Hurst Euless Bedford I.S.D.Employee Benefits2016 - 2017

Presented By: Karen Rose HEB ISD Benefits & Risk Manager

Contacts in the Benefit Office

Karen Rose• Benefits & Risk Manager• karenrose@hebisd.edu

Maria Ortiz• Benefits Secretary• mariaortiz@hebisd.edu• Ext. 2056 or 817-399-2056

Enrollment & PaperworkDue within 30 days of your Hire Date

Enroll Onlinewww.in-roll.com

•Your default login is your first initial of your first name followed by your last name and the last 4 digits of your social security number •Example: John Doe SSN

123-45-6789•Login ID: jdoe6789

•Your default password is the word “hebisd”

The following items must be turned in

to the benefits office:

• Employee Acknowledgement of the Alliance Direct Contracting Program

• Sick Leave Bank Enrollment/Declination Form

HEB ISD BENEFITSGUIDE

Please visit the Benefits web page for plan documents and more details on

each benefit.

This refers to the page

number in the Benefits Guide

Booklet

1

Login Pagewww.inrollplus.com/Login/Index

• As a new user you will need to register.• Complete the three required fields under the

New User heading.• Enter your Last Name, Last Four Digits of your SSN,

and your Date of Birth.

• Click Register and you will be directed to the screen to create your account.

• This will only be done once. Subsequent login will be done under the Returning User heading.

• Use the Video Tutorial and Chat features as necessary. The Chat feature will be available from 8:00 AM to 6:00 PM daily.

• Click the Español button on the top right to translate the whole site and videos to Spanish.

3

Annual Benefit Enrollment

Pages 4 – 7 contain information about our annual open enrollment

This information is for returning employees

Benefit Plan Year

September 1st through August 31st

is the benefit plan year.

8

Effective Date of Insurance

Health InsuranceOption 1: Actively-at-work date (premium must be paid for the entire month)

Option 2: First of the month following the actively-at-work date – example: if you started work on August 11th ; your insurance will begin September 1st

All other benefits

First of the month following the actively-at-work date

If you started work in July: August 1st is your effective date

If you started work in August: September 1st

is your effective date

New Hires

30 Days

New hires must enroll in benefits within 30 days of their hire date.

Failure to complete elections during this timeframe will result in the forfeiture of coverage.

Annual EnrollmentA

nnua

l En

rollm

ent • Typically held in July - August

• Opportunity to change benefit elections• Changes are not permitted during the plan

year unless you have a qualifying event

Retirement

All employees must contribute to Teacher Retirement System of

Texas instead of Social Security

Teacher Retirement System of Texas – 7.7%

of annual salary

This is an increase from 7.2% last year

TRS Insurance - .65% of annual salary

Mandatory active member contribution to TRS-Care (health

insurance for retirees)

TRS RetirementFor illustration purposes only! This information is not in your Benefit Guide

Benefits when you are eligible to retire: Average of 5 highest

salaries

Total # of years worked X 2.3% = % of salary you will

receive each year for the rest of your life

20 Years x 2.3% 46% of your salary = $25,30025 Years x 2.3% 57.5% of your salary = $31,62530 Years x 2.3% 69% of your salary = $37,95035 Years x 2.3% 80.5% of your salary = $44,27540 Years x 2.3% 92% of your salary = $46,55244 Years x 2.3% 100% of your salary = $55,000

Example: If you have an average salary of $55,000

Eligible Dependents

The employee is responsible for

notifying the Benefits Office when their

child no longer meets the dependent child

qualifications.

Spouse (including Common Law Spouse)

•A natural child•An adopted or a child who is lawfully placed for legal adoption•A stepchild•A foster child•A child under the legal guardianship of the employee

Child under the age of 26, who is one of the following: (They do nothave to be full time students.)

Disabled dependent children over the age of 26 are eligible for benefits if you can provide documentation of their disability.

Grandchildren are eligible for benefits if you can provide documentation that you are their legal guardian or that you claimed them as a dependent on your tax return.

Paychecks

Distributed by building Principal

Paid on the 20th of every month

During June, July & August paychecks are mailed directly to

your home address

9

Example of a Paycheck For Illustration Purposes Only!! This information is not in your Benefit Guide

Annual Salary $54,500

*Assumes Single Filing; 0 Deductions on W4 Form

Deductions AmountMonthly Salary $4,541.66- Medicare 1.45% ($65.85)- TRS 7.7% ($349.71)- TRS Ins .65% ($29.52)- Federal Taxes (Amount Varies)* ($654.37)Total Bring Home Amount before you take out insurance premiums

$3,442.21

Leaves & Absences Full time employees will earn 5 local sick days & 5 personal days per school year• Days are prorated based on the actual

time employed

Medical certification (doctor’s note) must be provided if:• Employee is absent more than 4

consecutive days because of sickness self or sickness family

• There is a questionable pattern of absences

• The employee requests FMLA

Medical Leave/Maternity/FMLA contact: (Must notify me at least 30 days prior to the beginning of your leave!)• Karen Rose• Benefits & Risk Manager• 817.399.2075• karenrose@hebisd.edu

Long Term Care

TRS offers a Long Term Care Plan

through Genworth Life Insurance Co.

Visit www.genworth.com/trsactivemember

If you are interested please call (866)

659-1970

Websites

Employee Benefits Web Site under www.hebisd.edu

Employee Access Center – change your address with HEB, look at paycheck stubs, etc.

Employee Benefits Facebook -”Like” our page www.facebook.com/hebbenefits

Employee Access Center App

App for your phone Allows you to view your

paychecks, leave balances, W2, employee directory and much more

To download the app: Search for “eFinance Plus

Employee” Type in “Hurst” as the school

district and then click on “Hurst-Euless-Bedford Independent SD

Follow the instructions to login to your account

Still working on a few bugs…

Changing Your Benefits

Benefits can only be changed during the middle of the plan year if you have a family status change AND you notify us within 30 days from the date the family status change occurred. Marriage

Divorce

Death Birth/Adoption

Loss of employment/benefits

Dependent lost eligibility

10

Employee Acknowledgment of the Alliance Direct Contracting Program

Please sign the acknowledgement form stating that you understand you must see an in-network doctor!

For more information on the Alliance please refer to the Benefits Guide

If you are injured on the job, you must tell your

supervisor IMMEDIATELY!

Your school nurse will have

the Workers Comp forms to

complete.

If you need to seek medical treatment you must see an in-

network workers compensation doctor in order

for your medical expenses to be

paid.

11

Sick Leave BankEVERYONE MUST COMPLETE AN

ENROLLMENT/DECLINATION FORM

Note: If you decline membership this year, you may enroll at a later date during open enrollment!

12

Purpose

The purpose of the sick leave bank is to provide additional paid sick leave days for members of the bank who have exhausted all available paid leave (sick, personal, old state, vacation, etc) because of the catastrophic injury or illness of the employee or the employee’s immediate family member.

Sick Leave Bank Summary

Membership • Contribute 3 days of

local leave• This is a one time

contribution

Sick leave bank days available to use for:• Employee, spouse

child’s illness/injury• Parent receiving

hospice or end-of-life care

Maximum # of days that can be used: • employee’s illness – 30 days per school year• spouse or child’s illness – 30 days per school year; 60 days lifetime maximum• parent – 10 days per school year; 20 lifetime maximum

Sick Leave Bank Continued

Catastrophic illness/injury – Serious in nature (not a passing disorder or temporary ailment) Examples: cancer, heart disease,

multiple sclerosis, car accident with life threatening injuries, etc.

Illness/Injury must require that you will miss at least 20 work days

Sick Leave Bank Committee will approve/deny requests

Not Covered: Any procedure that could be

scheduled, without detriment to the employee’s health, at a time more compatible with the member’s work responsibilities are not covered

Example of Procedures Not Covered: maternity, knee surgery, hysterectomy, etc.

Employee Assistance Program (EAP)The Standardbda – Bensinger, DuPont & Assoc.

13

What is an EAP?

An employee assistance program is a program which confidentially helps you in a time of need at no cost to you. The purpose of the program is to tackle your problems before these problems start to negatively affect your health and work performance. The program offers a variety of services ranging from family, health, and stress management to legal and financial counseling.

Who is Eligible to Receive Services

Employee

Spouse (Married or Divorced)

Significant Other / Partner

Children and Grandchildren (age 26 or

under)

Any household member, regardless

of age or relationship, residing

in employee’s home

The EAP Services Can Help With:

Child care & elder care

Alcohol & drug abuse

Life improvement

Difficulties in relationships

Stress & anxiety with

work or familyDepression Goal-setting Emotional

well-being

Financial & legal

concernsGrief & loss

Identity theft & fraud

resolutionOnline will

preparation

3 Sessions per incident or problem for assessment & counseling at no cost to the employee. Each

member of the employee’s household is

eligible for this service.

Health Insurance

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TRS ActiveCare Enrollment Guide

Please visit the Benefits website and download the Enrollment Guide!

More details about all our health plans.

www.trsactivecareaetna.com

This site gives you access to all of your health insurance resources in one place!

4 Health Plan Options

ActiveCare 1-HDActiveCare 2

ActiveCare Select

Scott & White HMO

What is TRS-ActiveCare?

Established and signed into law in 2001 (Chapter 1579, Texas Insurance Code)

A statewide health care benefits program for employees of school districts, charter schools, regional educational service centers and other educational districts

Law authorizes funding levels to help employees pay for coverage

1,127 districts/entities participate in TRS-ActiveCare (90% of eligible entities)

Plan Features ActiveCare 1-HD, ActiveCare 2, ActiveCare Select

Aetna Caremark is the Pharmacy vendor

ActiveCare 1HD & 2 are POS II Plans (Similar to PPO Plans) – you may see a doctor that is in or out of the network. If you stay in network you will have lower out-of-pocket costs!

ActiveCare Select is an EPO (Exclusive Provider Organization) – you must see a doctor that is in the network or the plan will not pay any benefits! There are NO OUT OF NETWORK Benefits!!! Make sure you review the list of providers in the network before you enroll in this plan!

No primary care physician (PCP) required; no referrals required to see a specialist

Plan Features HMO

Scott & White In order to enroll in the HMO plan, you must

work or reside in the HMO service plan area which includes: Denton, Collin, Tarrant, Dallas, and Rockwall counties.

You must see a doctor that is in the network or the plan will not pay any benefits! There are NO OUT OF NETWORK Benefits!!! Make sure you review the list of providers in the network before you enroll in this plan!

No primary care physician (PCP) required Referrals typically not needed to see a

specialist

Scott & White Service Area

Plan Overview (Network Level of Benefits)

ActiveCare 1-HD

ActiveCare 2

ActiveCare Select

Scott & WhiteHMO

Deductible $2,500 employee only$5,000 family

$1,000 individual$3,000 family

$1,200 individual$3,600 family

$1,000 individual$3,000 family

Maximum Out of Pocket (includes medical & prescription deductibles, copays and coinsurance)

$6,550 individual$13,100 family

$6,850 individual$13,700 family

$6,850 individual$13,700 family

$5,000 individual$10,000 family

Coinsurance 80% Plan pays20% Participant pays

80% Plan pays20% Participant pays

80% Plan pays20% Participant pays

80% Plan pays20% Participant pays

Office Visit Copay 20% after deductible $30 for primary$50 for specialist

$30 for primary$60 for specialist

$20 for primary-(first copay waived for a sick visit)

$50 for specialist

Primary means care provided by family practitioners, internists, OB/GYNs and pediatricians.

Family Deductible Illustration

ActiveCare 1-HD with a $5,000 family deductible• The family deductible may be met by one or more

people• Plan pays benefits once entire $5,000 is met – there

is no individual deductible to meet

ActiveCare 2 with a $1,000 individual deductible and a $3,000 family deductible• Plan pays benefits for an individual as his/her

deductible is met • Everyone helps to meet the family deductible, but

no one person pays more than the individual amount

Amy Ted Bob Sue Chris

Amy covers a spouse and three dependents

$5,000

Amy

$1,000

Ted

$800

Bob

$600

Sue

$400

Chris

$200

Preventive Benefits(Network Level of Benefits)

ActiveCare 1-HD

ActiveCare 2

ActiveCare Select

Scott & White HMO

Preventive Care Plan pays 100% (deductible waived)

Plan pays 100%(no copay required)

Plan pays 100%(no copay required)

Plan pays 100%(no copay required)

• 100% coverage for certain age and gender specific preventive care services when network providers are used

• Must be billed by provider as “preventive care”

• See page 17 for more details

Sample preventive care services:• Routine annual physicals* • Immunizations• Well-child care• Routine mammograms*• Routine colonoscopies• Bone density test• Screening for prostate cancer

*one per plan year

Plan Overview (Network Level of Benefits)

Benefits (continued)Services ActiveCare 1-HD ActiveCare 2 ActiveCare Select Scott & White HMO

Diagnostic Lab 20% after deductible

Quest FacilityPlan pays 100%

(deductible waived)

Quest FacilityPlan pays 100%

(deductible waived) 20% after deductibleOther Facility

20% after deductibleOther Facility

20% after deductible

High-tech Radiology(CT scan, MRI, nuclear medicine)

20% after deductible$100 copay per

service, plus 20% after deductible

$100 copay per service, plus 20% after deductible

20% after deductible

Outpatient Surgery 20% after deductible$150 copay

per visit, plus 20% after deductible

$150 copay per visit, plus 20%

after deductible

$150 copay per visit, plus 20%

after deductible

Plan Overview (Network Level of Benefits)

Benefits (continued)

Services ActiveCare 1-HD ActiveCare Select Scott & White HMO ActiveCare 2

Emergency Room(true emergency use)

20% after deductible

$150 copay, plus 20% after deductible

(copay waived if admitted)

$150 copay, plus 20% after deductible

(copay waived if admitted)

$150 copay, plus 20% after deductible

(copay waived if admitted)

Inpatient Hospital(facility charges)

Preauthorization required

20% after deductible

$150 copay per day, plus 20% after deductible

($750 max copay per admission)

$150 copay per day, plus 20% after deductible

($750 max copay per admission)

$150 copay per day, plus 20% after deductible

($750 max copay per admission)

Important NotesActiveCare 1-HD ActiveCare 2 ActiveCare Select Scott & White HMO

You must pay all of your deductible before insurance

will pay any benefits.You may see a provider in or out of the network.

You must see a provider in network or insurance will not pay any benefits

You must see a provider in network or insurance will

not pay any benefits

Deductible is waived for preventive visits and certain

preventive generic medications!

Provides the richest benefits, but also costs

the most!NO out of network

benefits!NO out of network

benefits!

“True Emergency” coverage for ER visit to

an out of network hospital

“True Emergency” coverage for ER visit to an out of

network hospital

If you have college kids attending college outside

of our area, they will need to come home to

go to the doctor.

If you have college kids attending college outside of our area, they will need to come home to go to the

doctor.

What is Teladoc?

Available only to those on TRS ActiveCare!! Not available for the HMO Plan!!

Teladoc’s board-certified doctors can resolve many of your medical issues, 24/7/365, via phone or online video consults from wherever you happen to be.

Imagine this…You wake up one morning with sudden cold-like symptoms: stuffy nose, cough, congestion. You have trouble getting an appointment with your existing doctor and you don’t want to miss time at work by sitting

in an urgent care or ER waiting room…so what do you do?

23

You contact Teladoc…

Step 1: Contact Teladoc – online or by phone•Request a phone or

online video consult with doctor (avg. call back time is 16 minutes or you can schedule a time for the doctor to call you back)

Step 2: Talk with a doctor•Physician •Dermatologist•Behavioral Health

Provider

Step 3: Resolve your issue •The doctor will

recommend the right treatment and write a prescription if necessary

Step 4: Settle up • ActiveCare 2 – no

charge• Select - no charge • 1HD - $40 fee

What Issues can Teladoc handle?

Cold & flu symptoms Bronchitis Acne Ear infection Conjunctivitis Allergies

Pink eye Skin infection Insomnia Sinusitis Tonsillitis Fever

Counseling Moles & warts Laryngitis Pharyngitis And more!

Prescription Drug Benefits

Prescription Drug Benefits

Features ActiveCare 1-HD ActiveCare 2 ActiveCare Select Scott & White HMO

Drug Deductible(per person, per plan year)

Subject to plan year deductible

$0 for generic$200 per person

$0 for generic$200 per person

$0 for generic$100 per person

20% coinsuranceafter deductible

(Certain generic preventive drugs are available at no cost)

Retail Maintenance 90-Days Retail Mainten

ance 90-Days Retail 90-Days

Generic $20 $35 $45 $20 $35 $45 $3 $6Preferred Brand $40 $60 $105 $40 $60 $105 30% 30%Non-Preferred Brand $65 $90 $180 50% 50% 50% 50% 50%

Specialty Drugs$200 per fill (up to 31-day

supply)$450 per fill (32-day to 90-day

supply)

20% coinsurance per fill 20% coinsurance per fill

Retail Short-Term - (up to 31-day supply) Maintenance - (after first fill) up to 31-day supply at your local retail pharmacyMail Order and Retail-Plus - (up to 90-day supply)

ActiveCare 1-HD Enhanced Preventive Drug Coverage

Effective September 1, 2016, certain generic preventive drugs are available at no cost to participants enrolled in the ActiveCare 1-HD plan. The deductible and coinsurance do not apply to these generic medications. Please know this list is maintained by the Internal Revenue Service and may change from time to time.

EXAMPLES: Anticoagulants/Antiplatelets

(Blood Clots)

Anticonvulsants (Seizures)

Bowel Preparations

Cardiovascular Conditions (Heart) Antiarrhythmic Antianginal

Coronary Artery Disease (Cholesterol) Antihyperlipidemics

Diabetes Hypertension (High Blood

Pressure) Ace Inhibitors Beta Blockers Calcium Channel Blockers Diuretics

Mental Health Antidepressants Antipsychotics Obsessive Compulsive

Disorder

Osteoporosis (Bone Health) Preventive Care Services

Chemical Dependency Anti-Obesity Smoking Deterrents

Respiratory Disorders (Asthma)

Women’s Health Antiestrogens Contraceptives Prenatal Vitamins

Cost for Health Coverage

What Type of Funding is Provided for TRS-ActiveCare?

$150.00 (minimum) from the district

75.00 from the state of Texas

$225.00 Monthly funding

Monthly Premiums

ActiveCare1-HD

ActiveCare2

ActiveCare Select

Scott & WhiteHMO

Employee Only $116 $420 $259 $305.16

Employee & Spouse $689 $1,327 $922 $967.82

Employee & Children $390 $817 $554 $614.16

Employee & Family $1,006 $1,372 $1,136 $1,097.98

How to Search for Providers

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ActiveCare 1HD, 2 or Select

Visit www.trsactivecareaetna.com

Click on Find a Doctor or Facility (not yet enrolled)

In the search bar enter name, specialty, procedure or condition

Choose your Health Plan

ActiveCare 1-HD

ActiveCare Select – Make sure you choose Baylor Scott & White

Quality Alliance (DFW Region)

NOT ActiveCare Select

ActiveCare 2

List of Hospitals in Select Plan

Baylor Scott & White Medical Center (Grapevine, Irving, Trophy Club, etc.)

Baylor Emergency Medical Center (Colleyville, Keller, Mansfield, etc.)

Baylor All Saints – Ft. Worth Cook Children’s Medical Center Children’s Medical Center Methodist Southlake Hospital

Out of Network Hospitals:

Harris Methodist – HEBNorth Hills Hospital

Warning: Many of these hospitals don’t have in network ER doctors or Anesthesiologist

Urgent Care Facilities in Select Plan

Urgent Care Facilities: Concentra – Arlington, Ft. Worth, Irving Cook Children’s – Hurst, Ft. Worth, Southlake MedSpring Urgent Care – Keller, Irving Walk In Clinic inside of Walgreens

Out of Network Urgent Care

Facilities: Carenow

List Primary Care Providers within 10 miles of HEB ISD in Select Plan

Provider CityColleyville Family Medicine Colleyville

Dr. Eileen O’Brien Colleyville

Dr. Mohammad Uddin Colleyville

Dr. Kenneth LeCroy Colleyville

Baylor Family Medicine @ Riverside Grand Prairie

Baylor Family Medicine @ Grapevine Grapevine

Baylor Family Practice @ Keller Keller

Southlake Family Medicine Southlake

North Country Family Practice Southlake

No Primary Care Providers in the cities

of Hurst, Euless or Bedford!

Scott & White HMO

Visit www.trs.swhp.org

Click on Provider Information

Click on Browse providers online

Choose your Health Plan

Choose TRS-ActiveCare Participants Network and then search for your provider

List of Hospitals/Urgent Care Facilities in Scott & White HMO

Hospitals: Baylor Scott & White Medical Center (Grapevine, Irving, Trophy Club,

etc.) Baylor Emergency Medical Center (Colleyville, Keller, Mansfield, etc.) Baylor All Saints – Ft. Worth Methodist Medical Center – Dallas, Richardson, etc. Cook Children’s Medical Center Children’s Medical Center Texas Scottish Rite

Urgent Care Facilities: Concentra Cook Children’s – Hurst, Ft. Worth, Southlake Minute Clinic in CVS Pharmacy

Out of Network Hospitals:

Harris Methodist – HEBNorth Hills Hospital

Out of Network Urgent Care

Facilities: Carenow

List Primary Care Providers within 10 miles of HEB ISD in HMO Plan

Provider CityMedical Clinic of North Texas Bedford

Colleyville Family Medicine Colleyville

Mohammad Uddin Colleyville

Kenneth Lecroy Colleyville

Randall Hayes Euless

Baylor Family Medicine @ Riverside Grand Prairie

Loren Lasater Grapevine

Carlos Bazaldua Grapevine

Donald Frusher Hurst

Basanti Vrushab Hurst

Baylor Family Practice @ Keller Keller

Southlake Family Medicine Southlake

North Country Family Practice Southlake

Total Out of Pocket Amounts(In Network for Employee Only)

ActiveCare 1 - HD

ActiveCare 2

ActiveCare Select

Scott & WhiteHMO

Deductible (Medical) $2,500 $1,000 $1,200 $1,000

Deductible (Prescription) $0 $200 $200 $100Maximum Out of Pocket (co-ins & copays) $4,050 $5,650 $5,450 $3,900Subtotal Medical & Prescription Costs $6,550 $6,850 $6,850 $5,000

Annual Premium $1,392 $5,040 $3,108 $3,662Total Premium, Medical & Prescription Expenses $7,942 $11,890 $9,958 $8,662

1-HD vs. 2 = $3,648 savings in annual premiums

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Employee & SpouseActiveCare 1 - HD ActiveCare 2 ActiveCare Select Scott & White HMO

Deductible (Medical) $5,000 $2,000 $2,400 $2,000Deductible (Prescription) $0 $400 $400 $200Maximum Out of Pocket (co-ins & copays) $8,100 $11,300 $10,900 $7,800

Subtotal Medical & Prescription Costs $13,100 $13,700 $13,700 $10,000Annual Premium $8,268 $15,924 $11,064 $11,614

Total Premium, Medical & Prescription Expenses $21,368 $29,624 $24,764 $21,614

Employee & Child(ren) - Assumes 2 childrenActiveCare 1 - HD ActiveCare 2 ActiveCare Select Scott & White HMO

Deductible (Medical) $5,000 $3,000 $3,600 $3,000Deductible (Prescription) $0 $600 $600 $300Maximum Out of Pocket (co-ins & copays) $8,100 $10,100 $9,500 $6,700

Subtotal Medical & Prescription Costs $13,100 $13,700 $13,700 $10,000Annual Premium $4,680 $9,804 $6,648 $7,370

Total Premium, Medical & Prescription Expenses $17,780 $23,504 $20,348 $17,370

Employee & Family - Assumes 4 family membersActiveCare 1 - HD ActiveCare 2 ActiveCare Select Scott & White HMO

Deductible (Medical) $5,000 $3,000 $3,600 $3,000Deductible (Prescription) $0 $800 $800 $400Maximum Out of Pocket (co-ins & copays) $8,100 $9,900 $9,300 $6,600

Subtotal Medical & Prescription Costs $13,100 $13,700 $13,700 $10,000Annual Premium $12,072 $16,464 $13,632 $13,176

Total Premium, Medical & Prescription Expenses $25,172 $30,164 $27,332 $23,176

Application to Split Premium22

Married couples working for different participating entities may “Split” funds

OR

Married couples both working for HEB ISD may “Pool” funds

Family coverage and all want the same plan

Requires an Application to Split Premium form to be completed by both employees and both employers

No Application needed if the couple both work for HEB ISD

Split Premiums For Family CoverageThe rates in your guide are wrong…

Standard Funding TRS ActiveCare 1 -HD

TRS ActiveCare Select

Scott & White HMO

TRS ActiveCare2

Employee Only Premium $116.00 $259.00 $305.16 $420.00Employee & Child(ren) Premium $390.00 $554.00 $614.16 $817.00

Total Premium due $506.00 $813.00 $919.32 $1,237.00

Pooling Funds TRS ActiveCare 1-HD

TRS ActiveCare Select

Scott & White HMO

TRS ActiveCare 2

Employee & Family Total Premium $1,231.00 $1,361.00 $1,322.98 $1,597.00HEB Contribution for Employee A -$225.00 -$225.00 -$225.00 -$225.00HEB Contribution for Employee B -$225.00 -$225.00 -$225.00 -$225.00

Total Premium due $781.00 $911.00 $872.98 $1,147.00÷ 2 ÷ 2 ÷ 2 ÷ 2

Each employee pays $390.50 $455.50 $436.49 $573.50

Monthly Savings or (additional cost) ($275.00) ($98.00) $46.34 $90.00 Annual Savings or (additional cost) ($3,300.00) ($1,176.00) $556.08 $1,080.00

Health & Wellness Resources

23

Mobile apps and tools

• Find a network doctor

• Check your plan coverage

• Check on a claim• Show your ID card• Contact TRS-

ActiveCare Customer Service

Aetna Mobile

• Check a symptom• Look up a

condition• Find the right

doctor• Check on ER wait

times

iTriage

• 24/7/365 access to doctors by phone

• Get treatment for colds, allergies, ear infections and much more

Teladoc

• Schedule a lab appointment

• Find a lab near you• Check your results

MyQuest

Meet ALEX

Need help deciding which plan is right for you, Meet ALEX, your online benefits advisor. ALEX can: Help you understand and compare plans Explain health benefits terms -

without all the jargon Show you how deductibles, coinsurance

and out-of-pocket maximums work Walk you through estimating tax savings

with a health savings account (if you are considering the ActiveCare 1-HD plan)

To use the tool, visit www.myalex.com/trsactivecare/2016

6

May be used to compare 1-HD, 2 & Select! Not HMO

GAP InsuranceSPECIAL INSURANCE SERVICES (SIS)

24

Gap Insurance

Gap insurance helps with out of pocket expenses one might incur due to a large deductible or high maximum out of pocket amounts.

You must be covered under a GROUP health plan in order to be eligible to enroll in the Gap plan.

2 Benefits: $1500 Inpatient & $1500 Outpatient

BenefitsInpatient Hospital Benefit• $1,500 per covered person per plan year

Outpatient Benefit• $1,500 per person per sickness/injury • Maximum of 3 occurrences per family per plan year• All expenses related to the treatment of the same or related sickness/injury will

accrue toward the outpatient benefit

How to file a claim:• Give your provider the Gap ID Card or• File a claim with SIS for reimbursement

Note: This plan will only reimburse you the amount the insurance carrier shows you owed to the provider.

Gap – Definition of Outpatient Services

The outpatient benefit does not cover a physician’s

office visit charge.

ER

Outpatient Surgery

Diagnostic testing (i.e.. X-rays, lab work, MRI, CT scans,

etc.)

Outpatient radiation/chemotherapy

Physical therapy

Chiropractic care

Durable medical equipment

Gap - Premiums

Under Age 40 Ages 40 - 49 Ages 50 & Above

Employee Only $26.89 $35.41 $74.37

Employee & Spouse $49.44 $65.05 $136.65

Employee & Children $64.64 $69.58 $128.15

Employee & Family $86.57 $98.44 $188.80

Dental InsuranceLINCOLN FINANCIAL

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DHMO PPO High PPO LowPreventive $5 Office Fee Plan Pays 100% Plan Pays 100%

Basic Fixed Co-Pays (see pg. 28)

Plan Pays 80%Deductible Applies

Plan Pays 70%Deductible Applies

Major Fixed Co-Pays(see pg. 28)

Plan Pays 50%Deductible Applies

Plan Pays 50%Deductible Applies

Orthodontics Fixed Co-Pays(see pg. 28)

Plans Pays 50% up to $1,000

Not Covered

Out of Network None; You must choose an in network provider (see page 26-27)

Yes Yes

Deductible Per Calendar Year None $50 Per Person$150 Family

$25 Per Person$75 Family

Annual Maximum Benefit(Maximum amount the insurance will pay per person per calendar year)

None $1,000 $750

Lincoln Financial Dental PPO & DHMO

PPO Plans MaxRewards

Both PPO Plans offer MaxRewards maximum rollover feature which will allow covered members to roll over a portion of their unused annual maximum into a MaxRewards Account Balance.

MaxRewards PPO High PPO Low

Eligible Range (Claim Threshold) $1 - $600 $1 - $300

Rollover Amount $250 per year $150 per yearRollover Amount with Preferred Provider $350 per year $200 per year

Maximum Rollover Account Balance $1,000 $750

30

Dental Premiums

DHMO PPO High PPO Low

Employee Only $13.91 $38.00 $25.00

Employee + 1 $26.42 $75.50 $51.50

Employee + Family $41.72 $114.50 $69.50

Vision PlanSUPERIOR VISION

31

Vision Plan

In Network Benefits

Examination (Once Every Plan Year) $10 copay

Material Copay (lenses & frames only, not contact lenses) $25 copay

Contact Lens Evaluation & Fitting (Once Every Plan Year)

$0 (standard)

$50 retail allowance (specialty)

Frames (Once Every Two Plan Years) $130 Allowance (20% discount off balance)

Contact Lenses (Once Every Plan Year)Up to $150

(Covered 100% if Medically Necessary)

Lenses (Once Every Plan Year)

•Single Vision, Bifocal, Trifocal Lenticular•Standard Scratch Coating

Covered in Full*Discounts on other types of

specialty lenses

PremiumsEmployee Only $6.10Employee + 1 $11.84Family $17.39

Disability InsuranceTHE STANDARD

32

The Standard Disability

Disability Income

Replaces a portion of your income when you are sick or injured and cannot work

Maximum Benefit Amount up to 2/3rds of your monthly earnings

Benefit Waiting Period 7, 14, 30, 60, 90, 180 days –

The period of time that you must be continuously disabled before benefits become payable. Benefits are not payable during the benefit waiting period!

First Day Hospital Benefit

If the insured employee is admitted as a hospital inpatient for at least four hours, the Benefit Waiting Period will be satisfied.

Benefits will become payable on the date of the hospitalization

This feature is included only on plans with Benefit Waiting Periods of 30 days or less 7 days

14 days

30 days

Disability Pre-Existing Conditions

Pre-existing Condition Exclusion:

•Any condition you had 90 days prior to the effective date of your insurance will

be considered pre-existing.

Pre-existing Condition Waiver:

•For the first 45 days of disability, The Standard will pay full benefits even if you

have a pre-existing condition

Annual Earnings

Monthly Earnings

Monthly Disability Benefit

Accident/Sickness Benefit Waiting PeriodCost Per Month

7 days 14 days 30 days 60 days 90 days 180 days

3,600 300 200 9.74 7.78 6.42 4.38 3.80 2.945,400 450 300 14.61 11.67 9.63 6.57 5.70 4.417,200 600 400 19.48 15.56 12.84 8.76 7.60 5.889,000 750 500 24.35 19.45 16.05 10.95 9.50 7.35

10,800 900 600 29.22 23.34 19.26 13.14 11.40 8.8212,600 1,050 700 34.09 27.23 22.47 15.33 13.30 10.2914,400 1,200 800 38.96 31.12 25.68 17.52 15.20 11.7616,200 1,350 900 43.83 35.01 28.89 19.71 17.10 13.2318,000 1,500 1,000 48.70 38.90 32.10 21.90 19.00 14.7019,800 1,650 1,100 53.57 42.79 35.31 24.09 20.90 16.1721,600 1,800 1,200 58.44 46.68 38.52 26.28 22.80 17.6423,400 1,950 1,300 63.31 50.57 41.73 28.47 24.70 19.1125,200 2,100 1,400 68.18 54.46 44.94 30.66 26.60 20.5827,000 2,250 1,500 73.05 58.35 48.15 32.85 28.50 22.0528,800 2,400 1,600 77.92 62.24 51.36 35.04 30.40 23.5230,600 2,550 1,700 82.79 66.13 54.57 37.23 32.30 24.9932,400 2,700 1,800 87.66 70.02 57.78 39.42 34.20 26.4634,200 2,850 1,900 92.53 73.91 60.99 41.61 36.10 27.9336,000 3,000 2,000 97.40 77.80 64.20 43.80 38.00 29.4037,800 3,150 2,100 102.27 81.69 67.41 45.99 39.90 30.8739,600 3,300 2,200 107.14 85.58 70.62 48.18 41.80 32.3441,400 3,450 2,300 112.01 89.47 73.83 50.37 43.70 33.8143,200 3,600 2,400 116.88 93.36 77.04 52.56 45.60 35.2845,000 3,750 2,500 121.75 97.25 80.25 54.75 47.50 36.7546,800 3,900 2,600 126.62 101.14 83.46 56.94 49.40 38.22

33

Disability ExamplesMaternity Benefits

$2600 Monthly BenefitOut for 6 weeks

30/30 Benefit Waiting Period

$2600 ÷ 30 days = $86 per day

7 days a week x 6 weeks = 42 days

42 days x $86 per day ≈ $3612

Knee Replacement Surgery$2000 Monthly Benefit

Out for 12 weeks30/30 vs. 60/60 Benefit Waiting Period

30/30$2000 ÷ 30 days = $66 per day

7 days a week x 12 weeks = 84 days

84 days x $66 per day ≈ $5544_________________________________

60/601st 8 weeks are unpaid

7 days a week x 4 weeks = 32 days

32 days x $66 per day ≈ $2112

If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first

day of inpatient confinement for Benefit Waiting Periods 7 days, 14 days, and 30 days.

Cancer PlanALLSTATE

37

Allstate

Pays actual doctor charges for Cancer related treatment

•Surgery, Radiation, Chemotherapy, Transportation,

Lodging, etc.

Pays benefits directly to you

Also covers 29 other specified diseases such as:•Lou Gehrig’s Disease, Muscular

Dystrophy, Multiple Sclerosis, Tuberculosis, Sickle Cell Anemia,

Bacterial Meningitis, Lyme Disease, Cystic Fibrosis, etc.

Policy is portable, which means if you leave the

district you can keep the plan at the same rate.

No evidence of insurability required at initial

enrollment for Low Plan•Pre-Existing Condition – Allstate

will not pay benefits for a pre-existing condition during the 1st

12 months

Allstate Cancer InsuranceBenefits Low Option High OptionAmbulance $100 $100Cancer Initial Diagnosis $2,000 $5,000Hospital Confinement $200 per day $200 per dayIntensive Care Unit $600 per day $600 per dayNon Local Transportation Coach Fare or .40/mileRadiation/Chemotherapy $10,000 $20,000Surgery Up to $3000 Up to $3000Wellness Benefit $100 per calendar yearPremiums Low Option High OptionEmployee Only $26.41 $40.33Employee & Child(ren) $37.28 $57.55Employee & Spouse $41.87 $63.24Employee & Family $52.72 $80.44

Group Term Life InsuranceLINCOLN FINANCIAL

42

Basic Life Insurance

HEB provides $5,000 Life Insurance upon the death of an employee

Term Life Insurance

Term Life Insurance for Employee

• Age Banded Rates – every 5 years when you are bumped to the next age bracket, your rates will increase

Term Life insurance for spouse and/or child(ren)

• Employee must choose term life insurance in order to choose term life insurance for spouse or child

• Spouse’s rates are based on the employee’s age

• Spouse’s coverage not to exceed ½ of employee’s coverage

Life Insurance

Maximum Benefits

• Employee - $500,000 not to exceed 5x annual salary

• Spouse - $75,000 not to exceed 50% of employee’s coverage

Guaranteed Coverage Amount For New Hires(no medical questions

required)

• Employee - $300,000 not to exceed 3x annual salary

• Spouse - $30,000

Term Life Insurance Premiums

Spouse Premiums

Employee Premiums

43

Child(ren) Life Insurance Rates

$5,000 per child - $.60 per month

$10,000 per child - $1.20 per month

Accidental Death & Dismemberment Life Insurance

46

Insurance that is payable in case death is ruled an accident

Examples:

AD&D Life Plan Accidental Death & Dismemberment

Family Coverage$100,000 = $3.30$500,000 = $16.50

Employee Only Coverage$100,000 = $2.40

$500,000 = $12.00

Benefit Employee Only Plan Family PlanAmount 1-10 times your

annual salary rounded to next higher $1000

• Spouse: 50% of the employee benefit, not to exceed $250,000 • Each Child: 15% of employee benefit, not to exceed $30,000 • Spouse + Each Child: Spouse 40% and Child 10% of the employee

benefit, not to exceed $30,000

Maximum Amount $500,000 $250,000Rate per $1,000 $.024 $.033

PrePaid Legal InsuranceLEGALEASE

48

What is PrePaid Legal?

The plan matches you up with an attorney

There are no deductibles

Benefits cover the attorney’s

time

Other costs, such as filing fees, are

not covered

LegalEASE offers employees a customized legal assistance plan that provides support and protection from unexpected personal legal issues.

Plan Benefits

Consumer

•Small Claims Court Representation

•Document Preparation•Promissory

Note•Simple

Affidavit

Estate Planning & Wills

•Simple Will•Living Will•Health Care

Power of Attorney

•Living Trust•Probate of

Small Estate

Family

•Divorce•Name Change•Adoption•Guardianship

Home

•Purchase of Primary Residence

•Sale of Primary Residence

•Refinancing

Criminal

•Traffic Defense•Misdemeanor

Defense

Other

•Civil Litigation Defense

•Foreclosure•Tax Audit•Financial

Planning & Coaching

•Office Consultation

•Telephone Advice

Individual $16.91Family $18.88

Premiums

50

Health Savings Accounts (HSA)HSA BANK

52

What is a Health Savings Account (HSA)?

An HSA, is a tax-advantaged account that you put money into to pay for current or future healthcare expenses

Tax free contributions

Unused funds roll over from year to year. There’s no “use it or lose it” penalty

Money in your account is invested

Money in your account is accessible as it is contributed. You do not have access upfront to all the money you are supposed to contribute to the account for the entire year like a Flexible Spending Account

EligibilityYou must be covered

by a qualified high deductible health

plan (HDHP) –ActiveCare 1HD

You cannot be enrolled in the GAP

PlanYou cannot be

enrolled in Medicare

You cannot be covered by other health insurance

You cannot be claimed as a

dependent on someone else's tax

return

You cannot be enrolled in a Flexible Spending Account

(FSA)

Maximum Contributions per Year

Age Under 55 Age 55+Individual Coverage $3,350 $4,350Family Coverage $6,750 $7,750

Funding your HSA:

Payroll deductions

Online transfers

Personal check

Eligible Medical Expenses

Note: You do not have to submit any

receipts to HSA Bank, save your bills and receipts for tax

purposes!

Expenses applied to your health plan

deductible

Dental Care Vision Care

Prescription drugs and medicines

How to Use Your HSA

Sign up for free internet banking

How to access your funds:•You can reimburse yourself for an expense paid

out-of-pocket or pay directly from your HSA account:•Debit Card•Checks – order checks from HSA bank for a fee•Online Transfers •Manual withdraw form - processing fee

Flexible Spending PlanTASC

55

Medical Reimbursement

Employee can pay for out-of-pocket medical expenses with before tax dollars • File claims for reimbursement• Use the debit card that is provided

Deductibles, co-insurance, co-pays, vision care, dental procedures, etc.

You must use it or lose it!!Plan year is September 1st

through August 31st. You must re-enroll every year.

Funds are front loaded (you have access to all the money on September 1st)

Maximum per year is $2,400 or $200 per month

Comparison of HSA & FSAQuestions Health Savings Account (HSA) Flexible Spending Account

(FSA)

Who qualifies as a participant?

All individuals under 65 who are participants in a qualified High Deductible Health Plan (HDHP).

A HDHP is TRS ActiveCare plan 1-HD

Non-Medicare enrolled persons

All employees (not required to be on District insurance to participate)

What is the maximum contribution per year? Individual - $3,350; over 55 - $4,350Family - $6,750; over 55 - $7,750 $2,400

Can I access the entire account at the start of the plan year?

No, money is available as it is contributed to the account

Yes, the total amount elected for the year is available to the employee on day one

Employee tax savings? Contributions are tax-free Contributions are tax-free

Does interest accrue on the account? Interest can be accrued Interest is NOT accrued

Can I roll unused dollars to next year?Yes. Funds may be carried over indefinitely throughout an account holder’s lifetime. Upon death, an account may be passed on to a surviving spouse.

No

What are qualified medical expenses on the plan?

Deductibles, coinsurance, prescriptions, includes dental and vision

Deductibles, coinsurance, prescriptions, includes dental and vision

Are claims substantiated? Only upon audit Yes. Receipts may be required.Can I use the money on non-medical qualified expenses?

Yes. The expense is subject to taxes and 10% tax penalty. (After age 65, no 10% penalty) No

Is there a “catch up” provision? Yes, individuals 55 and older may make additional contributions up to $1,000 per year. No

Portability Yes. It is owned by the account holder No

Subject to Cobra? No Yes

57

Dependent Day Care Reimbursement Plan

58

Dependent Day Care Reimbursement Plan

The plan allows you to set aside money on a pre-tax basis that you can use to cover certain costs associated with providing your dependent(s) with day care while you and your spouse are at work.

Any dependent under the age of 13 or any other dependent such as a parent or spouse can be covered

If you choose this plan you cannot claim the Federal Tax Credit.

Maximum contribution is $5,000 per year. You must use it or lose it.

Debit Card is provided and/or you can file claims for reimbursement.

Retirement Planning

60

Plan Administrators

403(b) Plan 457 PlanThe Omni Group877-544-6664

www.omni403b.com

TCG Administrators800-943-9179

www.tcgservices.com/documents/#/255/457b

What is a 403b or 457?

What is a 403(b)?A 403(b) plan is a retirement savings plan available for public education organizations. It has tax treatment similar to a 401(k) plan. Employee salary deferrals into a 403(b) plan are made before income tax is paid an allowed to grow tax-deferred until the money is taxed as income when withdrawn from the plan. 403(b) plans are also referred to as tax-sheltered annuity.

What is a 457?The 457 plan is a type of deferred-compensation retirement plan that is available for governmental employers. The employer provides the plan and the employee defers compensation into it on a pre-tax basis. For the most part the plan operates similarly to a 401(k) or 403(b) plan. The key difference is that there is no penalty for withdrawal before the age of 59½ (but subject to income tax).

Maximum Contributions for 2016:Annual Maximum - $18,000Over age 50 Catch-up - $6,000

Maximum Contributions for 2016:Annual Maximum - $18,000Over age 50 Catch-up - $6,000

Investment Options

You have 20 + companies to choose from with a variety of investment options available –Please visit www.trs.state.tx.usand select 403b Certification and click on View 403(b) Products List to see the list of fees charged by each company/product.

HEB ISD has selected 1 company to provide our employees with the 457 plan. TCG Administrators offers several investment options

403(b) Plan 457 Plan

How to Enroll

403(b) Plan 457 PlanHow to Enroll:Step 1: Set up your 403b

account with an approved vendor

Step 2: Complete the Salary Reduction Agreement with The Omni Group

How to Enroll:Complete the Salary Reduction Agreement with TCG Administrators

Enrollment or changes may be made anytime during the year

Effective Dates and Enrollment

Enrollment Due Date

Online enrollment and other forms must be completed and returned to the Benefits Office within 30 days of your hire date.

If you need help with your online enrollment, please call the Benefits Office to schedule an appointment!

Questions?