Hurst Euless Bedford I.S.D. Employee Benefits

Ennis Independent School
District
2015 - 2016
Open Enrollment
Open Enrollment
• Enrollment Dates: August 1, 2015 – August 24, 2015
• Effective Date of Changes: September 1, 2015
Summary of TRS ActiveCare Changes for
the 2015-2016 School Year
Health Insurance
•Premium Increase
•Out of Pocket Maximum Increase
•New HMO Plan
ENNIS ISD
125
BENEFITS
GUIDE
Please visit the Benefits web page for
plan documents and more details on
each benefit.
Section 125/Family Status Change

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
Sick Leave Bank
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 (one time contribution)
Returning members must donate
one additional day each year
Employees who join the bank are
eligible for benefits after a 90-day
waiting period (from the date of
his/her application for membership).
Sick leave bank days
available to use for:
• Employee, spouse child’s
illness/injury
• Parent receiving hospice
or end-of-life care
Health Insurance
4 HEALTH PLAN OPTIONS


AETNA

ActiveCare 1HD

ActiveCare Select

ActiveCare 2
SCOTT & WHITE

HMO
See Health
Insurance
Enrollment Guide
online for more
details
Affordable Care Act (ACA)

As of January 1, 2014, the Affordable Care Act (ACA)
requires you to have health insurance for yourself and
your dependents.

You may have to pay a penalty if you cannot provide
proof to the IRS that you had health insurance.

You can visit www.healthcare.gov to see the plans that
are available through the Marketplace
ActiveCare 1HD Changes
ActiveCare Select Changes
ActiveCare 2 Changes
New HMO Plan

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, Ellis, 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
$2,500 employee only
$5,000 employee & spouse;
Deductible
employee & children;
employee & family
Maximum Out of
Pocket
(includes medical &
prescription deductibles,
copays and coinsurance)
Coinsurance
Office Visit Copay
$6,450 employee only
$12,900 employee & spouse;
employee & children;
employee & family
80% Plan pays
20% Participant pays
20% after deductible
ActiveCare
Select
$1,200 individual
$3,600 family
$6,600 individual
$13,200 family
80% Plan pays
20% Participant pays
$30 for primary
$60 for specialist
Scott & White
HMO
ActiveCare
2
$800 individual
$2,400 family
$1,000 individual
$3,000 family
$5,000 individual
$10,000 family
(Excludes Deductible)
80% Plan pays
20% Participant pays
$6,600 individual
$13,200 family
80% Plan pays
20% Participant pays
$20 for primary
$50 for specialist
Primary means care provided by family practitioners, internists, OB/GYNs and pediatricians.
$30 for primary
$50 for specialist
Preventive Benefits
(Network Level of Benefits)
Preventive Care Clarification
Services
Preventive Care
ActiveCare
1-HD
ActiveCare
Select
Scott & White
HMO
ActiveCare
2
Plan pays 100%
(deductible waived)
Plan pays 100%
(no copay required)
Plan pays 100%
(no copay required)
Plan pays 100%
(no copay required)
• Must be billed by provider as “preventive care”
Plan Overview
(Network Level of Benefits)
Benefits (continued)
Services
Diagnostic Lab
High-tech
Radiology
(CT scan, MRI,
nuclear medicine)
Outpatient Surgery
ActiveCare 1-HD
20% after deductible
ActiveCare Select
Quest Facility
Plan pays 100%
(deductible waived)
Scott & White HMO
20% after deductible
ActiveCare 2
Quest Facility
Plan pays 100%
(deductible waived)
Other Facility
20% after deductible
Other Facility
20% after deductible
20% after deductible
$100 copay per
service, plus 20%
after deductible
20% after deductible
$100 copay per
service, plus 20%
after deductible
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
Emergency Room
(true emergency use)
ActiveCare
1-HD
20% after
deductible
Inpatient Hospital
(facility charges)
Preauthorization required
20% after
deductible
ActiveCare Select
Scott & White HMO
ActiveCare 2
$150 copay, plus 20%
after deductible
$150 copay, plus 20%
after deductible
$150 copay, plus 20% after
deductible
(copay waived if admitted)
(copay waived if admitted)
(copay waived if admitted)
$150 copay per day, plus
20% after deductible
$150 copay per day, plus
20% after deductible
$150 copay per day, plus
20% after deductible
($750 max copay per admission)
($750 max copay per admission)
($750 max copay per admission)
Important Notes
ActiveCare 1-HD
ActiveCare Select
Scott & White HMO
ActiveCare 2
You must pay all of your
deductible before this plan
begins to pay for covered
services
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
You must pay all of
your deductible
before this plan
begins to pay for
covered services
Deductible is waived for
preventive visits!
NO out of network
benefits!
NO out of network
benefits!
Deductible is waived;
no copay for
preventive visits!
Prescription
Drug Benefits
Prescription Drug Benefits
Features
Drug Deductible
(per person, per plan year)
ActiveCare 1-HD
ActiveCare Select
Scott & White HMO
ActiveCare 2
Subject to
plan year
deductible
$200 per person
(excludes generics)
$100 per person
(excludes generics)
$200 per person
(excludes generics)
Retail Short-Term
(up to 31-day supply)
and
Retail
Short Term
Retail
Maintenance
Retail
Short Term
Retail
Maintenance
Retail
Short Term
Retail
Maintenance
Generic
$20
$25
$3
$6
$20
$25
Preferred Brand
$40
$50
30%
30%
$40
$50
Non-Preferred Brand
50%
50%
50%
50%
$65
$80
Retail Maintenance
(after first fill)
Mail Order and Retail-Plus
(up to 90-day supply)
20% coinsurance
after deductible
Mail Order and Retail-Plus
Mail Order and Retail-Plus
Mail Order and Retail-Plus
Generic
$45
$6
$45
Preferred Brand
$105
30%
$105
Non-Preferred Brand
50%
50%
$180
$200 per fill (up to 31-day
20% coinsurance per fill
Tier I – 10%
Tier II – 20%
Tier III – 30%
Tier IV – 50%
Specialty Medications
$450 per
supply)
fill (32-day to 90-day
supply)
Monthly Premiums
ActiveCare
1-HD
ActiveCare
Select
New Plan
Scott & White
HMO
ActiveCare
2
Current
New
Current
New
Current
New
Current
New
Employee Only
$80
$96
$205
$228
n/a
$258.60
$310
$369
Employee & Spouse
$605
$669
$799
$877
n/a
$890.62
$1,042
$1,233
Employee & Children
$327
$370
$464
$517
n/a
$553.30
$630
$747
Employee & Family
$900
$986
$993
$1,086
n/a
$1,014.76
$1,078
$1,276
Total Out of Pocket Amounts
(In Network for Employee Only)
ActiveCare
1 - HD
ActiveCare
Select
$2,500
$1,200
$800
$1,000
$0
$200
$100
$200
$3,950
$5,200
$5,000
$5,400
$6,450
$6,600
$5,900
$6,600
Annual Premium
$1,152
$2,736
$3,103.20
$4,428
Total Premium, Medical &
Prescription Expenses
$7,602
$9,336
$9,003.20
$11,028
Deductible (Medical)
Deductible (Prescription)
Maximum Out of Pocket (co-ins &
copays)
Subtotal Medical & Prescription
Costs
Scott & White ActiveCare
HMO
2
1HD vs. 2 = $3,426 savings in annual premiums
Employee & Spouse
Deductible (Medical)
Deductible (Prescription)
Maximum Out of Pocket (co-ins & copays)
Subtotal Medical & Prescription Costs
Annual Premium
Total Premium, Medical & Prescription Expenses
ActiveCare 1 - HD
$5,000
$0
$7,900
$12,900
$8,028
$20,928
ActiveCare Select Scott & White HMO
$2,400
$1,600
$400
$200
$10,400
$10,000
$13,200
$11,800
$10,524
$10,687.44
$23,724
$22,487.44
ActiveCare 2
$2,000
$400
$10,800
$13,200
$14,796
$27,996
Employee & Child(ren) - Assumes 2 children
Deductible (Medical)
Deductible (Prescription)
Maximum Out of Pocket (co-ins & copays)
Subtotal Medical & Prescription Costs
Annual Premium
Total Premium, Medical & Prescription Expenses
ActiveCare 1 - HD
$5,000
$0
$7,900
$12,900
$4,440
$17,340
ActiveCare Select Scott & White HMO
$3,600
$2,400
$600
$300
$9,000
$10,000
$13,200
$12,700
$6,204
$6,639.60
$19,404
$19,339.60
ActiveCare 2
$3,000
$600
$9,600
$13,200
$8,964
$22,164
Employee & Family - Assumes 4 family members
Deductible (Medical)
Deductible (Prescription)
Maximum Out of Pocket (co-ins & copays)
Subtotal Medical & Prescription Costs
Annual Premium
Total Premium, Medical & Prescription Expenses
ActiveCare 1 - HD
$5,000
$0
$7,900
$12,900
$11,832
$24,732
ActiveCare Select Scott & White HMO
$3,600
$2,400
$800
$400
$8,800
$10,000
$13,200
$12,800
$13,032
$12,177.12
$26,232
$24,977.12
ActiveCare 2
$3,000
$800
$9,400
$13,200
$15,312
$28,512
Application to Split Premium

Married couples working for different
participating entities may “pool” funds
OR

Married couples both working for Ennis ISD

Family coverage and all want the same plan

Requires an Application to Split Premium form
to be completed by both employees and both
employers
How to Search
for Providers

TRS ActiveCare 1HD, Select or 2
www.trsactivecareaetna.com

Scott & White HMO
www.trs.swhp.org
DocFind
No
If you choose
ActiveCare
Select, you will
not see the
correct list!!!
Yes
ActiveCare
Select – you
must choose
the Baylor Scott
& White Quality
Alliance (DFW
Region) option!
List of Hospitals in Select & HMO Plans

Hospitals:






Baylor Medical Center (Grapevine, Irving, Waxahachie, etc.)
Baylor Emergency Medical Center (Colleyville, Keller,
Mansfield, etc.)
Baylor All Saints – Ft. Worth
Cook Children’s Medical Center
Children’s Medical Center
Out of Network
Hospitals:
Harris Methodist – HEB
North Hills Hospital
Urgent Care Facilities:
Concentra
 Cook Children’s – Hurst, Ft. Worth, Southlake

Out of Network
Urgent Care
Facilities: Carenow
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?
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 3: Resolve
your issue
Step 2: Talk with
a doctor
•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?
Non emergency
medical issues
Common list of short
term prescriptions
• Cold & flu symptoms
• Bronchitis
• Allergies
• Poison ivy
• Pink eye
• Urinary tract infection
• Respiratory infection
• Sinus problems
• Ear infection
• & more!
• Amoxicillin™
• Azithromycin™
• Bactrim DS™
• Augmentin™
• Cipro™
• Tessalon Perles™
• Flonase Nasal Spray™
• Pyridium™
• Prednisone™
• Diflucan™
GAP Insurance
COLONIAL LIFE
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.
Benefits
Note: This plan will only reimburse you
the amount the insurance carrier
shows you owed to the provider.
Inpatient Hospital Benefit
• $1,500 per covered person per plan year
Hospital Confinement Benefit
• $1,500 maximum of one day per covered person calendar year
• Outpatient surgical procedure benefit: Tier 1: $500 per day
Tier 2: $1000 per day
How to file a claim:
• Give your provider the Gap ID Card or
• File a claim with Colonial Life for reimbursement
Dental Insurance
CIGNA DENTAL
Cigna Dental Benefit DPPO
In Network DPPO
Out of Network
Preventive
Plan pays 100% - No charge
Plan pays 100% - no charge
Basic
Plan pays 80% - You pay 20%
Plan pays 80% - You pay 20%
Major
Plan pays 50% - You pay 50%
Plan pays 50% - You pay 50%
Plan pays 50% - You pay 50%
$1000 max (dependent children to age 19)
Plan Pays 50% - You pay 50%
$1000 max (dep. children to age of 19)
$50 Per Person
$150 Family
$50 Per Person
$150 Family
$1,250
$1250
Orthodontics
Deductible Per Calendar Year
Annual Maximum Benefit
(Maximum amount the insurance will pay per
person per calendar year)
Dental Premiums
DHMO
PPO High
Employee Only
$29.96
Employee & Spouse
$63.88
Employee + Children
$70.12
Employee + Family
$103.96
Vision Plan
EYE MED
Vision Plan
In Network Benefits
Examination (Once Every Plan Year)
$10 copay
Material Copay (eyeglass basic lenses, not contact lenses)
$25 copay
Contact Lens Evaluation & Fitting
Up to $55
(Once Every Plan Year)
Frames (Once Every Two Plan Years)
$0 copay; $130
allowance
Contact Lenses
$0 copay; $130
allowance
(Once Every Plan Year)
Lenses (Once Every Plan Year)
•Single Vision, Bifocal, Trifocal Lenticular
•Standard Scratch Coating
$25 copay / $15 for
scratch coating
Premiums
Employee Only
$6.98
Employee &
Spouse
$13.27
Employee &
Children
$13.97
Employee &
Family
$20.54
Disability
Insurance
UNUM
The Standard Disability
Disability
Income
Replaces a portion of your income when you are sick or
injured and cannot work
Maximum
Benefit
May purchase a monthly benefit in $100 units, starting at a
minimum of $200, up to 66 2/3% of your monthly earnings
rounded to the nearest $100, but not to exceed a monthly
maximum benefit of $7,500.
Benefit Waiting
Period 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!
Cancer Plan
ALLSTATE
Allstate
Guaranteed Issue this year
only!
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.
Benefits paid directly to
you, unless otherwise
assigned.
Policy is portable, which
means if you leave the
district you can keep the
plan at the same rate.
Allstate Cancer Insurance
Benefits
Option 1
Option 2
Option3
Radiation/Chemotherapy
$10,000
$10,000
$10,000
Cancer Initial Diagnosis (1st
Occurrence)
N/A
$5,000
$5,000
Hospital Confinement
$300 per day
ICU
N/A
Cancer Wellness Benefit
$600
$50 per calendar year
Private Duty Nursing Services
$300
New or Experimental Treatment
$5000
Surgery
Premiums
Up to $4500
EE
F
Option 1- BASIC
$20.28
$33.60
Option 2 - ENHANCED
$24.68
$41.60
Option 3 - PREMIER
$27.92
$48.20
Group Term
Life Insurance
UNUM
Term Life Insurance
Term Life Insurance for
Employee
• This year only, all employees have a
Guarantee Issue available up to
$150,000; the policy allows for
coverage in increments of $10,000,
up to 5x annual salary to a maximum
of $500,000 of coverage.
Term Life insurance for Spouse
• Coverage available for spouse and
child(ren) ONLY if you have UNUM
coverage for yourself
• Guaranteed Issue limit for spouse is
up to $25,000; the policy allows for
increments of $5,000 up to $250,000
of coverage
Child(ren) Life Insurance Rates

Guaranteed Issue Limit for child(ren) is
up to $10,000; the policy allows for
increments of $5000 up to $10,000 of
coverage.

Spouse and dependent children
coverage is limited to 100% of the
employee’s coverage election.
New
ILOCK
360
IDENTITY THEFT PROTECTION BY
iLOCK 360
Cyber Alert / Social
Security number
trace
Sex offender alerts
/ criminal records
Change of address
/ full service
restoration & lost
wallet
Daily monitoring /
Score Tracker
Plan Benefits
Ilock 360 (monthly)
PLUS
PREMIUM
Employee Only
$8
$15
Employee + Spouse
$15
$22
Employee + Children
$13
$20
Family
$20
$27
Flexible Spending Plan
Medical Reimbursement
Employee can pay for out-ofpocket medical expenses with
before tax dollars
• File claims for reimbursement
• Use the debit card that is provided
Deductibles, co-insurance, copays, 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 $2,550 or
$200 per month
Dependent Day Care
Reimbursement Plan
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.
If you are married and filing
separately, each spouse may
only elect up to $2,500.
Any dependent under the age of
13 or any for dependent adults
unable to care for themselves.
Maximum contribution is $5,000
per year. You must use it or lose it.
The debit card may be used for
payment of dependent care
expenses.
Retirement
Planning
Plan Administrators
403(b) Plan
457 Plan
RAMS / JEM
800-943-9179
www.region10rams.org
Password: ennis457
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 and allowed to grow taxdeferred until the money is taxed as income when
withdrawn from the plan. 403(b) plans are also
referred to as tax-sheltered annuity.
Maximum Contributions for 2015:
Annual Maximum - $18,000
Over age 50 Catch-up - $6,000
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 2015:
Annual Maximum - $18,000
Over age 50 Catch-up - $6,000
Online Enrollment

August 1, 2015 – August 24, 2015

Effective Date of Changes: September 1, 2015

Visit: tcgbenefits.com (at the top right hand corner – login to employee
benefits enrollment) Company key is: ennis (case sensitive).
It is your responsibility to check your paycheck stub in September to make
sure the correct amount is being deducted. Please contact the Benefits
Office promptly in the event of any error or discrepancy with these
deductions.