your guide for employee benefits 2017-2018 - … · neither the benefits, nor this guide, ......

YOUR GUIDEFOR EMPLOYEE BENEFITS

2017-2018

Richardson ISD Employee Benefits Package

EMPLOYEES

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.

Tips

Important Tips:

Take the time to carefully review the guide for any changes or updates.

Visit each vendor’s website for additional information.Don’t forget to review each plans provider directory. If your physician or doctor’s office is not considered in-network, you cannot change or drop plans mid-year without a change in status event. For additional questions, feel free to contact Customer Service as listed.

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

Gather the correct information for your dependents such as social security numbers and birth dates.

Make sure your address and personal information is current. If your information isnot up-to-date, you may miss out on important information such as insurance cards, plan documents, health notices, etc.

Avoid making quick decisions — enroll early!

If you have questions, contact your Employee Benefits Office:469-593-0350

[email protected]

Employee Benefit Guide 2017-2018

mailto:[email protected]

Your 2017-2018 BenefitsPlan Choices Page

Glossary 25

The Employee Benefit Guide for 2017-2018 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 the 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 conflict between the information in this summary and the actual plan documents and insurance contracts, the plan documents 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.


Long-Term Disability (LTD) Unum 21

Life Insurance

AD&D

Unum 22

Employee Assistance Unum 22

Travel Assistance Unum

Long Term Care Genworth Financial 23

Retirement Investments Plan RAMS 23

Important Contacts Customer Service Numbers 24

Employee Eligibility 4

Occupational Injury 5

New Hire Enrollment Instruction Sheet 6

Change in State Events 7

Medical Aetna (PPO) 8-13

Baylor Scott & White (HMO)

Cigna 14-16Dental

Vision/Wellness Discounts Cigna

Aetna17

18

Flexible Spending Navia Benefit Solutions 19-20

Short-Term Disability (STD) Unum 21

22

Getting Started

Employee Eligibility

Employees are eligible to enroll in the benefit plans as shown below. You are required to enroll no later than 31 days after your actively-at-work date with Richardson 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: Basic Term Life Insurance Plan Basic Accidental Death & Dismemberment Employee Assistance Plan Medical Plan Voluntary Dental Plan Flexible Spending Account Short Term & Long Term Disability Supplemental Term Life Insurance Plan Supplemental Accidental Death & Dis-

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

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

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

Dependent Eligibility

Dependent: the Employee’s legal spouse ora dependent child of the Employee. See eachplan’s 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 for coverage, and random eligibility audits may be conducted by the insurance companies.

New Hire Coverage

Employees may choose Medical coverage to begin on their actively-at-work date or the first of the month following their actively-at-work date.

Dental, Flexible Spending, Life, STD & LTDwill begin the first of the month following 30days of employment.


Reporting and Treatment of Occupational Injuries

Employee Responsibility

A. If you are injured in the course and scope of your employment you shall:

1. Report the injury to your supervisor immediately or at the earliest opportunity before the end of your work shift. Ifyour injury is not reported timely it may affect your entitlement to benefits.

2. Complete an Accident & Injury Report with assistance from your supervisor or Risk Management.

BE SURE THE COMPLETED ACCIDENT & INJURY REPORT IS SENT TO THE WORKERSCOMPENSATION OFFICE WITHIN 24 HOURS AFTER THE INJURY OCCURRED.

Risk Management

RISD Administration Building 400South Greenville Avenue Richardson, Texas 75081

Fax: 469-593-0417

Note: If this injury is of a serious or critical nature, contact Risk Management at 469-593-0346

immediately.

3. Proceed to a medical facility for examination or treatment if needed. You as the employee may choose to treat with any physician who accepts and is approved to treat Workers Compensation patients. Please notify your selected physicianyou are treating for a work related injury.

4. Arrange subsequent follow-up appointments at the beginning or end of your work shift. You will not be compensated for any time missed from work due to treatment or testing.

5. Submit the most current Work Status Report (DWC-73) to Risk Management after each visit to the treating physician. All missed time from work must be documented by a physician’s written statement providing a medical based opinion as to whyyou are unable to work.

6. Comply with instructions given by your physician.

7. Richardson ISD is committed to offering transitional duty whenever possible. Please discuss any restrictions given by yourphysician with your supervisor and Risk Management. You may be required to meet with Risk Management if you remainoff work longer than two weeks as a result of your injury.

A. Prescriptions may be filled by one of the following means:

1. Have the pharmacy contact Paula Scales at TRISTAR Risk Management (214-492-5600, ext. 2822) for approval. You should not incur any out of pocket expense.

2. Have the pharmacy contact Risk Management, (496-593-0346) for approval. You should not incur any out of pocket expense.

3. Pay for the prescription at the time of pickup and submit a valid receipt to Risk Management for reimbursement. If you are picking up your prescription during regular business hours please contact Paula Scales or RISD Risk Management.

B. Requirements to file for leave:

1. When an injury results in an absence of 5 or more duty days, you must submit an application for leave from the District. Contact Human Resources (469-593-0265) for the proper paperwork.

2. Workers Compensation is not a leave and therefore, an injured employee must follow all District procedures regarding leave of absences, the same as any other employee needing leave.



TRS-ActiveCare Plan Highlights

TRS-ActiveCare Plan HighlightsEmployee Benefit Guide 2017-2018

For more details visit https://www.trsactivecareaetna.com

http://www.trsactivecareaetna.com/


For more details visit https://trs.swhp.org/

Page

10


Medical Plan Costs

TO LOCATE A NETWORK DOCTOR OR HOSPITAL GO TO:

AETNA - ActiveCare 1HD, Select & 2 Customer Service:1-800-222-9205 https://www.trsactivecareaetna.com/

SCOTT & WHITE – HMO Customer Service:1-844-216-4150 https://trs.swhp.org/

Click on: Find a Doctor or Facility/Start a New Search. You will be able to search for a doctor or hospital by plan option. When searching for providers in the TRS-ActiveCare Select plan, you must choose from a network based

https://www.trsactivecareaetna.com/

https://trs.swhp.org/

Frequently Asked Questions:

Q. When can I enroll?A. As a New HireB. Annual Open EnrollmentC. Change in Status Event

Q. If I want to decline coverage, must I still complete the Enrollment process?

A. Yes. 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 another?

A. 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 1HD, Select & 2 (AETNA) Plans:

https://www.trsactivecareaetna.com or 1-800-222-9205 (SCOTT & WHITE )HMO Plan:

https://trs.swhp.org/ or 1-844-216-4150

Meet Alex...your benefits counselor!

ALEX will explain your plan options and help you decide which plan is right for you. It's simple and fun!

Start your conversation here:www.myalex.com/trsactivecare



http://www.myalex.com/trsactivecare

Talk to a doctor anytime, anywhere

24/7 Access to doctors at a low cost

Q. What is Teladoc?A. 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 with?A. 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 U.S. board– certified in internal medicine, family

practice, emergency medicine or pediatrics. Teladoc doctors are U.S. residents and licensed in your state with an average of 15 years of practice experience.

Q. Do I need to register?A. 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.

Q.Visit:

A. www.teladoc.com/aetna or Call Customer Service at 1-855-835-2362


NOTE: FOR AETNA PLANS 1-HD, SELECT & 2 ONLY

http://www.teladoc.com/aetna

Dental Plans

You have two Cigna dental plans to choose from; a DPPO and a DHMO. Both plans cover Preventive, Basic, Major and Orthodontic services.

The DPPO plan gives you the freedom to choose any dentist in or out of network, including specialists. Reimbursements are based on usual, cus-tomary and reasonable (UCR) fees. While participants may choose any dentist or specialist under the DPPO Plan, selection of a contract network dentist 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 you’re enrolled in a Cigna dental plan, you’re eligible for Cigna Healthy Rewards.

Q. Need to locate a network dentist or orthodontist?

A. Log on to www.mycigna.com or Call customer service at 1.800.CIGNA24


http://www.mycigna.com/

Voluntary Dental Plan - DPPO

UCR: Usual, Customary, and Reasonable

Always verify provider network status.

You pay more of the cost when you go out-of-network You may be required to file your own claim; and / or You could be balance billed for amounts over allowed amount. Visit www.MYCIGNA.com or call customer service at 1.800.CIGNA24 (6224)


Plan Feature BenefitDeductibles and Benefits Maximum $100 per person, $300 per family per plan year.

Maximum benefit paid per plan year is $1,250 per person.

Diagnostic and Preventive Benefits: oral examinations, x-rays, cleanings, fluoride treatment, sealants

100% of Cigna’s allowed (UCR) amount.Deductible is waived.

Basic: fillings, full-mouth/panoramic X-rays, root canal therapy

80% of Cigna’s allowed (UCR) amount.Subject to Deductible.

Major: Prosthodontic Benefits: bridges, partial, dentures, crownsdentures, full dentures

50% of Cigna’s allowed (UCR) amount.

Subject to Deductible.

Orthodontic Benefits: Child Only(up to age 19)

50% of Cigna’s allowed amount—$1,250 lifetime maximum

Subject to Deductible.

Waiting Period Major: 6 MonthsOrtho: 12 Months

Dental Plan CostsVoluntary DPPO

Employee Only $33.89

Employee + Spouse $67.80

Employee + Child(ren) $73.55

Employee + Family $106.83

http://www.MYCIGNA.com/

Voluntary Dental Plan - DHMO

For a full list of covered services and exclusions/limitations,

Call customer service at 1.800.CIGNA24 (6224) or visit www.MYCIGNA.com


Dental Plan Costs

Voluntary DHMO

Employee Only $10.29

Employee + Spouse $16.56

Employee + Child(ren) $22.32

Employee + Family $26.13

What You Will Pay

Sampling of Procedures Cost With Cigna DentalCare

Estimated Cost Without

Dental Coverage

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

$0 $66-$125 each

Child cleaning (Two per calendar year each at $0. Additional 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-$1,514

Periodontal (gum) scaling & root planing - 1 quadrant $135 $167-$316

Periodontal (gum) maintenance $93 $102-$193

Removal/extraction of erupted tooth $64 $112-$211

Removal/extraction of impacted tooth $300 $349-$660

Crown – porcelain fused to high noble metal $480 $797-$1,509Implant crown – porcelain fused to high noble metal crown

$780 $1,025-$1,939

http://www.MYCIGNA.com/

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 federalincome 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, your spouse, and your dependent children, regardless ofwhether they are covered by Richardson ISD’smedical, dental or vision plans.

The Flexible Spending Account also reimburses youfor certain dependent care expenses incurred whileyou and/or your spouse work.

How the Spending Accounts WorkYou choose to contribute part of your earnings intothe Medical Flexible Spending Account and/or the Dependent Care Flexible Spending Account. The accounts are maintained separately and you cannot make transfers between them. These accounts willreimburse 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 $2,500). 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 expenses. Funds come directly out of your Health FSA andare paid to the provider. Some swipes require verification, so hang on to your receipts!

5. If you are enrolled in an HSA plan you may useyour Flexible Spending Account for dental andvision expenses only.

Dependent Care Flexible Spending Account

1. Estimate your dependent care expenses for thecoming year.

2. Decide how much money you want to contribute

to the account with a $5,000 maximum per year.The 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 dependentcare expenses.

4. You will be reimbursed for eligible claims up to

the current contributed amount available in youraccount.

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


Medical Care Flexible Spending Account

Eligible ExpensesThe following are examples of expenses eligible forreimbursement when they are not covered by amedical, dental or vision care plan. You cannot claiman expense as a federal income tax deduction if it isreimbursed through your Flexible Spending Account.(For a full list, go to www.irs.gov.)

Amount applied to any medical, dental, or vision plan deductible, or copayment, or fees in excess of plan limits;

Vision expenses not covered by a plan, including exams, eye glasses, contact lenses

and solutions, optometrist and ophthalmologistfees and laser eye surgery;

Dental expenses not covered by a plan including cleanings, 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 ExpensesThe following expenses are examples of items not eligible for reimbursement through your Health CareFlexible Spending Account.

Cosmetic expenses; Fees for exercise/athletic/health clubs;

Premiums for health, dental, vision, or life insurance; and

Weight-loss programs for general healthpurposes.

Dependent Care Flexible Spending Account

Eligible ExpensesYou may claim dependent care expenses for any dependents 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 mentallydisabled, and claimed on your federal incometax return.

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

The following are examples of eligible 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.


Basic Term Life & Accidental Death and Dismemberment (AD&D)Insurance Coverage

Eligible to full-time employees, Richardson ISDprovides $10,000 basic term life insurance coverage and $10,000 basic AD&D insurance coverage at no cost.

You may choose additional coverage for yourself, up to four times your annual base salary. You may choose term life insurance in $10,000 increments,up to $50,000 for your spouse. You may elect$5,000 or $10,000 for you dependent child(ren).

Dependent life may not exceed 50% of employee coverage amount.

Term life insurance will pay a benefit to your designated beneficiary upon death.

AD&D provides additional benefits for anaccidental death, and for an accidentaldismemberment, as defined in the schedule of benefits.

Short-term & 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 it provides 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 if they experience disability.

Disability Options:

STD - 60% of your weekly earnings to a maximumof $500.

LTD - 60% of your monthly earnings to a maximumof $5,000.

Note: Long-term Disability benefits are reduced byother sources of income during disability, such as Workers’ Compensation, Social Security, and/orretirement systems.


Q. Do you need to change your beneficiary due to divorce, marriage or other lifeevent?

A. Yes, your designated beneficiary shouldalways be up to date.

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 complex interpersonal issues as well as assist with things such as wills and financial matters. It also provides a limited number of face-to-face counseling sessions for each issue. Seminars and workshops are also offered on managing a variety of issues.

Family and relationships – parenting, communication, domestic violence, marriage, and divorce

Dependent care – child care, elder care, prenatal education, adoption and special needs issues

Personal issues - stress, anxiety, grief, anger and depression

Well being – drug and alcohol dependency, physical illness, eating disorders and self-esteem

Job concerns – interpersonal conflicts, career crisis

Financial difficulties – overextended credit, budget worries

Legal issues (excluding employment related issues)

Call (800) 854-1446 for access to information on: www.lifebalance.net

Username Id and password : lifebalance

If counseling after your no-cost sessions is recommended, your cost for additional treatment will depend on coverage by your chosen medical plan.

Employee Assistance Program

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: Help replacing lost prescriptions and passports Hospital admission assistance Emergency medical evacuation

If you need travel assistance anywhere in the world, contact Unum day or night:

Within the U.S.: 1-800-872-1414 Outside the U.S. (U.S. access code) +609-986-1234 Via e-mail: [email protected]

Reference number: 01-AA-UN-762490

Travel Assistance


http://www.lifebalance.net/


Retirement Investment Plans

The District offers two retirement plan options, a 403(b) plan and a 457(b) Retirement Savings 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. This reduces current income tax and allows the money in the plans to grow untaxed until money is distributed to the participant.

RISD Retirement Plans are administered by JEM Resource Partners.

Region 10 website: www.Region10RAMS.org or call 1-800-943-9179

Long Term Care

Long Term Care insurance enhances TRS benefit offerings by meeting a largely unrecognized need many of us have. It pays for covered expenses for long term care 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 www.genworth.com/trsactivemember to log in to your account or call customer service at 866.659.1970.

Eligible employees may enroll at anytime (underwriting may apply)


http://www.Region10RAMS.org/

http://www.genworth.com/trsactivemember

Important Contacts


Insurance Services400 South Greenville Ave., Suite 208 Richardson, TX 75081

Employee Benefits: 469-593-0350

Workers Compensation: 469-593-0346

Vendor and Type of Plan Member Services Hours of Operation Website

Phone Number

TRS-ActiveCare https://www.trsactivecareaetna.com

Option 1: Aetna (Medical) or 1-800-222-9205 Monday through Friday www.caremark.com

Option 2: Caremark (Pharmacy) 8am - 6pm CT

HMO Medical 1-844-216-4150 https://trs.swhp.org/

Teladoc 1-855-835-2362 24/7 https://www.teladoc.com/

trsactivecare

CIGNA

Dental PPO & DHMO 1-800-244-6224 24/7 www.mycigna.com

Navia Benefit Solutions Monday through Friday

Flexible Spending Account 1-800-669-3539 7am—7pm CT www.naviabenefits.com

Unum Monday through Saturday

Long Term & Short Term 1-800-421-0344 7:30am - 11pm ET

Disability, Life, AD&D Sunday 11am - 8pm ET www.unum.com

Employee Assistance

Travel Assistance

1-800-854-1446

In US: 1-800-972-1414Out US: +609-986-1234

24/7 www.lifebalance.net(Password: lifebalance)

[email protected](Reference #01-AA-UN-762490)

Genworth Monday through Thursday

Long Term Care 1-866-659-1970 8:30am—8pm ET www.genworth.com/trsactivemember

Friday: 9am - 8pm ET

JEM Resource Partners Monday through Friday

Services 1-800-943-9179 8am—5pm CT www.region10rams.org


http://www.caremark.com/

http://www.teladoc.com/

http://www.mycigna.com/

http://www.naviabenefits.com/

http://www.unum.com/

http://www.lifebalance.net/


http://www.genworth.com/trsactivemember

http://www.region10rams.org/

Glossary of Terms

Allowed Amount: the maximum amount determined by to be eligible for con-sideration 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 charges/expenses) in a year before the plan will begin paying certain benefits in thatyear.

COBRA: Consolidated Omnibus Budget Reconciliation Act of 1985. This Act requires that continua-tion of group insurance be offered to covered persons who lose health, dental or flexible spending coveragedue to a qualifying 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-nates in the work, business, trade, or profession of the employer and that is performed by an employee whileengaged in 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 aplan that 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 plan participants. Out of Network: services and supplies that are provided by a Non-Network provider or arenot contracted with insurance company to provide services. There may be reduced reimbursement or no coverage depending on your plan type. You will be responsible for all charges remaining after plan has paidthe allowed amounts.

Occupational Injury: An injury or illness resulting from course and scope of employment. Also known as a workers compensation injury.

Out-of-Pocket Maximum: The maximum out of pocket amount you will pay per plan year. The deducti-bles, 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 restof the plan year.

Plan Year

Medical, Dental, FSA: September 1st through August 31st of the following year. Life & Disability: January 1st through December 31st.


your guide for employee benefits 2017-2018 - … · neither the benefits, nor this guide, ......

Documents