RISD Emplooyee Benefits Guide 2019-2020...other benefits including Dental, Flexible Spending,...

YOUR GUIDE FOR EMPLOYEE BENEFITS

2019-2020

Richardson ISD Employee Benefits Package

EMPLOYEES1

Employee Benefit Guide 2019-2020

Tips

Important Tips bull Take the time to carefully review the guide for any

changes or updates

bull Visit each vendorrsquos website for additional information Donrsquot forget to review each plans provider directory If your physician or doctorrsquos officeis not considered in-network you cannot change or drop plans mid-year without achange in status event For additional questions feel free to contact Customer Serviceas listed

bull Be sure to choose the right coverage level such as individual or family

bull Gather the correct information for your dependents such as social securitynumbers and birth dates

bull Make sure your address and personal information is current If your information is not up-to-date you may miss out on important information such as insurance cards plandocuments health notices etc

bull Avoid making quick decisions and enroll early

bull If you have questions contact your Employee Benefits Office469-593-0350

EmployeeBenefitsrisdorg

IMPORTANT NOTE Once your benefits have been selected please review as your selected benefits will be effective until the next plan year begins unless you have a change in status event

2


Your 2019-2020 Benefits PLAN CHOICES PAGE Employee Eligibility 4 Occupational Injury 5 Making Changes to Benefits 6 New Hire Enrollment Instructions 7 Medical Aetna (PPO) 8- 14

Scott amp White (HMO) Dental Cigna 15 -17 VisionWellness Discounts Cigna 18

Aetna 19 Vision SuperiorVision 20 Flexible Spending (FSA) Navia Benefit Solutions 21 - 23 Health Savings (HSA) Short-Term Disability (STD) Cigna 24 Long-Term Disability (LTD) Life Insurance ADampD Employee Assistance Program Cigna 25 Travel Assistance Long Term Care Genworth Financial 26 Retirement Investments Plan RAMS Important Contacts Customer Service Numbers 27 Glossary 28

The Employee Benefit Guide for 2019-2020 was designed with you and your family in mind In this valuable reference guide we have included brief explanations of each benefit program important plan information comparison charts contact information phone numbers and web addresses This document is not just a guide but it is an important resource for services and benefits provided to you as an employee with Richardson ISD You will find the information you need to make informed decisions regarding theselection and continued management of your benefits

Not all plan provisions limitations or exclusions are described in this publication In case of a conflictbetween the information in this summary and the actual plan documents and insurance contracts the plandocuments and insurance contracts will govern

Richardson ISD reserves the right to change or terminate benefits at any time Neither the benefits nor this guide should be interpreted as a guarantee of future benefits

3


Getting Started

Employee Eligibility

Employees are eligible to enroll in the benefitplans as shown below You are required toenroll no later than 31 calendar days after your actively-at-work date withRichardson ISD If enrollment is not completed within this time period you will have no coverage for the remainder of the plan year

Full-time Employees are Eligible for bull Basic Term Life Insurance Plan bull Basic Accidental Death amp Dismemberment bull Employee Assistance Plan bull Medical Plan bull Voluntary Dental Plan bull Flexible Spending Account bull Health Savings Account bull Vision bull Short Term amp Long Term Disability bull Supplemental Term Life Insurance Plan bull Supplemental Accidental Death amp Disshy

memberment bull 457(b) and 403(b) Retirement Plans bull Long Term Care

Part-time Employees are Eligible for bull Medical Plan bull 403(b) Retirement Plan bull Long Term Care

Eligible employees are automatically enrolledin the basic term life accidental death and dismemberment and employee assistance (EAP) plans However you must designate your beneficiary for your basic term life andaccidental death and dismemberment insurance coverage upon your enrollment

Dependent Eligibility Dependent the Employeersquos legal spouse ora dependent child of the Employee See eachplanrsquos definition of child

Please keep in mind you may be required to furnish evidence of dependency at any time as requested on anyone listed as eligible forcoverage and random eligibility audits may be conducted by the insurance companies

New Hire Coverage Employees may choose Medical coverage tobegin on their actively-at-work date or the firstof the month following their actively-at-workdate

All other benefits including Dental FlexibleSpending Health Savings Vision Life STDand LTD will begin the first of the monthfollowing an employeersquos actively-at-work date

4

Employee Responsibility


Reporting and Treatment of Occupational Injuries

5

MAKING CHANGES TO BENEFITS Changing Elections during the Plan Year - September 1st to August 31st The Richardson ISO benefit plan year for medical dental amp ftexible spending is September 1st to August 31st Richardson ISO participates in the IRC Section 125 Benefit Election Plan that allows employees to pay for eligible benefits on a pre-tax basis Because of this there are special rules and requirements for the plan Any election made as a new hire is irreversible unless you are affected by a Change in Status as defined below and the District is notified within thirty-one (31) calendar days of the Change in Status All benefit elections will remain in effect during the entire Plan Year unless you have one of the following status changes

The request will be made effective the first day of the month following the qualified event (Please note an employee cannot elect to drop coverage retroactively a future cancellation date is required)

If you do not make changes within the required 31-calendar day period you must wait until the next open enrollment period to make any changes Please include a required documentation with your RISO enrollment form

Change in Status You may be allowed to make changes add or drop coverage during the year A change in status is a material change in the employees family member(s) status under which the person has no control that affects medical benefits for which a person is eligible Under IRC Section 125 federal guidelines the Federal Government uses examples as

Status Change Changes Allowed Documentation Change in Employees Legal Marital status

Marriage I Employee may enroll newly eligible I A copy of the Marriage License spouse andor dependent children

f--~-~----+----~-~--~-----~--~-~---1 Employee may droP self andor J A copy of the Marriage License and proof of enrollment in another group plan (Names of all dependent children persons enrolling and effective date of coverage must be included)

ov~~-----------1 EniPioyeemaY-erirciiiSeifarid___ 1A-~p-~1i-Div~~o~euro~c1r~rr1~~r~~9middot~T~~~t-~uPpi~TN~~-~r I eligible dependents I all persons losing coverage amd cancellation date must be included) r--~-~----~----~-~--~-----~--~-~---Employee may dropmiddot spouse A copy of the Divorce Decree

Change in the Number of Employees Dependents

Birth or Adoption I Employee may enroll newly eligible I Verification of Birth Facts or Hearing Test Adoption Certificate

l chi~and oth~ dependen~-- I ------------------------------r Employee may dropmiddot self and r erification of Birth FactsAdoption Certificate and Proof of enrollment in another group plan dependent children (Names of all persons enrolling and effective date of coverage must be included)

-~~--~------~-middot-middot-middot-middot----~---middot-middot-middot-middot-~middot-middot-middot~middot-middot~middot-middot~-middot-middot-middot-middot-middot-middot~~ ~~~~------------ ~~_~~n-~~- ~~~~~~~_~~~~f~~-------------------------------Loss of eligibility Employee may drop dependent None (overage dependent is automatically dropped at age 26)

losing eligibility fl-middot-middot-middot-middot-middot-middot-middot-middot-middot-middot-middot-middot-middot-middot-middot-middot-middot-middot~middot-middot-middot-middot-middot-middot-middot-middot-middot-middot- -middot-middot-middot-middot-middotmiddot-middot-middot-middot- -middot-middot-middot-middot-middot-middot-middot-middot-Change in Employment Status of Spouse or Dependent Commencement of Employee may drop self andor Proof of employment with date of employment and proof of enrollment in another group plan Employment by spo11se or dependents (Names of all persons enrolling and effective date of coverage must be included) or proof in dependent or other change of employment status and proof of enrollment in another group plan ~Names of all change in employment I I persons enrolling and effective date of coverage must be included)

r7~7~Tiondeg7Jrs~~-tEniPiye~y-dd~if~dTo~---ir7~TtT~i~~r~i6Y~i-rthciicli~Tn~ro~~~d-~TtT~~c~~Tn-or Dependents f dependents I another group plan (Names of all persons losing coverage and cancellation date must be Employment or other

1 1

included) or proof in change of employment status and proof of_ loss of coverage_in another change in employment group plan (Names of all persons losing coverage and cancellation date must be included)

status i j

Event Causing Employee or Employees Dependent to Cease to Satisfy Eligibility Requirements Loss of eligibility due to Employee may add self and Proof of loss of eligibility and proof of loss of coverage in another group plan (Names of all age or plan changes I dependents I persons losing coverage and cancellation date must be included) under another group plan I I Change in Coverage Under Other Employer Plan

Open Enrollment Under I Employee may drop self and I Proof of other Employers Open Enrollment and proof of enrollment in another group plan Other Employer I dependents I (Names of all persons enrolling and effective date of coverage must be included) PlanDifferent Plan Year I I Important Note Enrollment in a private insurance plan 1s not a qualifying event to drop coverage Voluntary terminations of other coverage such as dropping coverage due to

premium or benefits changes including spousal surcharges or coverage restrictions are not special enrollment events


Page 4

6

RICHARDSON INDEPENDENT SCHOOL DISTRICT New Hire Benefits Enrollment Instructions 2019-2020

ENROLLMENT IS MANDATORY AND MUST BE COMPLETED ONLINE

WITHIN31 CALENDARDAYS OF YOUR ACTIVELY AT WORK DATE Access to the enrollment portal will be available

beginning on your actively at work date

New Hire Coverage Employees may choose Medical coverage t o begin on t heir actively-at-work date or the first of the month following their actively-at-work date All other benefits including Dental Flexible Spending Health Savings Vision Life STD and

LTD w ill begin t he first of the month following an employees actively-at-work date

Please log on to the Benefits Portal for 2019-20 rates and plan details Elections made will be effective through August 31 2020

Employees that do not lvish to elect coverage must still log n and Waive Coverage Full time employees must also log in to designate life insurance beneficimy(s) for the District provided

$10000 Basic Life and $10000 Basic ADampD Insurance

ONLINE ENROLLMENT PORTAL LOG-IN INSTRUCTIONS From any computer log on to httnsselfservicerisdori

The OEBS system and the Online Enrollment Portal is available every day from 600 am to midnight

User Name First Initial Middle Initial Last Name (ex Jane Elizabeth Doe= jedoe) Password RISD followed by your birth month and day (ex April09 = RISD0409)

Choose the following menu options ~ RISD Self Service Benefits ~ Benefits Once your final selections have been made in the Health Program please print a copy for your records

and select Close Enrollment to complete the process

QUESTIONS Regarding Access to the Portal

Call -469-593-4357 (option 1) or E-Mail -HelpDeskrisdorg

Regarding Employee Benefits Call -469-593-0350 or E-Mail - EmployeeBenefitsrisdorg

IF YOU DO NOT HAVE ACCESS TO A COMPUTER

PLEASE VISIT THE EMPLOYEE BENEFITS OFFICE FOR ASSISTANCE LOCATED AT

ADMINISTRATION BUILDING

400 S GREENVILLE AVE RICHARDSON TX 75081


7

Preventive Care

Medical Coverage

Deductible (per plan yr) In-Ne twork

Out- of-Ne twork

Out-of-Pocket Maximum (per plan year medical and prescription drug diductibles copays and coinsuranci count toward ~out-of-pocket maximum)

In-Ne twork

Out- of-Network

Cc insurance In-Network Panicipant pays (afterdoductiblo)

Out-of-Network Panicipant pays (after deductible)

Office Visit Copay Participant pays

Diagnostic Lab Participant pays

Preventive Care s~ below for examples

TeladoC- Physician Services

High-Tech Radiology CCT scan IViRl r11c~ medicine) Particioam oavs

Inpatient Hospital Facility Charges Only (preauthorization required) In-Network

Out-of-Network

Urgent Care

Freestanding Emergency Room Participant pays

Emergency Room (true emergency~) Participant pays

Outpatient Surgery Participant pays

Barlatric Surgery (only cOyenered 11 performed at an 100 facility) Physician charges Participant pays

Annual Vision Examination (one Pf plan yltNJr plfformed tgtI an Ollhthal~ or ~is) Participant pays

Annual Hearing Examination Participant pays

Some examples or preventive care ftequency and services

llRS-AdMCare Select llRS-AdMCare Select Wlllle HNllll (Baptist-Symmancl-Teltasshy

~ 8-bull Scat - -b Quality Alliance Kelsey Seled -i Hemgtann AcaJu- Cant-Seton -Alliance)

$27 50 emplOVbull onlySS500 fa mily U 200 individuaV$3600 family

$ 5500 emplOVbull onlySll000 family Not applicable This plan does not C019r outshyof-BetJCN1c services QXCQPt for emerg9ncies

The individual out-of-pockqt maximum only includes covered eXPenses incurreltI by tha t individual

$67 50 individuaV$13500 fa mily 57900 individuaVSlSBOO family

$20250 indfviduaVS40500 famity Not applicable This plan does not cover outshyof-rMltvJCN1c services excQPt for emerg9ncies

20 20

40 of allov1ed amount unless Not applicable This plan does not cover out-othelJiSE no~d of-BetJCN1c services QXCQPt for emerg9ncies

20 after deductible S30 copay for primary S70 copay for specia list

20 after deductillle 20o after deductible

Plan pays 100 Plan pays 100

$40 consultation f ie (counts toward deductible and out-ofiocket maximum)

20 after deductillle


Plan pays uP to SSOO per day cap of oovwed chalges after dlductille IQlJ pay me lXCVS owr the SSOO per day cap

20 after deductible

SSOO copay per visit plus 20 after deductible

20 after deductible

20 after deductible

ssooo copay (ooes aoply to out-ofshypocket maximum) plus 20 after deductib le

20 after deducuble

20 after deductible

Plan pays 100

SOO copay plus 20 aft~r deductible

5150 copay per day plus 20 aft~r deductible ($750 maximum copay DOlt admissioo)

Not apjl(icable This plan does not cltMr outmiddot ofmiddotnettJOrk senricamp5 exce0t for emerqQocies

S SO copay per visit

S 500 capay per visit plus 20 after deductible

S250 capay pllfgt 201 after deductible (copay waived if admitted)

SlSO capay per visit PlYO 20 after d9ductible

Not covered

$70 copay for specia list

S30 copay for primary $70 copay for SPecia list

bull Routine physicals - annually age 12 and over bull Well-child care - oollmited up to age 12 bull WeU woman exam amp pap smear - annually age 18 and over bull Mammograms - one evelty year age 35 and over bull Colonoscopy - one every 10 years age45 and ouvr middot Prostate cancer screening - one per year age 50 and rNer bull Smoking cessation counset-g - e~ visits pelt 12 manlhs bull Healthy diet olgtHlty counseling - IXlllmited to bull BreastfHding support - slx lactaoon counseling VISits

age 22 aJj 22 and over - 26 visits per 12 monlhs per 12 months Note Covered services under this benefit must tit billed by tile proider as bullptevQntivt care Non-nttWOrk PltMlltivt art Is noc paid at lOOoo If you rtctlw preventive senilcts from a non-ork ptOllldtr you will be rlSl)Onsible for any applicable deductitlle and coinsurance under tile TRS-ActlWCare l middotHO and TAS-ActiwCare 2 Tlle is no ccwerage lot nonnetwork services under the TRSmiddotAcbveCa1e Seelaquo plan or TRS-ActiYECate Select Whole Health fltgtr mOfe information please view dle Benefits Booklet at wwwtrsactiwcareaetnacom

TRsActiveCn is admnstered by Aetlll Jfe ln5Kance Company Aelna proiOes claims paymont seMCeS only and dotS not assume anv 111nclal risk or obligation wttll respect to Nim Presa1pUon drug benefits are administered by Catemark


8

Drug Deductible (per person per plan year)

bulltaampC1-11

Must meet plan-year deduct ible before plan pays

Short-Term Supply at 11 Retail Loc11tion (up to a 31-day supply)

TRS-ActiveCn Select ActivtCan Seled WIW lleallll (ampptist HNtth Symltn ild HwtthT_ Mldical Group Baylor Scott d Mlit Qwlity AlliM1c9

Kelsey Select M9morial ~ AcccuntatW c- N9tworlc ston HNlth Allianm)

$0 generic $200 bra nd

Tier l - Generic 20 coinsurance after deductible $15 copay except for certain gene ric prevent ive drugs that a re covere d at 100t

Tier 2 - Preferred Brand 25 coinsurance after deductible3 25 coinsurance (m in_ $40 max SBO)

Tier 3 - Non-Preferred Brand SOo coinsurance after deductible3 SOYo coinsurance

Extended-Day Supply 11t M11il Order or Retail- Plus Pharmacy Location (60- to 90-day supply)

Tier l - Gimeric

Tier 2 - Prefe rred Brand

Tier 3 - Non-Preferred Brand

20 coinsurance after deductib Le

2 5oo coinsurance after deductib Le3

50 coinsurance after deductible3

Specialty Medications (up to a 31-day supply)

Specia lty Medications 20 coinsurance after deductib Le

Short-Term Supply of 11 Maintenance Medication at Retail Location (up to a 31-day supp ly)

$45 copay

25 coinsura nce (m in_ $105 max $210)3

SOYo coinsurancel

20 coinsurance

The second t ime a pa rtic ipa nt ti lls a short-term supply of a maintenance med ication a t a retail pharmacy t hey will be charged the coinsurance and copa ys in the rows below Participants can save more over t he plan year by tilling a larger day supply of a mainum ance medication through mail order or at a Retail-Plus locat ion

Ti er l - Ge neric

Tier 2 - Preferred Brand

Tier 3 - Non-Prefe rred Brand

What is a maintenance medication

20 coinsurance after deductible

25 coinsurance after deduct ible3

SOYo coinsurance after deductib le3

$30copay

25 coinsurance (m in $60 max $120)1

SOYo coinsurancel

Maintenance medicat ions are prescriptions commonly used to t reat condit ions that are cons idered chronic or long-term These condit ions usually require regular daily use of medicines Examples of maintenance drugs a re those ured to treat h igh blood p ressure heart disease asthma and diabetes_

When does the convenience fee apply For exam ple if you are covered under TR5-Act iveCare Select t he fi rst t ime you fill a 31-day supply of a generic maintenance drug at a retail pharmacy you will pay $15 then you will pay $30 each m onth that you fill a 31-day supply of tha t generic maintena nce drug at a reta il pha rmacy A 90-day supply of that sa me generic maintenance medicat ion 1N0uld cost $45 a nd you wo uld save $180 over the year by filli ng a 90-day supply

A specialist is any physician other than family practitioner internist OBGYN or pediatrician ntusuates benefits when in-network providers are used For ~e plans non-network benefits are also available there is no coverage for non-network benefits under the TRS-ActiveCarn Select or TRS-ActiveCare Select Whole Health Plan see Enrollment Guide for more information Non-contracting providers may bill for amounts eKceeding the allowable amount for covered services Participants will be responsible for this balance bill amount which maybe considerable

For TRS-ActiveCare 1-HD cenain generic preventive drugs are covered at 100 Participants do not have to meet the deductible ($2750 - individual $5500 - fam ily) and they pay nothing out of pocket for these drugs Find the List of drugs at infocaremarkcom trsltlctivecare_

If a participant obtains a brand-name drug when a generic eQuivalent is available they are responsible for the 9eneric copay plus the cost difference between the brand-name drug and the generic drug

If the co5t of the drug is less than the minimum VoU will pay the cost of the d1119-5 Panicipancs can fill 32-day to 9o-day supply through mail orde[


For more details visit httpswwwtrsactivecareaetnacom

9

Scott and White Health Plan

TRS-ActiveCare 2019- 2020 Summary of Benefits Fully Covered Healthcare Services

Preventive Services

Standard Lab and X-Ray

Disease Management and Complex Case Manageme nt

Well Child care Annual Exams

Immunizations (age appropriate)

Plan Provisions

Annual Deductible

Annual out-of-pocket maximum (including medical and prescription copays and coinsurance)

Lifetime Paid Benefit Maximum

Outpatient Services

Primary care1

Speltialty care

other Outpatient Services

DiagnosticRadiology Procedures

Eye Exam (one annually)

Allergy Serum amp Injections

Outpatient Surgery

Maternity Care

Prenatal care

Inpatient Delivery

Inpatient Services

OVernight hospital stay includes all medical services inducting semi-private room or intensiE care

Diagnostic amp Therapeutic Services

Physical and Speech Tierapy

Manipulative Therapy

Equipment and Supplies

Preferred Diabetic Supplies and Equipment

Non-Preferred Diabejc Supplies

and Equipment

Durable Medical Equ pment

Prosthetics

No Charge

No Charge

No Charge

No Charge

No Charge

$950 Individual $2850 Family


(indudes combined Medical

and Rx copays deductibles and coinsurance)

None

$20 Copay (First Primary Care Visit for Illness

-so Cofgtal I SO Copay for primary visit fOf

dependents age 19 and under)

$70 copay

20 after deductible1

20 after deductible

No Charge

20 after deductible

$150 copay and 20 of charges after deductible

No Charge

$150 per day and 20 of charges after deductible


$70copay

20 without offioe visit $40 plus 20 with

office visit

$5$1250 copay no deductible

30 after Rx deductible

20 after deductible

Home Health Services

Home Healthcare Visit

Worldwide Emergency Care

Nurse Advice Line

Online Services

After-Hours Primary care Clinics

Ambulance and Helicopter

Emergency Room6

Urgent Care Facility

Prescription Drugs

Annual Benefit Maximum

Rx Deductible Does not apply to preferred generic drugs

$70 copay

1-877-505-794 7

No Charge - go to trsswhporg

$20 copay

$40 copay and 20 of charges

after deductible

$500 copay after deductible

$50 copay

Unlimited

$150

Ask an SWHP Maintenance Quantity Pharmacy Retail Quantity (Up to a 9oday supply) representative how to save money on (Up to a 30-day supply) Available at BSW Pharmaoes

m--netvork retail pharmaoes your prescriptions and ma11 order

Preferred Generic

Preferred Brand

Non-Preferred

Online Refills

Mail Order

Specialty Medications

(up to a 30-ltlay supply)

Tier 1

Tier 2

Tier 3

$5 copay $1250 copay

30 after Rx deductible 30 after Rx deductible


trsswhporg

SSWH 1-817-388-3090 OptumRx 1-855-205-9182




The SWHP MOMS Program provides you with specialized nurses who are notified of the delivery of your baby These licensed professionals w il contact you after you return home and help you with everything from the general well-being of both you and your baby to breasVbottle feeding to information on how to add your baby to your health plan

11nduding all services bil~d with office visit 2 Does not apply to w ellness or preventive visits 31no1udes other service5gt treatments o r procedures received at time of office visit

$750 maximum o~pay per admission and 20 after deductible 535 maximum visits per year 6Copay waived if cdmitted within 24 hours

trsswhp org


For more details visit httpstrsswhporg 10


Medical Plan Costs

To Locate a Doctor or Facilityhellip

ActiveCare Select Baylor Scott amp ActiveCare 1-HD White Quality Alliance DFW Region Scott amp White HMO

httpswwwtrsactivecareaetnacom httpswwwbswhealthcomqualityalliance httptrsswhporg

Or call 1-800-222-9205 Or call 1-844-279-7589 Or call 1-800-321-7947 11

New Health Insurance Marketplace Coverage Options and Your Health Coverage

PART A General Information

Form Approved OMB No 1210-0149 (expires 5-31-2020)

W hen key parts o f the h ealt h care law take e ffect in 2014 the re wil l be a new w a y to buy health insurance th e H ealth

Insurance M a rketp lace To assis t y ou as y o u ev a lua te opt ions fo r you and your fa m ily th is not ice p rovides some basic

in fo rma t ion about the new Market p lace and e m p lo ym ent -based health cov e rage offered by your e m p lo yer

What is the Health Insurance Marketplace

Th e M a rket p lace is designed to h e lp you f ind health insurance that meets your needs and fits your b udget T he

Marke tp lace offers one- stop shopping to f ind and com pare p rivate health insurance opt ions You m ay a lso be e lig ib le

fo r a new k ind o f tax c redit th at low ers your m onth ly p re m ium right aw ay Open enroll m ent fo r health insurance

coverage through the Marketp lace beg ins in October 2013 fo r coverage sta rting as early as J anua ry 1 2014

C an I Save M o ney on my Health Insurance Premiums in the Marketplace

You m ay q ua li fy to save money and lo w e r your month ly p re m ium b ut only if your employer does not o f fer cov e rage o r

offers cov e rage tha t doesn t m eet certa in standards The sav ings on your p re m ium that you re e lig ib le fo r depends on

your household income

Does Employer Health C overage Affect Eligibility for Premium Savings through the Marketplace

Yes If you hav e an offer o f health cov e rage from your e m p loyer that meets certa in standards you will not be e lig ib le

fo r a tax c red it through the M a rket p lace and m ay w ish to enroll in your employer s health p lan Ho w ev er you may be

e lig ib le fo r a tax c redit tha t low e rs your m onth ly p re m ium o r a reduct ion in certa in cost- s ha ring if you r employer does

not offer cov e rage to you a t a ll o r does not o f fer cov e rage tha t meets certa in standards If the cost o f a p lan from your

employer that w o u ld cov er you (and n o t any o ther m embers of your fa m ily) is m o re than 9 5 o f your household

incom e for the year o r if t he coverage your e m p lo ye r p ro v ides does not meet the m inimum v a lue s tandard set by the

Affordable Care Act you may be el ig ib le for a tax c redit

N o te If you purchase a h ealth p lan through the Marketp lace instead of accepting health coverage o f f e red b y your

employer then you may lose the employer contribution (i f any) to the employer-offered coverage Also th is employer

contribution - as well as your employee contribution to employer- offered coverage- is ofte n excluded f rom in come for

Federal and State income tax purposes Your payments for coverage through the Marketplace a re made on an aftershy

tax basis

H ow Can I Get M ore Inform ation

For more info rmation a b out your coverage offered by your employer please c heck your sum mary plan description or

contact EmployeeBenefitsrisdora or 469-593-0350

T he Marketplace can help you evaluate your coverage option s including your eligibi lit y for coverage th rough the

M arketp lace and its cost P lease visit HealthCaregov for more information including an online application for health

insurance coverage and contact information for a Health Insurance Marketplace in your a rea


12


Talk to a doctor anytime anywhere

247 Access to doctors at a low cost

NOTE FOR AETNA PLANS 1-HD AND SELECT ONLY Q What is TeladocA Teladoc doctors diagnose non-emergency medical problems recommend

treatment and can even call in a prescription to your pharmacy of choice when necessary

Q What kind of medical conditions can Teladoc help me withA Respiratory infections ear infections urinary tract infections allergies colds and

flu sore throat pink eye

Q Is a true doctor going to receive my call A Yes All Teladoc doctors are US boardndash certified in internal medicine family

practice emergency medicine or pediatrics Teladoc doctors are US residentsand licensed in your state with an average of 15 years of practice experience

Q Do I need to registerA Yes You are going to receive a welcome kit Please follow the instructions so you

can set up your account Complete your medical history and set up eligible dependents

Visit httpsmemberteladoccomtrsactivecare

OR Call Customer Service 1-855-835-2362

13


Frequently Asked Questions

Q When can I enroll A As a New Hire during Open Enrollment or if you have a Change in Status

Q If I want to decline coverage must I still complete the Enrollment process AYes It is important that Employee Benefits has a record of your decision

Q Can I enroll my spouse or dependent on one plan and myself on anotherA No All covered dependents including spouse must be on the same plan as the

employee

Q Can I drop or change plans during the plan year A Changes can only be made if there has been a change in status event

Examples include marriage divorce birth of a child or change in employment status

Q How can I locate a network physician or hospital A ActiveCare 1-HD httpswwwtrsactivecareaetnacom or call 1-800-222-9205

ActiveCare Select Baylor Scott amp White Quality Alliance DFW Region httpswwwbswhealthcomqualityalliance or call 1-844-279-7589

Scott amp White HMO httpstrsswhporg or call 1-800-321-7947 Meet Alexyour benefits

counselor

ALEX will explain your plan options and help you decide which plan is right for you Its simple and fun

Start your conversation here wwwmyalexcomtrsactivecare 14


Dental Plans

You have two Cigna dental plans to choose from a DPPO and a DHMOBoth plans cover Preventive Basic Major and Orthodontic services

The DPPO plan gives you the freedom to choose any dentist in or out ofnetwork including specialists Reimbursements are based on usual cusshytomary and reasonable (UCR) fees While participants may choose anydentist or specialist under the DPPO Plan selection of a contract networkdentist will provide participants with the highest level benefits and save out-of-pocket costs

The DHMO allows you to select a participating dentist from a network to manage your dental care The plan offers lower premiums and reduced co-pays for performed procedures

If yoursquore enrolled in a Cigna dental plan yoursquore eligible for Cigna HealthyRewards

Q Need to locate a network dentist or orthodontist A Log on to wwwmycignacom or Call customer service at

1800CIGNA24

15


Voluntary Dental Plan - DPPO

UCR Usual Customary and Reasonable

Always verify provider network status bull You pay more of the cost when you go out-of-network bull You may be required to file your own claim and or bull You could be balance billed for amounts over allowed amount bull Visit wwwMYCIGNAcom or call customer service at 1800CIGNA24 (6224)

Plan Feature Benefit Deductibles and Benefits Maximum $50 per person $150 per family per plan year

Maximum benefit paid per plan year is $1250 per person

Diagnostic and Preventive Benefits oral examinations x-rays cleanings fluoridetreatment sealants

100 of Cignarsquos allowed (UCR) amount Deductible is waived

Basic fillings full-mouthpanoramicX-rays root canal therapy

80 of Cignarsquos allowed (UCR) amount Subject to Deductible

Major Prosthodontic Benefits bridges partial dentures crownsdentures full dentures


Orthodontic Benefits Child Only (up to age 19)

50 of Cignarsquos allowed amountmdash $1250 lifetime maximum

Subject to Deductible

Waiting Period Major 6 Months Ortho 12 Months

Dental Plan Costs Voluntary DPPO

Employee Only $3594

Employee + Spouse $7190

Employee + Child(ren) $7799

Employee + Family $11328

16


Voluntary Dental Plan - DHMO Dental Plan Costs

Voluntary DHMO

Employee Only $1055 Employee + Spouse $1698 Employee + Child(ren) $2289 Employee + Family $2679

What You Will Pay

Sampling of Procedures Cost With Cigna Dental Care

Estimated Cost Without

Dental Coverage Adult cleaning (Two per calendar year each at $0Additional two cleanings available at $45 each)

$0 $66-$125 each

Child cleaning (Two per calendar year each at $0Additional two cleanings available at $30 each

$0 $49-$93 each

Periodic oral evaluation $0 $94-$178 Comprehensive oral evaluation $0 $37-$69 Topical fluoride $0 $57-$108 X-rays - (bitewings) 2 films $0 $26-$49 X-rays - panoramic film $0 $30-$58 Sealant - per tooth $16 $39-$74 Amalgam filling (silver colored) - 2 surfaces $28 $110-$208 Composite filling (tooth-colored) - 1 surface $33 $111-$211 Molar root canal (excluding final restoration) $595 $800-$1514 Periodontal (gum) scaling amp root planing - 1 quadrant $135 $167-$316 Periodontal (gum) maintenance $93 $102-$193 Removalextraction of erupted tooth $64 $112-$211 Removalextraction of impacted tooth $300 $349-$660 Crown ndash porcelain fused to high noble metal $480 $797-$1509 Implant crown ndash porcelain fused to high noble metal crown

$780 $1025-$1939

For a full list of covered services and exclusionslimitations

Call customer service at 1800CIGNA24 (6224) or visit wwwMYCIGNAcom

17

Plan 9234030

Routine vision examination noJlilg tamiddot AOt ed to~htah ~ltSa-Jon ~and pescrotJCn b ~a1tS Standard dtar plastic or glass lenses Si- t vision 8iocal Yifocil

lens Options

CVSTOMER COSr

UpoSSO UpoSJS UpoSlOS

Stardanf IN co1lOg Up ro Si S StaocbmscratdHesmla UpoSlS SQndJnf ~ Up to S40 Stancbsd aru-8laquoWe ltDiting Up to S4S Prog~e ~sr igs Omelidci-cns ant ~middotas 2096 SlbullClCJS kam~ ================================================================= ~ ost m P~SIXh~

J5 off~~on~ ~off~ ~onmos1fryenneS1

(~~ SenOira ~~a ttdetsloo~Gictr1uts ContalttlmStsandpiofessionalstlM~H---------------+--------------------------------~

ea-aa ~ pmiddot ~ ser m tm 9 m ~juationJ S 10 off coma lmsmn Cooiaa~ Oiedw )Oii Ciglaismnertdu)cn ~ ~~ ~

campsoom-nan ~ Hon-Prescription Sunglass~ frtqUtnlty bin rd tateNls

Tht CigN VISion netwotk offm onr 25000 loutions ntlo~ including tMse Nt lolW rm if opduls

Together all the way )f~ Cigna lMse discounts ut only iviilablt dvough i CigN VtSlon nttWOftc ~art profusionL Stttd discounts Qlnot be used In conjunction with othitr ducounu promotions or prior ordtn Httwotk -ye cart pro~uloculs 1n ~nt contrxtcm solfly rtsponsiblt for your routine vision eumfNtfons ind products 1 bull bull r1 ~MOftlrt bull ri ~irdpiagrmi-r-ttdlcittrd1urr-1rnfpr GgllJl Otbb b qdhXmjl ~~qr1n11attcr lQaJ~c(Yraquo~ ~ 0wirtqisr RiJ t-rim~Adciaulp~ GllDT ~MldJOG PIJtfwftUtttllmddi91dlSlt1ytolbt~rJtattitllWff

lt qdimn ctn tnmr

iy rr1 Otcrdimps tafinam l )llJ ltqibullVi mnrbullA~UPt ~llrirI tr dtih

Alltq-1pidmn~e st~~~~laquoertuiv~ ~dCil~oJbi ~Cq-i ~llr tiura~ Cure1bJGcnsil lJ iruiln CttlfmJ- 1 alm~rtlnmrJrr wmmld(9ittd4~ h llic(qurr~bJlnlaquorUrai ~17G]l~~h

ampmlc osn o1J1SGpa mcttcipMtdUdJkmlc


18

Save money on your health and wellness aetna

Aetna Discount Program

Start saving today

You can save on everything in this brochure and so much more Its easy To get started

1 Log in to your secure member website at wwwaetnacom once youre an Aetna member

2 Choose Health Programs then See the discounts

3 Follow the steps for each discount you want to use

Stay healthy with discounts that come with your Aetna health plan

Hear ing discounts

Save on hearing aids and exams You have two options to meet your hearing needs

With Hearing Care Solutions you get bull Savings on a large choice of hearing aids

bull A two-year supply of batteries (up to 96 cells) with mail-order discounts you can use after this original supply runs out

bull In-office service for one year

bull Free cleanings checks and battery-door replacements for the life of your hearing aid

With HearPO you get bull Savings on many styles of hearing aids Including

programmable and digital hearing aids from leading makers

bull A two-year supply of batteries (up to 160 cells per hearing aid)

bull Discounts on hearing exams and hearing aid repairs

bull Free follow-up services for one year

Vision discounts

Pay less for eye exams contact lenses and prescription and nonprescription eyeglasses Even most designer frames

Where you can save

You can visit many doctors In private practice Plus national chains like JCPenney Optlcal LensCraftersbull Target Opticatbull Sears Optical and Pearle Visionbull bull

To find a location near you go to wwwaetnacom

Great rates on eye exams Your cost for an exam is discounted Even if your health benefits or insurance plan covers your first exam you can get another one later at a discounted price from a provider participating in the discount program network

More eye-opening perks bull Contact lens replacements - delivered to your door bull Savings on LASIK eye surgery including a FREE consultation bull Discounts off eye care items like sunglasses contact lens cleaners and eyeglass chains


19


~f- SuperiorVisionmiddot

Vision plan benefits for Richa rdson ISO

Copays Monthly premiums Servicesfrequency Exam $15 Emp only $510 Exam 12 monltls

Materials $25 Emp + spouse $1019 Frame 24 monltls

Contact lens fitting $25 Emp + dlikl(ren) $1217 Contact lens fitting 12 monltls

(standard amp specialty) Emp +family $1859 Lenses 12 monltls

Contact lenses 12 monltls (Based on date of service)

Exam (ophtnalmologist) Exam (optometrist) Frames Contact lens fitting (standarltl2) Contact lens fitting (specialty2) Lenses (stanelard) per pair

Covered in full Covered in full

$130 retaa allowance Covered in full

$50 retail allowance

Single vision Covered in full Bifocal Covered in full Trifocal Covered in full Progressives lens upgraele See description3 Polycarbonate for depenelent Children Covered in full

Contact lenses $130 retaa allowance Co-pays apply to in-Oetworllt benefits ltXgt90ys for oukll-Oetworllt visits are deducted from reimbursements Materials oopay appies to lenses and frames~ not contact tenses

Up to $42 retail Up to $37 retail Up to $52 retail

Not covered Not covered

Up to $26 retail Up to $34 retail Up to $50 retail Up to $50 retail

Not covered Up to $100 retail

Slandard cortact lens fitting app6es to a current cootact lens userdeg ms disposable daily degextended lenses only Specially contact Jens fitting applies to new conroct weaetS ancVor a merrtJer who wear toric gas permeable or mufti-focal lenses

gt Cltweted to prrNiders in-Office 1gtdatd retail lined 11ifltgtca amourt member pays difference between progessive and standard retaD lined tdocal plus applicable co-pay Cortact lenses are in lieu of eyeglass lenses and frames beneM

Discount features

Look for providers in lhe provider directory who accept discoun1s as some do not please verify ltleir services and discounts (range from 10-30j prior to service as they vary

Discounts on covered materials

Fran1es Lens o~tions

20 off an1cunt over allowance 20 off retail

Progressives 20 off amount over retal lined trifocal lens including lens options

Specialty contact lens fit 10 offretail 1hen apply allowance

MaKimum member out-of-oocket The following options have out-ofpocket maximumss on standard (nd premium brand or progressive) lenses

Scrctch coat Ultraviolet ooat 1 ints so11a or graa1ents Anti-renective ooat Polycarbonate for aaults High index 16 Photochromics

Single vis on $13 $15 $10 $50 $40 $55 $80

Bifocal amp tri1ocal $13 $15 $10 $50

20 off retail 20 off retail 20 off retail

s Discounts and mximtms may WJY by lens type PfeJse check with )OUT protider

nre Pfo11 rJicuuut fei11u1e cue uut itljUtotrlte

superiorv isioncom

(800) 507-3800

Discounts on non-covered exam services and materials

Exams frames and irescription lenses Lens options contacts miscellaneous options Disposable contact lenses


Retinal imaging $39 maiamum out-of-pocket

Refractive surgery

Superior Vision has a nationwide networ1lt of inclependent refractive surgeons and partnerships wih leading LASIK networ1lts Who offer members a discount These discounts range from 10-50 and are the best possitAe discounts available to Superior Vision

Art allowances are retafl the member is responsible for gtaying the provider directly for a non-cwered items andor any amount over the ailowances mit1uJ available dk1co1H1ts TheJe are not covered by the plan

Oiscouns are subject to chaige without notice IJISC1a1mer All Mal aerermmauons oT oenerrcs aamm1scrawe aur1es ana dennmons are govemeJ oy rne GeTmcare oT Insurance Tor yourvSOn pian Please cieck with your Human Resources depa1ment if you have any ques~ons

SUperior Vision Srvices Inc Pgt Box 967 Rancho Cltrdova CA 95741 (800) 507-3300 supenorvisonoom The Superior Vision Plan is underwritten by National Guardian Life Insurance Compaiy National Guardan Life Insurance Compant is not affiliated with

The Guardian Life Insurance OmDaflY of America AKA The Guardian or GJardian Life MVIGRP fr07 0519-BS12TX

20


Flexible Spending Accounts

You can pay for eligible health care and dependentcare expenses with pre-tax income through aFlexible Spending Account You do not pay federal income tax on your deposit

The Flexible Spending Account reimburses you for eligible health care expenses that are not covered byinsurance Expenses may be incurred by you yourspouse and your dependent children regardless ofwhether they are covered by Richardson ISDrsquosmedical dental or vision plans

The Flexible Spending Account also reimburses youfor certain dependent care expenses incurred whileyou andor your spouse work

How the Spending Accounts Work You choose to contribute part of your earnings intothe Medical Flexible Spending Account andor the Dependent Care Flexible Spending Account The accounts are maintained separately and you cannotmake transfers between them These accounts will reimburse you for eligible expenses that you submitthroughout the year

Health Care Flexible Spending Account

1 Estimate your annual health care expenditureson items not reimbursed by insurance

2 Decide how much money you want to contribute to the account per year (Minimum is $120 andthe Maximum is $2700) The money is deductedbefore taxes so taxes are withheld on a loweramount of your earnings

3 You may file a paper or online claim when you have eligible health care expenses

4 You may also request a Navia Benefit Card to be used to pay for eligible health care expensesFunds come directly out of your Health FSA andare paid to the provider Some swipes requireverification so hang on to your receipts

Dependent Care Flexible Spending Account 1 Estimate your dependent care expenses for the

coming year 2 Decide how much money you want to contribute

to the account with a $5000 maximum per yearThe money is deducted before taxes are takenout so taxes are withheld on a lower amount of your earnings (pre-tax basis)

3 File a claim when you have eligible dependent care expenses

4 You will be reimbursed for eligible claims up to the current contributed amount available in your account

Note Dependent care deposits must be received and posted to your individual account before they can be used

21

- -


Medical Care Flexible Spending Account

Eligible Expenses The following are examples of expenses eligible forreimbursement when they are not covered by amedical dental or vision care plan You cannot claim an expense as a federal income tax deduction if it isreimbursed through your Flexible Spending Account(For a full list go to wwwirsgov)

Amount applied to any medical dental orvision plan deductible or copayment or fees inexcess of plan limits

Vision expenses not covered by a planincluding exams eye glasses contact lenses and solutions optometrist and ophthalmologistfees and laser eye surgery

Dental expenses not covered by a plan includingcleanings fillings and orthodontia

Hearing aids Prescription drugs Diabetic supplies Specialized equipment for disabled persons Physical therapy speech therapy and

psychotherapy and Smoking cessation programs Over-the-counter drugs if to treat a medical

condition Prescription is required

Ineligible Expenses The following expenses are examples of items noteligible for reimbursement through your Health CareFlexible Spending Account

Cosmetic expenses Fees for exerciseathletichealth clubs Premiums for health dental vision or life

insurance and Weight-loss programs for general health

purposes

Dependent Care Flexible Spending Account

Eligible Expenses You may claim dependent care expenses for anydependents who live with you and rely on you formore than half of their support as claimed on your taxes Dependents include

Children under the age of 13 Persons of any age if physically or mentally

disabled and claimed on your federal income tax return

You may be reimbursed for day care expensesonly if this enables you to work If married yourspouse must also work or be looking for workbe a full-time student or be disabled

The following are examples ofeligible expenses for reimbursement

Expenses for child care Care for a child under the age of 13 at a day

camp nursery school or private sitter and Care for an incapacitated adult who lives with

you at least eight hours a day

Note If you terminate employment or experience a change in employment status from full time to part time youare eligible to access FSA funds up to your termination or employment status change date This means that anyservices after the previous mentioned dates are ineligible for reimbursement 22

Health Savings Account

How it Works You can deposit money into your HSA accountup to an annual per person or family limit setby the IRS You can use money in your HSAaccount to pay for insurance deductibles and medical caresupplies like dentistryophthalmology and prescription drugs

A Health Savings Account (HSA)

You can use your HSA dollars on your Navia Benefits Card to pay for bull Prescription and health plan copayments

deductibles and coinsurance bull ldquoAmount Duerdquo on medical and dental

statements bull Orthodontics bull Mail-order or online prescription invoices bull Vision services eyeglasses bull LASIK surgery

bull Is Yours- Funds in your HSA account stay with you even if you change jobs And if yoursquore no longer covered by an HDHP your account stays active and you can use remaining funds for medical expenses

bull Reduces Your Taxable Income-The money is tax-free both when you put it in and when you take it out to cover qualified medical expenses

bull Grows With You- If you maintain a minimum balance of $1000 your additional funds may be invested in mutual funds yielding tax-free earnings In order to avoid monthly service fees you must maintain an average monthly balance of $3000 if you wish to invest in mutual funds

bull Helps You Plan For The Future- Until you turn 65 withdrawals used for eligible expenses are tax-free After you turn 65 or if you become disabled your HSA account becomes similar to a regular IRA withdrawals you use for non-eligible expenses will be taxed at your regular income tax rate but wont incur additional penalties

Who is Eligible All Full Time Employees

Any Full Time employee who is covered under the RISD ActiveCare 1-HD high deductible health plan

(HDHP) is not entitled to Medicare and cannot be claimed as a tax dependent

Is there an annual contribution limit

Yes as determined by the employers plan design and limited by health care reform The maximum

contribution is $2700

In 2019 limits are $3500 per individual and $7000 per family respectively

Do unused funds carry over to the next year

Generally No However there is a Grace Period which allows employees to incur expenses for up to

25 months after the end of the plan year Yes

Can you take the account with you if you change jobs change heatlh

plans or retire No Yes

Can you use the account for retirement income No

Yes after 65 you can withdraw funds for any reason with no penalty Although if not used for qualified medical expenses withdrawals will be

taxed as income

When are funds available This is a pre-funded benefit meaning that you will have access to your full annual election amount at

any time during the plan year regardless of the amount yoursquove contributed

An employee only has access to what has been contributed into their HSA account

23


Short-term amp Long-term Disability Income Protection Insurance Disability coverage helps you and your family meetfinancial obligations if injury or illness prevents youfrom working This coverage is an importantelement in your financial planning because itprovides a continuing source of income if you are unable to work because of a disability Richardson ISD offers eligible employees the opportunity to purchase short and long-termdisability insurance programs at discounted grouprates in order to replace a portion of their income ifthey experience disability

Disability Options Short-Term Disability Insurance

Available Coverage

Gross Weekly Benefit Maximum Gross Weekly Benefit Benefit Waiting Period

Plan 1 (Low)

60 of your weekly covered earnings $1000

20 Days for accident 20 Days for sickness

Plan 2 (High)



Effective 01012020

Basic Term Life amp Accidental Death and Dismemberment (ADampD) InsuranceCoverage

Eligible to full-time employees RichardsonISD provides $10000 basic term life insurance coverage and $10000 basic ADampD insurance coverage at no cost

You may choose additional coverage foryourself up to five times your annual basesalary You may choose term life insurance in$10000 increments up to $50000 for yourspouse You may elect$5000 or $10000 for you dependentchild(ren) Dependent life may not exceed 50 ofemployee coverage amount

Available Coverage

Gross Monthly Benefit Maximum Gross Monthly Benefit

Benefit Waiting Period

Plan 1 (Low)

40 of your monthly covered earnings $2500 90 Days

Plan 2 (High)


Long-Term Disability Insurance Term life insurance will pay a benefit toyour designated beneficiary upon death

ADampD provides additional benefits for anaccidental death and for an accidental dismemberment as defined in the schedule of benefits

Note Long-term Disability benefits are reduced byother sources of income during disability such as Workersrsquo Compensation Social Security andorretirement systems

Q Do you need to change your beneficiarydue to divorce marriage or other life event

A Yes your designated beneficiary shouldalways be up to date

24

Employee Benefit Guide 2019-2020 Effective 01012020 Employee Assistance Program

In addition to the wellness features the Employee Assistance Program provides a confidential source for information referrals and counseling to eligible employees and their dependents The program provides access to counselors and information that can help you resolve complexinterpersonal issues as well as assist with things such as wills and financial matters It also providesa limited number of face-to-face counseling sessions for each issue Seminars and workshops are also offered on managing a variety of issues

bull Family and relationships ndash parenting communication domestic violence marriage and divorce

bull Dependent care ndash child care elder care prenatal education adoption and special needs issues

bull Personal issues - stress anxiety grief anger and depression bull Well being ndash drug and alcohol dependency physical illness eating disorders and self-esteem bull Job concerns ndash interpersonal conflicts career crisis bull Financial difficulties ndash overextended credit budget worries bull Legal issues (excluding employment related issues)

If counseling after your no-cost sessions is recommended your cost for additional treatment will depend on coverageby your chosen medical plan

Travel Assistance Whenever you travel 100 miles or more from home - to another country or just another city - be sure to pack your travel assistance phone number

A few of the benefits bull Help replacing lost prescriptions and passports bull Hospital admission assistance bull Emergency medical evacuation

25


Long Term Care

Long Term Care insurance enhances TRS benefit offerings by meeting a largelyunrecognized need many of us have It pays for covered expenses for long termcare services whether they are received at home in the community or in a nursingfacility

TRS Long Term Care Plans are administered by Genworth Financial

Visit wwwgenworthcomtrsactivemember to log in to your account or call customer service at 8666591970

Eligible employees may enroll at anytime (underwriting may apply)

Retirement Investment Plans

The District offers two retirement plan options a 403(b) plan and a 457(b) RetirementSavings Plan Both voluntary savings programs serve a way for employees to save funds for retirement and other long-term financial needs

Payroll deductions can be contributed to the plans on a tax-deferred basis Thisreduces current income tax and allows the money in the plans to grow untaxed untilmoney is distributed to the participant

RISD Retirement Plans are administered by TCG

Region 10 website wwwRegion10RAMSorg or call 1-800-943-9179

26


Important Contacts

Employee Benefits 400 S Greenville Ave Suite 208 Richardson TX 75081

Employee Benefits 469-593-0350 Workerrsquos Compensation 469-593-0346

Vendor amp Type of Plan Customer Service Hours of Operation Website

TRS-ActiveCare httpswwwtrsactivecareaetnacom

Option 1 Aetna (Medical) or 1-800-222-9205 Mon- Fri 8am- 6pm CT wwwcaremarkcom Option 2 Caremark (Pharmacy) Scott and White HMO 1-800-321-7947 Mon-Fri 7am - 7pm CT httpstrsswhporg Teladoc 1-855-835-2362 247 httpswwwteladoccomtrsactivecare

Cigna Dental PPO amp DHMO 1-800-244-6224 247 wwwmycignacom

Long Term amp Short Term Disability Life and ADampD 1-800-362-4462

Employee Assistance Program 1-800-538-3543 247 wwwcignalapcom

Cigna Secure Travel 1-888-226-4567 must indicate that you are a member of the Cigna Secure Travel Program and group 57

or 202-331-7635

SuperiorVision Vision 1-800-507-3800 Mon-Fri 8am-9pm EST superiorvisioncom

Saturday 11am-430 EST

Navia Benefit Solutions Monday through Friday

Flexible Spending Account 1-800-669-3539 7ammdash7pm CT wwwnaviabenefitscom


Genworth Monday through Thursday

Long Term Care 1-866-659-1970 830ammdash8pm ET wwwgenworthcomtrsactivemember

Friday 9am - 8pm ET

TCG Monday through Friday

1-800-943-9179 8ammdash5pm CT wwwregion10ramsorg

27


Glossary of Terms

Allowed Amount the maximum amount determined by to be eligible for conshysideration of payment by the plan for a particular service supply or procedure

Deductible The amount you must pay for covered health services based on contracted rates (alsoreferred to as eligible chargesexpenses) in a year before the plan will begin paying certain benefits in that year

COBRA Consolidated Omnibus Budget Reconciliation Act of 1985 This Act requires that continua- tionof group insurance be offered to covered persons who lose health dental or flexible spending coverage due to aqualifying life event as defined in the Act

Co-insurance The portion of covered health care costs for which the covered person is financiallyresponsible usually according to a fixed percentage Co-insurance may be applied after a deductiblerequirement is met

Co-payment A predetermined amount you are required to pay for certain covered services such as aprescription or office visit

Course and Scope of Employment an activity of any kind or character that has to do with and origi- natesin the work business trade or profession of the employer and that is performed by an employee while engagedin or about the furtherance of the affairs or business of the employer

Explanation of Benefits (EOB) A description sent to an employee spouse or dependent child by a planthat includes the charges for services provided the benefits considered and the amount paid

Incurred Expense An expense is considered incurred on the date services were rendered or supplies were received

Initial Period The first 31 days of employment

Network A series of providers who have contracted with the insurance company for the benefit of planparticipants Out of Network services and supplies that are provided by a Non-Network provider or are notcontracted with insurance company to provide services There may be reduced reimbursement or no coveragedepending on your plan type You will be responsible for all charges remaining after plan has paid the allowed amounts

Occupational Injury An injury or illness resulting from course and scope of employment Also known as aworkers compensation injury

Out-of-Pocket Maximum The maximum out of pocket amount you will pay per plan year The deductishybles office visit copays and coinsurance all apply to your maximum out of pocket expense After you reach theout-of-pocket maximum TRS-ActiveCare pays 100 of the allowable amount for covered charges for the rest ofthe plan year

Plan Year Medical Dental FSA HSA Vision September 1st through August 31st of the following year Life amp Disability January 1st through December 31st

28

YOURG UIDE 13F ORE MPLOYEEB ENEFITS

Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28


Tips

Important Tips bull Take the time to carefully review the guide for any

changes or updates

bull Visit each vendorrsquos website for additional information Donrsquot forget to review each plans provider directory If your physician or doctorrsquos officeis not considered in-network you cannot change or drop plans mid-year without achange in status event For additional questions feel free to contact Customer Serviceas listed

bull Be sure to choose the right coverage level such as individual or family

bull Gather the correct information for your dependents such as social securitynumbers and birth dates

bull Make sure your address and personal information is current If your information is not up-to-date you may miss out on important information such as insurance cards plandocuments health notices etc

bull Avoid making quick decisions and enroll early

bull If you have questions contact your Employee Benefits Office469-593-0350

EmployeeBenefitsrisdorg

IMPORTANT NOTE Once your benefits have been selected please review as your selected benefits will be effective until the next plan year begins unless you have a change in status event

2








3


Getting Started











4




5















1 1


status i j





Page 4

6























7

Preventive Care

Medical Coverage


Out- of-Ne twork


In-Ne twork

Out- of-Network









Out-of-Network

Urgent Care















20 20









20 after deductible


20 after deductible

20 after deductible


20 after deducuble

20 after deductible

Plan pays 100








Not covered







8


bulltaampC1-11










Tier l - Gimeric









$45 copay


SOYo coinsurancel

20 coinsurance


Ti er l - Ge neric







$30copay


SOYo coinsurancel









9



Preventive Services





Plan Provisions

Annual Deductible



Outpatient Services

Primary care1

Speltialty care





Outpatient Surgery

Maternity Care

Prenatal care

Inpatient Delivery

Inpatient Services








and Equipment


Prosthetics

No Charge

No Charge

No Charge

No Charge

No Charge





None




$70 copay


20 after deductible

No Charge

20 after deductible


No Charge



$70copay


office visit



20 after deductible




Nurse Advice Line

Online Services



Emergency Room6


Prescription Drugs



$70 copay

1-877-505-794 7


$20 copay


after deductible


$50 copay

Unlimited

$150



Preferred Generic

Preferred Brand

Non-Preferred

Online Refills

Mail Order



Tier 1

Tier 2

Tier 3




trsswhporg

SSWH 1-817-388-3090 OptumRx 1-855-205-9182







trsswhp org




Medical Plan Costs
































tax basis








12














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28








3


Getting Started











4




5















1 1


status i j





Page 4

6























7

Preventive Care

Medical Coverage


Out- of-Ne twork


In-Ne twork

Out- of-Network









Out-of-Network

Urgent Care















20 20









20 after deductible


20 after deductible

20 after deductible


20 after deducuble

20 after deductible

Plan pays 100








Not covered







8


bulltaampC1-11










Tier l - Gimeric









$45 copay


SOYo coinsurancel

20 coinsurance


Ti er l - Ge neric







$30copay


SOYo coinsurancel









9



Preventive Services





Plan Provisions

Annual Deductible



Outpatient Services

Primary care1

Speltialty care





Outpatient Surgery

Maternity Care

Prenatal care

Inpatient Delivery

Inpatient Services








and Equipment


Prosthetics

No Charge

No Charge

No Charge

No Charge

No Charge





None




$70 copay


20 after deductible

No Charge

20 after deductible


No Charge



$70copay


office visit



20 after deductible




Nurse Advice Line

Online Services



Emergency Room6


Prescription Drugs



$70 copay

1-877-505-794 7


$20 copay


after deductible


$50 copay

Unlimited

$150



Preferred Generic

Preferred Brand

Non-Preferred

Online Refills

Mail Order



Tier 1

Tier 2

Tier 3




trsswhporg

SSWH 1-817-388-3090 OptumRx 1-855-205-9182







trsswhp org




Medical Plan Costs
































tax basis








12














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28


Getting Started











4




5















1 1


status i j





6























7

Preventive Care

Medical Coverage


Out- of-Ne twork


In-Ne twork

Out- of-Network









Out-of-Network

Urgent Care















20 20









20 after deductible


20 after deductible

20 after deductible


20 after deducuble

20 after deductible

Plan pays 100








Not covered







8


bulltaampC1-11










Tier l - Gimeric









$45 copay


SOYo coinsurancel

20 coinsurance


Ti er l - Ge neric







$30copay


SOYo coinsurancel









9



Preventive Services





Plan Provisions

Annual Deductible



Outpatient Services

Primary care1

Speltialty care





Outpatient Surgery

Maternity Care

Prenatal care

Inpatient Delivery

Inpatient Services








and Equipment


Prosthetics

No Charge

No Charge

No Charge

No Charge

No Charge





None




$70 copay


20 after deductible

No Charge

20 after deductible


No Charge



$70copay


office visit



20 after deductible




Nurse Advice Line

Online Services



Emergency Room6


Prescription Drugs



$70 copay

1-877-505-794 7


$20 copay


after deductible


$50 copay

Unlimited

$150



Preferred Generic

Preferred Brand

Non-Preferred

Online Refills

Mail Order



Tier 1

Tier 2

Tier 3




trsswhporg

SSWH 1-817-388-3090 OptumRx 1-855-205-9182







trsswhp org




Medical Plan Costs
































tax basis








12














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28




5















1 1


status i j





Page 4

6























7

Preventive Care

Medical Coverage


Out- of-Ne twork


In-Ne twork

Out- of-Network









Out-of-Network

Urgent Care















20 20









20 after deductible


20 after deductible

20 after deductible


20 after deducuble

20 after deductible

Plan pays 100








Not covered







8


bulltaampC1-11










Tier l - Gimeric









$45 copay


SOYo coinsurancel

20 coinsurance


Ti er l - Ge neric







$30copay


SOYo coinsurancel









9



Preventive Services





Plan Provisions

Annual Deductible



Outpatient Services

Primary care1

Speltialty care





Outpatient Surgery

Maternity Care

Prenatal care

Inpatient Delivery

Inpatient Services








and Equipment


Prosthetics

No Charge

No Charge

No Charge

No Charge

No Charge





None




$70 copay


20 after deductible

No Charge

20 after deductible


No Charge



$70copay


office visit



20 after deductible




Nurse Advice Line

Online Services



Emergency Room6


Prescription Drugs



$70 copay

1-877-505-794 7


$20 copay


after deductible


$50 copay

Unlimited

$150



Preferred Generic

Preferred Brand

Non-Preferred

Online Refills

Mail Order



Tier 1

Tier 2

Tier 3




trsswhporg

SSWH 1-817-388-3090 OptumRx 1-855-205-9182







trsswhp org




Medical Plan Costs
































tax basis








12














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28















1 1


status i j





Page 4

6























7

Preventive Care

Medical Coverage


Out- of-Ne twork


In-Ne twork

Out- of-Network









Out-of-Network

Urgent Care















20 20









20 after deductible


20 after deductible

20 after deductible


20 after deducuble

20 after deductible

Plan pays 100








Not covered







8


bulltaampC1-11










Tier l - Gimeric









$45 copay


SOYo coinsurancel

20 coinsurance


Ti er l - Ge neric







$30copay


SOYo coinsurancel









9



Preventive Services





Plan Provisions

Annual Deductible



Outpatient Services

Primary care1

Speltialty care





Outpatient Surgery

Maternity Care

Prenatal care

Inpatient Delivery

Inpatient Services








and Equipment


Prosthetics

No Charge

No Charge

No Charge

No Charge

No Charge





None




$70 copay


20 after deductible

No Charge

20 after deductible


No Charge



$70copay


office visit



20 after deductible




Nurse Advice Line

Online Services



Emergency Room6


Prescription Drugs



$70 copay

1-877-505-794 7


$20 copay


after deductible


$50 copay

Unlimited

$150



Preferred Generic

Preferred Brand

Non-Preferred

Online Refills

Mail Order



Tier 1

Tier 2

Tier 3




trsswhporg

SSWH 1-817-388-3090 OptumRx 1-855-205-9182







trsswhp org




Medical Plan Costs
































tax basis








12














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28























7

Preventive Care

Medical Coverage


Out- of-Ne twork


In-Ne twork

Out- of-Network









Out-of-Network

Urgent Care















20 20









20 after deductible


20 after deductible

20 after deductible


20 after deducuble

20 after deductible

Plan pays 100








Not covered







8


bulltaampC1-11










Tier l - Gimeric









$45 copay


SOYo coinsurancel

20 coinsurance


Ti er l - Ge neric







$30copay


SOYo coinsurancel









9



Preventive Services





Plan Provisions

Annual Deductible



Outpatient Services

Primary care1

Speltialty care





Outpatient Surgery

Maternity Care

Prenatal care

Inpatient Delivery

Inpatient Services








and Equipment


Prosthetics

No Charge

No Charge

No Charge

No Charge

No Charge





None




$70 copay


20 after deductible

No Charge

20 after deductible


No Charge



$70copay


office visit



20 after deductible




Nurse Advice Line

Online Services



Emergency Room6


Prescription Drugs



$70 copay

1-877-505-794 7


$20 copay


after deductible


$50 copay

Unlimited

$150



Preferred Generic

Preferred Brand

Non-Preferred

Online Refills

Mail Order



Tier 1

Tier 2

Tier 3




trsswhporg

SSWH 1-817-388-3090 OptumRx 1-855-205-9182







trsswhp org




Medical Plan Costs
































tax basis








12














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28

Preventive Care

Medical Coverage


Out- of-Ne twork


In-Ne twork

Out- of-Network









Out-of-Network

Urgent Care















20 20









20 after deductible


20 after deductible

20 after deductible


20 after deducuble

20 after deductible

Plan pays 100








Not covered







8


bulltaampC1-11










Tier l - Gimeric









$45 copay


SOYo coinsurancel

20 coinsurance


Ti er l - Ge neric







$30copay


SOYo coinsurancel









9



Preventive Services





Plan Provisions

Annual Deductible



Outpatient Services

Primary care1

Speltialty care





Outpatient Surgery

Maternity Care

Prenatal care

Inpatient Delivery

Inpatient Services








and Equipment


Prosthetics

No Charge

No Charge

No Charge

No Charge

No Charge





None




$70 copay


20 after deductible

No Charge

20 after deductible


No Charge



$70copay


office visit



20 after deductible




Nurse Advice Line

Online Services



Emergency Room6


Prescription Drugs



$70 copay

1-877-505-794 7


$20 copay


after deductible


$50 copay

Unlimited

$150



Preferred Generic

Preferred Brand

Non-Preferred

Online Refills

Mail Order



Tier 1

Tier 2

Tier 3




trsswhporg

SSWH 1-817-388-3090 OptumRx 1-855-205-9182







trsswhp org




Medical Plan Costs
































tax basis








12














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28


bulltaampC1-11










Tier l - Gimeric









$45 copay


SOYo coinsurancel

20 coinsurance


Ti er l - Ge neric







$30copay


SOYo coinsurancel









9



Preventive Services





Plan Provisions

Annual Deductible



Outpatient Services

Primary care1

Speltialty care





Outpatient Surgery

Maternity Care

Prenatal care

Inpatient Delivery

Inpatient Services








and Equipment


Prosthetics

No Charge

No Charge

No Charge

No Charge

No Charge





None




$70 copay


20 after deductible

No Charge

20 after deductible


No Charge



$70copay


office visit



20 after deductible




Nurse Advice Line

Online Services



Emergency Room6


Prescription Drugs



$70 copay

1-877-505-794 7


$20 copay


after deductible


$50 copay

Unlimited

$150



Preferred Generic

Preferred Brand

Non-Preferred

Online Refills

Mail Order



Tier 1

Tier 2

Tier 3




trsswhporg

SSWH 1-817-388-3090 OptumRx 1-855-205-9182







trsswhp org




Medical Plan Costs
































tax basis








12














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28



Preventive Services





Plan Provisions

Annual Deductible



Outpatient Services

Primary care1

Speltialty care





Outpatient Surgery

Maternity Care

Prenatal care

Inpatient Delivery

Inpatient Services








and Equipment


Prosthetics

No Charge

No Charge

No Charge

No Charge

No Charge





None




$70 copay


20 after deductible

No Charge

20 after deductible


No Charge



$70copay


office visit



20 after deductible




Nurse Advice Line

Online Services



Emergency Room6


Prescription Drugs



$70 copay

1-877-505-794 7


$20 copay


after deductible


$50 copay

Unlimited

$150



Preferred Generic

Preferred Brand

Non-Preferred

Online Refills

Mail Order



Tier 1

Tier 2

Tier 3




trsswhporg

SSWH 1-817-388-3090 OptumRx 1-855-205-9182







trsswhp org




Medical Plan Costs
































tax basis








12














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28


Medical Plan Costs
































tax basis








12














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28




























tax basis








12














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

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Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28














13






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

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Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28






employee






counselor




Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

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Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28


Dental Plans






1800CIGNA24

15


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28


















Employee Only $3594




16



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

Slide Number 12

Slide Number 13

Slide Number 14

Slide Number 15

Slide Number 16

Slide Number 17

Slide Number 18

Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28



Voluntary DHMO


What You Will Pay




$0 $66-$125 each


$0 $49-$93 each


$780 $1025-$1939



17

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

Slide Number 7

Slide Number 8

Slide Number 9

Slide Number 10

Slide Number 11

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Slide Number 14

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Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28

Plan 9234030


lens Options

CVSTOMER COSr









lt qdimn ctn tnmr





18



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

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Slide Number 8

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Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28



Start saving today






Hear ing discounts











Vision discounts


Where you can save






19





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

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Slide Number 8

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Slide Number 19

Slide Number 20

Slide Number 21

Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28





















Discount features









Single vis on $13 $15 $10 $50 $40 $55 $80





superiorv isioncom

(800) 507-3800





Refractive surgery






20


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

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Slide Number 22

Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28


















21

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

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Slide Number 23

Slide Number 24

Slide Number 25

Slide Number 26

Slide Number 27

Slide Number 28

- -













purposes



































taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

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Slide Number 24

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Slide Number 27

Slide Number 28

























taxed as income




23




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

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Slide Number 28




Available Coverage


Plan 1 (Low)



Plan 2 (High)



Effective 01012020




Available Coverage



Plan 1 (Low)


Plan 2 (High)







24









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

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Slide Number 27

Slide Number 28









25


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

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Slide Number 27

Slide Number 28


Long Term Care










26


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

Slide Number 4

Slide Number 5

Slide Number 6

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Slide Number 8

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Slide Number 28


Important Contacts










or 202-331-7635








Friday 9am - 8pm ET



27


Glossary of Terms














28


Slide Number 2

Slide Number 3

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Glossary of Terms














28


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RISD Emplooyee Benefits Guide 2019-2020...other benefits including Dental, Flexible Spending,...

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Transcript of RISD Emplooyee Benefits Guide 2019-2020...other benefits including Dental, Flexible Spending,...