The content of this CD is designed only for communication purposes and is not to be considered a contract, nor does it guarantee or imply coverage. Consult your plan booklet or Benefit Administrator for detailed coverage or pre-existing limitations.

FRENSHIP ISD

2012 Benefit Open Enrollment Plan Overview

Online Benefit Access 24/7

Visit www.birdvilleisdbenefits.com for all of your benefit needs. Review the Employee Benefit Guide. Find important links to all benefit carriers.

Section 125 Cafeteria Plan

There are special rules and requirements to receive the pre-taxbenefit election plan privileges:

Birdville ISD must set a plan year. The plan year is September 1 – August 31 of each year.

Although coverage is voluntary, every employee is required to review their current elections, make changes as desired, by completing the Birdville ISD online enrollment.

Any pre-tax elections will remain in effect unless you have a qualified event change in family status. Qualifying event benefit changes must be made within 30 days of the event and changes must be consistent with the event.

Qualifying Event Examples: Marriage, Divorce, Birth or Adoption, Death, Change in Dependent Eligibility Status, etc.

Medical Out-of-Pocket Expenses ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3

Deductible $2,400/$2,400 $1,200/$3,000 $750/$2,250 $300/$900

Ind./Family Ind./Family Ind./Family Ind./Family

Co-Pay N/A N/A $30 co-pay for primary

$20 co-pay for primary

$50 co-pay for specialist*

$30 co-pay for specialist*

Co-Insurance 20% (In-net) after deductible

20% (In-net) after deductible

20% (In-net) after deductible

20% (In-net) after deductible

40% (Out-net) after deductible

40% (Out-net) after deductible

40% (Out-net) after deductible

40% (Out-net) after deductible

*Specialist In-Network office visits are subject to the co-pay amount. Specialist In-Network treatment visits are subject to the deductibles and then the co-insurance percentages. Specialist Out-of-Network office visits and treatment visits are all subject to the deductibles and then the co-insurance percentages. For specific coverage amounts, contact BCBS at 1-866-355-5999.

Understanding Prescription Benefits

Did you know…

• Most pharmacies will charge you the co-pay amount for a generic drug even if it is offered on

their discount plan for less.

• The following are a few pharmacies that offer discount generic drug plans:

CVS Walgreens Wal-Mart/Sam’s Kroger

• Ask your Pharmacy to “use the list” for applicable generic drugs and you could save approximately $120.00 per year on just 1 generic maintenance medication by using the pharmacy discount plans instead of your insurance co-pay!

RX Deductible

ActiveCare 1-HD

ActiveCare 1 ActiveCare 2 – 2012-2012

change

ActiveCare 3

Deductible: $2,400/ $1,200/ $0 Individual for Generic $200 Individual for Brand

$75 Individual $2,400 $3,000

NEW THIS YEAR: American Public Life MEDlink® Plan *MEDlink is designed to supplement your employer’s medical plan. This plan provides supplemental coverage to help offset out-of-pocket costs that you may experience due to deductibles and coinsurance for an inpatient hospital stay.

In-Hospital BenefitPays expenses you incur as an Inpatient (at least 18 continuous hours) up to $2,500 or $1,500 per confinement (based on plan you select).

Out-patient Benefit Pays up to $200.00 per treatment in:

Hospital Emergency RoomOutpatient surgery in a Hospital Outpatient Facility Outpatient surgery in a free-standing Outpatient Surgical CenterDiagnostic testing in a Hospital Outpatient FacilityDiagnostic testing in a MRI Facility

All benefits for the same or related conditions will be subject to the maximum benefit, unless such conditions are separated by 90 consecutive days, then a new maximum out-patient benefit will apply.

Physician Benefit:Physician visits for sickness or injury due to an accident: $25.00 per visit, maximum five visits per family per calendar year, for treatment received in a:

Physician’s officeHospital Outpatient ClinicFree-standing Emergency Care Clinic

*This policy has limitations and exclusions. Please refer to the policy and brochure for benefits and provisions.

MEDlink® – Example of Savings

INPATIENT HOSPITAL EXAMPLE:Hospital Stay + Surgery = $28,500 total expensesEmployee only, age 45

ActiveCare 2 ActiveCare 1

Medical Plan Medical Plan

without MEDLink with MEDLink

Deductible: $750 $1,200 Hospital Co-pay (3 days in-patient): $450 Coinsurance (20% in-network): $2,000 $2,000 Out-of-Pocket (deductible & coinsurance combined): $2,750 $3,200 MEDLink GAP Coverage N/A $1,500 Average Annual Premium for MEDLink (GAP) @ $21.00 X 12 $252 Total Out-of-Pocket Expense: $3,200 $1,952 Total Savings: $ 1,248.00

MEDlink® Eligibility

You are not eligible for the MEDlink plan if any of the following apply to you:

Employees (or their dependents) who are not covered under the school’s major medical plan.

Anyone covered by TRS-Care (retiree plan), Medicare, Medicaid or Medical Savings Accounts.

Employees who have an HSA that is being actively funded.

Non-residents of the United States. Employees not actively at work on the plan effective

date.

MetLife PPO Dental Insurance

NEW PROVIDER: MetLife offers two PPO plan options:

PPO plans allow the freedom to choose any dentist, however, if you go to a network provider, benefits will be based on a reduced fee schedule. Utilizing a network provider gives you “more bang for your buck”.

If you choose to go to an out-of-network provider, the High PPO plan has less out of pocket cost / balance billing versus the Low PPO option.

High PPO Plan – $1,250 calendar year maximum, $50 Deductible. Orthodontics for children to age 19: $1,000 lifetime maximum. PPO In-Network Benefits: 100% Preventive services, 80% Basic services, 50% Major services and 50% Orthodontics. Out-of-Network reimbursement at 90% of usual and customary charges.

Low PPO Plan – $1,250 calendar year maximum, $50 Deductible. Orthodontics for children to age 19: $1,000 lifetime maximum. PPO In-Network Benefits: 100% Preventive services, 50% Basic services, 50% Major services and 50% Orthodontics. Out-of-Network reimbursement is based on the in-network fee schedule.

Employees currently enrolled in Guardian’s NAP plan will rollover to MetLife High PPO plan. Employees currently enrolled in Guardian’s Value plan will rollover to MetLife Low plan.

MetLife will takeover current deductible and calendar year benefits you have met under Guardian prior to 9/1 for the current calendar year.

MetLife DHMO Dental Insurance

MetLife offers a cost effective DHMO dental plan : The DHMO plan requires you to select a primary care dentist. No benefits are payable if

you visit a dentist out-of-network or a dentist who is not your assigned primary care dentist.

DMHO Plan – This plan offers dental benefits through a network of participating primary and

specialty care dentists with co-pays for services. This plan has no waiting periods or plan maximums.

All Employees must select a MetLife primary care dentist in the enrollment system.

If a covered participant is banded and in active Orthodontic treatment as of 9/1/2012, you must complete a transition of care form and return to Babs within 30 days of 9/1/2012 to receive DHMO Orthodontic benefits under the MetLife plan.

When searching for a network provider, the MetLife DHMO Managed Dental Care Plan is: MET335

MetLife Optional Life Insurance Eligible employees receive $10,000 employer-paid life and AD&D

insurance from Birdville ISD.

Employees cannot be enrolled as both an employee and a spouse. If both parents are employees, only one may elect coverage on dependent children.

*This Year Only Employees can enroll new or increase coverage for the lesser of $100,000 or 5 times salary/up to $400,000 with no health questions asked!

*Employees can increase spouse coverage by one $5,000 increment as long as current spouse coverage is less than $30,000. All increases for spouse will require a statement of health if your spouse has $30,000 or more of current coverage .

*Must meet Actively at Work Requirement

New coverage for a spouse or child requires a statement of health.

National Benefit Services – FSA

National Benefit Services (NBS) is the new TPA for flexible spending accounts beginning September 1, 2012.

The Birdville ISD Flexible Spending Account (FSA) Plan Year:

September 1, 2012 to August 31, 2013

Plan Maximum- decreasing to $2,500/plan year due to PPACA.

Eligible services must be incurred in the plan year.

FSA accounts can be used for all IRS Classified Dependents.

FSA accounts are “Use it or lose it” – plan contributions carefully!

Participants have a 90 day grace period to file claims following plan year.

Healthcare Reimbursement Flex Card

The NBS Flex Card makes using your FSA quick and easy – just swipe it as a payment for your eligible expenses (doctor’s visits, prescriptions, etc.) and the funds are automatically deducted from your FSA.

There is no cost for the flex card fee for healthcare reimbursement participants!

All participating employees will receive 2 NBS flex cards; additional cards may be ordered for family members for $5.00. Keep your cards, flex cards are valid for four years.

Always keep your receipts! An itemized receipt may be required for substantiation of certain expenses.

The best form of substantiation for medical expenses is your Explanation of Benefits form (EOB) from BC/BS (see Babs).

There is a $5 replacement fee for lost/stolen cards.

Additional Supplemental Benefits

The following benefits will remain with the same carrier and same rates for the 2012-2013 plan year:

Superior VisionUNUM Educator Disability – all new or increases in

coverage are subject to a 12 month pre-existing condition exclusion.

American Public Life (APL) Cancer IDWatchdog Identity Theft Protection

For complete benefit information go to: www.birdvilleisdbenefits.com.

Enrollment assistance will be available on various campuses April 30th – May 18th. Contact Babs at 817.547.5782 or FBS at 800.583.6908 if you have questions. any