2015-2016 EMPLOYEE BENEFITS GUIDEc8ca6e5e43a19f2300e1-04b090f30fff5ccebaaf0de9c3c9c18a.r54.cf… ·...
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EMPLOYEE BENEFITS GUIDE 2015-2016
Transcript of 2015-2016 EMPLOYEE BENEFITS GUIDEc8ca6e5e43a19f2300e1-04b090f30fff5ccebaaf0de9c3c9c18a.r54.cf… ·...
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EMPLOYEE BENEFITS GUIDE
2015-2016
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WHY PUTTING THE BEST TEAM ON THE FIELD MATTERS
Our employees are our most valuable asset in furthering our Mission of College for All Children. For this very reason, IDEA Public Schools is committed to offering a comprehensive employee benefi ts program that helps our employees stay healthy, feel secure, and maintain a work/life balance.
Benefi ts offered through the workplace can help protect important things such as your income and your assets if you become sick or injured. Other benefi ts can help cover expenses that might not be covered in your medical plan such as day care, travel expenses, rent, mortgage, and every day cost of living expenses. These benefi ts are not only valuable, but also provide great protection for you and your family while reducing fi nancial exposure in your medical plan. For this very reason we at IDEA Public Schools work to ensure that the benefi ts we offer are best-in-class. The voluntary benefi ts program is something we also fi nd value in because these benefi ts work hand-in-hand with the medical plan in lowering fi nancial exposure for you and your family while providing benefi ts over and above what is covered by a traditional medical plan. Below is a brief snapshot of the benefi ts we offer at IDEA Public Schools. Thank you for all that you do!
Benefi ts Carrier Funding Description
Medical InsuranceTRS Active
Care
IDEA contributes a minimum of $341/month/ employee towards
monthly premiums
IDEA Public Schools provides you the opportunity to enroll in the TRS Active Care health plan, which offers you options of Aetna PPO, Scott and White HMO, and Allegian HMO plans.
Health Reimbursement
Arrangement Account
AmeriFlex
IDEA contributes $1,000/employee/year into an HRA account for full time employees enrolled in a medical plan (prorated contributions are made for
mid-year hires)
IDEA Public Schools provides $1,000 in a Health Reimbursement Arrangement Account to assist with your out-of-pocket cost for medical, dental, and vision prescription. You must participate in a medical plan through IDEA Public Schools in order to receive this benefi t.
Flexible Spending Account
AmeriFlex Employee Paid
This is a tax savings account that allows you to pay for eligible out-of-pocket medical, dental, and vision expenses with tax free dollars. In addition, it comes with a dependent day care account that assists with eligible day care expenses. DCA plan is a separate plan offered through Amerifl ex. It is not part of the FSA although they are both tax-sheltered. Employees have to actually enroll in a DCA plan.
Dental Guardian Employee PaidProvides benefi ts for preventive dental services, restorative care, periodontics, root canals, major services
Vision Guardian Employee Paid Provides benefi ts for eye exams, lenses, frames, and/or contacts.
Voluntary Group Term Life
Reliance Standard
Employee paidProvides a voluntary group term life benefi t for employees up to $200,000 in coverage, for a spouse up to $50,000 in coverage, and dependents up to $10,000 in coverage.
Short Term Disability Reliance Standard
Employee PaidBenefi t pays 60% of weekly salary up to $2,700 per week after a 7 day waiting period.
Long Term DisabilityReliance Standard
Employee PaidBenefi t pays 60% of monthly salary up to $15,000 per month after 90 day waiting period.
Cancer Insurance Trans America Employee PaidCovers Radiation/Chemotherapy, New and Experimental Treatment, and comes with a Wellness Benefi t.
Accident Insurance TrustMark Employee PaidProvides coverage for Emergency Accidents, Hospital Admission and comes with a Wellness Benefi t.
Critical Illness Allstate Employee PaidPays a lump sum up to $10,000 for Heart Attack, Stroke, and other major illness.
Universal Life with LTC
TrustMark Employee PaidProvides permanent life insurance coverage with long term care coverage.
Total Lifestyle Advantage Plan
Total Benefi ts Solution
Employee PaidProvides six benefi ts in one: Doctor by Phone, Roadside Assistance, Identity Theft, Vision Care, Chiropractic Care and Savings Guide.
Employee Assistance Program
Reliance Standard
No Cost
Provides professional counseling and referral service designated to help you with your personal, family and job issues.
ANNUAL BENEFITS OPEN ENROLLMENT OVERVIEW
We understand that life can be busy. But we encourage you to take the time to read the material inside this Benefits Guide to familiarize yourself with the benefits available to you. At this time of the year, you will have the opportunity to participate in open enrollment and make changes to your benefit elections.
What do you need to do during the Benefits Open Enrollment period?You must complete the enrollment process and either elect, change, or waive benefits. Even if you don’t wish to make any changes to your current benefit elections, you are still required to complete the enrollment process by August 26th.
NOTE: After the Open Enrollment Period ends on August 26th, you cannot make changes to your plan elections unless you experience a change in family status, such as: • Loss or gain of coverage through your spouse • Loss of eligibility of a covered dependent • Death of your covered spouse or child • Birth or adoption of a child • Marriage, divorce or legal separation
You have 30 days from a change in family status to make changes to your current coverage.
What benefits changed compared to last year?
MEDICALIDEA will continue to provide employees with an array of medical plans administered through TRS ActiveCare. There are a few changes this year which include: • Monthly premium rate increases ranged from 3.29% to 14.97% across all tiers and plan types. For the second year in a row, IDEA will absorb these increases to avoid increases to our staff. This means plan premium rates will remain the same for our staff in the 2015-2016 plan year. • Out of pocket maximums and deductible amounts have been slightly adjusted*.
*Please review the enclosed TRS ActiveCare Plan Highlight comparison for detailed information of specific plan changes.
HEALTH REIMBURSEMENT ARRANGEMENT (HRA)IDEA will continue to offer the Health Reimbursement Arrangement (HRA). An HRA is an employer-funded account that will assist employees with out-of-pocket medical expenses.
• IDEA will rollover unused HRA balances from the 2014-2015 plan year into the 2015-2016 plan year. • IDEA will continue to contribute $1,000 annually for every full time employee that enrolls in any of the PPO or HMO TRS ActiveCare medical plans offered through IDEA (pro-rated contributions will be made for mid-year enrollers). • Married IDEA staff members are each both eligible to receive $1000 if they are full time and enrolled in a medical plan.
DENTAL and VISIONThe dental and vision plan offered through Guardian provides a high level of benefits for you and your family. The monthly premium amounts for these plans are slightly increasing due to the high number of claims experienced last year.
We thank you for being a part of IDEA’s Team & Family and look forward to supporting you through this year’s annual open enrollment. If you have any questions or concerns, please feel free to reach out to us.
IDEA Benefits Team956-377-8000
07/15/15 to 08/26/16
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TABLE OF CONTENTS
2015-2016 Open Enrollment Benefit Election Worksheet ..................................................................5
Benefit Enrollment Methods ................................................................................................................6
Open Enrollment Calendar of Events ..................................................................................................7
Medical Insurance – TRS Active Care PPO Plan Highlights by Aetna ..............................................8
Medical Insurance – Scott & White HMO Plan Highlights (Austin only) ............................................10
Medical Insurance – Allegian HMO Plan Highlights (RGV only) .........................................................11
2015-2016 Health Insurance Plans – Cost to Employee .....................................................................12
Health Reimbursement Account .........................................................................................................13
Flexible Spending Account And Dependent Care Account ...............................................................14
Dental Insurance Plan Highlights ........................................................................................................15
Vision Insurance Plan Highlights .........................................................................................................16
Voluntary Group Term Life Insurance .................................................................................................17
Short Term and Long Term Disability ..................................................................................................18
Cancer Insurance Benefit Plans ..........................................................................................................20
Accident Insurance Benefit Plan .........................................................................................................21
Critical Illness Benefit Plan ..................................................................................................................22
Universal Life with Long Term Care ....................................................................................................23
Total Lifestyle Advantage Plan ...........................................................................................................24
Employee Assistance Program ...........................................................................................................25
403(b) Plan ............................................................................................................................................26
Benefits FAQs .......................................................................................................................................27
Benefit Communication and Engagement Resources .......................................................................28
Benefits Contact Information .............................................................................................................29
Afforable Care Act Overview ...............................................................................................................30
Glossary of Benefit Terms ...................................................................................................................31
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2015-2016 OPEN ENROLLMENT BENEFIT ELECTION WORKSHEET
Pre-Tax/ Post Tax Deduc on Deduc on Amount
EXAMPLE:Pre- Tax $125.00
Pre-Tax $
Pre-Tax $
Pre-Tax $
Pre-Tax $
Post - Tax $
Post - Tax $
Post - Tax $
Post - Tax $
Post - Tax $
Post - Tax $
Post - Tax $
Post - Tax $
$
$
*Add all items in the deduc on amount column to determine your total cost of premiums per month/biweekly. Please note these are es mated costs. Some plans are calculated on a pre-tax basis while others are calculated post-tax and may affect your paychecks.
Monthly (12 Pay):
Biweekly (24 Pay):Biweekly Premiums deducted twice a month to IDEA Staff that are paid on a biweekly basis year-round (example: Clerical Hourly Staff and Custodians).
Manual Trade Biweekly (20 Pay):This is a special Biweekly Premium deducted twice a month to hourly IDEA Staff that are paid on a biweekly basis but only work 10 months out of theyear (Bus Drivers and Cafeteria staff only).
Voluntary Group Term Life
TBS Lifestyle Advantage
Short-Term Disability
Long-Term Disability
Universal Life with LTC
Accident
Total Monthly Cost
Use this worksheet to help facilitate your enrollment process through self-enrollment or assisted-enrollment. As you review the various plans available, fill in the plan type, note the er you would like to par cipate in (i.e. employee only, employee and spouse, employee and children, family), and add the cost of each plan you elected.
IDEA Public Schools2015-2016 Open Enrollment Benefit Elec on Worksheet
Medical
Vision
Cancer
Total Biweekly Cost
Medical
Plan Name Coverage Tier
Ac veCare Select Employee Only
Flexible Spending Account
Dental
Cri cal Illness
Pre - Tax $403B
EXPLANATION OF THE PREMIUM CALCULATIONS BY PAY FREQUENCYAny staff member who enrolls in any of the plans offered by IDEA will have the corresponding deduction according to their pay frequency
Monthly (12 Pay):Monthly premiums deducted once a month to IDEA Staff who are salary and paid on a monthly basis (All salary staff).
Biweekly (24 Pay):Biweekly premiums deducted twice a month to IDEA Staff who are hourly and paid on an annualized biweekly basis (All hourly staff with exception
of bus drivers and hourly cafeteria staff).
Biweekly (20 Pay):Biweekly Premium deducted twice a month for hourly IDEA Staff that are paid on a biweekly basis but only work 10 months out of the
year (Hourly Bus Drivers and Cafeteria Staff Only).
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BENEFIT ENROLLMENT METHODS…EASY AS 1, 2, 3!It is required that every employee go through the enrollment process to either elect or waive benefi ts.
1. ONE-ON-ONE ENROLLMENT METHOD
Employees have the option to enroll in benefi ts one-on-one with a benefi ts counselor at their convenience. Benefi ts counselors will be available by appointment at designated times during the annual open enrollment period. To set up your appointment, login to www.meetme.so/IDEABenefi ts to look for appointment times available at your campusand region.
2. CALL CENTER ENROLLMENT METHOD
In the event you don’t have the time to meet with a Benefi ts Counselor one-on-one, IDEA’s benefi ts enrollment call center is available to you from 8 a.m. to 4:30 p.m. CST Monday through Friday. The design of the call center is the same as a one-on-one session but facilitated over the telephone. Please contact Total Benefi t Solutions at 1-888-783-9653 to speak with a benefi ts counselor who can assist you with your benefi ts enrollment needs.
3. WEB SELF-ENROLLMENT METHOD
In the event you don’t have time to meet with a benefi ts counselor or contact IDEA’s benefi ts call center, you can conduct your enrollment by going online. It’s easy! Below is a snapshot of what the site portal looks like. Simply go to https://www.benselect.com/Enroll/Login.aspx to start your enrollment today!
Username: Social Security Number
PIN: Last 4 of social followed by year of
birth (ex. 555584)
Enrollment Guide: Once you enter into the
site you will be prompted to change your pin
and set up a security pass code. In the event
you forgot your PIN, go to FORGOT PIN to
reset for future use.Forgot PIN
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BENEFITS OPEN ENROLLMENT METHOD SCHEDULEDay Date
Self-Enrollment
Call Center Enrollment
One-on-One Enrollment
IDEA’s Benefit Counselor
Wednesday July 15
Thursday July 16
Friday July 17
Saturday July 18
Sunday July 19
Monday July 20
Tuesday July 21
Wednesday July 22
Thursday July 23
Friday July 24
Saturday July 25
Sunday July 26
Monday July 27
Tuesday July 28
Wednesday July 29
Thursday July 30
Friday July 31
Saturday August 1
Sunday August 2
Monday August 3
Tuesday August 4
Wednesday August 5
Thursday August 6
Friday August 7
Saturday August 8
Sunday August 9
Monday August 10
Tuesday August 11
Wednesday August 12
Thursday August 13
Friday August 14
Saturday August 15
Sunday August 16
Monday August 17
Tuesday August 18
Wednesday August 19
Thursday August 20
Friday August 21
Saturday August 22
Sunday August 23
Monday August 24
Tuesday August 25
Wednesday August 26
Self-Enrollment (Online Portal)Available 24/7
One-on-One EnrollmentBy Appointment Only
Call Center EnrollmentAvailable 8:00am-4:30pm
IDEA’s Benefit Counselor At HQ - By Appointment Only
METHOD AVAILABILITY
IDEA Staff will now have an improved 24/7 online benefit presentation throughout Open Enrollment. The link to watch this online benefit presentation will be available on July 15th at The Hub. The IDEA Benefits Team will ensure communication is sent to all IDEA Staff in advance. For Auxiliary Departments, IDEA Benefits Team will have a Face-to-Face Benefits Presentation during the Summer Trainings already scheduled by HQ leaders to participate. Benefits counselors will also be present during the assigned 3-days scheduled trainings:
Facilities Staff: July 14th & 17th | Transportation Staff: July 23rd – July 24th | Child Nutrition Program Staff: July 31st
Group Benefits Presentation
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TRS ACTIVE CARE PPO PLAN HIGHLIGHTS
Type of Service ActiveCare 1-HD
ActiveCare Select or ActiveCare Select – Aetna Whole Health (Baptist Health System and HealthTexas Medical
Group; Baylor Scott & White Quality Alliance; Memorial Hermann Accountable Care Network; Seton
Health Alliance)
ActiveCare 2
Deductible (per plan year)
$2,500 employee only$5,000 employee and spouse; employee and child(ren); employee and family
$1,200 individual$3,600 family
$1,000 individual$3,000 family
Out-of-Pocket Maximum (per plan year; does include medical deductible/any medical copays/coinsurance/any prescription drug deductible and applicable copays/coinsurance)
$6,350 employee only**$9,200 employee and spouse; employee and child(ren); employee and family**
$6,600 individual$13,200 family
$6,600 individual$13,200 family
CoinsurancePlan pays (up to allowable amount)Participant pays (after deductible)
80%20%
80%20%
80%20%
Office Visit CopayParticipant pays
20% after deductible $30 copay for primary$60 copay for specialist
$30 copay for primary$50 copay for specialist
Diagnostic LabParticipant pays
20% after deductible Plan pays 100% (deductible waived) if performed at the Quest facility; 20% after deductible at other facility
Plan pays 100% (deductible waived) if performed at the Quest facility; 20% after deductible at other facility
Preventative CareSee next page for list of services
Plan pays 100% Plan pays 100% Plan pays 100%
Teladoc® Physician Services $40 consultation fee (applies to deductible and out-of-pocket maximum)
Plan pays 100% Plan pays 100%
High-Tech Radiology(CT Scan, MRI, nuclear medicine) Participant Pays
20% after deductible $100 copay plus 20% after deductible $100 copay plus 20% after deductible
Inpatient Hospital (preauthorization required)(facility charges)Participant pays
20% after deductible $150 copay per day plus 20% after deductible ($750 maximum copay per admission)
$150 copay per day plus 20% after deductible ($750 maximum copay per admission; $2,250 maximum copay per plan year)
Emergency Room(true emergency use)Participant pays
20% after deductible $150 copay per visit plus 20% after deductible (copay waived if admitted)
$150 copay per visit plus 20% after deductible (copay waived if admitted)
Outpatient SurgeryParticipant pays
20% after deductible $150 copay per visit plus 20% after deductible
$150 copay per visit plus 20% after deductible
Bariatric SurgeryPhysician charges (only covered if performed at an IOQ facility)Participant pays
$5,000 copay plus 20% after deductible Not covered $5,000 copay (does not apply to out-of-pocket maximum) plus 20% after deductible
Prescription DrugsDrug deductible (per plan year)
Subject to plan year deductible $0 for generic drugs$200 per person for brand-name drugs
$0 for generic drugs$200 per person for brand-name drugs
Retail Short-Term(up to a 31-day supply)Participant pays• Generic copay• Brand copay (preferred list)• Brand copay (non-preferred list)
20% after deductible
$20$40***50% coinsurance
$20$40***$65***
Retail Maintenance(after first fill; up to a 31-day supply)Participant pays• Generic copay• Brand copay (preferred list)• Brand copay (non-preferred list)
20% after deductible
$25$50***50% coinsurance
$25$50***$80***
Mail Order and Retail-Plus(up to a 90-day supply)Participant pays• Generic copay• Brand copay (preferred list)• Brand copay (non-preferred list)
20% after deductible
$45$105***50% coinsurance
$45$105***$180***
Specialty DrugsParticipant pays
20% after deductible 20% coinsurance per fill $200 per fill (up to 31-day supply)
$450 per fill (up to 90-day supply)
A specialist is any phsyician other than family practitioner, internist, OG/GYN or pediatrician. *Illustrates benefits when network providers are sued. For some plans non-network benefits are also available; 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 may be considerable. **Includes perscription drug coinsurance ***if the patient obtains a brand-name drug when a generic equivalent is available, the patient will be responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug.
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TRS ACTIVE CARE PPO PLAN HIGHLIGHTS
TRS-ActiveCare Plans - Preventative Care
Preventative Care Services
Network BenefitsWhen Using Network Providers
(Provider must bill services as “preventative care”)
ActiveCare 1-HD ActiveCare Select orActiveCare Select - AetnaWhole Health
(Baptist Health System and HealthTexas Medical Group; Baylor & White Quality
Alliance; Memorial Hermann Accountable Care Network; Seton Health Alliance)
ActiveCare 2 Network
Evidence−based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (USPSTF)
Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved
Evidence−informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children and adolescents. Additional preventive care and screenings for women, not described above, as provided for in comprehensive guidelines supported by the HRSA.
For purposes of this benefit, the current recommendations of the USPSTF regarding breast cancer screening and mammography and prevention will be considered the most current (other than those issued in or around November 2009).
The preventive care services described above may change as USPSTF, CDC and HRSA guidelines are modified.
Examples of covered services included are routine annualphysicals (one per year); immunizations; well-child care;breastfeeding support, services and supplies; cancer screening mammograms; bone density test; screening for prostate cancer and colorectal cancer (including routine colonoscopies); smoking cessation counseling services and healthy diet counseling; and obesity screening/counseling.
Examples of covered services for women with reproductivecapacity are female sterilization procedures and specifiedFDA-approved contraception methods with a written prescription by a health care practitioner, including cervical caps, diaphragms, implantable contraceptives, intra-uterine devices, injectables, transdermal contraceptives and vaginal contraceptive devices. Prescription contraceptives for women are covered under the pharmacy benefits administered by Caremark. To determine if a specific contraceptive drug or device is included in this benefit, contact Customer Service at 1-800-222-9205. The list may change as FDA guidelines are modified.
Plan pays 100% (deductible waived)
Plan pays 100% (deductible waived; no copay required)
Plan pays 100% (deductible waived; no copay required)
Annual Vision Examination(one per plan year; performed by an opthalmologist or optometrist using calibrated instruments)Participant pays
After deductible, plan pays 80%; participant pays 20% $60 copay for specialist $50 copay for specialist
Annual Hearing ExaminationParticipant pays
After deductible, plan pays 80%; participant pays 20%
$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.
! Note: Covered services under this benefit must be billed by the provider as “preventive care.” If you receive preventive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the ActiveCare 1-HD and ActiveCare 2. There is no coverage for non-network services under the ActiveCare Select plan or ActiveCare Select – Aetna Whole Health.
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SCOTT-WHITE HMO PLANHIGHLIGHTS (AUSTIN REGION ONLY)
Plan Provisions Co-Payment
Annual Deductible $1,000 Individual/$3,000 Family
Annual out-of-pocketmaximum including medical co-paysand co-insurance
$3,000 Individual/$6,000 Family
(excludes deductible)
Lifetime Paid Benefi t Maximum None
Fully Covered Health Care Services Co-PaymentPreventive Services No Charge
Standard Lab and X-ray No Charge
VitalCare Condition Guidanceand Wellness Programs No Charge
Well Child Care Annual Physicals No Charge
Immunizations (age appropriate) No Charge
Outpatient Services Co-PaymentPrimary Care $20 co-pay
Specialty Care $50 co-pay
Other Outpatient Services 20% after deductible1
Diagnostic/RadiologyProcedures 20% after deductible
Eye Exam (one annually) No Charge
Allergy Serum & Injections 20% after deductible
Outpatient Surgery$150 co-pay and
20% of charges after deductible
Maternity Care Co-PaymentPre-Natal Care No Charge
Inpatient Delivery$150 per day2
and 20% of chargesafter deductible
Inpatient Services Co-PaymentOvernight hospital stay: includesall medical services includingsemi-private room or intensive care
$150 per day2 and 20% of charges
after deductible
Diagnostic & Therapeutic Services Co-Payment
Physical and Speech Therapy $50 co-pay
Equipment and Supplies Co-Payment
Diabetic Supplies and Equipment Same as DME or Rx,as appropriate
Durable Medical Equipment/ Prosthetics $1,000 maximum annual benefi t 50% after deductible
Home Health Services Co-PaymentHome Health Care Visit $50 co-pay
Worldwide Emergency Care Co-PaymentVitalCare Nurse On Call 1-877-505-7947
VitalCare Online Services No Charge — go towww.swhp.org
After Hours Primary Care Clinics $20 co-pay
Ambulance and Helicopter $40 co-pay and 20% ofcharges after deductible
Emergency Room $150 co-pay and 20% ofcharges after deductible
Urgent Care Facility $55 co-pay
Ask a SWHPPharmacyrepresentative howto save money onyour prescriptions.
Retail Quantity(Up to a 34-day supply)
Maintenance QuantitySWHP Pharmacies Only(Up to a 90-day supply)
Preferred Generic4 $3 co-pay 1-877-505-7947
Preferred Brand 30% after deductible No Charge — go towww.swhp.org
Non-preferred 50% after deductible $20 co-pay
Non-formulary Greater of $50 or50% after deductible
$40 co-pay and 20% ofcharges after deductible
Mail Order 1-800-707-3477
Online Refi lls http://www.swhp.org/homepage/trs
Prescription DrugsAnnual Benefi t Maximum Unlimited
DeductibleDoes not apply to generic drugs $100
Specialty Medications Co-Payment
Level 1 10% after deductible
Level 2 (Preferred) 20% after deductible
Level 3 (Premium preferred) 30% after deductible
Level 4 (Non-preferred) 50% after deductible3
1 Includes other services, treatments, or procedures received at time of offi ce visit.2 $750 maximum co-payment per admission and 20% after deductible.3 Level 4 co-payment does not count toward out-of-pocket maximum.4 If a brand name drug is dispensed when a generic is available, 50% co-pay applies.
If you need additional information regarding Employee Benefi ts, please contact our
Benefi ts Team at IDEA Public Schools Headquarters at 956-377-8000 or email us at
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ALLEGIAN HMO HIGHLIGHTS (RGV REGION ONLY)
Medical Plan Year Deductible $500 Individual $1,000 Family
Out-of-Pocket Maximum (includes deductible and copays) $4,500 Individual $9,000 Family
Annual Maximum UnlimitedPrimary Care Provider (PCP) Office Visit• Includes lab/X-ray services, injectables, and supplies• Other services provided in a physician’s office are subject to additional deductible and copayments/coinsurance
$25 copayment
Specialist Office Visit• Includes lab/X-ray services• Other services provided in a physician’s office are subject to additional deductible and copayments/coinsurance
$60 copayment
Preventive CareWell-woman exam, immunizations, physicals, mammograms, colorectal cancer screening No copayment
Surgical Procedures Performed in the Physician’s Office 20% copayment*
Minor Emergency/Urgency Care Visit $75 copayment
Emergency Room 20% copayment*
AmbulanceAir/Ground 20% copayment*
Inpatient ServicesFacility charges, physician services, surgical procedures, pre-admission testing,operating/recovery room, newborn delivery and nursery, ICU/coronary care units, laboratorytests/X-rays, rehabilitation facility
20% copayment*
Outpatient ServicesFacility charges, physician services, surgical procedures, observation unit 20% copayment*
Diagnostic TestsMRI, CT scan, sleep study, stress test, PET scan, ultrasound, cardiac imaging, genetic testing,colonoscopy (non-preventive)
20% copayment*
Behavioral HealthMental Health/Chemical Dependency 20% copayment*
Home Health Care Limited to 30 visits per plan year 20% copayment*
Hospice Care 20% copayment*
Skilled Nursing Facility Limited to 60 days per plan year 20% copayment*
Accidental Dental CareLimited to $3,000 per plan year 20% copayment*
Prosthetics Lifetime Maximum $10,000 per device 20% copayment*
Orthotics Lifetime Maximum $10,000 20% copayment*
Spinal Manipulation Limited to 10 visits per plan year 20% copayment*
Durable Medical Equipment Limited to $3,000 per plan year 20% copayment*
All Other Covered Services 20% copayment*
Pharmacy Plan Year Deductible $100 per Member
Annual Maximum Unlimited
Participating Retail PharmacyStandard Drugs/30-day supply Tier 1: GenericTier 2: Preferred Brand NameTier 3: Non-Preferred Brand NameTier 4: Specialty/High Cost Drugs
$10 per prescription$40 per prescription$65 per prescription20% per prescription
out-of-pocket maximum of $4,000
Participating Mail Order PharmacyMaintenance Drugs/90-day supply Tier 1: GenericTier 2: Preferred Brand NameTier 3: Non-Preferred Brand NameTier 4: Specialty/High Cost DrugsParticipating Mail Order Pharmacy and Local Participating Pharmacies
$30 per prescription$120 per prescription$195 per prescription
Not Covered
* Subject to deductible
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2015-2016 HEALTH INSURANCE PLANS MONTHLY EMPLOYEE PREMIUMS
Full-time employees at IDEA Public Schools receive standard deductions including Federal Withholding, Medicare
and TRS (Teacher Retirement System of Texas). IDEA Public Schools participates in the TRS Active Care health plan,
which offers three PPO plans, and region specific HMO plans. Note: The San Antonio region does not have an HMO
plan available. IDEA contributes a minimum of $341 per month per employee towards health care premiums. The totals
represented below are the monthly cost to the employee for each plan. In addition IDEA contributes $1000/annually into
an HRA account for each full time employee enrolled in a health care plan (annual contributions will be prorated for mid-
year hires). These funds are available to be used toward out of pocket medical expenses. Please refer to next page for
additional information.
Services
ActiveCare 1-HD
(PPO)AVAILABLE IN ALL
REGIONS
ActiveCare Select
(PPO) AVAILABLE IN ALL
REGIONS
ActiveCare 2
(PPO)AVAILABLE IN ALL
REGIONS
Allegian
(HMO)AVAILABLE IN RGV
REGION ONLY
Scott & White
(HMO)AVAILABLE IN AUSTIN
REGION ONLY
Deductible Employee $2,500
Family$5,000
Employee $1,200
Family$3,600
Individual$1,000
Family$3,000
Individual$500
Family$1,000
Individual$1,000
Family$3,000
Out-of-Pocket Maximum(individual/family;includes deductibles)
$6,450 $12,900 $6,600 $13,200 $6,000 $12,000 $4,500 $9,000 $4,000 $9,000
Coinsurance(Plan pays/participant pays)
80% / 20% 80% / 20% 80% / 20% 80% / 20% 80% / 20%
Office Visit Copay 20% after deductible$30 for primary
$60 for specialist$30 for primary
$50 for specialist$25 for primary
$60 for specialist$20 for primary
$50 for specialist
Preventive Care Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100%
Prescription Drug Deductibles
Subject to plan year deductible
$0 for Generic$200 for Brand Name
$0 for Generic$200 for Brand Name
$100$0 for Generic
$100 for Brand Name
Cost to Eligible Employees
EmployeeOnly
$0.00Employee
Only$125.00
EmployeeOnly
$204.00Employee
Only$62.06
EmployeeOnly
$93.42
Employee and Spouse
$469.00Employee
and Spouse$719.00
Employee and Spouse
$878.00Employee
and Spouse$616.04
Employee and Spouse
$620.10
Employee and Children
$247.00Employee
and Children$384.00
Employee and Children
$516.00Employee
and Children$282.86
Employee and Children
$339.00
Employee and Family
$735.00Employee and Family
$913.00Employee and Family
$998.00Employee and Family
$635.14Employee and Family
$723.54
True Out-Of-Pocket Cost (TROOP)True Out-Of-Pocket Cost is just that, your actual total out-of-pocket cost. HealthCare Reform has brought on many changes and TROOP is one of
them. TRS ActiveCare has complied with the ACA guidelines and all plans are now subject to TROOP. This means is that your deductible and co-
pays are included into to the total amount you spend on healthcare, period.
HMO vs. PPO (Open Access Network)Health Maintenance Organizations commonly referred to as HMO are considered network steerage programs meaning that you must see only the
providers that are listed within the HMO network. An HMO tends to have slightly richer benefits at a comparable rate vs. an Open Access Network
Plan. Open Access Network allows an individual to see a doctor of choice but rewards those with deeper discounts by seeing a preferred provider.
If your providers are in the HMO network or you don’t mind having a limited list of providers then think about the HMO route. If you like the freedom
to see whom you wish, then think about going the Open Access Network route.
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HEALTH REIMBURSEMENT ARRANGEMENT ACCOUNT
Health Reimbursement Arrangement Account (HRA), is an employer-funded account that is designed to assist employees in paying for qualifi ed out-of-pocket expenses related to medical, dental and vision care costs.
Benefi ts: • IDEA Public Schools will contribute $1000/annually for every full time employee who participates in a medical plan offered through IDEA Public Schools. (prorated contributions will be made for mid-year enrollers)
• Contributions made by IDEA Public Schools can be excluded from your gross income.
• Any un-used amounts in the HRA will be carried forward for use in later years.
Enrollment: • No action is needed by the employee to enroll for this specifi c benefi t. Employees enrolled in a medical plan will automatically have an HRA account set up on their behalf and will receive an AmeriFlex Debit MasterCard mailed to their home address within two weeks from the date of enrollment.
• Married IDEA staff members are each both eligible to receive $1000 if they are full time and enrolled in a medical plan.
Usage: • You and your eligible dependents may use the Amerifl ex Debit MasterCard funds on any qualifi ed medical expenses such as co-pays, deductibles, dental, vision, prescription, over-the-counter medications (prescription required).
• Once funds are utilized, keep the receipt as you will need this for substantiation.
• All funds will be forfeited upon separation of employment.
Online Balance Access: • Login to www.� ex125.com to register your card, look at a list of all medical expenses covered, check your balance and upload receipts used.
• AFC Portal Mobile Application
NOTE: If you were enrolled in the HRA for 2014-2015 benefi t plan year you will not be reissued anew card. If you need a replacement card please contact Amerifl ex directly.!
Download the AFC Mobile Application
CARRIER: AmeriFlex
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FLEXIBLE SPENDING ACCOUNT Flexible Spending Accounts (FSAs), were developed as part of Internal Revenue Code Section 125 to provide employees with tax relief for their out-of-pocket medical and dependent daycare costs. FSAs enable employees to utilize pre-tax dollars and save federal, FICA, and, in most cases, state taxes.
There are two types of Flexible Spending Accounts:
1) Medical Reimbursement Accounts: Accounts used to pay for eligible medical expenses such as co-pays, deductibles, dental, vision, prescription, over-the-counter medications (prescription required), and more.
ü Annual Minimum Contribution: $600.00 ($50 per month) ü Annual Maximum Contribution: $2, 550.00 ($206 per month)
2) Dependent Day-Care Reimbursement Accounts: Accounts used to pay for the daily care of an eligible child or adult dependent (as defined by law).
ü Annual Maximum Contribution: $5,000; $2,550 if married and filing separately
NOTE: An Ameriflex Debit MasterCard is provided for any of these plans, however if you are enrolled in HRA, you will use the same card that was previously issued to you.
The following table is for illustrations purposes only, consult your tax accountant for all tax advice.
!Without FSA With FSA
Gross Income $30,000 $30,000
FSA Contributions $0 $5,000
Gross Income – FSA contributions $30,000 $25,000
Estimated Taxes
Federal -$2,500* -$1,776*
State -$900** -$750**
FICA -$2,295 -$1,913
After Tax Earnings $24,255 $20,561
Eligible expenses $5,000 $0
Remaining Income $19,255 $20,561
Income increase $0 $1,306
*It assumes standard deductions and four exemptions **Varies, assumes 3%
Premiums are paid by annual contributions divided by number of deductions, for example:PREMIUM ILLUSTRATION:
Monthly (12 Pay) Biweekly Premium (24 pay) Biweekly Premium (20 pay)
Based on $5,000 Annual Contribution
Premiums $416.67 $208.33 $250.00
Based on $2,500 Annual Contribution
Premiums $208.33 $104.17 $125.00
CARRIER: AmeriFlex
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DENTAL INSURANCE PLAN HIGHLIGHTS IDEA’s Dental Plan provides a high level of benefits for you and your family. Dental benefits include preventative care visits and discounts on services offered by dentists who are members of Guardian’s network.
There are two types of Dental Choice Plans: 1. Network Access Plan: The Network Access Plan (NAP) allows you to see any dentist of your choice and you receive 100% coverage for preventive services, 80% coverage for basic service, and 50% coverage for major services (all subject to deductible).
2. Value Plan: The Value Plan requires you to see an in-network Guardian provider and if you choose this plan you will receive richer benefits for basic care (100% vs. 80%) and major care (60% vs. 50%) reducing your financial exposure.
To look up a dental provider go to www.guardiananytime.com
Summary of Dental Plans Coverage
BenefitGuardian Choice Plans
Network Access Plan Value Plan
Deductibles & Maximums
Calendar year deductible
Individual $100 per person $100 per person
Family Up to 3x family maximum or $300 Up to 3x family maximum or $300
Annual Benefit Maximum
Individual $1,250 $1,250
Family $1,250 per person $1,250 per person
Covered Services
Preventive care (cleaning, x-rays, fluoride
treatments, sealants)
100%
After deductible has been met
100%
After deductible has been met
Basic services (fillings, simple extractions,
root canal, endodontics, oral surgery)80% 100%
Major services (crowns, inlays, onlays,
veneers, bridges, dentures50% 60%
Orthodontia50% coverage up to $1,000 lifetime max;
dependents to age 19 only eligible50% coverage up to $1,000 lifetime max;
dependents to age 19 only eligible
PREMIUMS:
Coverage Tiers Monthly (12 Pay) Biweekly Premium (24 pay) Biweekly Premium (20 pay)
Employee Only $25.63 $12.82 $15.38
Employee + 1 $49.87 $24.94 $29.92
Employee + 2 or more $92.06 $46.03 $55.24
CARRIER: Guardian
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VISION BENEFITS PLAN HIGHLIGHTS
IDEA’s Vision Plan provides personalized eye care for yourself and your entire family. It will help you achieve the quality care you deserve with yearly exams all the way to purchasing the frames and lenses you want.
To look up a vision provider go to www.guardiananytime.com
Summary of Vision Plan Benefi ts
Benefi ts In-Network
Eye examination $10 co-pay; covered in full every 12 months
Prescription LensesSingle vision lenses $25 co-pay; covered in full every 12 months
Lined bifocal vision lenses $25 co-pay; covered in full every 12 months
Lined trifocal vision lenses $25 co-pay; covered in full every 12 months
Lenticular lenses $25 co-pay; covered in full every 12 months
Frames or Contacts (in lieuof glasses)
$25 co-pay; up to $130 allowance with a 20% discounton the difference every 24 months
Medical Necessity $25 co-pay; covered in full every 12 months
Elective Up to $130 allowance
PREMIUMS:
* Benefi ts for exams and lenses are provided every 12 months and every 24 months for frames.
CARRIER: Guardian
Coverage Tiers Monthly (12 Pay) Biweekly Premium (24 pay) Biweekly Premium (20 pay)
Employee Only $8.29 $4.15 $4.97
Employee + 1 $17.11 $8.56 $10.27
Employee + 2 or more $24.08 $12.04 $14.45
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PREMIUMS:
VOLUNTARY GROUP TERM LIFE BENEFITSThis plan is term life insurance and provides no cash value. However, it provides you the benefit you need for a low cost so you are financially secure during your working career.
IDEA Employees are offered this benefit in increments of $10,000 and can get coverage on dependents as well.
New Hire Guarantee Issue Benefit:Employee age 18-59: $10,000 to $200,000Employee age 60-69: $10,000Spouse up to age 60: $10,000 to $50,000 Children: $10,000
Age Reduction: Reduces by 60% of the amount in force at age 74 at age 75, 35% at age 80, 27.5% at age 85, 20% at age 90, 7.5% at age 95 and 5% at age 100.
AGE $10,000 $20,000 $30,000 $50,000 $100,000 $200,000
0-24 $.65 $1.30 $1.95 $3.25 $6.50 $13.00
25-29 $.65 $1.30 $1.95 $3.25 $6.50 $13.00
30-34 $.65 $1.30 $1.95 $3.25 $6.50 $13.00
35-39 $.95 $1.90 $2.85 $4.75 $9.50 $19.00
40-44 $1.56 $3.12 $4.68 $7.80 $15.60 $31.20
45-49 $2.39 $4.78 $7.17 $11.95 $23.90 $47.80
50-54 $3.64 $7.28 $10.92 $18.20 $36.40 $72.80
55-59 $5.72 $11.44 $17.16 $28.60 $57.20 $114.40
60-64 $9.56 $19.12 $28.68 $47.80 $95.60 $191.20
65-69 $15.73 $31.46 $47.19 $78.65 $157.30 $314.60
!IMPORTANT: You may elect one $10,000 level up to the Guarantee Issue on the Voluntary Life VG-184426. If you
were previously declined or declined coverage in the past, you will have to go through medical underwriting for any
amount of coverage.
CARRIER: Reliance Standard
*AVAILABLE IN $10,000 INCREMENTS UP TO $200,000 *SPOUSE RATE IS BASED ON THE SPOUSE’S AGE*CHILD COVERAGE IS UP TO AGE 26 AS LONG AS HE/SHE IS A FULL-TIME STUDENT
Rates shown on table below, are monthly premiums if you are a 24 pay or 20 pay staff member, you will be deducted according to your pay frequency.
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SHORT TERM AND LONG TERM DISABILITY
Voluntary Short Term Disability Benefits
Elimination Period (Benefits Start): 7th day
Benefit Duration: 12 Weeks
Gross Income Protection:60% up to $2,700 a Week(not taxed, and paid depending on nature of disability)
Pre-existing Conditions:
3/6 Any injury/sickness occurring 3 months prior to the effective date will not be covered under the plan for 6 months after the effective date. If you are new to the plan your coverage is Guaranteed Issue but you are subject to the Pre-Existing Conditions clause.
Premium Contribution Rate: 48 cents per $10
Voluntary Long Term Disability Benefits
Elimination Period (Benefits Start): 90 days
Benefit Duration: Social Security Normal Retirement Age
Gross Income Protection:60% up to $15,000 a Month(not taxed, and paid on a monthly basis)
Pre-existing Conditions
12/12 Any injury/sickness occurring 12 months prior to effective date will not be covered under plan for 12 months after effective date.) If you are new to the plan your coverage is Guaranteed Issue, but you are subject to the Pre-Existing Conditions clause
Premium Contribution Rate: From 6 – 83 cents per $100 of coverage
These disabilities plans are a way for IDEA Staff to have protected income either short term or long term due to an accident, long term medical leave, maternity leave, etc.
There are important clauses and benefits depending on the type of plan, read carefully below:
! IMPORTANT: Both Short Term and Long Term Disability are guarantee issue regardless if you are new or current but
do have pre-existing condition clauses. Detail information about these plans are available at The Hub. Note: Rates
will increase based on your salary increasing, your age in the long term disability plan, or a combination of both.
CARRIER: Reliance Standard
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SHORT TERM AND LONGTERM DISABILITY (CONT.)
Short Term Disability Rates and Benefi t Calculation
Short Term Disability Rate: $0.48 per $10 in coverage
Benefi t Calculation: $30,000 (gross salary) x 60% protection = $18,000/52 weeks = $346.15 weekly benefi t
Rate Calculation: $346.15 weekly benefi t/$10 increments = $34.62 x $.48 = $16.62 per month premium
Long Term Disability Rates and Benefi t Calculation
Age Rate per $100 in coverage
18-24 $.06
25-29 $.09
30-34 $.17
35-39 $.27
40-44 $.40
45-49 $.52
50-54 $.65
55-59 $.82
60-64 $.83
65-69 $.58
70+ $.42
Benefi t Calculation: $30,000 (gross salary) x 60% protection = $18,000/12 months = $1,500 monthly benefi t
Rate Calculation: $30,000 (gross salary)/12/100 x your rate based on your age = monthly premium
Example at 32 yrs. old: $30,000 (gross salary)/12/100 x $.17 (32 year old rate) = $4.25 monthly premium
Rates and Benefi t Calculations:
CARRIER: Reliance Standard
20
CANCER INSURANCE BENEFIT PLANS
Transamerica Basic Cancer PlanInitial Diagnosis Benefit A $1,000 lump sum benefit
Wellness Benefit A $50 lump sum (each insured on the plan)
Inpatient/Outpatient Benefits $200 per day for 90 days, $400 for each day after
Radiation/Chemotherapy Benefits Up to $15,000 of actual incurred charges
New/Experimental Treatment Benefit Up to $15,000 per calendar year
Surgery Benefit Up to $3,000 in-patient, up to $4,500 for out-patient
Anesthesia for Surgery A 25% of covered surgery benefit
Bone Marrow Transplant Benefit Up to $15,000 of actual incurred charges
Prosthesis Benefit Up to $1,500 per device
Stem Cell Transplant Benefit Up to $15,000 of actual incurred charges
Transamerica Enhanced Cancer PlanInitial Diagnosis Benefit A $2,000 lump sum benefit
Wellness Benefit A $100 lump sum (each insured on the plan)
Inpatient/Outpatient Benefits $300 per day for 90 days, $600 for each day after
Radiation/Chemotherapy Benefits Up to $20,000 of actual incurred charges
New/Experimental Treatment Benefit Up to $20,000 per calendar year
Surgery Benefit Up to $2,000 in-patient, up to $3,000 for out-patient
Anesthesia for Surgery A 25% of covered surgery benefit
Bone Marrow Transplant Benefit Up to $20,000 of actual incurred charges
Prosthesis Benefit Up to $1,000 per device
Stem Cell Transplant Benefit Up to $20,000 of actual incurred charges
The Cancer Insurance Benefit Plan is offered to all IDEA Employees who would like peace of mind should they have a cancer diagnosis or treatment needed unexpectedly. There are two types of cancer plans:
PREMIUMS:
Coverage Tiers Monthly Premium (12 Pay) Biweekly Premium (24 pay) Biweekly Premium (20 pay)
Basic Plan
Employee Only $23.56 $11.78 $14.14
1 Parent Family $26.45 $13.23 $15.87
Family $42.29 $21.15 $25.37
Enhanced Plan
Employee Only $33.30 $16.65 $19.98
1 Parent Family $37.68 $18.84 $22.61
Family $60.06 $30.04 $36.04
CARRIER: Reliance Standard
IF YOU ARE A NEW EMPLOYEE THIS BENEFIT IS GUARANTEE ISSUE FOR YOU ONLY. YOU WILL BE SUBJECT TO A 12/12 PRE-EXISTING
CONDITIONS CLAUSE WHICH MEANS THAT ANY PRIOR CANCER DIAGNOSIS OR TREATMENT WITHIN THE PAST 12 MONTHS WILL BE
EXCLUDED THE FIRST 12 MONTHS OF THE POLICY. IN THE EVENT YOU ARE A CURRENT EMPLOYEE AND DO NOT HAVE THIS COVERAGE
THEN YOU WILL BE SUBJECT TO MEDICAL EVIDENCE, THE 12/12 PRE-EXISTING CLAUSE AND POSSIBLE DECLINATION.
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Coverage Tiers Monthly Premium (12 Pay) Biweekly Premium (24 pay) Biweekly Premium (20 pay)
Employee Only $13.52 $6.76 $8.11
Employee / Spouse $19.85 $9.93 $11.91
Employee and Child(ren) $26.04 $13.02 $15.62
Family $32.32 $16.16 $19.39
ACCIDENT INSURANCE BENEFIT PLANThough most people do not like to think about it, accidents can happen at any place at any time and can be devastating. You could have an accident while driving to work, exercising, doing chores around the house, enjoying outdoor activities such as sports and hunting or just playing with your kids.
After an accident you may have expenses you’ve never thought about before. Can your finances handle them? It’s reassuring to know that an accident policy can be there for you through the many stages of recovery, from the initial emergency treatment or hospitalization, to follow up treatments or physical therapy.
Did you know?
• In 2007, more than 34 million people sought medical attention for an injury.* • In 2006, more than 42 million visits to hospital emergency departments were due to injuries.* • Falls are the leading cause of unintentional injuries that are treated in hospital emergency departments.*
*Injury Facts, 2010 Edition, National Safety Council.
The Accident Insurance Benefit Plan offered to IDEA Employees is a reassuring policy that can be there for you through the many stages of recovery, from the initial emergency treatment or hospitalization, to follow up treatments or physical therapy. This benefit plan is provided by Trustmark Solutions.
PREMIUMS:
Benefits:
What is Covered by Trustmark’s Accident Insurance Plan?
Accidental Death Benefit(with common carrier)
Up to $25,000 Employee BenefitUp to $10,000 Spouse
Up to $5,000 Child(ren) Benefit
Catastrophic Accident BenefitUp to $100,000 Employee Benefit
Up to $50,000 Spouse or Child(ren) Benefit
Health Screening Benefit Benefit of $50 for routine health screener tests
To get the full disclaimer of this benefit plan and summary details please visit the Hub.
CARRIER: Trustmark
22
CRITICAL ILLNESS BENEFIT PLAN
Allstate Critical Illness Plan BenefitsHeart Attack $10,000/$5,000
Stroke $10,000/$5,000
End Stage Renal Disease $10,000/$5,000
Quadriplegia Benefit $10,000/$5,000
Major Organ Transplant $10,000/$5,000
Bypass Surgery Benefit $10,000/$5,000
Balloon, Angioplasty, or Stent Benefit $10,000/$5,000
Although medical insurance and other insurance coverage’s you may have are essential, they won’t cover everything. Medical treatment has never been better, but it is expensive. People today can experience financial hardship because of the expenses their insurance plan does not cover. Critical illness insurance could be a strong supplement to other health insurances.
Did you know?
• 1 in 5 men suffer a critical illness before their normal retirement age.* • 1 in 6 women suffer a critical illness before their normal retirement age.* • The probability of surviving a critical illness before age 65 is almost twice as great as dying.* • Approximately 1.5 million Americans suffer a heart attack each year, of those 1.1 million will survive at least 3 years.* * Munich Reinsurance Co. 2000.
Monthly Premiums-Non-Tobacco Age: 18-35 36-50 51-60 61-63 63+
Employee $2.73 $6.93 $14.73 $24.53 $38.82
Employee/Spouse $3.55 $9.88 $21.58 $36.27 $57.72
Employee/Child $2.73 $6.93 $14.73 $24.53 $38.82
Family $3.55 $9.88 $21.58 $36.27 $57.72
Monthly Premiums-Tobacco Age: 18-35 36-50 51-60 61-63 63+
Employee $4.12 $11.61 $25.00 $38.61 $61.53
Employee/Spouse $5.68 $16.90 $37.01 $57.42 $91.78
Employee/Child $4.12 $11.61 $25.00 $38.61 $61.53
Family $5.68 $16.90 $37.01 $57.42 $91.78
PREMIUMS:
CARRIER: Allstate
Rates shown on table below, are monthly premiums if you are a 24 pay or 20 pay staff member, you will be deducted according to your pay frequency.
!Note: Critical Illness is guarantee issue for new employees however the employee will be subject to the pre-existing
condition clause. Current employees who did not participate do not receive the guarantee issue underwriting and
will have to answer medical questions being subject to the pre-existing clause and possible declination.
23
PREMIUMS:
UNIVERSAL LIFE INSURANCEWITH LONG TERM CAREMany people don’t think about Long Term Care (LTC) when they are young because they feel it won’t affect them until they are old. That’s not always the case. In fact, 40 percent of people currently receiving LTC are between the ages of 18 and 64.
Unfortunately, when people finally realize they need LTC, most don’t get coverage because they either can’t afford it or can’t qualify for it anymore, which is why it’s important to purchase it as early as possible — before the need occurs. Young, working adults qualify easily and have lower premiums. Inflation protection is also available, just like with traditional LTC policies. Benefit increases are automatic, guaranteed and fully portable for both employees and spouses.
People purchase life insurance for many reasons, like taking care of their family should something happen. But having the option to wrap in LTC coverage is invaluable.
How Does It Work?If the life insurance benefit amount is $100,000, LifeEvents advances 4 percent of that — or $4,000 a month — to help pay for care.
Some LTC policies limit benefits to a type of care or daily benefit. LifeEvents doesn’t. It pays benefits directly to the policy owner and enables a choice of care facilities: home care, assisted living, adult daycare and nursing home. If a policyholder never uses the money in the policy for LTC, it just goes backto the family as a death benefit.
Why It’s ValuableGuarantee Issue: As an employee you can elect up to $200,000 or $8.00 per week
Portability: It is 100% completely portable, regardless of job changes or retirement
Family Coverage: Coverage is available for spouses even if the employee does not participate
Benefit Restoration: Restores the death benefit that is reduced to pay for LTC
Extension of LTC: Extends LTC benefit an additional 25 months
Accidental Death: Doubles the death benefit if death occurs by accident
Child Coverage: Covers children, from newborn to 23 years old
EZ Value: Guaranteed automatic increases to Death Benefit and all Living Benefits
Living Benefits: Helps supplement the cost of home healthcare, assisted living, adult day
care and nursing home care
CARRIER: Trustmark
Age Monthly Premium (12 Pay) Biweekly Premium (24 pay) Biweekly Premium (20 pay)
Based on $50,000 life example
25 $16.81 $8.41 $10.09
35 $24.53 $12.27 $14.72
45 $47.15 $23.56 $28.29
55 $88.01 $44.01 $52.81
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TOTAL LIFESTYLE ADVANTAGETotal Lifestyle Advantage Plan by Total Benefi ts Solution provides services that are essential for you and your family needs like Doctors by Phone, Safe Identity and Roadside Assistance, Vision Care, Chiropractic Care and SaversGuide. Learn more about these services below, and receive them all for only one monthly premium cost.
Doctors By PhoneDoctors by Phone services are available to you at home, work, or wherever you may be. Benefi ts include: • On-demand healthcare-wherever and whenever you need it • Access to a physician from anywhere via telephone or online, 24/7 • Physicians discuss symptoms, recommend treatment options, diagnose many common conditions, and prescribe medications when appropriate • Prescriptions phoned into your local pharmacy for pickup
Safe IdentitySafe Identity protects members from identity theft. A detection system scans thousands of databases to fi nd attempts to steal your ID. Members are told by phone if suspicious activity is found. Benefi ts include: • Creates a risk score from 0-999 that shows the likelihood of becoming a victim of identity theft. • Early detection and warning: scans billions of records to fi nd attempts to steal a member’s identity. • $1,000,000 coverage guarantee. • Child Protect- enhanced detection of whether your child’s social security number is being used
Roadside AssistanceRoadside Assistance is available 24/7/365. It helps members when owned or leased vehicles are disabled due to unavoidable circumstances. The following benefi ts are provided under the Roadside Assistance service: • Towing Assistance • Flat Tire Assistance • Lock-out Assistance • Fuel, Oil, Fluid and Water Delivery Service • Battery Assistance • Collision Assistance • Up to 15 miles towing per occurrence maximum for covered charges (up $80 retail value)
Vision Care • Coast to Coast Vision (CTC) has over 12,000 eye care locations nationwide. The CTC provider network includes ophthalmologists, optometrists, independent optical centers and national chain locations. • Discounts on prescription eyewear, contact lenses, soft contact lenses, frames, eye exams and LASIK Surgery. • No limit to the number of times you can use your card.
Chiropractic Care • Members save 30% to 50% at over 3,000 participating chiropractors nationwide. • Free initial consultation. • 50% off diagnostic services, 50% off X-rays performed on-site and 30% off treatment or other services. • No limit to the number of times you can use your card.
ServicesGuide®SaversGuide® is an interactive, online discount program that gives members access to over 235,000 discounts/locations from Entertainment’s® exclusive database of merchant offers. Members will be able to select relevant, high-value discounts by searching where they live, work, or travel.
Limit one service within 72 hours and fi ve services per year.To get the full disclaimer of this benefi t plan and summary details, please visit The Hub.
CARRIER: Total Benefi ts Solution
Coverage Tiers Monthly Premium (12 Pay) Biweekly Premium (24 pay) Biweekly Premium (20 pay)
Employee and Dependents $21.62 $10.81 $12.97
PREMIUMS:
25
EMPLOYEE ASSISTANCE PROGRAM
Life can be challenging. We’re constantly trying to balance our careers, families, leisure activities, health and wellness. It’s not easy…and every now and then we all can use a little help.
The Employee Assistance Program (EAP) is a professional counseling and referral service designed to help you with your personal, family and job issues. It’s free, voluntary and strictly confidential!
Your EAP can help with the following issues and concerns:
Emotional & Mental Health• Stress, Anxiety and Depression • Anger Management • Grief and Loss• Life Transitions • Illness and Disability
Family •Parent-Child Conflicts • Coping with Serious Illnesses • Elder Care Issues• Single Parenting • Child Care Issues
Relationships and Marriage• Separation and Divorce • Communication Problems • Conflict Resolution• Domestic Violence
Workplace• Reorganizations • Workplace Conflicts • Harassment• Team Building
Substance Abuse/Addictions• Alcohol and Drug Problems • Prescription Drug Misuse
Financial• Problem Gambling • Household Budgeting • Credit Counseling• Retirement Planning
Legal• Civil and Consumer Issues • Criminal Legal Issues
What to expect?An EAP counselor will: ü Help you assess the problem ü Provide short-term counseling, when appropriate ü Assist you in selecting a local resource, when necessary ü Provide supportive follow-up
CALL 1-800-767-5320Any time, 24 hours a day, 7 days a week!
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403(B) RETIREMENT SAVINGS PLAN
The key to enjoying your retirement is to begin contributing to your retirement savings plan now and continue to contribute on a regular basis.
Your retirement years will be here before you know it and you want to enjoy them. You will be living longer and your needs will be greater than they are at present. The assets in your retirement savings plan are tax-sheltered; any income earned within the plan is not taxable until you withdraw the funds. Leaving the assets in the plan allows the funds to compound, meaning you earn interest on the interest. A 403(b) Retirement Savings Plan will do just that and all IDEA employees are elgibile to participate. JEM Resource Partners is IDEA’s third party administrator who will assist you.
Why contribute to a 403B Plan?Fill in the Gap: Your pension to TRS will likely not provide members with a full salary upon retirement. You need to make up this gap in salary by contributing to a separate retirement plan.
Lower your Taxes: Immediate savings on current taxes as well as tax deferred growth and earnings.
Ease of Savings: Once you have enrolled in your 403(b), the funds come directly out of your paycheck on a regular basis.
How much can I tax shelter per year?For 2015 the limits are $18,000 for age 49 or less and $24,000 for age 50 or over. There is no minimum amount you may contribute and you can choose to opt in and out at any time.
THE KEY TO A SUCCESSFUL RETIREMENT IS TO START EARLY!
CARRIER: JEM Resources Partners
27
BENEFITS FAQS1. Who is IDEA’s medical insurance carrier?
ü RGV Region: Aetna (PPO) & Allegian (HMO)
ü Austin Region: Aetna (PPO) & Scott & White (HMO)
ü San Antonio Region: Aetna (PPO)
2. Will I receive new cards for this plan year?If you are not making any changes to your plans, you will not receive a new card. If you are making changes, like adding dependents or changing plans, you will receive a new card for all plans.
3. I lost or have not received my medical ID cards after enrollment. Who do I call?
ü Aetna-You can log in online https://www.trsactivecareaetna.com/need-id-card/ and print out a temporary card or call 1-800-222-9205.
ü Allegian- You can call 1-800-829-6440
ü Scott & White-You can call 855-463-7264
4. I lost or have not received my HRA card after enrollment. Who do I call?Call Ameriflex at 888-868-3539 ext. 255 and they can help verify your address and request another card to be sent to you.
5. I lost or have not received my dental/vision ID cards after enrollment. Who do I call?You can register yourself at https://www.guardiananytime.com/gafd/wps/portal/fdhome and print out a paper copy as well as request a new card. IDEA Group# - 00487503.
6. Can I enroll in benefits at any time?No, IDEA Employees can only enroll in benefits if: a) They are a New Hire- within their 30 days of their start date or b) They have a Qualifying life event- birth of child, death, marriage, divorce, gain or loss of other coverage or court order. or c) Open Enrollment
7. If I am a new hire and I just enrolled, when do my benefits start?Your Choice between 2 options: 1) The first day of the month following start date 2) The actively-at-work start date
8. If I have the Flexible Spending Account (FSA) how will the HRA benefit me? And how will they work together?AmeriFlex administers both the FSA and the HRA for IDEA Public Schools through the convenience Debit Card provided after you enroll. If you are participating in the FSA and are eligible to receive the employer HRA contribution, funds for both accounts will be available on the same AmeriFlex Debit Card. When utilizing these funds, the FSA funds will pay first and the HRA will pay second.
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BENEFITS COMMUNICATION & ENGAGEMENT RESOURCESTo stay educated and engaged on information pertaining to your benefits and how to use them to their fullest extent, IDEA’s Benefits Team will provide you with communication and resources during the school year such as:
Monthly Benefits NewslettersThese Newsletters are designed to keep you aware of health events around your local community, important benefit updates happening during the year and most importantly benefit plan utilization. It is emailed to all active IDEA Staff on a monthly basis and you may find archives of past newsletter at the HR site of The Hub. Main 3 topics are:
• Important Benefit Updates • Plan Utilization • Awareness Month
Annual Open Enrollment CampaignOn an annual basis during theend of July and August, all IDEA Staff are required to enroll or waive their benefit elections according to new rates, deductions and benefits offered. In order to keep IDEA educated on the important decisions to come during this time of year, we start a campaign full of educational resources 5 months ahead. It is important to be in the lookout for the following communication methods:
• Posters all over IDEA Campuses and Headquarters • Mailing (make sure you mailing address is always updated in Skyward) • Email Blasts • Benefits Presentations • Benefits Counselors available by appointment and during Summer Trainings for Auxiliary Staff. • Robocalls (calls made to your IDEA work phone) • Annual Benefits Guide printed delivered to your home and also available at The Hub.
The HubThe Hub’s HR Site - Benefits is available 24/7/365. It helps all IDEA Staff to have a one-stop place to navigate at their own time and look through the resources available to make the best out of your benefits plans. You may simply login to The Hub -> Team Sites -> Human Resources -> Employee Benefits. The following sub sites are just some of the most commonly visited and used:
• Insurance Cards – Provider Directory • Benefit Claim Forms • Benefit Coverage Summaries • FSA and HRA Eligible Expenses Lists
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BENEFITS CONTACT INFORMATION
Beatrice ValenciaAssistant Director of Human Resources956-373-6844
Chelsi RodarteBenefits Counselor501-580-2127
Tonie Castaneda Benefits Analyst956-337-8000
• HR General Inquiries and Requests• Benefits Communication and Engagement Management • New Hire Process Management• Substitute Teacher Program Management
• Customer Service of Benefits Inquiries and Claims• 403B Administration • New Hires Benefits Enroller • Qualifying Events Inquiries and Entries.
• Workers Compensation Administration• Administrator of Reconciliations for all plans
Benefit Carrier Contact Information
Medical Plan TRS ActiveCare-Aetna800.222.2905 (customer service/claims)www.trsactivecareaetna.com (website)
HMO Medical Plan TRS ActiveCare-Scott and White800.321.7947 (customer service/claims)www.trs.swhp.org (website)
HMO Medical Plan TRS ActiveCare-Allegian800.829.6440 (customer service/claims)www.valleybaptisthealthplans.com (website)
HRA/FSA Administration AmeriFlex888.868.3539 (customer service/claims)www.flex125.com (website)
Dental and Vision Guardian212.598.8000 (customer service/claims)www.guardiananytime.com (website)
Voluntary Group Term LifeShort Term DisabilityLong Term Disability
Reliance Standard800.351.7500 (customer service/claims)www.reliancestandard.com (website)
Accident and Universal Life Trustmark800.918.8877 (customer service/claims)www.trustmarksolutions.com (website)
Critical Illness Allstate800.521.3535 (customer service)800.348.4489 (claims)www.allstate.com/mybenefits (website)
Cancer Plan Transamerica 888.763.7474 (customer service/claims)www.transamericaemployeebenefits.com (website)
Total Benefits Solution Lifestyle Advantage Program888.783.9653 (customer service/claims)www.tbsins.net (website)
Employee Assistant Program (EAP) Reliance Standard 800.767.5320 (24/7 counselors)
403(b) Retirement JEM Resource Partners800.943.9179 (customer service)www.region10rams.org (website)
Norma CruzBenefits Manager956-373-0780
• Benefits Inquiries, Compliance and Claims• HRA Administration • Benefits System Administrator• Workers Compensation and Reconciliations Management
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New Health Insurance Marketplace Coverage Options and Your Health Coverage
PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health
Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic
information about the new Marketplace.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The
Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible
for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance
coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or
offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on
your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible
for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be
eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does
not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your
employer that would cover you (and not any other members of your family) is more than 9.5% of your household
income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the
Affordable Care Act, you may be eligible for a tax credit.1
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your
employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer
contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for
Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-
tax basis.
How Can I Get More Information?
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the
Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health
insurance coverage and contact information for a Health Insurance Marketplace in your area.
1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered
by the plan is no less than 60 percent of such costs.
Form Approved OMB No. 1210-0149 (expires 1-31-2017)
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GLOSSARY OF BENEFIT TERMSBenefit CarrierA benefit carrier is the agency responsible for administrating your plan. Example Aetna or Allegian are medical plan carriers. Guardian is the visions
and dental plan carrier.
Co-InsuranceThe amount the insurance company covers after deductible is reached.
Co-PayThe amount the Employee will pay for a standard or regular doctor consultation.
DeductibleThe amount an Employee pays before your co-insurance takes place.
High Deductible vs. Traditional PlansHigh Deductible Health Plans (HDHP) are attractive due to the cost vs. the more traditional plan which comes with co-pays. When comparing the
two understand the HDHP program is really designed for those who are not heavy consumers because everything is subject to the deductible
in which correlates into lower premiums. The more traditional plan comes with typically a lower deductible, co-pays, but a higher premium.
The traditional route is for someone who tends to utilize the plan more frequent or is fearful of paying the actual cost of care. Please take into
consideration the premium savings vs. the out-of-pocket exposure you might have when choosing each plans.
HMO vs. PPO (Open Access Network)Health Maintenance Organizations commonly referred to as HMO are considered network steerage programs meaning that you must see only the
providers that are listed within the HMO network. An HMO tends to have slightly richer benefits at a comparable rate vs. an Open Access Network
Plan. Open Access Network allows an individual to see a doctor of choice but rewards those with deeper discounts by seeing a preferred provider.
If your providers are in the HMO network or you don’t mind having a limited list of providers then think about the HMO route. If you like the freedom
to see whom you wish, then think about going the Open Access Network route.
Preventative CarePreventative Care services are those services that are provided within a plan’s network that are regulated by Health Care Reform prohibiting any
cost-sharing such as co-pays or co-insurances. These services are at no-cost to you so long as you follow specific guidelines provided by your
medical plan.
Qualifying Life EventA change in your life that can can make you eligible for a special enrollment period to enroll in health coverage. Examples of qualifying life events
include birth or adoption of a child, lost or gain of coverage, marriage, divorce, etc.
TRS Active CarePPO (Preferred Provider Organization) health insurance plans offered through TRS.
TRS – Teacher Retirement SystemTRS is a public pension plan of the State of Texas. Established in 1937, TRS provides retirement and related benefits for those employed by the
public schools, colleges, and universities supported by the State of Texas.
True Out-Of-Pocket Cost (TROOP)True Out-Of-Pocket Cost is just that, your actual total out-of-pocket cost. HealthCare Reform has brought on many changes and TROOP is one of
them. TRS ActiveCare has complied with the ACA guidelines and all plans are now subject to TROOP. This means is that your deductible and co-
pays are included into to the total amount you spend on healthcare, period.
Benefit Guide Disclosure Notice
Please note, this guide is for illustration purposes only. Regions Insurance Group and its affiliates recommend that you review your contract in detail
and any carrier illustration information made available to you via The Hub and IDEA Enroll. Any illustration in this guide is designed to provide you
with a brief summary of the plan and not take place of the carrier contract or benefits illustration. Please contact IDEA’s Benefits Team if you
have any questions.
