2020-2021

EMPLOYEE

ENROLLMENT

GUIDE

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2020-21 Humana Medical Plans

***Lighthouse generously pays $282.88 a month towards your premium.***

HDHP Base PPO Buy UP PPO

Employee $0 $74.10 $88.94

Employee & Spouse $339.45 $502.48 $535.12

Employee & Child(ren) $254.59 $395.38 $423.58

Employee & Family $622.33 $859.46 $906.94

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2020-21 TRS –Active Care Plan Highlights

TRS ActiveCare Primary

TRS ActiveCare HD

TRS ActiveCarePrimary +

TRS ActiveCare 2

Employee only

$103.12 $114.12 $231.12 $654.12

Employee & Spouse

$806.12 $837.12 $981.12 $1,939.12

Employee & Child(ren)

$412.12 $432.12 $551.12 $1,110.12

Employee & Family

$1,108.12 $1055.12 $1,305.12 $2,344.12

***Lighthouse generously pays $282.88 a month towards your premium.***

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• Preventative Services = Cleanings, Oral Examinations, and X-Rays

• Basic Services = Fillings, Endodontics, Periodontics, Oral Surgeries

• Major Services = Bridges, Dentures, Crowns

• Orthodontia = Tooth Alignment (Braces)

Humana Dental Insurance

Coverage Basic Basic w/ Ortho

Deductible $50/$150 $50/$150

Preventive 100% no deductible 100% no deductible

Basic services coinsurance % 80% after deductible 80% after deductible

Major services coinsurance % 50% after deductible 50% after deductible

Orthodontia none $1,500 annual maximum

Coverage Basic Basic w/ Ortho

EmployeeOnly

$0 $3.15

Employee &Spouse

$26.31 $32.62

Employee &Children

$40.78 $55.08

Employee &Family

$67.09 $85.79

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Humana Vision Insurance

Healthy eyes and clear vision are an important part of your overall health and quality of life. You vision plan helps you care for your eyes while saving you money.

In Network Basic

Eye Exam Copays $10

Eye Exam $10

Contact LensEvaluation

$10

Allowance (Frames) $130

Allowance (Contact Lenses)

$130

Coverage EmployeeOnly

Employee &Spouse

Employee &Child(ren)

Employee & Family

Premium $0 $6.16 $5.54 $12.93

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Lighthouse Public School generously provides employees life insurance coverage at no cost to the employee with $25,000 coverage.

Voluntary Life InsuranceMinimum Voluntary:

$15,000Maximum Voluntary:

$100,000Guarantee Issue $75,000

Age Rate per $1,000

Spouse rate per $1,000

0-24 $0.09 $0.10

25-29 $0.09 $0.10

30-34 $0.10 $0.12

35-39 $0.12 $0.14

40-44 $0.13 $0.20

45-49 $0.23 $0.29

50-54 $0.35 $0.44

55-59 $0.54 $0.69

60-64 $0.75 $0.96

65-69 $1.21 $1.53

70-74 $2.33 $3.02

75-79 $4.47 $5.80

80-99 $8.32 $10.79

Voluntary Life InsuranceChild rate $5,000= $1.00

Spouse Guaranteed Issue: $35,000EOI: $50,000Child: $5,000

Humana Basic Employee Life/ AD&D

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➢ Unlimited Usage for whole family➢ Never pay a consultation fee➢ Prescriptions sent immediately to your local pharmacy

MyTelemedicine - Virtual Doctor Visits

MyTelemedicine provides access to licensed physicians who will diagnose the patient’s ailment, make recommendations, and if necessary and appropriate, writes a DEA controlled* prescription, that will be sent to the member’s pharmacy of choice.

Members, their spouses, and dependents, will have unlimited access to telephone, smartphone app, and video consultations by a physician licensed in their state, 24 hours a day, 365 days a year. Telephone consultation requests will be answered by a licensed physician within 2 hours. Results from the member’s consultation will be sent to their Primary Care Physician.

If district, or organization has an onsite clinic, electronic health record generated by consultation results will also be integrated into the clinic’s database to improve quality, safety, efficiency, and reducing health disparities, providing a continuum of care.

All physician consults may be conducted in either English or Spanish, at the member’s request; and member NEVER pays a consult fee.

Monthly Premium for My Telemedicine:

FREE for all Employees that choose Humana

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TrueFlex Universal Life Key Features:

• Available to Lighthouse Charter School Employees, their Spouse, Children and Grandchildren.

• You do not have to apply for coverage

for yourself in order to purchase spouse

or child coverage.

• Coverage is portable so you can take it

with you even if you leave the district or

retire.

• Builds cash value.

• More affordable when you’re younger.

• Whole life give you valuable protection

in addition to any term life insurance you

might have.

• Guaranteed Issue

The TrueFlex product was built with the Texas Educator in mind, more coverage at lower premiums.

• Universal Life provides higher face amounts at lower rates.

• Permanent Coverage to age 121.

• Level Premium Guarantees for an average of 30 years.

• Individual Polices, so you can purchase on dependents even if the employee does not purchase a policy.

• All policies come with an Accelerated Death Benefit that can be accessed through a living benefit for Terminal Illness or Chronic illness at no additional cost.

• Waiver of Premium and Accidental Death Riders are available at the group level.

Texas Republic TrueFlex Universal Life Insurance

Face Amount Express Issue for Lighthouse Employee

Age Minimum Maximum

17 to 34 $25,000 $150,000

35 to 49 $10,000 $150,000

50 to 65 $10,000 $75,000

66 to 70 $10,000 $10,000

Face Amount Express Issue for Spouse

Age Minimum Maximum

17 to 34 $25,000 $50,000

35 to 49 $10,000 $50,000

50 to 65 $10,000 $25,000

66 to 70 N/A N/A

Face Amount Express Issue for Youth

Children 15 days to 26 Years $25,000 Only

Grandchildren 15 days to 18 Years $25,000 Only

Riders Available

Employer Elected

• Life Only

• Accidental Death – 1X Face Amount*

• Waiver of Premium*

Employee Elected

• Child Term Rider – 15 Days to 18 Years can be attached to employee or spouse policy.$10,000 Coverage for each child for one monthly premium of $5.00

*ages 17 to 59 employee and spouse only

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Allstate Critical Illness (Voluntary)

INITIAL CRITICAL ILLNESS BENEFITS† PLAN 1 PLAN 2

Heart Attack (100%) $10,000 $20,000

Stroke (100%) $10,000 $20,000

Major Organ Transplant (100%) $10,000 $20,000

End Stage Renal Failure (100%) $10,000 $20,000

Coronary Artery Bypass Surgery (25%) $2,500 $5,000

Waiver of Premium (employee only) Yes Yes

CANCER CRITICAL ILLNESS BENEFITS† PLAN 1 PLAN 2Invasive Cancer (100%) $10,000 $20,000

Carcinoma in Situ (25%) $2,500 $5,000

SECOND EVENT BENEFITS† PLAN 1 PLAN 2

Second Event Initial Critical Illness(same amount as Initial Critical Illness)

Yes Yes

Second Event Cancer Critical Illness(same amount as Cancer Critical Illness)

Yes Yes

SUPPLEMENTAL CRITICAL ILLNESS BENEFITS II† PLAN 1 PLAN 2

Advanced Alzheimer’s Disease (25%) $2,500 $5,000

Advanced Parkinson’s Disease (25%) $2,500 $5,000

Benign Brain Tumor (100%) $10,000 $20,000

Coma (100%) $10,000 $20,000

Complete Blindness (100%) $10,000 $20,000

Complete Loss of Hearing (100%) $10,000 $20,000

Paralysis (100%) $10,000 $20,000

OPTIONAL/ADDITIONAL BENEFIT PLAN 1 PLAN 2

Wellness Benefit (per year) $50 $50

Critical Illness Insurance (GVCIP2)from Allstate Benefits

BENEFITAMOUNTS†Covered dependents receive 50% of your benefit amount

• Biopsy for skin cancer• Bone Marrow Testing• Blood tests for triglycerides• CA15-3 (breast cancer)• CA125 (ovarian cancer)• CEA (colon cancer)• PSA (prostate cancer)• Chest X-ray; Colonoscopy• Doppler screening for carotids or

Peripheral Vascular Disease• Echocardiogram• EKG• Flexible sigmoidoscopy• Hemoccult / stool analysis• HPV (Human Papillomavirus) Vaccination• Lipid panel (total cholesterol count)• Mammography, including Breast Ultrasound• Pap Smear, including Thin Prep Pap Test• Serum Electrophoresis (test for myeloma)• Stress test on bike or treadmill• Thermography• Ultrasound

Wellness Benefit $50 per person 23 exams:

Coverage Option 1$10,000

Option 2$20,000

EmployeeOnly

$21.85 $41.45

Employee &Spouse

$32.90 $62.30

Employee &Children

$21.85 $41.45

Employee &Family

$32.90 $62.30

Key Features

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Allstate Accident Insurance (Voluntary)

Coverage Option 1

Employee $17.99

Employee & Spouse $35.44

Employee & Child(ren) $42.78

Employee & Family $52.73

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Hospital Indemnity Insurance (SHOP)from Allstate Benefits

Hospitalization Benefits PLAN 1 PLAN 2Initial Hospital Confinement (daily, once per year) $250 $750

Daily Hospital Confinement (daily) $100 $300

Hospital Intensive Care (daily) $100 $300

Surgery Benefits* PLAN 1 PLAN 2

Surgery (according to schedule) $20 - $500 $20 - $500

Anesthesia (% of Surgery) 25% 25%

Inpatient Physician’s Treatment (daily) $25 $25

Outpatient Benefits* PLAN 1 PLAN 2

Outpatient Emergency Accident (daily) $250 $250

Outpatient Physician’s Treatment (daily)

$25 $25

At Home Nursing (daily) $50 $50

Ambulance (daily)Ground Air $150

$300$150$300

Non-Local Transportation (daily) $150 $150

About Group Supplemental Health

Options offered by Allstate Benefits

Life is full of challenges. An illness or injury can lead to hospital confinement, medical treatment and unexpected out-of-pocket expenses. Having the right coverage before costs are incurred can help eliminate some financial concerns, so employees and their families can concentrate on getting appropriate treatment and most importantly, their recovery.

Group Supplemental Health Options Plan

Design

Our Supplemental Health Options insurance pays cash benefits for hospital confinements and more. The benefit is paid directly to the covered person and can be used to help cover deductibles, treatment costs, or for anything the insured sees fit. There are no restrictions as to how their money is spent. Coverage includes benefits for hospitalization, surgery, outpatient procedures, nursing, transportation, plus additional benefits may be added for enhanced protection.

HOSPITALIZATION BENEFITS PLAN 1

ALLSTATE HOSPITAL INDEMNITY INSURANCE

Issue Age Employee Employee /

Spouse

Employee /

Child(ren)

Family

18-35 $21.33 $40.86 $35.87 $54.28

36-49 $24.84 $47.70 $41.17 $62.86

50-59 $30.42 $59.85 $47.23 $75.38

65+ $52.38 $104.76 $71.28 $121.88

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One-stop solution for all consumer-driven healthcare accounts

Integrated Plans

Health SavingsAccount

• Cash Account

• InvestmentAccounts

Mobile app features

The NBS mobile app supports a wide variety of

features, empowering you to more proactively

manage your account.

•View account balances

•View claims

•View reimbursement history

•Submit claims

•Submit documentation using your device´s camera

•Pay providers

•Setup a variety of SMS alerts

•Edit your personal information

•View contribution details

•View plan information

•View calendar deadlines

•Contact a service representative

•View Benefits Card information

Health Reimbursement Account

• Stacked Card

• Over 1,400 Plan Designs

Flexible Spending Account

• Stacked Card with HSA, HRA

• Standard and Limited Purpose

• Dependent Care FSA

Health Savings Account

& Flexible Spending Account

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Individuals covered by and IRS-qualified High-Deductible Health Plan may open and

contribute to an HSA and take advantage of this great tax savings opportunity. HSAs

are accounts set up to pay for your medical care including dental and vision and allow

you to build up savings to pay for future medical expenses. The qualified medical

expenses must be incurred after the HSA is established in order to be reimbursable on

a tax-free basis. HSAs are available in conjunction with a high deductible health

insurance plan. Contributions to an HSA are tax deductible.

•Contributions made through a cafeteria plan are excluded from your gross income.

•The contributions remain in your account from year to year until you use them.

•The interest or other earnings on the assets in the account are tax free.

•An HSA is "portable" so it stays with you if you change employers or leave the work force.

Health Savings Account (HSA)

2020 Contribution Limit

Single - $3,550

Family - $7,100

Health Savings Account

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Flexible Spending Account

• A Flexible Spending Account (FSA) allows you to set aside dollars on a pre-tax basis to pay for eligible

medical, dental, vision, and hearing expenses.

• Such expenses may include: co-pays, coinsurance, deductibles, dental & vision expenses, hearing

examinations & hearing aids and prescriptions.

• Plan runs by calendar year and all eligible claims must be “incurred” during plan/calendar year.

• Funds must be used by the end of the calendar year or you will lose your accumulated funds.

• You will receive a PayFlex Mastercard in the mail which gives you the ability to pay for certain eligible

expenses at the time of service. While PayFlex attempts to verify expenses automatically, there are times they

cannot. An FSA reimbursement form may be submitted in those situations.

• For additional information, you may contact PayFlex at the number listed in the back of this booklet.

Dependent Care Spending Account

• A Dependent Care Spending Account allows you to set aside dollars on a pre-tax basis to pay for eligible

child and adult care expenses.

• Such expenses may include: day care centers, before-school and after-school care up to age 13, special

education schools, and nurse or other dependent care services for an incapacitated adult who lives with you

at least 8 hours per day.

• Funds are for your dependent(s) age 12 or younger. Funds may also be used for a spouse or dependent

incapable of self-care.

• Occasional baby sitting services are not covered.

2020 Annual Maximum Contribution :$5,000 (married, filing joint OR single / head of household)

Utilize the PayFlex Mobile app:

• Manage your account and view alerts

• Snap a photo of your receipts to submit claims

• View PayFlex debit card transactions

• View common eligible expense items, and more

(Standard text messaging and other rates may apply)

FSA and Dependent Care

Important Numbers

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Benefit Telephone Website

Medical – Humana 1 (844) 330-7799 https://www.humana.com/help

Medical -- BCBS TRS-ActiveCare1 (800) 528-7264 https://www.bcbstx.com/provider/index.html

Telemedicine – 1 (844) 330-7799 https://www.humana.com/help

Dental – Humana 1 (844) 330-7799 https://www.humana.com/help

Vision – Humana 1 (844) 330-7799 https://www.humana.com/help

Universal Life – Texas Republic 1 (512) 330-0099 https://texasrepubliclife.com/contact-2

Critical Illness – Allstate 1 (800 255-7828 https://www.allstate.com/support/overview.aspx

Accident – Allstate 1 (800) 255-7828 https://www.allstate.com/support/overview.aspx

Hospital Indemnity – Allstate 1 (800) 255-7828 https://www.allstate.com/support/overview.aspx

FSA, HSA, & Dependent Care – National Benefit Service

1 (800) 274-0503 https://www.nbsbenefits.com/

Additional Questions – Barrett Insurance Services

1 (866) 902-8239 www.barrettinsurance-services.com

How can I find a Network Provider?

To find network providers, go to the Humana website: www.humana.com

When will I receive ID cards?

You can expect to receive your medical ID cards by the end of September. To access

your medical card prior to this date, please go to the Humana website:

www.humana.com

Humana Basic Employee Life/ AD&D 1 (844) 330-7799 https://www.humana.com/help

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barrettinsurance-services.com(210) 485-1855