Table of Contents Enrollment Information 2 3 LA PORTE ISD ... · 2017 – 2018 . TRS-ActiveCare Plan Highlights . Effective September 1, 2017 through August 31, 2018 | In-Network

Table of Contents

Enrollment Information ....................... 2

Contacts ............................................... 3

Plan Rules ............................................ 3

Medical Plan ......................................... 4

Hospital Indemnity Plan ...................... 5

Dental Plan ........................................... 5

Vision Plan ........................................... 6

Critical Illness Plan .............................. 6

Cancer Plan .......................................... 6

Educator Disability Plan ...................... 7

Accident Insurance Plan ..................... 7

Individual Life Insurance ..................... 7

Basic Group Term Life and AD&D ...... 7

Group Term Life Insurance ................. 8

Identity Theft Protection ...................... 8

Catastrophic Sick Leave Bank ............ 9

457(b) Retirement Savings Plan ......... 9

403(b) Retirement Savings Plan ......... 9

Flexible Spending Accounts (FSA)...10

Health Savings Accounts (HSA) …..10

Frequently Asked Questions ............ 11

Enrollment Navigation ......................12

LA PORTE ISD

2017-2018 OPEN ENROLLMENT

BENEFIT SUMMARY

PLAN YEAR IS SEPTEMBER 1, 2017 TO AUGUST 31, 2018

Online Enrollment Information for

• Medical & Supplemental Benefits

• Section 125 Cafeteria Plan

• Supplemental Retirement Plan

BENEFIT WEBSITE AND MEDICAL ANDVOLUNTARY BENEFITS!!!

See the details for all the benefits with a

Benefit Advisor at the help sessions or

online in the Reference Center on the

benefit website!

Elections made for the Open Enrollment

plan benefits are deducted from payroll

in September and coverage is

effective September 1, 2017.

ACA RULES: Due to Federal Regulations under the Affordable Care Act (ACA), all

employees must enroll in or decline coverage for themselves and their

dependents (and include their social security numbers) under a medical plan.

OPEN ENROLLMENT: August 1-August 22

Benefit Advisors onsite IMPORTANT INFORMATION TO KNOW THIS YEAR

OPEN ENROLLMENT THIS YEAR— this is your opportunity to review your

benefit elections and plan options offered this year! Please take the time to review

the options for your families needs. You may either self-enroll or attend one of the

help sessions at the ITC.

KEY ITEMS

NEW THIS YEAR - HEALTH SAVING ACCOUNT (HSA)—Must be enrolled in the TRS

1 HD – High Deductible Plan to be eligible.

MEDICAL FLEXIBLE SPENDING ACCOUNT (FSA)—You must RE-ENROLL every

year in the FSA "use-it-or-lose-it" account—even if the amount is the same as last

year; $2,600 maximum.

NEW VENDOR Combined Life is being replaced with TEXAS LIFE - employee,

spouse and children. Express issue* available THIS YEAR. Chronic Illness rider for

employee. To apply for this coverage you must login and select it.

Please Note: Combined Life will no longer be payroll deducted as of September 1, 2017

however, you may keep your coverage by paying directly to Combined Life.

NEW VENDOR - VISION PLAN - new provider is Ameritas Vision - better benefits -

more providers! If you are currently enrolled in the vision plan, you will be moved over to

this new vendor. If you would like to change who is covered, drop, or add this benefit you

will need to login and select your desired changes online.

*Some limitations may apply—please see the plan documents at www.benefitsolver.com or a Benefit Advisor

at the Enrollment Help sessions for details.

LPISD OES 6/17

Your company key is

lpisd

(case sensitive)

http://www.benefitsolver.com/


This is an outline of benefits only. If there is a conflict between the terms of this outline of benefits and the contract, the terms of the contract will prevail. Please see a Benefits Advisor or review plan summary in the Reference Center at www.benefitsolver.com for additional information.

2

Enrollment Information & Schedule

Welcome to La Porte ISD 2017-18 Benefit Booklet. This booklet briefly describes the plans offered

for this Plan Year, which is from September 1, 2017 through August 31, 2018. La Porte ISD strives

to provide a wide array of benefit choices to meet you and your family’s needs.

The enrollment information provided in this booklet is a brief outline of the benefit coverages

available for you and your family. Please see the Reference Center on the benefit website, which

contains benefit certificates or plan information sheets, for more details on the plans. You may

enroll online for the supplemental benefit plans by following the directions on the last few pages of

this Open Enrollment (OE) booklet, or see a Benefits Advisor who will be

available to assist you.

Your 2017-2018 Employee Benefits Plan reflects our school district’s values and

is a significant part of your compensation package. Some of the benefits require contributions from you, while others

are fully paid by La Porte ISD. Elections made for the Open Enrollment plan benefits are deducted from payroll

starting in September and coverage is effective September 1, 2017.

Enrollment Help Dates Enrollment Time Enrollment Location

Tuesday and Thursday,

August 1st and August 3rd 10:00 AM – 5:30 PM Instructional Technology Center (ITC)

Thursday, August 10th 1:00 PM – 5:30 PM Instructional Technology Center (ITC)

Tuesday, August 15th 11:00 AM – 5:30 PM Instructional Technology Center (ITC)

Friday, August 18th 11:00 AM – 5:30 PM Instructional Technology Center (ITC)

APPOINTMENT Make an appointment with a Benefits Advisor at

http://lpisdappt.timetap.com

Click on Login on bottom-right of page to see location and to see available times to "Schedule an Appointment with a Benefits Advisor.” Click box to pick a day and time, or you can call 855.523.8422 between 8AM and 4PM. Enrollment assistance will be available based on dates / times at the ITC listed below.

WALK-IN

Walk-ins are welcome, but

those with appointments will

take precedence. Location

for walk-in sessions will also

be located at the ITC.

ONLINE

Visit the enrollment portal at

www.benefitsolver.com to

accept or decline each benefit

offered. To set up or reset

your password, Company Key

is lpisd (case sensitive). Full step-by-step instructions can

be found on the very last page

of this booklet.

PLEASE NOTE: If you currently have a Combined Life policy, it will no longer be deducted from payroll as of September 1,

2017. You can elect the new plan being offered for payroll deduction or, if you would like to keep the Combined Life policy,

you MUST fill out the form located in the Reference Center on www.benefitsolver.com to make arrangements to pay them

directly—you will NOT be auto enrolled into the new plan.

3 WAYS TO ENROLL





3

Contacts

BENEFIT VENDOR PHONE WEBSITE DEPENDENT

ELIGIBILITY AGE

Medical Insurance TRS ActiveCare 800.222.9205 www.trsactivecareaetna.com To age 26

Distirct Benefits Contact Lupe Lara 281-604-7054 N/A

Pharmacy CVS/Caremark 800.222.9205 www.caremark.com To age 26

Dental Insurance—DHMO DHMO Delta

Group #18428

800.422.4234 www.deltadentalins.com To age 26

Dental Insurance—PPO Delta Insurance

Group#18428

800.521.2651 www.deltadentalins.com To age 26

Vision Insurance Ameritas / VSP

Group #

800-877-7195 www.vsp.com To age 26

Critical Illness Allstate 800.521.3535 www.allstateatwork.com To age 26

Cancer Plan Allstate 800.521.3535 www.allstateatwork.com To age 26

Disability Educator Plan Unum

Group #124859

800.858.6843 www.unum.com N/A

Accident Insurance Allstate 800.521.3535 www.allstateatwork.com To age 26

Hospital Indemnity Plan MetLife 800.438.6388 www.metlife.com To age 26

Individual Life Insurance

Texas Life 800.283.9233 www.texaslife.com To age 25 to apply—

covers to age 26

Group Term Life and

Voluntary Term Life

Insurance

Sun Life Group #245044

800.247.6875 www.benefitsolver.com To age 26

Identity Theft Protection iLOCK360 855.287.8888 www.iLOCK360.com To age 18

457(b) Retirement

Savings Plan TCG Administrators 800.943.9179 www.tcgservices.com N/A

403(b) Retirement Savings Plan

TCG Administrators 800.943.9179 www.tcgservices.com N/A

Flexible Spending

Accounts (FSAs) and

Health Savings Accounts

(HSAs)

First Financial Group 866.853.3539 [email protected] N/A

Section 125 Cafeteria Plan Rules The 125 Cafeteria Plan allows you to deduct certain benefit premiums from your gross earnings, before federal withholding taxes are

calculated. The amount you elect to have deducted “pretax” lowers your taxable income.

TWO IMPORTANT ITEMS TO KEEP IN MIND

You must make an election each plan year to continue your eligibility for cafeteria

plan benefits.

A benefit cannot be changed during the plan year unless you have a qualified

family status change. These changes include, but are not limited to,

Marriage or divorce

Birth, adoption, or death of a spouse or child

Change in a spouse’s or dependent’s

employment status

Change in eligibility status of a dependent

Becoming Medicare eligible

Eligible Benefits

Under Section 125

Accident Insurance

Cancer Insurance

Critical Illness Insurance

Dental Insurance

Flexible Spending Accounts

Hospital Indemnity Plan

Medical Insurance

Vision Insurance

[email protected]


www.trsactivecareaetna.com

http://www.deltadentalins.com/

http://www.allstateatwork.com/

www.caremark.com

www.vsp.com

www.allstateatwork.com


www.unum.com


www.texaslife.com

www.ilock360.com

www.tcgservices.com

www.tcgservices.com

mailto:[email protected]

mailto:[email protected]


4

Medical Plan

The Medical coverage is available to all eligible employees and their eligible dependents to age 26. Employees who have questions on

the medical insurance can refer to documents and comparison charts in the Reference Center on the benefit enrollment website at

www.benefitsolver.com or contact TRS Aetna/Wellsystems directly at www.trsactivecareaetna.com or

800.222.9205. Annual Enrollment is the opportunity for employees to enroll in a TRS-ActiveCare medical plan

for the first time, add/drop dependents, change coverage, or move from one medical plan option to another.

PLEASE NOTE: The Select Plan is an Exclusive Provider Organization—similar to an HMO that’s quite

restrictive. There are no out-of-network benefits except emergencies. If you live in Fort Bend, Harris or

Montgomery County, you must use the Memorial Hermann Accountable Care Network OR new Kelsey-Select

Network (you are not allowed to change networks mid-year). If you live in Galveston County or most zip codes

in Brazoria County, you must use the Kelsey-Select Network. See www.trsactivecareaetna.com for

information about the plans.

TRS ActiveCare Plan 1—HD Total premium

(monthly)

Employer

Contribution

(monthly)

Employee cost

(monthly)

Employee cost

(semimonthly)

Employee Only $351.00 $351.00 $0.00 $0.00

Employee + Spouse $991.00 $370.00 $621.00 $310.50

Employee + Child(ren) $671.00 $370.00 $301.00 $150.50

Employee + Family $1,316.00 $370.00 $946.00 $473.00

TRS ActiveCare Select Plan Please note: Based on your zip code, you will have either the Memorial

Hermann network or Open Acess, OR if Kelsey-Select is available for you

to choose this year.

Total premium

(monthly)

Employer

Contribution

(monthly)

Employee cost

(monthly)

Employee cost

(semimonthly)

Employee Only $514.00 $370.00 $144.00 $72.00

Employee + Spouse $1,264.00 $370.00 $894.00 $447.00

Employee + Child(ren) $834.00 $370.00 $464.00 $232.00

Employee + Family $1,589.00 $370.00 $1219.00 $609.50

TRS ActiveCare Plan 2 Total premium

(monthly)

Employer

Contribution

(monthly)

Employee cost

(monthly)

Employee cost

(semimonthly)

Employee Only $714.00 $370.00 $344.00 $172.00

Employee + Spouse $1,694.00 $370.00 $1,324.00 $662.00

Employee + Child(ren) $1,062.00 $370.00 $692.00 $346.00

Employee + Family $2,004.00 $370.00 $1,634.00 $817.00

Questions for my Benefits Advisor:



http://www.trsactivecareaetna.com/


2017 – 2018 TRS-ActiveCare Plan Highlights Effective September 1, 2017 through August 31, 2018 | In-Network Level of Benefits*

Medical Coverage ActiveCare 1-HD ActiveCare Select or ActiveCare

Select Whole Health (Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Kelsey Select; Memorial Hermann Accountable Care Network; Seton Health Alliance)

ActiveCare 2

Deductible (per plan year) In-Network $2,500 employee only/$5,000 family $1,200 individual/$3,600 family $1,000 individual/$3,000 family Out-of-Network $5,000 employee only/$10,000 family Not applicable. This plan does not cover out- $2,000 individual/$6,000 family

of-network services except for emergencies.

Out-of-Pocket Maximum The individual out-of-pocket maximum (per plan year; medical and prescription drug only includes covered expenses incurred deductibles, copays, and coinsurance count by that individual. toward the out-of-pocket maximum) In-Network $6,550 individual/$13,100 family $7,150 individual/$14,300 family $7,150 individual/$14,300 family Out-of-Network $13,100 individual/$26,200 family Not applicable. This plan does not cover out- $14,300 individual/$28,600 family

of-network services except for emergencies.

Coinsurance In-Network Participant pays (after deductible) 20% 20% 20% Out-of-Network Participant pays (after 40% of allowed amount Not applicable. This plan does not cover out- 40% of allowed amount deductible) of-network services except for emergencies.

Office Visit Copay Participant pays

20% after deductible $30 copay for primary $60 copay for specialist

$30 copay for primary $50 copay for specialist

Diagnostic Lab Participant pays

20% after deductible Plan pays 100% (deductible waived) if performed at a Quest facility; participant pays 20% after deductible at other facility

Plan pays 100% (deductible waived) if performed at a Quest facility; participant pays 20% after deductible at other facility

Preventive Care See below for examples

Plan pays 100% Plan pays 100% Plan pays 100%

Teladoc® Physician Services $40 consultation fee (counts toward deductible and out-of-pocket maximum)

Plan pays 100% Plan pays 100%

High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays

20% after deductible $100 copay plus 20% after deductible $100 copay plus 20% after deductible

Inpatient Hospital 20% after deductible $150 copay per day plus 20% after deductible $150 copay per day plus 20% after deductible (preauthorization required) ($750 maximum copay per admission) ($750 maximum copay per admission; (facility charges) $2,250 maximum copay per plan year) Participant pays

Emergency Room (true emergency use) Participant pays

20% after deductible $200 copay plus 20% after deductible (copay waived if admitted)

$200 copay plus 20% after deductible (copay waived if admitted)

Outpatient Surgery Participant pays

20% after deductible $150 copay per visit plus 20% after deductible

$150 copay per visit plus 20% after deductible

Bariatric Surgery $5,000 copay (does apply to out-of- Not covered $5,000 copay (does not apply to out- Physician charges (only covered if performed pocket maximum) plus 20% after of-pocket maximum) plus 20% after at an IOQ facility) deductible deductible Participant pays

Annual Vision Examination (one per plan year; performed by an ophthalmologist or optometrist using calibrated instruments) Participant pays

20% after deductible $60 copay for specialist $50 copay for specialist

Annual Hearing Examination Participant pays

20% after deductible $30 copay for primary $60 copay for specialist

$30 copay for primary $50 copay for specialist

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.

• Routine physicals – annually age 12 and over • Well-child care – unlimited up to age 12 • Well woman exam & pap smear – annually age 18 and over • Mammograms – 1 every year age 35 and over • Colonoscopy – 1 every 10 years age 50 and over • Prostate cancer screening –1 per year age 50 and over

• Smoking cessation counseling – 8 visits per 12 months • Healthy diet/obesity counseling – unlimited to • Breastfeeding support – 6 lactation counseling visits


Prescription Coverage ActiveCare 1-HD ActiveCare Select or ActiveCare

Select Whole Health (Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Kelsey Select; Memorial Hermann Accountable Care Network; Seton Health Alliance)

ActiveCare 2

Drug Deductible (per person, per plan year)

Must meet plan-year deductible before plan pays.**

$0 generic; $200 brand $0 generic; $200 brand

Short-Term Supply at a Retail Location (up to a 31-day supply) Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand

20% coinsurance after deductible, except for certain generic preventive drugs that are covered at 100%.** $20 for a 1- to 31-day supply

$40 for a 1- to 31-day supply*** 50% coinsurance for a 1- to 31-day supply***

$20 for a 1- to 31-day supply $40 for a 1- to 31-day supply*** $65 for a 1- to 31-day supply***

Extended-Day Supply at Mail Order or Retail-Plus Pharmacy Location (60- to 90-day supply)**** Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand

20% coinsurance after deductible

$45 for a 60- to 90-day supply $105 for a 60- to 90-day supply*** 50% coinsurance for a 60- to 90-day supply***

$45 for a 60- to 90-day supply $105 for a 60- to 90-day supply*** $180 for a 60- to 90-day supply***

Specialty Medications 20% coinsurance after deductible 20% coinsurance per fill $200 per fill (up to 31-day supply) $450 per fill (32- to 90-day supply)

Short-Term Supply of a Maintenance Medication at Retail Location (up to a 31-day supply) The second time a participant fills a short-term supply of a maintenance medication at a retail pharmacy, they will pay a convenience fee. They will be charged the coinsurance and copays in the row below the second time they fill a short-term supply of a maintenance medication. Participants can avoid paying the convenience fee by filling a larger day supply of a maintenance medication through mail order or at a Retail-Plus location.

Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand

20% coinsurance after deductible $35 for a 1- to 31-day supply $60 for a 1- to 31-day supply 50% coinsurance for a 1- to 31-day supply

$35 for a 1- to 31-day supply $60 for a 1- to 31-day supply $90 for a 1- to 31-day supply

What is a maintenance medication? Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes.

When does the convenience fee apply? For example, if you are covered under TRS-ActiveCare Select, the first time you fill a 31-day supply of a generic maintenance drug at a retail pharmacy you will pay $20, then you will pay $35 each month that you fill a 31-day supply of that generic maintenance drug at a retail pharmacy. A 90-day supply of that same generic maintenance medication would cost $45, and you would save $225 over the year by filling a 90-day supply.

Premium Information for ALEX

You will need to enter the applicable amount – YOUR ANNUAL COST – from the table below into ALEX when prompted. To determine this cost, ask your Benefits Administrator for your monthly cost (this is the amount you will owe each month after your employer contributes to your coverage). Then multiply your monthly cost by 12 to get YOUR ANNUAL COST. Use monthly amounts on page 4 of this Benefit Booklet and multiply by 12 for Annual Cost .

TRS-ActiveCare Monthly Premium

ActiveCare 1-HD

ActiveCare Select/ ActiveCare Select Whole Health

ActiveCare 2 Your Monthly Cost (amount you pay after employer contribution)

Your Annual Cost (use this amount

for ALEX)

Individual $351 $514 $714

+Spouse $991 $1,264 $1,694

+Children $671 $834 $1,062

+Family $1,316 $1,589 $2,004

A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician.

*Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits underthe ActiveCare Select or ActiveCare Select Whole Health 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.

**For ActiveCare 1-HD, certain generic preventive drugs are covered at 100%. Participants do not have to meet the deductible ($2,500 - individual, $5,000 - family)and they pay nothing out of pocket for these drugs. The list of drugs is on the TRS-ActiveCare website.

***If a participant obtains a brand-name drug when a generic equivalent is available, they are responsible for the generic copay plus the cost difference between thebrand-name drug and the generic drug.

****Participants can fill 32-day to 90-day supply through mail order.


5

GI •

Hospital Indemnity Insurance Plan by MetLife Dependents covered up to age 26; if still a dependent child

Even with a comprehensive health plan that covers expenses, there is a chance you could still have to pay for deductibles, co-

payments, and co-insurance. This plan can offer added financial protection for out-of-pocket costs related to a covered accident or a

covered sickness. Here is how this plan works:

With MetLife, the plan provides payments in addition to

any other insurance payments you may receive

This would help to cover deductibles and out-of-pocket

expenses

Pays if you are admitted and/or confined to the hospital

for illness or sickness

Plan is Guaranteed Issue for everyone, but there is a 12-month pre-existing clause for illness/sickness, that will not pay for the

first 12 months of a newly elected policy for items that you are or should be receiving treatment for and/or taking medications

• Please Note: Routine pregnancies will not be covered under this plan

• Plan also includes a wellness benefit that pays you for taking an annual health exam

Dental Plans by Delta Dental Dependents covered up to age 26; if still a dependent child

Visiting the dentist can help you and your family keep a great smile as well as maintaining good health. This plan is designed to help

you keep your teeth in the best shape possible. Highlights include

DHMO Dental Plan

No claim forms

No deductibles

No pre-existing conditions

No annual maximum

Must choose from the Directory of Dentists

Orthodontia coverage for up to 24-months

New enrollees will receive ID card via USPS

PPO Dental Plan

Freedom to choose dentists in- or out-of-network

Out-of-pocket costs are lower if you chose from

the preferred Provider list of “in-network” PPO

dentists

Annual deductible of $50 per individual; $150

per family; annual maximum benefit of $1,000

per person

Preventive care (e.g., cleaning, exams, and x-rays) is paid at 100% and not

subject to the deductible

Basic restorative care (e.g., fillings, root canals & gum treatments) is paid at 80% up to annual maximum

Major services are covered at 50% up to annual maximum

No waiting period for major services

Orthodontia lifetime maximum of $1,000 for children under age of 26

Questions for my Benefits Advisor:

Hospital Indemnity Plan

(semimonthly rates)

Employee Only $7.82

Employee + Spouse $12.68

Employee + Children $12.68

Employee + Family $18.28

Dental Plan

(semimonthly rates)

Employee Only $6.24

Employee + One $11.87


Dental Plan

(semimonthly rates)

Employee Only $17.57






6

Keeping up with routine eye exams is extremely important—regardless of how perfect your vision might be. On top of providing you with

prescriptions for glasses or contacts, your eye doctor can check you for diseases or infections. This plan is designed to help you and

your family’s vision stay as healthy as possible. Highlights include

• $10 co-pay for eye exam

• $10 co-pay for eyeglass basic lenses

• $150 frame allowance OR $150 contact lens allowance

• Frequency of benefit: Exam—once every 12 months; lenses

or contact lenses—once every 12 months; frame—once every 12 months

• Must choose an in-network provider for less out-of-pocket expense

• More providers in your area!

• Employees will receive ID cards via USPS

Critical Illness Plan by Allstate Dependents covered up to age 26; if still a dependent child

Receiving news that you’ve been diagnosed with a critical illness can impact your financial and emotional stability. Paying for treatment

can be costly and your savings may not cover everything. These plans are designed to help you through the illness. Highlights include

Plan is Guarantee Issue for new hires only; some limitations apply

Existing employees can apply for coverage and will go through the

underwriting guidelines of Allstate for approval process

Low and High plans available to meet your needs

You choose lump-sum benefit amount of $10,000 on Low Plan

or $20,000 on High Plan

Dependents coverage is 50% of employee’s coverage

Wellness benefit pays you $50 on Low Plan and $100 on High Plan for annual health

screening

A percentage of the basic-benefit is payable for each covered person in each category and

a recurrence benefit is payable in the critical illness and cancer categories

Smoker and Non-Smoker, Age-Banded rates listed in Reference Center

Cancer Plan by Allstate Dependents covered up to age 26; if still a dependent child

If you are suddenly diagnosed with cancer, it might present a challenge to your family’s financial and emotional stability. This plan can

help provide financial security as you undergo treatment and are not able to work. Benefits include

Plans pay directly to offset expenses related to the treatment of

cancer and other specified diseases like Lupus, Cystic Fibrosis,

Lyme Disease, etc.

Choose Low Plan or High Plan

Plan pays for hospital stay, new experimental treatment and more

Both plans pay $10,000 annually for Radiation/Chemotherapy

Both plans pay $10,000 for Blood, Plasma, and Platelets

Both plans include a $75 Wellness Benefit

High plan includes an Intensive Care Unit benefit that will pay $600 daily, up to 45 days, if you are confined to the ICU for ANY

reason

Current employees who did not elect coverage when first offered will be required to apply for coverage.

New hires only (within 31 days of hire), and their dependents who apply for coverage during this open enrollment will be guaranteed

coverage. Pre-existing condition limitations will apply for one year for those who are not currently in the group cancer plan. A pre-

existing condition is a disease or physical condition for which symptoms existed or medical advice or treatment was recommended or

received within the twelve-month period prior to the effective date of coverage. Allstate does not pay for any loss due to a pre-existing

condition during the first 12-months of coverage.

Vision Plan by Ameritas - VSP Dependents covered up to age 26; if still a dependent child

Vision Plan

(semimonthly rates)

Employee Only $4.00




Covered Illnesses

Heart attack

Stroke

Major organ transplant

End stage renal failure

Invasive cancer

Coronary artery bypass (25%)

Carcinoma in situ (25%)

Cancer Plan

(semimonthly rates) Low Plan High Plan

Employee Only $12.25 $13.79

Employee + Spouse $18.87 $21.73

Employee + Children $17.27 $19.66

Family $23.88 $27.59



7

Educator Disability Plan by Unum

Having disability insurance can help protect your income in the event you become sick, injured, or pregnant, and the doctor says you’re

unable to work. This plan can help provide financial security for you and your family so you can focus on recovering. Here is how this

plan works:

In the event that you become sick, injured, or pregnant, and are

unable to work, disability insurance helps take the place of your

missing paycheck

Your monthly benefit will pay you up to 66⅔% of your salary for as

long as you are medically disabled—up to the age of 65

Prices vary based on how much insurance you select, and on how

long an “elimination period” you select (see rate chart at www.benefitsolver.com);

elimination periods tell you how long you have to wait after being diagnosed as

disabled before you get paid your disability benefit; elimination periods for

illness/accident are 0/7 days, 14 days, 30 days, 60 days, 90 days, or 180 days

If you select an elimination period of 30 days or less, the waiting period is waived upon being admitted into the hospital as an

"in-patient" for at least 24 hours

Accident Insurance Plan by Allstate Dependents covered up to age 26; if still a dependent child

This plan is designed to help you cope with the costs associated with unexpected accidents. Despite having health insurance, out-of-

pocket costs may add up quickly when you factor in expenses like co-payments and deductibles. Here is how this plan works:

GI

•Guaranteed Issue for employees

Plan is fully portable even if you leave your employer

No deductibles required

Pays directly to the employee, based on the schedule of benefits

Coverage includes—but is not limited to—accidents, fractured bones,

burns, concussions, broken teeth, emergency room treatment, ambulance, hospital

confinement, chiropractic, emergency dental, rehabilitation, sports injuries, accidental death

Individual Life Insurance by Texas Life Insurance Dependents coverage can be elected up to age 25; covered up to age 26

New Carrier! Texas Life is the new life insurance carrier. Texas Life offers individual portable life insurance with a chronic illness rider

to help cover unexpected long term care expenses. See brochure in reference center for more details.

Express Issue coverage available for employee, spouse, child(ren) and grandchildren

Chronic Illness Rider – the policyholder is eligible to withdraw 92% of the face value tohelp cover the cost of unexpected expenses caused by long term care facilities and inhome nursing. See brochure in Reference Center for details.

Employees age 49 and under: eligible to receive up to $300,000 Express Issue

Employees age 50-65: eligible to receive up to $100,000 Express Issue

Spousal express issue coverage up to $50,000, varies based on spouse age.

Additional coverage amounts available subject to medical underwriting and approval.

Child(ren) and Grandchildren eligible to receive up to $50,000

See FAQs page for definition of “express issue”

Detailed rate chart at www.benefitsolver.com (click Login)

Attention: Combined Life Insurance will no longer be payroll deducted as of 9/1/2017. If you wish to keep your policy please

see an enroller for details or see information in the Reference Center. If you would like to keep your policy(s), you must make

this change within 31 days of new plan year, September 1, 2017. You must elect the Individual Life by Texas Life if you wish

it to be payroll deducted.

Highlights

Portable at same rate

Coverage up to age 121

No scheduled rate increase

Child and Grandchildren coverage available

Chronic Illness Rider – pays up to 92% policy value to help cover cost of long term care, if you cannot perform 2 out of the 5 ADL (Assisted Daily Living) functions

Highlights

• Select coverage in $100 increments; up to

66⅔% of salary or maximum of $7,500

• Pays until the doctor says you can return to

work, or to age 65

• Guaranteed issue for everyone, but any

new or enhanced coverage has a 12-month

pre- existing condition* limitation

Coverage Cost

Employee Only $8.34









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Voluntary Group Term Life Insurance by Sun Life Dependent coverage can only be carried on one employee if both work for the district Dependents covered up to age 26; is still a dependent child

Although no dollar amount can ever be placed on the value of your life, this insurance plan can provide stability and protection to your

loved ones after you are gone. Here is how this plan works:

This policy has age-banded rates for employees, spouse and children. The policy will

age the insured as of their age on September of each year and rates will be based on

your age-band for that plan year

For amounts of coverage still in underwriting after September 1, the effective date of

coverage will be the first day of the month following the date of approval by Sun Life

Coverage available for spouse and child(ren) ONLY if you have coverage for yourself

New Hires (within 31 days of hire)—Guaranteed issue up to limits below; some limitations apply; please see a Benefit Advisor

or the Reference Center on the Benefit Website.

Employee: Up to $200,000 of coverage or 5x your annual salary

Spouse: $30,000 of coverage, cannot exceed 100% of employee coverage

Children: $10,000 of coverage

Existing employees electing new or additional coverage and any new hires electing over the GI limits are subject to underwriting

Employee: may apply for coverage in $10,000 increments up to a maximum of $500,000 of coverage

Spouse: $10,000 increments to a maximum of $250,000 (not to exceed 100% of employee coverage)

Child(ren): $5,000 increments to a maximum of $10,000

Identity Theft Protection by iLOCK360 Dependents covered up to age 18

Your identity may be your most important asset. It defines who you are, determines how much you can borrow and can be a deciding

factor in employment. These factors are why your identity is a target for online criminals. In 2015, identity fraud affected 13.1 million

consumers costing a total of $15 billion. Last year, 20% of all fraud losses were due to new account fraud—meaning that fraudsters

were opening new accounts under stolen identities, going beyond the usual credit card fraud many consumers anticipate. Keep your

identity protected with iLOCK360’s comprehensive identity protection. Here is how this plan works:

• Basic coverage provided FREE to all eligible employees, but

no dependent coverage. You can upgrade for more

protection for you and add your spouse and children

• Monitors your identity 24/7/365

• Personal email address required to

sign up for this program

• Registration required after initial email notification

iLOCK360

(semimonthly rates) Plus Premium

Employee Only $4.00 $7.50

Employee + Spouse $7.50 $11.00

Employee + Children $6.50 $10.00

Employee + Family $10.00 $13.75

Basic Group Term Life and AD&D by Sun Life

Your employer provides of $15,000 Basic Life and AD&D insurance coverage at no cost to full-time active employees (20-hour a week

minimum). Qualified Retirees who were hired prior to 6/1/1986 are covered up to age 65 for $15,000 of term life.

Service Plus Premium

CyberAlertSM ✓ ✓ ✓ ✓

Social Security number trace ✓ ✓ ✓ ✓

Change of address ✓ ✓

Sex offender alerts ✓ ✓

Payday loan ✓ ✓

Court/criminal records ✓ ✓

Full service restoration and lost wallet ✓ ✓ ✓

$1M insurance ✓ ✓

Daily monitoring of one credit bureau

(TransUnion) ✓

Daily monitoring of three credit bureaus

(TransUnion, Equifax, Experian) ✓

ScoreTracker ✓

✓ adults ✓ children



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Flexible Spending Account (FSA)—Medical

This plan allows for tax savings on most medical, dental, and vision expenses not covered by insurance. Non-

covered expenses apply to all dependent family members even if not covered by a particular insurance plan. The

employee estimates an annual election based upon the amount of non-covered expenses expected to be

incurred. The maximum election amount for 2017 is $2,600—this amount is deducted in equal amounts from

each paycheck, before taxes are calculated, and then set aside for the employee in a special account. A

MasterCard debit card will be issued to you to pay for most expenses incurred. Please consult your employee

benefits office or a Benefits Advisor, or visit the Reference Center (www.benefitsolver.com) for a list of eligible

expenses. REMEMBER: If you don't use it, you lose it! You MUST re-enroll every year.

Flexible Spending Account (FSA)—Dependent Care

This is a plan that allows for a tax savings on day care expenses for children under the age of 13 and for dependent adults unable to

care for themselves. The employee estimates an annual election for the amount of expenses to be incurred. The annual election

amount is deducted in equal parts from each paycheck, before taxes are calculated, and then set aside in a special account for the

employee. As expenses are incurred the employee submits a claim and the money is reimbursed to the employee from the employee’s

account as the monies come in from each paycheck. The IRS does not allow the Dependent Care Account (DCA) to be pre-

funded. Where accepted, the debit card may be used for payment of dependent care expenses. Please see

the summary plan description located on the enrollment website for more information. Note: Any money not

claimed by the employee within ninety days (90) after the end of the plan year is forfeited. The maximum

annual election amount is $5,000 per household. If you are married and filing separately, each spouse may

only elect up to $2,500. Please consult your employee benefits office or a Benefits Advisor, or visit the

Reference Center (www.benefitsolver.com) for a list of eligible expenses. (See FAQ page).

Health Savings Account (HSA)

NEW!! The Health Savings Account is only available for employees that elect a High Deductible Health

Plan (HDHP). This would include the TRS AC1-HD. So to be eligible for the HSA, you would need to be

enrolled in or to elect this medical plan for next year. 2017 HSA Contribution limits: Individuals (self-only

coverage)—$3,400; Family coverage—$6,750. HSA Catch-up contributions (age 55 or older): $1,000. The

HSA is very different from the Flexible Spending Account (FSA), as it is not pre-funded and you can only

utilize the account as the monies from your paycheck are received to the HSA. Also the HSA is NOT a use-

it-or-lose-it plan. The monies will continue to stay in your account until utilized for qualified expenses. The

HSA can be increased, decreased, started or stopped at any time throughout the plan year. These

changes can be made by contacting your Benefits Office. Employees who select a general purpose FSA,

or whose spouse has a general purpose FSA, cannot have an HSA also.


www.benefitsolver.com

www.benefitsolver.com

Catastrophic Sick Leave Bank

Eligible employees may select to become members of the Catastrophic Sick Leave Bank through the

Benefit Solver website viewable by all employees when electing/declining benefits selections during the

annual Open Enrollment period.

All fulltime or permanent part-time employees of the District, who have two (2) days of earned local leave

as of August 1 of the current school year, are eligible for initial membership in the Catastrophic Sick Leave

Bank. Employees new to the district will have 31-days from their date of hire to apply for Catastrophic Sick

Leave Bank membership. Please see more information on the Reference Center of the benefit website.


Section 457(b) Deferred Compensation Plan refers to Section 457(b) of the

Internal Revenue Code of 1986. This is a district-sponsored voluntary

retirement savings plan that allows an employee to save money for retirement

on a tax-deferred basis. This plan allows you to start, stop, increase or

decrease contributions at any time. The plan contains most of the same

features of the 403(b) plan, but is particularly different in one unique way:

distributions from the 457(b) Deferred Compensation Plan are not subject to

the 10% excise tax for early withdrawal. In 2017, you can contribute 100% of

your includible compensation

up to $18,000, whichever is less. If you are age 50 or older, you can contribute up to an additional

$6,000 for a total of $24,000 for the year. TCG Administrators (formerly JEM Resource Partners) is the

plan administrator; you can elect salary deductions at www.tcgservices.com. Your initial password to

enroll online is lapor457 (case sensitive). All investing involves risk. Past performance is not a

guarantee of future returns.


A 403(b) is a retirement savings plan generally offered by public schools and

other tax-exempt organizations that allows employees to make contributions on a

pretax basis. Most plans allow you to start, stop, increase or decrease

contributions at any time. The employer determines the investment providers and

employees must open an account with one of those providers to contribute. TCG

Administrators (formerly JEM Resource Partners) is the plan administrator; you

can elect salary deductions at www.tcgservices.com. In 2017, you

can contribute 100% of your includible compensation up to $18,000, whichever

is less. If you are age 50 or older, you can contribute up to an additional $6,000

for a total of $24,000 for the year. Your initial password to

enroll online is lapor403 (case sensitive). All investing involves risk. Past performance is not a

guarantee of future returns.

This is an outline of benefits only. If there is a conflict between the terms of this outline of benefits and the contract, the terms of the contract will prevail. Please see a Benefits Advisor or review plan summary in the Reference Center at www.benefitsolver.com for additional information

10

http://www.region10rams.org/

http://www.region10rams.org/


Frequently Asked Questions

What is Guaranteed Issue (GI)?

Also referred to as Guaranteed Acceptance, or GA, means that you can’t be turned down for health reasons.

Guaranteed Issue is typically offered during initial enrollment for benefits.

What is Express Issue (EI)?

You may apply for the Texas Life permanent, portable coverage, not only for yourself, but also for your

spouse, children and grandchildren by answering just 3 questions:

During the last six months, has the proposed insured:

a. Been actively at work on a full time basis, performing usual duties?

b. Been absent from work due to illness or medical treatment for a period of more than five consecutive days?

c. Been disabled or received tests, treatment or care of any kind in a hospital or nursing home or received chemotherapy,

hormonal therapy for cancer, radiation therapy, dialysis treatment, or treatment for alcohol or drug abuse?

What is a "pre-existing condition"?

A pre-existing condition is a disease or physical condition for which symptoms existed or medical advice or treatment was recommended or

received prior to the effective date of coverage.

What is a deductible?

A deductible is what you must pay for your health care before your insurance pays its part. Most plans have deductibles, which start over when

your “PLAN YEAR” starts over. For example, if your plan has a $1,000 deductible and you have surgery that costs $5,000, you’ll pay $1,000

before your insurer helps you cover your bills.

What is a co-pay?

A copay is a small, fixed amount—often $15 or $20—that you pay for covered services like a prescription or a doctor’s visit. Some health plans

also apply coinsurance to certain services. With it, you pay a percentage of the total cost of care. For example, if you have a 20% coinsurance,

and your doctor's appointment costs $300, you'd pay $60. That's if you've met your deductible.

What does out-of-pocket maximum mean?

Your out-of-pocket maximum is the most you have to pay each year toward your medical services or prescription drugs before your insurance

pays for all your care. This amount does not include what you pay in premiums. The Affordable Care Act limits the out-of-pocket maximums. In

2017, for one adult, it can be no more than $7,150, and for a family, it can be no more than $14,300.

What does EOB mean?

After you’ve visited your doctor or had a procedure in a hospital, you’ll receive an explanation of benefits (EOB) form explaining how much of

the charges your insurance will pay. The EOB isn’t a bill itself, but it can tell you what your doctor may charge you. Look for the words “due from

patient” to see how much you may owe after your insurance pays.

Before you get certain tests or procedures, do you need permission from your health insurance plan?

If your doctor says you need a test or procedure, your health plan may have to give permission if it's to be covered by insurance. Giving that

permission is called preauthorization. Your plan's overview of benefits lists what care needs to be preauthorized. If you don't get it when it's

required, your health plan won't pay its part of the costs.

Dependent Care Accounts

If I contribute to a Dependent Care Account, can I also write-off my daycare expenses on my taxes?

No, you may not. If you use the Dependent Care Account, you save money up-front on your taxes. Your per-paycheck deductions

are taken out of your paycheck before you pay taxes on your income. Thus, your taxable income is less, and you pay less in taxes.

What kinds of care does this cover?

Before-school and after-school care

Expenses for preschool/nursery school

Extended day programs

Au pair services (amounts paid for the actual care of the dependent)

Baby sitter (in or out of the home)

Nanny services (amounts paid for the actual care of the dependent)

Summer day camp for your qualifying child under the age of 13

Elder day care for a qualifying individual

Can I use the dependent care account to fund elder care for my mother/father/spouse?

Yes, you may use your Dependent Care account to fund care for individuals who qualify as your dependent child under the age of 13

who lives with you for more than half the year (and for whom you are the custodial parent in cases of divorce) your spouse, or other

tax dependent, who is incapable of self-care and lives with you for more than half the year.


11



12

Enrollment Navigation

2 When you enter the site for the first time click Register and proceed. After you have registered, you will go to User Name and Password.

If password is forgotten, click Forgot Your Password, and proceed with prompts.

Your company key is lpisd (case sensitive)

AFTER YOU HAVE

REGISTERED FOR

THE FRST TIME,

YOU WILL GO HERE

FORGOTTEN

PASSWORD You will be prompted for SSN, company key (lpisd), and DOB (MM/DD/YYYY). Follow prompts.

3 Click START HERE

You may go to the Reference Center to get more details on the available plans. You can view provider directories for the dental and vision plans if you would like to see the available network providers.

4 5

Click START ENROLLMENT

The next screen contains text regarding the upcoming changes and important benefits dates. Please read the text and click START ENROLLMENT at the bottom of the page to proceed.

6You will need to go through each benefit to select or waive each one this year. After you have completed all the benefits you will be directed to the “Review Enrollment” page. You are still able to make a change to a benefit there also. Click EDIT to the right of the benefit you wish to change or elect. After you review your benefits, please scroll down to the bottom of the page and click NEXT.

7

When finished making your benefit change, scroll to the bottom of the page and click NEXT. You will advance to the review page.

8When you are finished reviewing your enrollment and making changes, click APPROVE at the bottom or top of the Review Enrollment page. Continue to the last step on the next page. On the next screen click I

AGREE, and then click PRINT for a summary of your chosen benefits.

1Visit the enrollment website at www.benefitsolver.com and click LOGIN to get started.

EDIT

HERE

VIEW CURRENT

BENEFITS BY

CLICKING HERE

FIRST TIME

REGISTERING



Documents

Table of Contents Enrollment Information 2 3 LA PORTE ISD ... · 2017 – 2018 . TRS-ActiveCare Plan Highlights . Effective September 1, 2017 through August 31, 2018 | In-Network