Employee Benefit Plans 2015-2016

Employee Benefit Plans 2015-2016 2016

Page 2 Dickinson ISD Business Services LEIGH MANUS COORDINATOR OF BENEFITS PAYROLL/BENEFITS Contact Information 281-229-6050 lmanus@dickinsonisd.org 281-229-6030 Table of Contents NOTIFICATION OF NEW HIRE BENEFITS ENROLLMENT FOR ELIGIBLE EMPLOYEES 3 INTRODUCTION TO SECTION 125/CAFETERIA PLAN 4 TRS ACTIVECARE PLAN HIGHLIGHTS 5 TRS ACTIVECARE STATE PLANS 7 ELIGIBLE BENEFITS UNDER THE CAFETERIA PLAN 8 NON ELIGIBLE BENEFITS UNDER THE CAFETERIA PLAN 21 FREQUENTLY ASKED QUESTIONS 21 BENEFITS WEBSITE ENROLLMENT 21 RETIREMENT SAVINGS 12 CONTACT INFORMATION 13 TRS ACTIVE-CARE DECLINATION CERTIFICATION 14 OVERVIEW OF BENEFITS 11

Page 3 Notification of New Hire Benefits Enrollment For Eligible Employees Overview of Benefits All eligible new employees shall review the benefits offered by the District and make the desired selections for the current benefit plan year. Eligible new employees have 31 days from date of hire to enroll for benefits. If not enrolled by day 31, new employees must wait for Open Enrollment. Plans Open Enrollment Period Coverage Dates Deductible Plan Year Medical August September 1-August 31 September 1-August 31 CareHere Clinic August September 1-August 31 N/A Dental September October 1-September 30 January 1 December 31 Vision September October 1-September 30 Once every 12 months Other Supplemental Benefits September October 1-September 30 N/A New employees must elect or decline each benefit that is offered to Dickinson ISD employees. Employees who decline medical coverage with the District must complete the TRS Active-Care Declination Certification form (located on the Reference Center on the online benefit system at www.benefitsolver.com, or at the end of this booklet) and return to the DISD Coordinator of Benefits. Eligible new employees are also offered coverage for themselves and their eligible dependents on a variety of plans, including CareHere Clinic, dental, vision, critical illness, accident, individual life, disability, legal services, and flexible spending accounts. Employees do not have to be enrolled in medical insurance to enroll in supplemental benefits. For plans not requiring health underwriting, coverage is effective the first of the month following date of hire. For benefits that require underwriting, coverage will be effective the first of the month after the company s approval. If payroll has been processed for the time period that the benefits are effective, the District will double the premiums for those benefits on the next payroll. The employee s benefit elections will roll forward to the new plan year; changes to an employee s benefits thereafter may only be made during the Open Enrollment period. Note: Employees must re-enroll each year (during the Open Enrollment period) for the Flexible Spending Accounts. Refer to the Reference Center on benefitsolver.com for more information about each benefit offered by the District.

Page 4 Introduction to Section 125/Cafeteria Plan The Section 125/Cafeteria Plan Benefit refers to Section 125 of the Internal Revenue Service Code of 1978. The Cafeteria Plan allows employees to deduct certain benefit premiums from gross earnings before federal withholding taxes are calculated. The amount elected for pre-tax deduction reduces taxable income, which reduces the amount of federal taxes withheld. The example below illustrates the effect of a pre-tax deduction on taxable income and take home pay for a married employee claiming one exemption: Without Section 125 With Section 125 (Pre-Tax) Monthly Salary $2000 Monthly Salary $2000 Less TRS ($128) Less TRS ($128) Taxable Income $1872 Less Insurance ($250) Less Taxes ($228) Taxable Income $1622 Less Insurance ($250) Less Taxes ($186) Take Home Pay $1394 Take Home Pay $1436 This employee saved $42 per month in taxes by paying for insurance benefits on a pre-tax basis. This means more spendable income at the end of the month to use for additional benefits or to increase take home pay. Important issues to keep in mind regarding Cafeteria Plans: Benefits, such as Flexible Spending Accounts, must be re-enrolled each year with an annual amount. If a benefit plan is changing to a new provider, the election must be made with the new provider in order to continue the coverage for that benefit. The pre-tax election of a benefit cannot be changed during the plan year unless a Qualified Family Status Change occurs. A qualified change includes the following: Marriage or divorce Birth, adoption, or death of a spouse or child Change in a spouse s or dependent s employment status Change in eligibility status of a dependent Becoming Medicare eligible

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Page 7 TRS ActiveCare Aetna State Plans Group # 866325 Dickinson Independent School District 2015-2016 ActiveCare 1-HD (District Pays $112.50 Per Check) Cost to Employee Employee Only $58.00 Employee and Child(ren) $195.00 Employee and Spouse $344.50 Employee and Family $503.00 Family (Both Employees Employed at DISD) $390.50 Split Premium Family (Spouse works at another TRS ActiveCare district) ActiveCare Select Plan (District Pays $112.50 Per Check) $195.25 Cost to Employee Employee Only $124.00 Employee and Child(ren) $268.50 Employee and Spouse $448.50 Employee and Family $553.00 Family (Both Employees Employed at DISD) $440.50 Split Premium Family (Spouse works at another TRS ActiveCare district) ActiveCare 2 (District Pays $112.50 Per Check) $220.25 Cost to Employee Employee Only $194.50 Employee and Child(ren) $383.50 Employee and Spouse $626.50 Employee and Family $648.00 Family (Both Employees Employed at DISD) $535.50 Split Premium Family (Spouse works at another TRS ActiveCare district) $267.75

Page 8 Eligible Benefits Under the Cafeteria Plan CareHere Clinic CareHere Clinic (Galveston County Government Employees Healthcare Center) offers healthcare to Dickinson ISD employees. Primary Care/Family Practice Services can be provided through the Healthcare Center for patients ages 2 and up. Preventative care, sports physicals, chronic conditions such as asthma or high blood pressure, and treatments for the common cold are some of the many services provided by the Healthcare Center. Employees and their families who are covered by a district-offered TRS-Active Care plan are eligible to access the clinic and its services by paying a monthly membership fee through payroll deduction. Only family members covered by the employee s TRS-Active Care plan may have access to the clinic. Employees NOT covered on one of the district s TRS-Active Care plans are eligible to access the clinic by paying a higher monthly membership fee. Family members of employees not covered by a TRS-Active Care Plan are not eligible. All services performed and prescriptions dispensed at the clinic are free to the enrolled employee and covered family members. Note: Membership to the clinic is NOT Health Insurance and does NOT satisfy the government s requirement to have Health Insurance coverage. Coverage Type Employee Rates if Covered on TRS Active Care Employee Rates if NOT Covered on TRS Active Care Employee Only $12.50 $25.00 Employee and Family $22.50 N/A

Page 9 Dental Insurance MetLife Dental is the dental insurance provider for the District. MetLife provides a traditional insurance plan that requires enrolled employees to pay an annual deductible of $50 and share in a percentage of the dental costs. The plan allows for the freedom to choose any dentist or to select a PPO dentist from a list of providers (located on their website at www.metlife.com), and receive contracted lower pricing for procedures with no balance billing. Coverage Type Cost To Employee Employee Only $19.03 Employee and Spouse $43.98 Employee and Child(ren) $47.02 Employee and Family $55.96 Coverage Type In-Network Out-of-Network Type A-Cleanings, Oral Exam 100% of Negotiated Fee 100% of R&C Fee* Type B-Fillings 80% of Negotiated Fee 80% of R&C Fee* Type C-Bridges and Dentures 50% of Negotiated Fee 50% of R&C Fee* Type D-Orthodontia 50% of Negotiated Fee 50% of R&C Fee* Deductible In-Network Out-of-Network Individual/Family $50.00/$150.00 $50.00/$150.00 Annual Maximum Benefit In-Network Out-of-Network Per Person $1,500.00 $1,500.00 Orthodontia (Lifetime) $1,500.00 $1,500.00 *R&C Fee Refers to Reasonable and Customary charge of most dentists in the same geographic area for the same or similar service.

Page 10 Vision Insurance VSP offers an economical way to purchase eye examinations, eyeglasses, and contact lenses from member doctors (located on their website at www.vsp.com). At the time of the visit, enrolled employees will pay a $10.00 co-payment for one eye exam a year and a $25.00 co-payment for materials (glasses or contacts). Glasses or contacts are covered up to $150 and may be purchased every 24 months. Additional services requested may result in additional charges. Coverage Type Cost To Employee Employee Only $4.95 Employee and Family $10.48 Cancer Insurance Allstate Benefits is the provider of cancer insurance. This is a supplemental insurance plan that provides payments directly to you to offset expenses related to the treatment of cancer. Once approved for this coverage, the plan pays according to a schedule of benefits. Optional coverage is available for an initial diagnosis rider and for any condition when confined to an intensive care unit of a hospital. Eligible dependent children may be enrolled up to age 26. Employees and their eligible dependents who enroll in the plan within 31 days of hire are guaranteed to be accepted without regard to prior cancer history. Pre existing condition limitations will apply for one year. A pre existing condition is a disease or physical condition for which symptoms existed or medical advice or treatment was recommended or received within the twelve month period prior to the effective date of coverage. The next plan year, evidence of insurability will be required for anyone electing coverage who waived the coverage during the current year s Open Enrollment. Coverage Type Base Plan Rates Plan Rates w/initial Diagnosis Plan Rates w/initial Diagnosis and ICU Rider Employee Only $10.82 $13.02 $14.64 Employee and Family $17.98 $21.98 $25.28 Accident Insurance SunLife offers supplemental insurance that pays a lump sum to the insured to use however is needed if injured as a result of a covered accident. Spouse is covered at a 100% of the employee benefit level and dependent children are covered at 50%. Coverage is guaranteed to be issued.

Page 11 Flexible Spending Account (FSA) Dependent Care Expense Account is a back-load account (expense reimbursed when money becomes available) that offers a tax savings on day care expenses for children under the age of 13 and for dependent adults unable to care for themselves. The employee makes an annual election for the estimated amount of expenses to be incurred. The annual election amount is deducted in equal amounts from each paycheck, before taxes are calculated, and then deposited in a special account for the employee. The employee is issued a debit card to pay for day care expenses and the money is deducted from the employee s account. When the debit card cannot be used at a day care facility, a claim form may be submitted for reimbursement of the expense. Medical Expense Reimbursement Account is a front-load account (all money is available Oct 1) that provides a tax savings on eligible medical, dental, and vision expenses incurred but not covered by insurance. Non-covered expenses apply to all family members. A MasterCard debit card will be issued to enrolled employees to pay for eligible expenses incurred. If the debit card is not accepted (or if the employee chooses not to use the debit card), the employee must submit a claim form and the expense will be reimbursed to the employee from his/her account. Only eligible expenses incurred during the plan year (Oct 1 Sept 30) may be reimbursed. Note: Any money not claimed by the employee ninety (90) days after the end of the plan year is forfeited. As of January 1, 2011, plan participants are no longer able to use FSA plans for over the counter medicines and drugs. Not all expenses are eligible for reimbursement. New employees to the District cannot enroll for the Flexible Spending Accounts until September enrollment. Maximum Dependent Care Expense (Per Household) Maximum Medical Expense Reimbursement $5,000 $2,550

Page 12 Non-Eligible Benefits Under The Cafeteria Plan Term Life Insurance Sun Life is the provider of a district paid $10,000 group term life insurance policy to every full time employee. Employees may elect to purchase optional life insurance coverage not to exceed $100,000. A new employee, under age 60 and within 31 days of hire date, may purchase up to $100,000 of coverage on the employee, up to $50,000 of coverage for an eligible spouse, and up to $10,000 of coverage for all eligible children without providing evidence of insurability. Lesser amounts are available for new employees age 60 or over. New amounts of coverage elected during the open enrollment period will be effective the first full day an employee is actively at work on or after October 1 of that plan year. The coverage terminates upon termination of employment with Dickinson ISD. Permanent/Portable Life Insurance Combined Life Insurance is the provider for permanent/portable individual life insurance. They offer low cost life insurance plans that are designed to last a lifetime. Coverage is available for employees, their spouses, and eligible dependents. The cost varies by age, gender, and the amount of coverage desired. All new hires who enroll within 31 days of hire, will be guaranteed up to $100,000 of coverage without having to provide evidence of insurability. The plan also contains a unique long term care benefit. The policy allows for up to 4% of the death benefit to be used monthly for long term care expenses. Example: A policy of $75,000 would pay $3,000 a month for up to twenty-five months for long term care expenses. Any amounts used for long term care expenses are deducted from the death benefit. Employees may apply for additional amounts of coverage on themselves and their spouses. Approval of any additional employee coverage over $100,000 and of any amount for spouse coverage is subject to health and underwriting guidelines set by the insurance company. The coverage is permanent/portable upon termination of employment with Dickinson ISD. Refer to the Reference Center on benefitsolver.com for more information about each benefit offered by the District.

Page 13 Critical Illness Insurance Metlife Critical Illness Insurance is the provider of supplemental insurance for certain major critical illnesses. Amounts of coverage are available in increments of either $10,000 or $20,000 and are payable upon the diagnosis of the illness. The initial benefit provides a lump-sum payment upon the 1st diagnosis of a covered condition. The plan will pay up to the total benefit of 3X the amount of your initial benefit until you receive the maximum of $30,000 or $60,000. (6 month waiting period between claims) Disability Insurance Standard Disability offers disability insurance, which provides payment of up to 2/3 (66.6%) of the employee s salary in the event that he or she becomes ill or injured and cannot work. Cost of coverage depends upon the amount of coverage selected and on how quickly the employee elects for benefits to begin. By selecting an elimination (waiting) period of 30 days or less, if you are ever hospitalized for a minimum of 24 hours, your elimination period will be waived. Pre-existing conditions will not be covered until after twelve months of continuous coverage. A pre-existing condition is any condition for which advice or treatment was received in the 90 days prior to the effective date of coverage (including pregnancy). Note: Disability coverage will be issued, without having to provide evidence of insurability, for new employees within 31 days of hire. Employee Assistance Plan (EAP) Interface EAP is the provider of various counseling, legal, financial, and wellness resources for employees and eligible family members. The service is provided by Dickinson ISD at no cost to the employee. No enrollment is required for this service.

Page 14 Legal Insurance ARAG Legal Insurance is the provider for legal services, providing you with easy access to legal support for you and your family. Last Will and Testament, living will, family law, divorce, motor vehicle driving defense, tax matters are all some of the many benefits offered. It also provides online resources to help you learn more about legal issues on your own. Coverage Type Cost to Employee UltimateAdvisor $9.00 Expanded UltimateAdvisor $11.75 Identity Protection Insurance ilock360 is the provider for identity protection solutions. With identity being your biggest asset and over 100,000 compromised identities found every day, you are protected at every angle. It can provide credit report monitoring, social security trace, CyberAlert, a full service identity restoration and much more. Coverage Type Plus Plan Premium Plan Employee Only $4.00 $7.50 Employee and Spouse $7.50 $11.00 Employee and Child(ren) $6.50 $10.00 Employee and Family $11.00 $13.50

Page 15 Frequently asked Questions Q. When is open enrollment for DISD benefit plans? A. Open enrollment for the medical plan and CareHere Clinic is August of each year for effective 9/1. Open enrollment for all other benefits (dental, vision, etc.) is in September for effective 10/1. Q. Who are the health care providers? Where can I find a list of network providers? A. Medical: Aetna (www.trsactivecareaetna.com) Dental: Metlife Dental (www.metlife.com) Vision: Vision Service Plan (VSP) (www.vsp.com) Q. Do I have to be enrolled in the medical insurance to receive any of the supplemental benefits (visions, dental, disability, etc)? A. No. You can enroll in any of the benefits we offer without being enrolled in medical insurance. Q. What do I do if I have lost or do not have my health insurance card? A. Log onto the Aetna website at www.trsactivecareaetna.com to order a new card. Temporary cards can be printed and used until you receive your new card in the mail. Q. Why have I not received my dental or vision card in the mail? A. Dental and vision cards are not mailed out by the provider. You may obtain paper cards for dental insurance at the Dickinson ISD Business Services. Social security numbers are used to verify coverage. Q. Can I cancel or make changes to my benefits during the year? A. No. All changes have to be done during Open Enrollment. Exception: You have a Family Status Change which consists of: marriage or divorce, the death of a spouse or child in your family, the birth or adoption of a child, or a change in the employment status of you or your spouse. Q. What benefits can be deducted pre-tax? A. Medical, CareHere Clinic, dental, vision, cancer, and Flexible Spending Accounts (FSA). FSAs include Medical Expense Reimbursement Accounts and Dependent Care Expense Accounts. Q. How can I find out the balance on my Flexible Spending Card? A. To order replacement cards, review card transactions and card balances: log onto www.mywealthcareonline.com and register. Q. What do I do if I haven t received information from COBRA? A. Medical: Contact Well Systems at (855)820-8198. All Other Benefits: Contact JEM Resources at (800)943-9179 Ext. 278.

Page 16 Benefits Website Enrollment 1. Go to www.benefitsolver.com 2. Click on Register 3. Type in your Social Security Number, Company Key and Date of Birth. The Company Key is DISD in all CAPITAL LETTERS.

Page 17 4. Read through the Electronic Signature notification and click Accept to move forward. 5. Create a User Name and Password. Confirm the password (at least 6 characters). Click Continue. Please make a note of ID and password for future use. Select your security phrase and answer.

Page 18 6. Click Continue to proceed to Log-In Page. 7. Log in with the new User Name and Password created in step 5. Log in here with the User Name and Password that you just created from steps above.

Page 19 Click here to start Benefit Enrollment. Click Reference Center for Plan Information at any time during enrollment. 8. Click the New Hire Enrollment button to begin enrollment. 9. If you are enrolling for health insurance, you will be asked if you want to start it on your date of hire or on the first of the month following your date of hire. Please be aware that if you select Date of Hire, you will be charged for a full month of insurance regardless of your hire date. This option is only for the health insurance; all other supplemental policies will start the month following your date of hire. 10. Continue through all of the steps, enter the required information, and accept enrollment at the end of these steps. If you close out at any time before you click I Agree, your enrollment will NOT be complete. You may close out and re-enter the website again and your previous information will be saved and you can continue to make changes until you finally click the I Agree button. When you click I Agree, you can no longer make changes.

Page 20 You must click I Agree to finish your enrollment. If you do not, the changes you have requested will not be received by the benefits and payroll departments. 11. Once enrollment is complete, a summary of benefits selected may be printed for your records. Click the I Agree button. A record of your enrollment will be available on the website to view all year long. Plans Open Enrollment Period Coverage Dates Deductible Plan Year Medical August September 1-August 31 September 1-August 31 CareHere Clinic August September 1-August 31 N/A Dental September October 1-September 30 January 1 December 31 Vision September October 1-September 30 Once every 12 months Other Supplemental Benefits September October 1-September 30 N/A

Page 21 Retirement Savings Section 457 Deferred Compensation Plan The 457 plan is a district sponsored voluntary retirement savings plan that allows an employee to save money for retirement on a tax-deferred basis. The Region 10 457 plan has investment options which do not contain any surrender charges or penalties upon distribution. The plan contains most of the same features of the 403(b) plan, but is different in which it is not subject to the 10% IRS excise tax for early withdrawal. Section 403(b) Tax Deferred Retirement Savings Plan The 403(b) plan is a voluntary retirement savings plan that allows an employee to save money for retirement on a tax-deferred basis. There are different types of investments and a number of representatives who are available to assist the employee in establishing a 403(b) retirement plan. 403(b) Versus 457 Retirement Savings Plans Feature 403(b) 457 Tax Penalty to Withdraw Funds 10% (goes away at age 59 1/2 OR 55 and retired) None Investment Options Annuities or Mutual Funds/Custodial Accounts Managed Portfolios or Self Directed Mutual Funds Investment Committee/ Advisor Oversight Fees NO Higher fees, surrender charges, pay commissions YES Very low fees relative to most 403(b) products; no commissions Contribution Limits (Can contribute to both) $17,500; $23,000 age 50+ $17,500; $23,000 age 50+ Withdrawals, Loans Service Loan rules same for both plans; withdrawal rules very similar Choice of individual sales agent, toll free numbers, and/or Internet Loan rules same for both plans; withdrawal rules very similar Toll free numbers, and/or Internet

Page 22 Retirement Savings WITHOUT Retirement Savings WITH Retirement Savings Gross Income $3000 Gross Income $3000 Less TRS ($192) Less TRS ($192) Less TDSP ($0) Less TDSP ($200) Taxable Income $2808 Taxable Income $2608 Less 28% Tax ($786.24) Less 28% Tax ($730.24) Take Home Pay $2021.76 Take Home Pay $1877.76 The take home pay is reduced $144.00 and you have $200.00 invested and working for you. To participate for the first time or to make changes to your current 403(b)/457 plan, you must go to the Region 10 website, www.region10rams.org. All transactions regarding 403(b)/457 plans, including starting a new plan or making changes to contribution amounts to a current plan, must be done on the Region 10 website. First Time Users Go to www.region10rams.org. 1. Click on Login. 2. Click on Register. 3. Input the district password (case sensitive): 403(b) district password: disd403b 457(b) district password: dicki457 4. Enter your SS# and click Continue. 5. Create your own User Name and Password select Participant and click Login. If you establish an account with a new vendor, please note that you must still contact the vendor to set up the 403(b) account paperwork with them. If you need assistance with the JEM website or have questions on the 403(b) process, please call JEM Resource Partners at 1-800-943-9179.

Page 23 Contact Information Dickinson ISD Business Services LEIGH MANUS COORDINATOR OF BENEFITS PAYROLL/BENEFITS Contact Information 281-229-6050 lmanus@dickinsonisd.org 281-229-6030 Benefit Provider Contact Information Allstate Benefits 1-800-521-3535 ARAG Legal 1-800-247-4184 CareHere Clinic 1-877-423-1330 www.carehere.com Caremark Prescriptions 1-800-222-9205 Combined Life Insurance 1-877-352-3303 Flexible Spending Accounts 1-800-943-9179 Interface EAP 1-800-324-2490 JEM Resources (403b Annuities/457 Deferred Compensation Plan) 1-800-943-9179 Metlife Critical Illness 1-800-438-6388 MetLife Dental (Group # 138501) 1-800-942-0854 Standard Disability 1-800-368-1135 Sunlife Accident 1-800-247-6875 SunLife Group Term Life Insurance 1-888-724-0525 TRS Active-Care (Aetna-Group # 866325) 1-800-222-9205 www.trsactivecareaetna.com VSP Vision 1-800-877-7195 Well Systems (Cobra Medical) 1-855-820-8198

I am enrolling myself and declining coverage for those listed below. Page 24 TRS Active-Care Declination Certification Dickinson ISD TRS #1377 Group # 866325 This is to certify that the available health coverage has been explained to me. I have been given the opportunity to apply for the coverage offered to me and my eligible dependents and have voluntarily elected to decline the coverage as indicated below. If I desire to apply for coverage at a later date, I understand there may be a delay in the effective date of the coverage as well as a preexisting condition exclusion period (not applicable to HMO coverage). Employee Name: SSN: Open Enrollment for Plan Year: 2015-2016 New Hire Actively-at-work Date: I am declining coverage for myself and my spouse/dependents. Spouse name: Reason for declining: Other Group Coverage Medicare Medicaid Other, explain: Dependent Child name: Reason for declining: Other Group Coverage Medicare Medicaid Other, explain: Dependent Child name: Reason for declining: Other Group Coverage Medicare Medicaid Other, explain: Dependent Child name: Reason for declining: Other Group Coverage Medicare Medicaid Other, explain: Dependent Child name: Reason for declining: Other Group Coverage Medicare Medicaid Other, explain: Employee name: Reason for declining: Other Group Coverage Medicare Medicaid Other, explain: Spouse name: Reason for declining: Other Group Coverage Medicare Medicaid Other, explain: Dependent Child name: Reason for declining: Other Group Coverage Medicare Medicaid Other, explain: Dependent Child name: Reason for declining: Other Group Coverage Medicare Medicaid Other, explain: Dependent Child name: Reason for declining: Other Group Coverage Medicare Medicaid Other, explain: Dependent Child name: Reason for declining: Other Group Coverage Medicare Medicaid Other, explain: Signature: Date: Please Mail Completed Form To: Dickinson ISD Business Services Attn: Leigh Manus P.O. Drawer Z Dickinson, TX 77539

Page 25 Notification of New Hire Benefits Enrollment For Eligible Employees Overview of Benefits As of January 1, 2014, The Affordable Care Act (ACA) requires you to have health insurance for yourself and your dependents. All eligible new employees shall review the benefits offered by the District and make the desired selections for the current benefit plan year. Eligible new employees have 31 days from date of hire to enroll for benefits. If not enrolled by day 31, new employees must wait for Open Enrollment. New employees must elect or decline each benefit that is offered by visiting www.benefitsolver.com. Employees who decline medical coverage with the District must also complete the TRS Active-Care Declination Certification form (located at www.benefitsolver.com on the Reference Center or at the end of this booklet) and return to the DISD Coordinator of Benefits. Eligible new employees are also offered coverage for themselves and their eligible dependents on a variety of plans, including CareHere Clinic, dental, vision, cancer, critical illness, accident, individual life, disability, legal services, and flexible spending accounts. Employees do not have to be enrolled in medical insurance to enroll in supplemental benefits. Follow the instructions in this booklet to elect or decline coverage. Call the Coordinator of Benefits at 281-229-6050 or the Payroll/Benefits Office at 281-229-6030 with any questions concerning health insurance or any of the supplemental benefits. Visit www.trsactivecareaetna.com for details on the district s health plan or to locate network providers. Your signature confirms that you have received a copy of the Affordable Care Act notice and a copy of the New Hire Benefits Plans. Employee Signature Date Name ID Number Campus/Department Hire Date Email