Southside ISD. Enrollment Benefits and Overview Booklet Download our Mobile App:

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1 Southside ISD Enrollment Benefits and Overview Booklet Download our Mobile App: Enrollment is required; benefits do not roll over from your current plan. You will lose coverage on new products if you do not enroll in the 2014 benefit offerings.

2 CONTACT INFORMATION Refer to this list when you need to contact one of your benefit vendors. For general information contact Human Resources or please feel free to contact Mullen Pensions & Benefit Group, L.P. GAP PLAN: Special Insurance Services, Inc. (SIS) Provider Phone Number: DENTAL Humana Provider Phone Number: VISION: Avesis Provider Phone Number: BASIC LIFE/VOLUNTARY LIFE/GROUP ACCIDENT Aetna Provider Phone Number: GROUP TERM LIFE WITH LEVEL PREMIUM/CRITICAL ILLNESS Reliance Standard Provider Phone Number: DISABILITY Aetna Provider Phone Number: , Option 2 CONSULT A DOCTOR Provider Phone Number:

3 Flexible Spending Accounts (FSA) A Health Flexible Spending Account (FSA), Limited Purpose FSA and Dependent Care Flexible Spending Account (DCA) allow you to set aside dollars on a pre-tax basis to pay for uncovered medical, dental, vision and many over the counter expenses. The plan runs on a calendar year and all eligible claims must be incurred during the plan/calendar year. Funds must be used by the end of the calendar year or you will lose your accumulated funds. You do not have to participate in the medical or dental plans at Southside ISD to participate in a flexible spending account. Two reimbursement methods: o Benefits Card (VISA) used at point of purchase o Direct deposit Elections are made annually and are fixed for the duration of the plan year, unless you experience a qualifying life event that would entitle you to make a change. ANNUAL FSA MAXIMUMS Health Care FSA $2,500 Limited Purpose FSA $2,500 Dependent Care FSA $5,000 TRADITIONAL FSA MAXIMUMS Maximum Annual Election: $2,500 Entire election available 1 st day of the plan year Can only be used for unreimbursed medical, dental or vision expenses, including many eligible OTC items (e.g., co-pays, deductibles, band aids, eye glasses, contacts & solution, Tylenol, etc.) Must be for the treatment of a specific condition (not cosmetic or general health) LIMITED PURPOSE HEALTH FSA If enrolled in HSA you will have a limited purpose FSA Compatible with HDHP health plan only Maximum Annual Election: $2,500 Entire election available 1 st day of plan year Must first meet your medical plan deductible before you can rec eive reimbursement for eligible medical expenses Can be used for eligible dental and vision expenses right away Table of Contents 1. MPBG Contact Information 2. Enrollment Instructions 3. GAP Plan Secure Advantage/SIS 4. Dental Humana Low Plan 5. Dental Humana High Plan 6. Vision - Avesis 7. Basic Life - Aetna 8. Voluntary Life - Aetna 9. Group Term Life with Level Premium Reliance Standard 10. Critical Illness Reliance Standard 11. Accident Aetna 12. Disability Aetna 13. Consult-a-Doctor 14. Health Savings Account (HSA) 15. Flex Spending Account (FSA) 16. Claim Contacts

4 For any questions or claims on any product, please contact: Maria Robinson Billing & New Members Senior Account Manager Stephanie Olguin Billing & New Members Benefits Account Manager/VPO Mullen Pensions & Benefits Group, L.P Cimarron Path, Suite 118 San Antonio, TX Phone: / Fax: [email protected] Health Savings Account (HSA) If you enroll in a HSA Qualified High Deductible Health Plan (HDHP), you can establish a tax-exempt Health Savings Account with your own funds. An HSA can be used to pay for eligible medical expenses, deductibles, coinsurance, prescriptions, vision and dental care. Balances roll over from year to year and the account is portable. You cannot contribute to HSA if you are enrolled in another non-qualified medical plan through your spouse/partner s employer or Medicare through the GAP plan. Employee and employer contributions cannot exceed the IRS Annual Maximum listed below. Only funds in your bank account are available for reimbursement. If you are 55 or older, you can contribute an extra $1,000 every year IRS ANNUAL HSA MAXIMUMS Individual Coverage $3,250* Family Coverage $6,450* Third Party Administrator: EBSO (formerly known as SOMI) *The contribution made by the company to your account applies toward the maximum listed You can only elect this plan if you are enrolled in TRS Active Care 1. If you choose the HSA plan you will not be eligible to enroll in the GAP plan Southside ISD has generously matched up to $500 annually if you choose the HSA plan. Funds are available as they are deposited. An HSA account does not advance funds.

5 Consult-A-Doctor When to Use Consult A Doctor Primary care physician is not available or accessible Need treatment for your medical condition After normal business hours, nights, weekends For non-emergent medical issues, questions, or concerns Traveling and need medical advice Request prescription or refills* *If appropriate Easy to Use Call 800-DOC-CONSULT ( ) or log into your Consult A Doctor account at Complete your Medical Assessment and History Questionnaire If you are not feeling well, or need to request a prescription, you can order a priority consultation, where a doctor will call you back within 3 hours, or you can schedule an appointment for a time that is convenient for you. 4 Easy Ways to Connect By Phone: On Call Consultation: Talk to a doctor immediately. Receive medical advice. Priority Consultation: Talk to a doctor within 1 hour. Get a comprehensive consultation, request prescription *medication. By Appointment Consultation: Talk to a doctor at a time that is convenient for you. Get a comprehensive consultation, request prescription *medication. By E-Consult: a doctor about sensitive medical issues. Receive medical advice. Get a response within 24 hours. Secure, discreet, HIPAA-compliant. Only $4.95 a month per household Online Enrollment Instructions Group # 824 This year s annual enrollment begins on May 19, 2014 and ends on May 30, During this time period, you may select your benefits for the plan year beginning September 1, All employees must complete the 2014 online enrollment whether or not you are making changes or waiving coverage. Enrollment Checklist (before you get started, be sure you have the items below) Your current benefit elections Beneficiary and Dependent Information including Social Security Numbers Southside ISD Employer Group # 824 Login/Registration: Step 1: Go to Step 2: Choose Members from the home page Step 3: Click on the Total Benefit Enrollment option within the menu on the left side Step 4: Click on the Registration button to create your user name and password. You will need to know the Group Number for Southside ISD (824), your Date of Birth, Last Name, First Name Initial and last four digits of your Social Security Number. To Re-Set Your Password: If you don t remember your username/password or are a first time user, you can click on the Registration button on the login page to re-set your information. Start Enrollment: Step 1: Once logged in, you will be brought to your Employee Home Screen. To begin enrolling, click the Enroll button. Step 2: Step 3: Step 4: You will be guided through several screens, each displaying your benefit options offered through Southside ISD. Please review any populated information on the demographic and dependent screens. You can make changes, add or update any information as needed. You will then proceed to each benefit screen and make your elections or indicate your intent to waive coverage for 9/1/2014 and click on the Update button. This will update the screen to reflect your current elections. If all of the information is correct, click the Save and Continue button to move to the next step in the enrollment process. The final step of the online enrollment will be an Event Summary page. This page will summarize your 9/1/2014 elections. Please review the information for accuracy. If all is correct, check on the I Agree box at bottom of screen and click the Submit Enrollment button. Once you have submitted your enrollment, you will be brought back to your Employee Home Screen where you can open and view/print/save a copy of your 2014 elections. All information you enter and Save and Continue with each step will be saved if you log out and return at a later time to complete. You may return to the online enrollment system as many times as needed to make updates/changes as long as you do so prior to 5/30/2014. FAQs: Q What happens if I don t have time to finish and need to log out and come back later? A All information is saved as you Update each page. When you log back in at a later date, you will be brought right back to where you left off. Q Who should I contact if I have questions on the benefit options? A Contact Mullen Pension and Benefits at ext 305 Q Who should I contact if I have questions or need help using the Online Enrollment System? A Contact EBSO s Customer Service Department at , M-Th 7:00am to 7:00pm CST and Friday 7:00am to 5:00pm CST or Mullen PBG at ext 305 M-TH 9:00am to 5:00pm Friday 9:00-4:00pm

6 GAP Plan Disability IN HOSPITAL BENEFITS Secure Advantage is a Group Hospital Confinement Insurance Plan designed to offset out-of-pocket expenses such as deductible and co-insurance. Secure Advantage pays a calendar year benefit, up to the maximum benefit selected, for each Covered Person who incurs eligible out-of-pocket expenses due to a hospital in-patient confinement. Expenses eligible under this benefit include: In-Patient hospital stays In-Patient surgeries In-Patient tests, procedures, and medications Physician In-Hospital charges Emergency Room treatment for injuries and sickness (sickness must result in hospital confinement within 24 hours of ER treatment) OUT-PATIENT BENEFITS Out-patient benefits range from a minimum of $200 to a maximum of $2,500 per person per calendar year, provided the maximum benefit selected is not greater than the amount of the Hospital Confinement Insurance selected. The out-patient benefit pays on a per person, per sickness or injury basis, up to a maximum of four occurrences per family per calendar year. Covered expenses including but not limited to: Hospital Emergency Room treatment for injury or sickness Out-patient surgery in an out-patient surgical facility, emergency facility or physicians office Diagnostic testing including but not limited to X-rays, diagnostic labs, MRI s and CT scans Out-patient chemotherapy or radiation therapy Physical therapy or chiropractic care If you choose the GAP plan you will not be eligible to enroll in the HSA plan. Please see online for rates.

7 Accident Dental Low Plan *please see online for further benefits

8 Dental High Plan Voluntary Group/Critical Illness COVERAGE Voluntary critical illness insurance provides a fixed, lump-sum benefit upon diagnosis of a critical illness, which can include heart attack, stroke, paralysis and more. These benefits are paid directly to the insured and may be used for any reason, from deductibles and prescriptions to transportation and child care. Class Increments Maximum GI Employee $5,000 $50,000 New Hires Only $10,000 Spouse $5,000 $50,000 New Hires Only $10,000 Dependents 25% of employee $12,500 New Hires Only $12,500 CRITICAL ILLNESS CATEGORIES Category 1 Category 3 Life Threatening Cancer 100% Blindness 100% Cancer in Situ 25% Coma 100% Kidney (Renal) Failure 100% Category 2 Major Organ Transplant 100% Coronary Artery Bypass 25% Paralysis 100% Heart Attack 100% Severe Brain Damage 100% Ruptured Cerebral Carotid or Aortic Aneurysm 100% BENEFIT REDUCTION DUE TO AGE Age 70 Original benefit reduced to 50% LIMITATIONS Pre-ex Condition Limitation- 12/12 Benefit Waiting Period- 30 Days Please note- benefit waiting periods and pre-ex limitations also apply to benefit increases FEATURES Wellness (Health Screening) Benefit- $50 Lifetime Maximum Benefit per Category- 200% of Insurance Amount Subsequent Occurrence Benefit-(Different Category of Critical Illness diagnosed 6 months or later)- 100% if Enhanced; 25% if Partial Recurrence Benefit-(Same Category of Critical Illness diagnosed 18 months or later)- 50% if Enhanced; 12.5% if Partial FMLA / MSLA Continuation Transfer of Coverage Portability to employee age 70 EXCLUSIONS A benefit will not be paid if the Critical Illness is caused by or contributed to by one of the following: an act of war, declared or undeclared; intentionally self-inflicted Injury; commission or attempted commission of a felony; the use of alcohol or drugs unless taken as prescribed by a Physician; a Sickness or Injury that occurs while confined in a penal or correctional institution; cosmetic or elective surgery that is not medically necessary; committing or attempting to commit suicide while sane or insane; participation in a riot or insurrection; a Critical Illness Diagnosed

9 Group Term Life - Level Premium Vision ELIGIBILITY Dependents: You or your spouse must be insured in order for Dependent children to be covered. Dependents are: Your legal spouse under age 70. Spouse coverage terminates at age 75. Your unmarried financially dependent children* age 14 days to 20 years (to 26 years if full time student). *natural and adopted children upon finalization of adoption; stepchildren and foster children living with you. Age limit does not apply to handicapped children. A person may not have coverage as both an Employee and Dependent. Only one insured spouse may cover Dependent children. BENEFIT AMOUNT Class Increments Maximum GI Employee $10,000 $500,000 New Hires Only Spouse $10,000 $100,000 New Hires Only Dependents $10,000 $20,000 New Hires Only Eligible Dependent Child(ren): Age 14 days to 6 months: $1,000 Age 6 months to 20 years of age (26, if full time student): choice of $10,000 or $20,000 Choose one benefit amount for all eligible children in family. GUARANTEED ISSUE (INITIAL ELIGIBILITY PERIOD ONLY) Employee: Under age 60: $100,000 Age 60 but under age 70: $10,000 Age 70 or older: none Spouse: Under age 60: $30,000 Age 60 or older: none GUARANTEED ISSUE is subject to underwriting rules and is not available in all circumstances. FEATURES FMLA/MSLA Continuation Portability Waiver of Premium EXCLUSIONS Death by suicide is not covered during the first two years an insured s insurance is in force. Insurance coverage is incontestable after it has been in force two years during the insured s lifetime, except for non payment of premium. For a comprehensive list of exclusions and limitations, please refer to the Certificate of Insurance. The Certificate also provides all requirements necessary to be eligible for coverage and benefits.

10 Basic Group Life Voluntary Group Life/ Accidental Death & Dismemberment Southside ISD provides coverage for employees for Basic Life/AD&D for active employees at a max of: $20,000 per employee* *Age reduction in benefits to employees who are over the age of 65, benefits are reduced by 35%, also at age 70 benefits are reduced by 50% ACCIDENT DEATH & DISMEMBERMENT This policy pays benefits for losses that are a direct result of an accidental injury that occurs while covered by this policy. Loss must occur within 90 days of the accident date and independent of all other causes. Please refer to schedule for a breakdown of AD&D qualification. Class Increments Max GI Employee Voluntary Life $10,000 $250,000* $150,000 Spouse $5,000 $100,000** $50,000 Dependent Children $1,000 $10,000** NA All full time active employees, spouses and children* are available for coverage. Employees are eligible for the following: *For the 2014 school year only new employees will be eligible for the GI amount. Any employee applying to increase their coverage will be subjected to underwriting guidelines by completing an EOI form. ACCIDENT DEATH & DISMEMBERMENT This policy pays benefits for losses that are a direct result of an accidental injury that occurs while covered by this policy. Loss must occur within 90 days of the accident date and independent of all other causes. *Any group policy combined with Aetna under this policy will not exceed the lesser of: a) $250,000 b) Five times annual salary **In no event shall a spouse or dependent child coverage exceed 50% of employees coverage. Dependent children covered from 14 days to age 21.