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2020-2021
UISD Benefits Guide
FOR BENEFITS EFFECTIVE SEPTEMBER 1, 2020,
THROUGH AUGUST 31, 2021
2
W hether you are a
new employee or
an existing one,
UISD wants you
and your family to be happy,
healthy, and secure. That’s why
UISD offer’s a comprehensive
benefits package that is designed
to help you achieve your physical,
financial and work-life potential.
We are committed to providing
you with tools and resources to
help you maximize your benefits,
including this Benefits Guide.
Please review it carefully for
highlights of our benefits and
discuss your options with your
family.
Note: If you are a new employee
or rehire, you must visit Human
Resources at 201 Lindenwood La-
redo TX 78045 to be processed
first and then visit Benefits De-
partment at Portable 6.
Contents
Getting Started ·························· 3
Eligibility and Enrollment
Frequently Asked Questions
Health ··············································· 4
Medical & Prescription Drug Coverage
Dental Coverage
Vision Coverage
Wealth ·············································· 14
Life Insurance
Disability Insurance
Flexible Spending Account
Annuities 403b OMNI
Air Transportation ··················· 21
Emergency Transportation
Rates ·················································· 22
3
Getting Started Eligibility
“Group health insurance coverage is available to all regular full-time employees. The district’s contribution to employee insurance premiums is determined annually by the board of trustees. Detailed descriptions of insurance coverage, prices, and eligibility requirements are provided to all employees. Additional information is available through the Risk Man-agement Department. New employees must complete en-rollment forms within the first 30 days of employment. Cur-rent employees can make changes in their insurance cover-age only during the district annual enrollment which is held in the latter part of August. Employees should contact Risk Management Department at 956-473-6390 for more infor-mation.” Source Employee Handbook.
Dates to Remember
Our plan year is September 1st through August 31st
New Hires must enroll within 30 days of employment.
Elections you make when first becoming eligible or dur-ing Open Enrollment will remain in effect until our next Open Enrollment period.
In addition, if you decline coverage for yourself and/or your dependent(s) when first becoming eligible, you must wait until the next Open Enrollment period to en-roll.
Ways to Enroll?
During Open Enrollment
Qualifying Events
New Employee
How to Enroll?
Visit https://www.uisd.net/benefits
Click on “Your Personal Benefits Online”
Click login on the upper right of the screen
Follow Instructions to access your account.
Remember every year password is reset and you must set a new one.
Qualifying Events? A change in your situation — like getting
married, having a baby, or losing health
coverage — that can make you eligible for
a Special Enrollment Period, allowing you
to enroll in health insurance outside the
yearly Open Enrollment Period.
Qualifying event through the Loss of health
coverage
Losing existing health coverage, includ-
ing job-based, or individual.
Losing eligibility for Medicare, Medi-
caid, or CHIP.
Turning 26 and losing coverage through
a parent’s plan
Qualifying events through changes in
household
Getting married or divorced
Having a baby or adopting a child
Death in the family
For any qualifying event, employee has 30
days to visit Benefits department to submit
documentation and sign documentation. If
requirements are not met changes will not
become effective.
Required Documentation
Documentation should be personally deliv-
ered Benefits Department at 201 Linden-
wood Street Laredo TX 78041, faxed to
(956) 473-6497 or emailed to bene-
[email protected] (please note: that either
email address or fax are not is not secure.
We preferred to have them delivered in
person). Should you have any questions,
please call (956) 473-6324.
4
Beneficiaries
At UISD we want to help you take care of your loved ones even when you are no longer here with us. Starting the year 2019-2020 we request to all eligible employees to assign a beneficiary for their life insur-ance(s). This way, we make sure that your loved ones are receiving the benefits they need.
The Plan Benefit Information
This benefit information presented in this booklet is not intended to replace or serve as the plan’s Evidence of Coverage, Summary Plan Description or Group Service Contract. If you have specific questions regarding the benefits, limitations or ex-clusions of your plan, please visit Risk Manage-ment website https://www.uisd.net/risk-management for more information. Or reach us at
Risk Management Portable 6
201 Lindenwood Dr
Laredo TX, 78045
Dependent Verification Audit? What is it?
A dependent eligibility audit is a process used to veri-fy that all dependents enrolled in a group benefit plan are eligible for coverage. Dependent eligibility audits require employees to provide documentation to vali-date the relationship between the employee and the dependent. This confirms the dependent is eligible for coverage based on the plan’s rules. Dependent eligi-bility audits are a best practice among employers and helps manage both regulatory compliance and rising health insurance costs. Dependent eligibility verifica-tion protects the health plan from ineligible depend-ents, helping plan sponsors ensure their health plan is compliant and that benefit dollars are only being spent on participants who are eligible, keeping health care costs down for everyone.
Frequently Asked Questions & Notices
5
BLUE CROSS BLUE SHIELD OF TEXAS EFFECTIVE DATE: 9/1/2020 TO: 8/31/2021
WEBSITE: WWW.BCBSTX.COM
UISD SCHEDULE OF BENEFITS 2020-2021 SCHOOL PLAN YEAR
CORE PLAN CORE PLUS PLAN Provider Network
Doctor's Hospital Yes Yes
Laredo Medical Center Yes Yes
Benefit Service Deductible
Annual Ray/CT/MRI/Sonograms $-0- Deductible CO-INSURANCE APPLIES $-0- Deductible CO-INSURANCE APPLIES
All Other Deductible-Annual (New Limits) In-Network $2,000 Indiv/$4,000 Family $1,500 Indiv/$3,000 Family
Out-of-Network $4,000 Indiv/$8,000 Family $3,000 Indiv/$6,000 Family
Doctor's Visits Physician Copay $35 $35
Specialist Copay $60 $45
VIRTUAL VISITS $15 Per Virtual Visit $15 Per Virtual Visit
After Hours Urgent Care Clinics
(Non-Emergency Rooms/Centers) $35 Then 100% $35 Then 100%
List of in-network Clinics can be found on the Risk Management Website
Emergency Room (Hospitals & ER Centers)
In-Network $500 & Then 70% $500 & Then 70%
Out-of-Network $500 & Then 70% $500 & Then 70%
Deductible-Hospital
In-Network $-0- Per Admission $-0- Per Admission
Out-of-Network $500 Per Admission $500 Per Admission
Co-Insurance Percent (New Coinsurance Share) In-Network 30% / 70% 30% / 70%
Out-of-Network 50% / 50% 50% / 50%
Out of Pocket Maximum (New Limits) In-Network $8,150 Indiv/$16,300 Family $8,150 Indiv/$16,300 Family
Out-of-Network $17,000 Indiv/$34,000 Family $17,000 Indiv/$34,000 Family
Out of Pocket Maximums Include Calendar Year Deductible
Prescription Drugs (New Specialty Category) Retail-Supply Limit RX 30 Days 30 Days
RX Category RX Copay RX Copay
Generic $10 $10
Brand-Preferred $60 $50
Brand-Non Preferred $105 $80
Specialty Prefered / Non-Preferred (New) $250 $250
Plus cost difference between generic & brand if generic equivalent is available
Prescription Drugs (New Specialty Category) Mail Order-Supply Limit RX 90 Days 90 Days
RX Category RX Copay RX Copay
Generic $20 $20
Brand-Preferred $120 $100
Brand-Non Preferred $210 $160
Specialty Prefered / Non-Preferred (New) $250 $250
Plus cost difference between generic & brand if generic equivalent is available
*Changes effective Plan Year 09/01/2020: NEW CONTRIBUTIONS EMPLOYEE + INCREASES ACROSS ALL PLANS **Changes effective Plan Year 09/01/2020: NEW UNITED ISD CONTRIBUTIONS
***Dual Family Plan is only for legally married couples (with children) who both are employees for UISD. Must visit Risk Management to enroll in plan.
6
Our medical plans not only offer comprehensive care—they connect you with tools and resources to help you meet your wellbeing goals. From 24/7 access to board-certified doctors by phone or online
video chat to exclusive member discounts on health products and programs, your plans offer support. The following are highlights of just a few of the many programs available.
BENEFITS VALUE ADVISORS (NO LONGER ACTIVE)
You have choices when deciding where to go for care. BCBSTX’s Benefits Value Advisor program can help you find the doctors, providers and facilities that are right for your needs. Benefits Value Advisors can help you get the information you need to choose between cost-effective, in-network providers.
Benefits Value Advisors can also help you understand your benefits, find in-network doctors and hospitals to help avoid out of- network costs, schedule doctor visits, get preauthorization for certain services and use online educational tools.
Call the number on your medical ID card to reach a Bene-fits Value Advisor today.
BCBSTX’S SECURE MEMBER WEBSITE: BAM
BCBSTX’s secure member website, Blue Access for Members (BAM) at www.bcbstx.com/member, puts online tools and information at your fingertips 24/7 to help you make educated health care decisions and manage your benefits. When you logon, you can:
Check the status or history of a claim
View or print Explanation of Benefits statements
Locate a doctor or hospital in your plan’s network
Find Spanish-speaking providers
Request a new ID card, or print a temporary one
Visit the Health Care School to see articles and videos to help you make the most of your benefits
Use the Provider Finder tool to find an in-network primary care physician, specialist or hospital. It can also estimate the cost of hundreds of procedures, treatments and tests and help estimate your out-of-pocket expenses.
Participate in the Well on Target program, which offers free resources to help you on your journey to lifelong well-being, including a health assessment, online courses, health trackers and more. It even has a mobile app.
Access exclusive discounts on a wide variety of health services and products through the Blue365® Member r Discount Program.
log-in
7
Our medical plans not only offer comprehensive care—they connect you with tools and resources to help you meet your wellbeing goals. From 24/7 access to board-certified doctors by phone or online
video chat to exclusive member discounts on health products and programs, your plans offer support. The following are highlights of just a few of the many programs available.
MDLIVE VIRTUAL VISITS
With MDLIVE, you have access to U.S. board-certified doctors 24/7/365, whether you are at home, work or on the road. You can get the care you need when and where it’s convenient for you via your mobile device or computer. Even better: doctors can write a prescription, if needed, that you can pick up at an in network pharmacy. You can get medical advice within minutes for a variety of non-emergency medical issues (cold/flu symp-toms, ear infections, allergies, asthma, pinkeye, etc.). These services are covered by your medical plan and costs just $15 per visit. Visit www.MDLIVE.com/bcbstx or call (888) 680-8646 to get connected today.
24/7 NURSELINE
You and your family have unlimited, 24-hour toll-free access to a team of registered nurses experi-enced in providing information on a variety of health topics. Use this service to choose the right providers, understand treatment options, manage chronic conditions and more. Call the number on your medical ID card to get in touch.
SPECIAL BEGINNINGS® MATERNITY PROGRAM
Having a baby? Help protect your health and your baby’s health by signing up for the BCBSTX Special Begin-nings Program. You can receive the personal attention and information you may need to care for yourself and your baby during pregnancy and up to six weeks after you give birth. The program offers:
A healthy pregnancy calendar to help you keep track of your pregnancy
Videos that cover topics such as eating habits, exercise, stress and more
Details about each trimester and the changes in you and your baby
A list of screenings and vaccines to help you prepare for your checkups
Program support available Monday through Friday, 8 a.m. to 6:30 p.m. CT Call (888) 421-7781 to enroll!
8
Prescription Drug Tool: Find out if your medicine is covered!
Find out if your drug is covered, make sure to follow these 4 easy steps! 1. Go into www.myprime.com and click on “Find Medicines”
2. Click on “Continue Without Sign In” (you can enroll is optional)
3. Make the following elections BCBS TEXAS, No, & Other BCBSTX Plans
4. Finally choose Performance Drug List and search your medicine!
Yes , is that simple!
9
Group No: 15502 Effective Date: 9/1/19 Benefit Highlights DPO
Eligibility Primary enrollee, spouse and eligible dependent children to the end of the month dependent turns 26
Deductibles
Deductibles waived for Diagnostic & Pre-
ventive (D&P) and Orthodontics?
$50 per person / $150 per family each calendar year
Yes
Maximums
Low Plan: $750 per person each calendar year High Plan: $1,000 per person each cal-
endar year
D&P counts toward maximum? Yes
Waiting Periods Basic Benefits None
Major Benefits 12 Months High Plan only
Prosthodontics 12 Months High Plan only
Orthodontics 12 Months High Plan only
Benefits and Covered Services* Low Plan** High Plan**
Diagnostic & Preventive Services (D&P) Exams, cleanings, x-rays and sealants
100% 100%
Basic Services Fillings
80% 80%
Oral Surgery 80% 80%
Endodontics (root canals) 0% 50%
Periodontics (gum treatment) 0% 50%
Major Services Crowns, inlays, on lays and cast restorations
0% 50%
Prosthodontics Bridges, dentures and implants
0% 50%
Orthodontics Dependent children to age 25
0% 50%
Orthodontic Maximums Not Applicable $1,000 Lifetime
* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursements
based on Delta Dental contract allowances and not necessarily each dentist’s actual fees.
** Fees are based on DPO contracted fees for DPO dentists, Premier contracted fees for Premier dentists and Premier contracted
fees for non-Delta Dental dentists.
Delta Dental Insurance Company Customer Service Claims Address 1130 Sanctuary Parkway (Toll−Free) P.O. Box 1809 Alpharetta, GA 30009 800-521-2651 Alpharetta, GA 30023
10
Delta Dental PPOSM
The Difference
UISD offers two dental plans: High & Low plans. Both plans
feature various coinsurance, deductibles and copays for
periodontics, endodontics and other services. DPO & Non-
Delta Dental dentists preventive screenings are covered at
100 percent under both plans. These plans are PPO plans,
meaning they offer you the freedom to select your health
care providers from a nationwide network. In the next
page there is a side-by-side comparison of both dental
plan options. For complete coverage details, please refer
to the Plan Documents, which are posted on https://
www.uisd.net/benefits
Save with PPO
Visit a dentist in the PPO1 network to maximize your sav-
ings.2 These dentists have agreed to reduced fees, and you
won’t get charged more than your expected share of the
bill.3 Find a PPO dentist at deltadentalins.com.
Set up an online account
Get information about your plan anytime, anywhere by
signing up for an Online Services account at deltadenta-
lins.com. This free service, available once your coverage
kicks in, lets you check benefits and eligibility information,
find a network dentist and more.
Check in without an ID card You don’t need a Delta Dental ID card when you visit the
dentist. Just provide your name, birth date and enrollee ID
or social security number. If your family members are cov-
ered under your plan, they will need your information.
Prefer to take a paper or electronic ID card with you?
Simply sign in to Online Services, where you can view or
print your card with the click of a button.
Coordinate dual coverage
If you’re covered under two plans, ask your dental office to
include information about both plans with your claim, and
we’ll handle the rest.
Understand transition of care
Did you start on a dental treatment plan before your PPO
coverage kicked in? Generally, multistage procedures are
only covered under your current plan if treatment began
after your plan’s effective date of coverage.4 You can find
this date by logging in to Online Services.
Newly covered?
Visit www.deltadentalins.com/welcome
1 In Texas, Delta Dental Insurance Company offers a Dental Provider Organization (DPO) plan.
2 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-PPO dentist. Network dentists are paid
contracted fees.
3 You are responsible for any applicable deductibles, coinsurance, amounts over plan maximums and charges for non-covered services.
4 Applies only to procedures covered under your plan. If you began treatment prior to your effective date of coverage, you or your prior carrier is
responsible for any costs. Group- and state-specific exceptions may apply. If you are currently undergoing active orthodontic treatment, you may
be eligible to continue treatment under Delta Dental PPO.. Review your Evidence of Coverage, Summary Plan Description or Group Dental Service
Contract for specific details about your plan.
LEGAL NOTICES: Access federal and state legal notices related to your plan at deltadentalins.com/about/legal/index-enrollee.html.
11
Estimate Your Costs Looking to budget your dental costs? Try the Cost Estimator. This feature of Delta
Dental’s online account gives you a personalized estimate of how much you’ll pay
for your next dentist visit. Whether you’re getting braces or need a cavity filled, you’ll choose from the top reasons for visiting the den-tist, written in everyday language. The Cost Estimator organizes information logically, so you don’t need to be concerned whether the service involves multiple procedure codes or visits.
1. Log in to your account at deltadentalins.com. (If you don’t have one yet, click on Register.)
2. Click on the Cost Estimator link by your name.
This section summa-rizes the type of vis-it or procedure se-lected.
Click on I need to go
back to the full list of
procedures.
Looking for a procedure not listed? Scroll to the bottom of the page for a link to a longer list.
Clicking on Explain cost
details will expand the
breakdown of how
your estimate was cal-
culated.
To change the dentists
shown, click on Change
compared dentists.
Select your options,
then click on Show cost.
The benefits sidebar will show the current status of your maxi-mums and deducti-bles, if applicable.
12
Eyetopia Vision Care Benefits ADVANTAGE PLAN (120/145) Co-pay
Eyetopia provides two vision benefits each eligibility period. By coordinating your coverage with your Health Insurance you have the opportunity to maximize your Eyetopia benefits.
Benefit One 2 (choose either one of the following 2 options every 12 months):
1. Refractive Exam. One refraction (CPT code 92015) or one routine Vision Exam. $10.00
2. A $45 allowance toward medical co-pays or any material or service of an equal or lesser value.
Benefit Two (choose only one of the following Vision Correction Options): Eyetopia Vision Care provides you with three (3)
options for correcting your vision. If your prescription has changed a least ½ diopter or your eye doctor recommends a change of lenses, you may select one of the following every 12 months:
1. Prescription Eye Wear (lenses and/or frame)3
Standard Prescription Lenses – covered 100%
Non-coated CR-39 plastic single vision, bifocal, trifocal or standard Progressive lenses4.
Eyetopia Labs standard single vision or bifocal flat top 28 lenses with premium Anti-Reflective Coating 5.
$20
Child dependents (under age 26) can upgrade to EyetopiaLabs polycarbonate lenses5.
Basic Anti-Reflective Coating (Ultra Violet Protection & Scratch Resistant Coating)
Standard Tints (Gradient and Solid)
Polycarbonate upgrade 6
Warranted Anti-Reflective Coating
Eyetopia Labs high definition PAL or premium SV in CR-39 with a premium anti-reflective coating. 5
$25.00
$12.00
$35.00
$65.00
$65.00
Frame: The member may select any frame on display. Eyetopia Vision Care provides an allowance of $120.00 to be applied toward the frame selected. The member pays any amount exceeding the $120.00 allowance8.
2. Contact Lens Option: 7 Eyetopia Vision provides a $145.00 allowance to be applied toward the Participating Pro-vider’s usual and customary (U&C) fees toward prescription contact lenses.
This allowance can be applied toward the contact lens fitting fee and all other charges including follow-up visits and contact lenses.
$20.00
Medically necessary spectacle or contact lenses - $400 total allowance.8
3. Refractive Surgery Option. 9 You may select refractive surgery instead of spectacles or contact lenses during each plan period. Eyetopia Vision Care provides a $350 per eye allowance for in-network surgeons and a $75 per eye allowance for out-of-network surgeons toward the fees for the following procedures: LASIK, ASA, ICL or RLE. The member pays any amount exceeding the per eye allowance.
None
1The co-pay must be paid to the Participating Provider at the time of service. 2 When Health Insurance Carriers offer an annual wellness eye exam it creates an overlap in benefits for Eyetopia Members. If this occurs, the member may choose another option under Benefit One as described, a $10.00 co-pay is still required to exercise these other options. 3 Special Lens Materials and Non-covered Items: Transition, ultra light, premium PALs, rush service, service agreements, other special lens materials, oversize, other extras and any items not specifically mentioned above may be substituted provided the Member pays any amount exceeding the price of the covered benefit and the Participating Provider’s usual and cus-tomary fees for the upgrade at the time of service. 4 Standard Progressive Lenses are defined as any brand of PAL offered by the Participating Provider with up to a $120.00 retail value. 5 Members can upgrade from standard non-coated lens to the Eyetopia Labs premium coated lenses at no charge. They can upgrade to the Eyetopia Labs high definition PAL or single vision in CR-39 plastic for an additional $65.00. 6 Child Dependents not being prescribed Resolution� polycarbonate lenses, Members (employees) and Dependent Spouses are charged a polycarbonate upgrade fee. 7 If the contact lens exam or “fitting” is performed and the patient decides against getting contact lenses, the patient is responsible for the cost of the contact lens fitting fee. 8 The Participating Provider must pre-authorize medical necessity. 9 Non-covered Items and Exclusions – Facility fees, medications and enhancements or treatments related to complications. Access to surgeons must come by referral from a Primary Eye
13
Eyetopia Vision Care Benefits GOLD PLAN (150/250) Co-pay1
Eyetopia provides two vision benefits each eligibility period. By coordinating your coverage with your Health Insurance you have the opportunity to maximize your Eyetopia benefits.
Benefit One (choose either one of the following 2 options every 12 months):
1. Refractive Exam. One refraction (CPT code 92015) or one routine Vision Exam. $5.00
2. A $65 allowance toward medical co-pays or any material or service of an equal or lesser value.
Benefit Two (choose only one of the following Vision Correction Options): Eyetopia Vision Care provides you with three (3)
options for correcting your vision. You may select one of the following every 12 months:
1. Prescription Eye Wear (lenses and/or frame)2,3 Prescription High Index or Polycarbonate single vision, bifocal, trifocal or basic PAL lenses that also include a Basic Anti-Reflective Coat – covered 100%. Members can get Eyetopia Labs lenses that come with premium anti-reflective coatings and are covered 100%.
Specific to Eyetopia Labs Lenses Only: Premium Anti-glare, anti-smudge, anti-scratch with UV Protection
Optimized Manufacturing Technology
None
Tint (Solid and Gradient) $12.00
Transition or Polarized Lenses 2 Note 2
Warranted Anti-Reflective Coating $65.00
Premium Anti-Reflective Coating 2 Note 2
Frame: The member may select any frame on display. Eyetopia Vision Care provides an allowance of $120.00 to be applied toward the frame selected. The member pays any amount exceeding the $120.00 allowance.
None
2. Contact Lens Option: 3,4 Eyetopia Vision provides a $250.00 allowance to be applied toward the Participating Pro-vider’s usual and customary (U&C) fees toward prescription contact lenses.
Noe
This allowance can be applied toward the contact lens fitting fee and all other charges including follow-up visits and contact lenses.
Medically necessary spectacle or contact lenses - $400 total allowance.
3. Refractive Surgery Option6. You may select refractive surgery instead of spectacles or contact lenses during each plan period. Eyetopia Vision Care provides a $500 per eye allowance for in-network surgeons and a $125 per eye al-lowance for out-of-network surgeons toward the fees for the following procedures: LASIK, ASA, ICL or RLE. The mem-ber pays any amount exceeding the per eye allowance.
None
1 The co-pay must be paid to the Participating Provider at the time of service. 2 Special Lens Materials: The member may select special lens materials (transition, ultra light, premium PALs, etc.) provided they pay any amount exceeding the participating provider’s U&C fees for the covered lenses. 3 Non-covered items: Any items not specifically mentioned above, including but not exclusive to rush service, service agreements, special lens materials, oversize and other extras are paid for by the patient at the time of service. Standard Progressive Lenses are defined as any brand of PAL offered by the Participating Provider with a retail value of $120.00 or less. 4 If the contact lens exam or “fitting” is performed and the patient decides against getting contact lenses, the patient is responsible for the cost of the contact lens fitting fee. 5 The Participating Provider must pre-authorize medical necessity. 6 Non-covered Items and Exclusions – Facility fees, medications and enhancements or treatments related to complications. Access to surgeons must come by referral from a Primary Eye Care Provider who provides pre and post-op care and counseling.
14
Group Customized Disability Benefits for All
Eligible Employees of United Independent
School District - #222916
Benefits:
Coverage for All Full-Time UISD employees working in the United
States working 30 hours or more per week.
This Customized Disability plan from Sun Life allows you to cus-
tomize your coverage from the following options:
Benefit Duration:
Allows you to select the duration of coverage for disabilities due
to injuries and sickness. Options are 36 months, or To age 65
ADEA.
Benefit Amount:
This plan allows you to select a benefit amount between $200
and $7,500 per month, in increments of $100. The benefit elect-
ed cannot exceed 66.67% of your monthly salary.
Elimination Period:
Allows you to select the number of days that you must be disa-
bled before benefits are available. Options are after 14 days,
after 30 days, or after 60 days for absences due to covered inju-
ries and sickness.
Employees must meet the definition of Total Disability as de-
fined in the policy to be eligible for the benefits described here.
Benefits are not payable under the 3/12 pre-existing conditions
clause as defined in the policy.
Included Benefits: In addition, your coverage is enhanced by the
following benefits:
Child Care Benefit: Pays an additional benefit to insured in
an approved rehabilitation program if they have a qualifying
dependent enrolled in approved child care.
Survivor Benefit (SB): Pays a 3 months lump sum gross Sur-
vivor benefit.
Limitations
Limitations include but are not limited to, the list below. Limita-
tions may vary depending on your specific benefit plan. No Cus-
tomized Disability Insurance benefit will be payable for any Total
or Partial Disability during any of the following periods:
Any period you are not under the regular and continuing
care of a physician providing appropriate treatment and
regular examination and testing in accordance with the dis-
abling condition, unless you reached a maximum point of
recovery and still totally or partially disabled, or
Any period you fail to submit any medical examination or
clinical assessment requested by Sun Life, or
Any period you are incarcerated. Other limitations that are
plan or state specific may apply. Please review the certifi-
cate for information on the specific limitations.
Exclusions
Exclusions include but are not limited to the list below. Exclu-
sions may vary depending on your specific benefit plan. No Cus-
tomized Disability benefit will be payable for any Total or Partial
Disability that is due to:
An intentionally self-inflicted injury,
War, declared or undeclared, or any act of war,
Active participation in a riot, rebellion, or insurrection, or
committing or attempting to commit an assault, felony, or
other criminal act.
If a pre-existing condition limitation applies to the plan, then no
Customized Disability benefit is payable for any period of disabil-
ity that occurs within the exclusionary period and is caused by,
contributed to by, or resulting from a pre-existing condition. For
more information, consult with your Benefits Administrator.
Exclusions may vary depending on your specific benefit plan and
state requirements.
15
Choice 1 Choice 2 Choice 3
Benefit Duration: To age 65 ADEA Benefit Dura-
tion: To age 65 ADEA
Benefit Dura-
tion: To age 65 ADEA
Benefit Amount: $100 Increments Benefit Amount: $100 Increments Benefit Amount: $100 Increments
Elimination
Period: 14 days
Elimination
Period: 30 days
Elimination
Period: 60 days
Included Benefits:
See previous page for descriptions
of benefits
Child Care Benefit
Survivor Benefit
Included Benefits:
See previous page for descriptions
of benefits
Child Care Benefit
Survivor Benefit
Included Benefits:
See previous page for descriptions
of benefits
Child Care Benefit
Survivor Benefit
Your Age Rate per $100 Your Age Rate per $100 Your Age Rate per $100
Under 25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70 and over
$1.50
$1.50
$1.75
$1.95
$2.18
$2.86
$3.76
$5.02
$5.06
$6.69
$6.69
Under 25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70 and over
$1.07
$1.07
$1.22
$1.45
$1.74
$2.34
$3.07
$3.98
$3.56
$4.66
$4.66
Under 25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70 and over
$0.76
$0.76
$0.88
$1.06
$1.33
$1.85
$2.47
$3.36
$2.93
$3.78
$3.78
Estimate Your Disability Costs
16
Choice 4 Choice 5 Choice 6
Benefit Duration: 36 months Benefit Dura-
tion: 36 months Benefit Duration: 36 months
Benefit Amount: $100 Increments Benefit Amount: $100 Increments Benefit Amount: $100 Increments
Elimination
Period: 14 days
Elimination
Period: 30 days
Elimination
Period: 60 days
Included Benefits:
See previous page for descriptions
of benefits
Child Care Benefit
Survivor Benefit
Included Benefits:
See previous page for descriptions
of benefits
Child Care Benefit
Survivor Benefit
Included Benefits:
See previous page for descriptions
of benefits
Child Care Benefit
Survivor Benefit
Your Age Rate per $100 Your Age Rate per $100 Your Age Rate per $100
Under 25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70 and over
$1.24
$1.24
$1.43
$1.52
$1.58
$1.98
$2.58
$3.66
$4.99
$6.61
$6.61
Under 25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70 and over
$0.82
$0.82
$0.89
$1.02
$1.14
$1.45
$1.89
$2.62
$3.79
$4.58
$4.58
Under 25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70 and over
$0.50
$0.50
$0.55
$0.62
$0.73
$0.97
$1.30
$2.00
$2.86
$3.70
$3.70
Estimate Your Disability Costs
17
Voluntary Life Insurance Benefits for Employees of United Independent School District – #222916
For the employee An amount between $10,000 and $500,000, in increments of $1,000, not to exceed 7x basic annual earnings. Guaranteed Is-sue Amount is $350,000. Benefits cease at retirement.
For your spouse An amount between $5,000 and $250,000, in increments of $1,000. Guaranteed Issue Amount is $50,000. Spouse Voluntary Life coverage may not exceed 100% of the employee’s coverage. Spouse coverages terms at the Spouse age of 80.
For your dependent child(ren) An amount of $10,000 for each eligible child who is 6 months to 26 years old; $1,000 for a child from live birth to under 6 months. Child coverage cannot exceed 100% of the employee’s coverage. You must elect Voluntary Life coverage for yourself in order to cover your spouse and/or children.
Features of the Plan The plan also includes many special features including
Waiver of Premium
Accelerated Benefits.
How to Enroll Once you have selected the amount of coverage that’s right for you, your spouse and your children, simply fill out the Voluntary Life enrollment form provided at enrollment. Be sure to e-sign, date, and return the form to us.
About Evidence of Insurability Evidence of Insurability – also called “proof of good health” – is required if: You decline coverage during your initial eligibility period and then want coverage at a later date; or You apply for Voluntary Life in excess of the Guaranteed Issue Amount. All late entrants and increases require Evidence of Insurability. Your employer will advise you if you need to submit an Evidence of Insurability application. If so, Sun Life Financial may arrange for you to take a medical exam (at our expense) and/or complete a questionnaire. Coverage will not go into effect until Sun Life Fi-nancial approves the application.
18
What is a
Flexible Spending
Account (FSA)?
What’s a cafeteria plan
(FSA)? A cafeteria plan enables you to
save money on group insurance,
healthcare expenses, and depend-
ent care expenses. Your contribu-
tions are deducted from your
paycheck by your employer before
taxes are with withheld. These de-
ductions lower your taxable in-
come which can save you up to
35% on income taxes!
Two types of FSAs For a health FSA, start by choosing
an annual election amount. This
amount will be available on day
one of your plan year for eligible
medical expenses. Then, payroll
deductions will be made through-
out the plan year to fund your ac-
count. A dependent care FSA works
differently than a health FSA. Mon-
ey is only available as it is contrib-
uted and can only be used for de-
pendent care expenses. Both are
pre-tax benefits your employer
offers through a cafeteria plan.
Choose one or both —whichever is
right for you.
What if I don’t use it
all? Because an FSA is a planning tool
with great tax benefits, you must
use the account balance in its en-
tirety before the end of the plan
year or it will be forfeited. This is
known as the “use-it-or-lose-it”
rule. Your employer may offers a
$500 rollover to help if you miss
the mark a little bit. Just make sure
to plan carefully when you enroll.
Enrollment Considera-
tions After the enrollment period ends,
you may increase, decrease, or
stop your contribution only when
you experience a qualifying event.
Change of status” (e.g. marriage,
divorce, employment change, de-
pendent change). Be conservative
in the total amount you elect to
avoid forfeiting money at the end
of the plan year.
Spending is easy
Our convenient NBS Benefits Card
allows you to avoid out-of-pocket
expenses, cumbersome claim
forms and reimbursement delays.
Or you may also utilize the “pay a
provider” option on our web por-
tal.
Account access is easy Get account information from our
easy-to-use online portal and mo-
bile app. See your account balance,
contributions and account history
in real time.
Partial List of Eligible
Expenses: Medical/Dental/Vision Copays and
deductibles
Prescription Drugs
Physical Therapy
Chiropractor
First-Aid Supplies
Lab Fees
Psychiatrist/Psychologist
Vaccinations
Dental Work/Orthodontia
Eye Exams
Laser Eye Surgery
Eyeglasses, Contact Lenses, Lens.
19
Are you aware of our 403(b) benefit? The Opportunity You have the opportunity to save for retirement by participating your employer’s 403(b) retirement plan. A
403(b) is a retirement plan for certain employees of public schools, tax-exempt organizations and ministers.
Why Save with 403(b)? You do not pay income tax on allowable contributions until you begin making withdrawals from the plan,
usually after your retirement.
Investment gains in the plan are not taxed until distributed.
Retirement assets cans be carried from one employer to another in most cases.
How Can I Participate? Prior to contributing you must open an account with an investment provider participating in the plan, a list of
which is available at the OMNI 403(b) Website (https://www.omni403b.com/). You may then complete a sal-
ary reduction agreement (SRA) online at: https://www.omni403b.com/forms_SRA_403b.aspx
How much can I contribute annually? You may contribute up to $19,000 in 2019. For appropriate limits for your particular circumstances, please
contact OMNI’s Customer Care Center at 877-544-6664
Looking for help? Please visit: https://www.omni403b.com/ to get the assistance you need.
Sample: Future retirement savings value assuming 6% yield on invest
Monthly Contributions 5 Years 15 Years 20 Years
$50 $3,489 $14,541 $23,102
$200 $13,954 $58,164 $92,408
$500 $34,885 $145,409 $231,020
20
Telephone and office con-
sultations
For an unlimited number of personal
legalmatters with an attorney of your
choice
Estate Planning
Documents
Simple and Complex Wills
Powers of Attorney (Healthcare, Fi-
nancial, Childcare)
Healthcare Proxies
Living Wills
Codicils
Document Review
Any Personal Legal Documents
Family Law
Divorce, Dissolution and Annulment
(Contested & Uncontested)
Uncontested Adoption
Uncontested Guardianship or Conser-
vatorship
Name Change
Elder Law Matters
Consultations and Document Review
for issues related to your parents in-
cluding Medicare, Medicaid, Prescrip-
tion Plans, Nursing Home Agree-
ments, leases, notes, deeds, wills and
powers of attorney as these affect
participant
Real Estate Matters
Sale or Purchase of your Primary Resi-
dence
Eviction and Tenant Problems
(Primary Residence - Tenant only)
Security Deposit Assistance (For Ten-
ant)
Document Preparation
Affidavits
Demand Letters
Mortgages
Promissory Notes
Criminal & Traffic Offens-
es*
Driving Privilege Restoration (Includes
License Suspension due to DUI)
Misdemeanor Defense
Personal Property Protec-
tion
Consultations and Document Review
for Personal Property Issues
Assistance for disputes over goods
and services
Juvenile Matters
Juvenile Court Defense, including
Criminal Matters
Parental Responsibility Matters
Financial Matters
Negotiations with Creditors
Debt Collection Defense
Tax Audit Representation (Municipal,
State or Federal)
Foreclosure Defense
Tax Collection Defense
Identity Theft Matters
Identity Theft Defense
**LifeStages - Identity Management
Services
Defense of Civil Lawsuits
Civil Litigation Defense
Insurance Matters
Insurance Claims
Consumer Protection
Disputes over Consumer Goods and
Services
Small Claims Assistance
Family Matters™***
Available for an additional fee
Separate plan for parents of partici-
pants for Estate Planning Documents
Easy Enrollment - online or by phone
For More Information: Visit our website info.legalplans.com and enter access code: 5610010 for the Single Plan or 5620010 for the Family Plan or call our Client Service Center at 1-800-821-6400 Monday - Friday from 8am – 8pm (Eastern Time).
21
In a medical emergency every second counts, especially when transporting patients who are far away from
adequate medical treatment. We respond to scene calls and provide hospital-to-hospital transports—
carrying seriously ill or injured patients to the nearest appropriate medical facility.
AirMedCare Network is America’s largest air medical membership network. AMCN provides coverage across
320 locations in 38 states.
Expenses for emergency air medical transport can put stress on your finances. With an AirMedCare Network
membership, you will have no out-of-pocket expenses if flown by an AMCN provider. Best of all, United ISD
employees receive a special discounted rate — Automatically deducted from your paycheck—removing any
hassles and worry.
Secure financial peace of mind for you and your family today!
22
MONTHLY RATES SUMMARY 2020-2021
Health Benefit
**New District Contribution for 2019-2020 $425.00 $425.00
Employee Plans Core Plan Core Plus+ Plan
Cost Distribution *Employee
Contribution *Policy Cost
*Employee Contribution
*Policy Cost
Employee Only $81.12 $506.12 $170.62 $595.62
Employee & Children $296.36 $721.36 $434.83 $859.83
Employee & Spouse $488.04 $913.04 $665.95 $1,090.95
Employee & Family (Children & Spouse) $690.04 $1,115.04 $911.86 $1,336.86
***Dual Family $265.04 $1,115.04 $486.86 $1,336.86
Dental Benefit
Employee Plans Low Plan High Plan
Enrollee only $18.21 $25.64
Enrollee + dependent(s) $51.85 $69.16
Vision Benefit
Employee Plans Standard Plan 120/145 Gold Plan 150/250
Employee only $7.50 $18.00
Employee + 1 $14.00 $36.00
Employee + Family $22.00 $50.00
Legal Services
Employee Plans Single Tiered
Employee Only $15.95
Employee + Family $17.40
Emergency Transportation
Employee Plans Single Tiered
Household Plan $5.00
Basic Life Insurance
Employee Plan Benefit Amount Employee Cost
Employee Only $25,000 $0.00
Flexible Spending Accounts
Employee Plan Employee Cost (Annual Contributions divided by 12)
Dependent FSA Annual Contribution Up to $2,500 if you are single or $5,000 if you are married
Health FSA Annual Contribution Up to $2,750 regardless of status
Voluntary Life Insurance
Employee Plans Employee Cost
Employee Only Plan Based on the employee's age
Employee Spouse Plan Based on the employee's benefit election and spouse's age
Employee Child Life Based on the employee's benefit election and child's age
Disability Insurance
Employee Plan Employee Cost
Employee Only Plan Based on employee's benefit election
23
THANK YOU!
FOR BENEFITS EFFECTIVE SEPTEMBER 1, 2020,
THROUGH AUGUST 31, 2021.
