $50 per year for employee & spouse.
Spouse may continue coverage if employee dies.
Benefit Reductions
Benefits reduce 50% for any covered person above age 70 on the date of diagnosis.
Base Only with $50 Health Screening Benefit and 50% Reoccurrence/Additional Occurrence Included
Monthly Premiums by Face Amount
Rate Tier Issue Age
$5,000
$10,000
$15,000
$20,000
$25,000
Under 30
$ 2.60
$ 3.34
$ 4.24
$ 5.14
$ 6.20 $
30 - 39
$ 3.82
$ 5.36
$ 7.08
$ 8.78
$ 10.76
$ 12.72 $ 14.72 $ 16.68 $ 18.66 $ 20.64
40 - 49
$ 6.94
$ 10.54
$ 14.34
$ 18.10
$ 22.40
$ 26.72 $ 31.02 $ 35.32 $ 39.64 $ 43.94
50 - 59
$ 11.40
$ 17.94
$ 24.76
$ 31.44
$ 39.10
$ 46.74 $ 54.40 $ 62.02 $ 69.68 $ 77.30
60 - 69
$ 17.56
$ 28.16
$ 39.14
$ 49.88
$ 62.12
$ 74.38 $ 86.66 $ 98.88 $ 111.14 $ 123.38
Under 30
$ 2.64
$ 3.40
$ 4.30
$ 5.22
$ 6.30 $
30 - 39
$ 3.88
$ 5.44
$ 7.18
$ 8.90
$ 10.92
$ 12.92 $ 14.94 $ 16.94 $ 18.94 $ 20.94
40 - 49
$ 7.04
$ 10.70
$ 14.56
$ 18.36
$ 22.74
$ 27.12 $ 31.50 $ 35.84 $ 40.22 $ 44.60
50 - 59
$ 11.58
$ 18.22
$ 25.12
$ 31.92
$ 39.68
$ 47.44 $ 55.22 $ 62.96 $ 70.72 $ 78.46
60 - 69
$ 17.84
$ 28.58
$ 39.72
$ 50.64
$ 63.06
$ 75.50 $ 87.96 $ 100.36 $ 112.82 $ 125.22
Under 30
$ 4.28
$ 5.32
$ 6.64
$ 7.96
$ 9.56
$ 11.22 $ 12.88 $ 14.48 $ 16.14 $ 17.76
Individual
Single
Parent
Family
Two
Parent
Family
$30,000
$35,000
7.28 $
7.40 $
$40,000
8.36 $
8.50 $
$45,000 $50,000
9.40 $ 10.48 $ 11.54
9.54 $ 10.64 $ 11.70
30 - 39
$ 6.30
$ 8.52
$ 11.10
$ 13.60
$ 16.56
$ 19.60 $ 22.68 $ 25.68 $ 28.74 $ 31.78
40 - 49
$ 11.46
$ 16.74
$ 22.50
$ 28.04
$ 34.50
$ 41.14 $ 47.78 $ 54.38 $ 61.02 $ 67.66
50 - 59
$ 18.80
$ 28.52
$ 38.84
$ 48.74
$ 60.20
$ 71.98 $ 83.78 $ 95.52 $ 107.30 $ 119.06
60 - 69
$ 28.98
$ 44.78
$ 61.40
$ 77.32
$ 95.68
$ 114.54 $ 133.44 $ 152.28 $ 171.16 $ 190.00
Guarantee Issue Coverage
Page 21
Unum Basic Term Life & AD&D - Group #469014
Duncanville ISD provides you with Basic Term Life insurance coverage in the amount of $10,000 at no cost to you.
Base Life & AD&D
Eligibility
Life Benefit Amount
AD&D Benefit Amount
Portability & Conversion
Survivor Support
Benefit Reduction Schedule
Accelerated Death Benefit
Full Time Employee working 30+ hours per week.
$10,000
$10,000
Included
Included
50% at age 70
75% of life benefit amount
Unum Supplemental Term Life - Group #469014
Voluntary Life
Eligibility
Life Benefit Amount
Guarantee Issue
Portability and Conversion
Survivor Support
Benefit Reduction Schedule
Accelerated Death Benefit
Full Time Employee working 30+ hours per week.
Employee - Up to 5 times annual earnings in increments of $10,000. Not to exceed
$500,000.
Spouse - Up to 100% of employee amount in increments of $5,000. Not to exceed
$100,000.
Child(ren)- Up to 100% of employee coverage amount in increments of $2,000. Not to
exceed $10,000.
Employee - $200,000
Spouse - $50,000
Child- $10,000
Included
Included
65% at age 70; 45% at age 75; 30% at age 80 and 20% at age 85
75% of life benefit amount to a maximum of $500,000
Age
EE Cost per
$10,000
Spouse Cost
per $10,000
Under 25
$0.50
$0.50
25-29
$0.50
$0.50
30-34
$0.60
$0.60
35-39
$0.80
$0.80
40-44
$1.20
$1.20
45-49
$1.70
$1.70
50-54
$2.70
$2.70
55-59
$4.10
$4.10
60-64
$5.20
$5.20
65-69
70+
Cost for your Child(ren)
$10.10
$10.10
$10,000
$10.10
$10.10
$1.60
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Page 22
Texas Life Individual Life—PURELIFE-plus
Flexible Premium Life Insurance to Age 121. Policy Form PRFNG-NI-10
See the PureLife-plus brochure for details.
Voluntary permanent life insurance can be an ideal complement to the group term
and optional term your employer might provide. Designed to be in force when you
die, this voluntary universal life product is yours to keep, even when you change jobs
or retire, as long as you pay the necessary premium. Group and voluntary term, on
the other hand, typically are not portable if you change jobs and, even if you can
keep them after you retire, usually costs more and declines in death benefit.
The policy, PURELIFE-plus, is underwritten by Texas Life Insurance Company, and it
has these outstanding features:

High Death Benefit. With one of the highest death benefits available at the
worksite₁, PURELIFE-plus gives your loved ones peace of mind, knowing there
will be significant life insurance in force should you die prematurely.

Minimal Cash Value. Designed to provide high death benefit, PURELIFE-plus
does not compete with the cash accumulation in your employer-sponsored
retirement plans.

Long Guarantees₂. Enjoy the assurance of a policy that has a guaranteed death
benefit to age 121 and level premium that guarantees coverage for a significant period of time (after the guaranteed period, premiums may go down, stay the same, or go up).

Refund of Premium. Unique in the marketplace, PURELIFE-plus offers you a refund of 10 years’ premium, should you
surrender the policy if the premium you pay when you buy the policy ever increases. (Conditions apply.)

Accelerated Death Benefit Rider. Should you be diagnosed as terminally ill with the expectation of death within 12 months
(24 months in Illinois), you will have the option to receive 92% (84% in Illinois) 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.) ICC ULABR-07 or ULABR-07
You may apply for this permanent, portable coverage, not only for yourself, but also for your spouse, domestic partner, minor
children and grandchildren₃.
Like most life insurance policies, Texas Life policies contain certain exclusions, limitations, exceptions, reductions of benefits,
waiting periods and terms for keeping them in force. Please contact a Texas Life representative for costs and complete details.
₁Voluntary and Universal Whole Life Products, Eastbridge Consulting Group, October 2012
₂Guarantees are subject to product terms, exclusions, limitations and the insurer's claims-paying ability and financial strength.
₃Coverage and spouse/domestic partner eligibility may vary by state. Coverage for children and grandchildren not available in
Washington. Texas Life complies with all state laws regarding marriages, domestic and civil union partnerships, and legally recognized familial relationships.
Texas Life is licensed to do business in the District of Columbia and every state but New York.
For more information, please visit the Duncanville ISD benefits website at www.mybenefitshub.com/duncanvilleisd to see
the PURELIFE-plus brochure.
TEXASLIFE Insurance Company
900 Washington
Post Office Box 830
Waco, TX 76703-0830
14M088-C 1064 (exp0816)
Page 23
A Cafeteria Plan enables you to save money on group insurance, health-related expenses, and dependent-care expenses. Your
contributions are deducted from your pay before taxes are withheld. Because you are taxed on a lower amount of pay, you pay
less in taxes and you have more to spend. You may save as much as 35 percent on the cost of each benefit option! Eligible
expenses must be incurred within the plan year and *CONTRIBUTIONS ARE USE-IT-OR-LOSE-IT*. Don’t forget you have a $500
rollover for unused funds. Remember to retain all your receipts.
NBS Prepaid MasterCard® Debit Card
NBS Flexcard – FSA Pre-paid MasterCard
You may use the card to pay merchants or service providers that accept VISA credit cards, so there is no need to pay cash up front
then wait for reimbursement. If you are participating in the Dependent Care portion, the money isn’t loaded to the card. You
must file paper claims or enroll in continual reimbursement.
Current plan participants: NBS debit cards are good for 4 years. If you throw away your cards, there is a $5.00 fee to replace them.
New Plan Participants: NBS will mail out your new benefit cards to the address listed in THEbenefitsHUB. They will be sent in
unmarked envelopes so please watch for them as they should arrive in mid-September.
FSA Annual Contribution Max: $2,550
Dependent Care Annual Max: $5,000
??? When Will I Receive My Flex Card?
Rollover: $500
Grace Period: 90 days
Expect Flex Cards to be delivered to
the address listed in THEbenefitsHUB
near the end of September.
Account Information:
Participant Account Web Access: www.nbsbenefits.com
Participants may call NBS and talk to a representative during regular business hours, Monday-Friday, 7 am to 4 pm Central
Time. Participants can also obtain account information using the Automated Voice Response Unit, 24 hours a day, 7 days a week at
(801) 838-7324 or toll free (888) 353-9125. For immediate access to your account information at any time, log on to the NBS
website www.NBSbenefits.com. Information includes:
Detailed claim history and processing status
Health Care and Dependent Care account balances
Claim forms, Direct Deposit form, worksheets, etc.
Online webclaim
FAQs
For a list of sample expenses, please refer to the Duncanville ISD benefit website: www.mybenefitshub.com/duncanvilleisd
NBS Contact Information:
8523 South Redwood Road
West Jordan, UT 84088
Phone-800-274-0503
Fax-800-478-1528
Email: claims@nbsbenefits.com
Page 24
HSA Bank Health Savings Account (HSA)
What is an HSA?
An HSA, or health savings account, is a unique tax-advantaged account that you can use to pay for current or future IRSqualified medical expenses. With an HSA, you’ll have:
 A tax-advantaged savings account that you can use to pay for IRS-qualified medical expenses as well as deductibles,
co-insurance, prescriptions, vision, and dental care.
 Unused funds that will roll over year to year. There’s no “use it or lose it” penalty.
 Potential to build more savings through investing. You can choose from a variety of HSA self-directed investment options
with no minimum balance required.
 Additional retirement savings. After you turn 65, funds can be withdrawn for any purpose without penalty.
Investment accounts are not FDIC insured, may lose value and are not a deposit or other obligation of, or guarantee by the bank. Investment losses which are
replaced are subject to the annual contribution limits of the HSA.
2015 Annual HSA Contribution Limits
Individual: $3,350
Family: $6,650
Catch-Up Contributions:
Account holders over the age of 55 who have not yet enrolled in Medicare are eligible to make an additional $1,000 “catch-up”
contribution to their HSA.
What is a HDHP?
A HDHP, or high-deductible health plan, is a major-medical health insurance plan that has a lower premium than traditional
health plans. Your HDHP:
 Is a major-medical health plan that is HSA-compatible. That means it can be used with a health savings account from HSA
Bank.
 Has a higher annual deductible with lower monthly premiums, which means you’ll have less taken out of your paycheck
and more to add to you HSA.
 Covers 100% of preventative care, including annual physicals, immunizations, well-women and well-child exams, and more
–all without having to meet your deductible.
 Providers coverage for health screenings, such as blood pressure, cholesterol, diabetes, vision, and more.
For a list of sample expenses, please refer to www.mybenefitshub.com/duncanvilleisd
HSA Bank Contact Information:
605 N. 8th Street
Sheboygan, WI 53081
Phone 800.357.6246
Mon.—Fri. 7am to 9pm, and Saturday 9am to 1pm
www.hsabank.com
This is a general overview of your plan benefits. Additional details on covered expenses, limitations and exclusions are included
in the summary plan description located on the Duncanville ISD Benefits Website: www.mybenefitshub.com/duncanvilleisd.
Page 25
Receive Your Dependent Care
Reimbursement Quicker!
Flexible Spending Accounts FAQ
i
A Direct Deposit form is available on the
Benefits Website which will help you get
reimbursed quicker!
What is a Flexible Spending Account?
A Flexible Spending Account allows you to save money by paying out-of-pocket health and/or dependent care related
expenses with pre-tax dollars. Your contributions are deducted from your pay before taxes are withheld and your
account is up fronted with an annual amount. Because you are taxed on a lower amount of pay, you pay less in taxes
and you have more to spend.
How does a Flexible Spending Account Benefit Me?
A Cafeteria plan enables you to save money on group insurance, health-related expenses, and dependent-care
expenses. You may save as much as 35 percent on the cost of each benefit option! Eligible expenses must be incurred
within the plan year and contributions are use-it-or- lose-it. Remember to retain all your receipts.
What Can I Use My Flexible Spending Account On?
For a full list of eligible expenses, please refer to the www.mybenefitshub.com/duncanvileisd benefits
website but a few examples are listed below:
Health Care Expense Account Example Expenses:
Acupuncture
Body scans
Breast pumps
Chiropractor
Co-payments
Deductible
Diabetes Maintenance
Eye Exam & Glasses
Fertility treatment
First aid
Hearing aids & batteries
Lab fees
Laser Surgery
Orthodontia Expenses
Physical exams
Pregnancy tests
Prescription drugs
Vaccinations
Vaporizers or humidifiers
Dependent Care Expense Account Example Expenses:

Before and After School and/or Extended Day Programs

The actual care of the dependent in your home

Preschool tuition

The base costs for day camps or similar programs used as
care for a qualifying individual
Tax S
aving
Did You Know?
s on D
epen
dent
Care!
Your FSA has a $500
rollover! $500 of your
unused funds will roll
into next plan year.
What Happens If I Don’t Use All of My Funds by The End of the Plan Year (August 31st)?
Eligible expenses must be incurred within the plan year and contributions are use-it-or- lose-it. Remember to retain all your
receipts.
How Do I File A Claim?
In most situations, you will be able to swipe your card however, in the event you loose your card or are waiting to received one you
can visit www.mybenefitshub.com/duncanvilleisd and complete the “Claim Form” to send to NBS.
Page 26
LegalShield Legal Services and Identity Theft
Legal Services
LegalShield attorneys can help with all sorts of issues from the trivial to the traumatic, including:
Home: Purchase, Refinance, Foreclosure, Landlord/Tenant
Financial: Collections, Warranties, Guarantees, Contacts
Family Matters: Divorce, Child Custody, Child Support
Estate Issues: Wills, Living Wills, Power of Attorney
Auto: Moving Violations, Accidents
Identity Theft Protection
Identity Theft affects millions of Americans each year. Get the information and expertise to help prevent theft, and it a fraud does
occur, team up with industry leader Kroll Advisory Solutions to get your identity back to what is was before the fraud.
Identity Protection: Continuous Credit Monitoring, Email Safety Alerts, Credit Score Analysis, Secure Web Access to Up-to-Date Credit
Report.
Identity Restoration: Assistance from Kroll Advisory Solutions including Issuing Fraud Alerts, Disputing Fraudulent Accounts, Working
with Banks and Creditors to Restore your Identity.
Member Benefits
IDTHEFTSHIELD
Licensed Identity Theft Investigators
Investigator Consultation and Advice
Online Member Portal
Online Id Risk Assessment and Score
Credit Report
Credit Score
Credit Monitoring w/Alerts
Address Changes Monitoring
Fraud Alert Assistance
Lost Wallet Assistance
Credit Card Opt-Out*
Junk/Spam Email Opt-Out*
Telemarketing Opt-Out*
Medical Bureau Report*
Sex Offender Report*
Identity Restoration by Investigators
Legal Advice and Consultation
24/7 Emergency Access
Attorney Phone Calls on Your Behalf
Attorney Letters Written on Your Behalf
Attorney Contract and Document Review
Online Legal Document Services Center
Moving Traffic Violation Representation
Attorney Trial and Lawsuit Defense
Attorney IRS Audit Assistance
24/7 Emergency Attorney Access
Will Preparation by Attorney
Health Care Power of Attorney
Physician Directive
Member Discounts on Other Legal Services
LEGALSHIELD
IDTHEFTSHIELD
+LEGALSHIELD
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
*Guidance will be provided to members for obtaining and opting out.
Monthly Premiums
Tier
IDTHEFTSHIELD
LEGALSHIELD
IDTHEFTSHIELD+LEGALSHIELD
Employee+Spouse
$12.95
$15.95
$25.90
Family
$13.95
$15.95
$26.90
Page 27
Tax Sheltered 403(b) Annuity (TSA)
A Tax Sheltered Annuity (TSA) is otherwise knows as a 403(b) plan. 403(b) is a section of the Internal Revenue Code
that provides for a Voluntary Tax Deferred Retirement Program that supplements your Teacher Retirement.
Reaching your financial goals for retirement takes time and patience. The sooner you start saving in your retirement plan, the faster you may reach your goals.
The Texas Teacher Retirement System will provide generous benefits for those retiring within the system.
However, chances are that this retirement plan will not provide enough income after retirement to enable you to
maintain your standard of living. A TSA allows you to accumulate a retirement nest egg on a highly tax-favored basis.
The Internal Revenue Services has made changes to the way the District must administer 403(b) Annuities effective
1/1/2009. Duncanville ISD now works with Region 10’s Retirement Asset Management System with National
Benefit Services (NBS) serving as the third party administrator.
To start a 403(b) plan, contact an agent (certified list may be found at www.nbsbenefits.com) and follow the
instructions located on the benefits website regarding 403(b) annuities located at www.duncanvilleisd.org/benefits.
You may also find information to increase, decrease, or drop your 403(b) contribution on the benefits website.
457 Deferred Compensation
457 Deferred Compensation Plan provider for the district is Voya Financial, effective 11/1/2005.








A 457 plan is similar to a 403(b) annuity; however, the District may choose a specific provider for this service.
Another difference between a 457 and a 403(b) product is that withdrawals of 457 deferrals are not subject to
the 10% federal tax penalty imposed on early withdrawals from a 403(b) plan should you decide to retire
before age 55.
You can contribute the maximum amount allowed ($18,000 per year) ($6,000 over age 50 catch-up) to 457
plan without reducing the amount you contribute to 403(b).
Final 3 years (Special Catch-up): $18,000
(May not be used simultaneously with age 50 catch-up)
457 does not have a loan provision.
Voya Financial website: www.voya.com
Zera J. Harris, zera.harris@voyafa.com, (972) 225-1524
Judson D. Arrington, judson@arringtonfinancial.com,
(972) 643-6342
Page 28
Online Benefit Enrollment
For benefit information and to enroll go to: www.mybenefitshub.com/duncanvilleisd
1
2
If you have trouble logging in, click on the “Login Help Video” for assistance.
3
Passwords
All passwords have been RESET to the default described below:
Username:
The first six (6) characters of your last name, followed by the first
letter of your fir t name, followed by the last four (4) digits of your
Social Security Number.
Default Password:
Last Name* (lowercase, excluding punctuati n) followed by the last
four (4) digits of your Social Security Number.
Example) George Washington
000-00-1234
!
Username: washing1234
Password: washington1234
Example)
John Smith
000-00-4321
Enrollment Instructions
Click on “Enrollment Instructions” for more information about how to enroll.
Page 29
Username: smithj4321
Password: smith4321
EMPLOYEE GUIDE TO ENROLL IN BENEFITS WITH
THEbenefitsHUB gives you access to your benefits 24 hours a day, 7 days a week from anywhere that you have Internet access.
This guide is meant to see you through the simple enrollment process page-by-page, taking you through your enrollment screens and
providing information on how to efficiently complete your enrollment walkthrough.
Logging In
Employee Usage Agreement:
The Employee Usage Agreement is displayed when you login to the system as an employee. Read this section carefully as it contains
disclaimer information and requires an “Electronic Signature”. By clicking the
button, you are agreeing to the terms.

Change Password: When logging in for the first time, you will be prompted to update your password following your company’s
password policy. Once your new password has been set, click the
button.
Demographic Information
The Employee Information Entry process requires you to enter demographic information. You will need to review any pre-filled
information for accuracy. Complete new or missing information and click on the
button when you are ready to proceed to
the next step.
Please Note: All fields in BOLD are required.

Personal Information: Enter an email address if you have one. If you need to use the Forgot Password link on the Login page, the
system will deliver your new login credentials to this email address.

Emergency Information: Enter an emergency contact and the preferred contact method.

Dependent Information: To add a dependent, click on the
icon. To edit an existing dependent, click on the
icon or the name
of the dependent listed. Click on the
button after successfully adding information for each dependent. Please make sure to
indicate if your child is a full-time student and/or claimed on your tax return as this could affect eligibility on some benefit plans.

To revisit any of the sections mentioned select the
button to return to the previous section.
Benefits Enrollment
When you have completely entered all of your personal and dependent information, you will begin your online enrollment for any of the
benefits in which you are eligible. Each benefit will appear on individual pages for your review. Choose your election and then click the
button to proceed to the next benefit.

View Benefit Descriptions: To view, click on the View Plan Outline of Benefit link or the
icon next to the name of the plan you
would like to review. This shows a plan summary and any available links or documentation related to this plan.

View Plan Cost: Click on the checkbox next to each eligible family member or choose the coverage level you would like. The cost will
automatically appear in the box to the right of the members’ names. Additionally, the “Election Summary” box will be updated as
coverage adjustments are made.

View Total Plan Cost: While selecting plans, the cost will automatically adjust in the “Election Summary” box in response to your
selections.

Forms: One or more of your Benefit Plans may require a paper form to be submitted with the Insurance Carrier. If this is the case,
THEbenefitsHUB will prompt you to print the necessary forms during your online enrollment session.

View Important Plan Information: Your benefits administrator will spotlight the importance of specific features in a plan or add any
disclaimers that may be necessary in the “Plan Information” section. You may expand/collapse this information by clicking anywhere
on the section.

Product Summary Video: Videos are placed throughout the benefit election process. You can access product videos that explain the
purpose, function and importance by clicking on the
icon when available.
Page 30
Beneficiary Information
Beneficiaries are required. You will need to choose a beneficiary for each applicable plan.
Consolidated Enrollment Form
Consolidated Enrollment Form:
This form signals the end of your enrollment walkthrough and will display information from each of the sections listed above, including
personal and enrollment information. You may make changes to anything that is incorrect by clicking on the Benefit Plan name. Once you
are finished with the enrollment process, you will be sent to the “Employee Menu” where you may make changes. (See Employee Menu
section)
When you have completed your benefit selections, click the
c
button and you will be redirected to the Employee Menu screen.
Employee Menu
After you have completed your enrollment in the system, you will see the following Employee Menu icons:
Personal Information: You can access and edit information by selecting the menu items under Personal Information. This
section will also allow you to change your Password.
Dependent Information: You can access and edit information for Dependents in this section. Make sure the HR Department
knows of any changes made as this may change eligibility status or give an opportunity to change enrollment in certain
benefits!
Benefit Plan Information: You can access and view benefits in this section. You will not be able to change benefit elections
unless it is during your annual enrollment period. See a quick overview of all your elected information on the Consolidated
Enrollment Form.
Navigation and Information Entry Tips…
Below are tips to help you familiarize yourself with the THEbenefitsHUB:

HELP? If you need assistance during the enrollment process, select HELP located at the upper right corner of the screen.

BACK & FORTH: Please do not use the web browser’s “back” or “forward” arrows while in the system. Use the navigation buttons
in the THEbenefitsHUB instead:

REQUIRED INFORMATION: As noted on each screen, the BOLD items are required to allow continuation to the next page. The
more information entered, the better the system will work for you; but you may skip non-bolded items if they do not apply.

MOVING ON: When each election page is complete, go to the bottom of the page and select the

UNABLE TO FINISH? If for any reason you are unable to complete the enrollment process you may LOGOUT and login at a later
time. When you login again, you will walk through the same process. The information previously entered will be stored.

WHAT ARE THOSE SYMBOLS? If you “toggle” the cursor/arrow on the icons, the definition of the icons will be revealed.
= Edit
= View

LINKS… Any words, names or phrases with your company’s primary color that becomes underlined when you click the
highlighted link it will take you to designated section.

SCREEN NAVIGATOR: This line is at the top of your screen. You may click on the links to quickly jump back to those previous
screens.
HUB-1.3 (06/2014)
Page 31
button.
Notes
i
n
Where Your Benefits Meet Technology.
2121 N. Glenville Drive | Richardson, Texas 75082 | (800) 583 6908 | www.fbsbenefits.com

Employee Benefit Guide

Transcription

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