The content of this presentation is designed only for communication purposes and is not to be...

The content of this presentation is designed only for communication purposes and is not to be considered a contract, nor does it guarantee or imply coverage. Consult your Benefit Administrator for questions.

FRENSHIP ISD

2013 Benefit

Open Enrollment

Plan Overview

Online Benefit Access 24/7

Visit www.mybenefitshub.com/cedarhillisd for all of

your benefit needs.

Review the Employee Benefit Guide.

Find important links to all benefit carriers.

Find enrollment times and locations for your campus.

Section 125 Cafeteria Plan

There are special rules and requirements to receive the pre-tax

benefit election plan privileges:

Cedar Hill ISD must set a plan year. The district’s plan year is

September 1 - August 31 of each year. Open Enrollment will be held July 26 through August 26.

Although coverage is voluntary, every employee is required to review their personal information, make elections/waive as desired, by completing the CHISD on-line 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 31 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.

CIGNA PPO Dental Insurance

CIGNA 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, PPO plan Option 2 has less out of pocket cost / balance billing versus Option 1.

Base DPPO Plan – $1,000 annual maximum, $50 Deductible. Orthodontics for children to age 19: $1,000 lifetime maximum. Out-of-Network Reimbursement is based on the in-network fee schedule.

High DPPO Plan – $1,000 annual maximum, $50 Deductible. Orthodontic for children to age 19: $1,000 lifetime maximum. Out-of-Network Reimbursement at 90% UCR.

PPO In-Network Benefits: 100% Preventive services, 80% Basic services, 50% Major services and 50% Orthodontics (for child to age 19).

PPO dental network: CORE network.

CIGNA Dental Monthly Premiums

CIGNA Dental DPPO Plans Base Plan Employee Only $23.34

Employee + One Dependent $45.47

Employee + Family $68.50

High PlanEmployee Only $32.96



Superior Vision Insurance In-Network Benefits:

$10 Exam and $25 Materials co-pay

Prescription Lenses – once every 12 months

One Frame (up to $125) – once every 24 months

OR you may choose contacts instead of lenses

Contacts (up to $120) – once every 12 months

Extra Discounts and Savings

10% to 30% savings on additional purchases of eyewear and contact lenses.

Superior Vision Monthly Premiums

Vision Monthly Premium

Employee Only $ 7.10



Hartford Educator Select Disability Coverage is guaranteed issue up to $7,500 monthly benefit

(based on income). New coverage and increased coverage is subject to a 12-month

pre-existing condition exclusion. However, there is a four week benefit paid.

Benefits can last while you are under a doctor’s care to age 65 due to illness or injury.

You may choose waiting periods in days of: 0/7, 14/14, 30/30, 60/60, 90/90, and 180/180, based on your need. Waiting period is waived if you elect a 30 day elimination or less plan, and you are hospitalized.

Telephonic Claims for faster, easier processing

TransAmerica Cancer Insurance

.

This is a supplemental plan designed to help cover out of pocket expenses not covered by your medical plan and pays benefits directly to you.

Coverage is available for employees age 18 or over, and their spouse and unmarried, dependent children up to age 25.

This coverage is offered to employees who have not been diagnosed with cancer, or who have been cancer and treatment free for the last 10 years.

Annual Cancer Screening Benefit - $50 per calendar year Hospital Indemnity Benefit - $100 a day Radiation/Chemotherapy – options of $5,000 or $15,000 per 12 month period Lodging Benefit – Up to $50 a day for non-local treatment up to 50 days First Occurrence benefit- $1000 or $2000 Intensive Care Optional Rider - $300 or $600

Dearborn National Group Life Insurance

New Employees can enroll within the first 30 days of employment for the lesser of $200,000 or 7-times your annual salary and 50% of employee amount up to $50,000 for your spouse and up to $10,000 for your dependent child(ren) without a statement of health (must meet actively at work requirements).

Employee must cover themselves to cover a spouse or dependent child.

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

Premiums are age-banded.

Axis AD&D Insurance

This plan is designed to help provide you with peace of mind against the risk of covered accidental death or dismemberment.

Coverage is available for employee or family. The amount of insurance you select is called the “Principal

Sum”. Employee principal sum can be elected for $200,000,

$100,000 or $50,000. Spouse and child coverage is a percentage of principal sum of employee coverage.

Texas Life Individual Life Insurance

Offers guaranteed level coverage to age 121; premium stays level for a significant period of time.

You and your family continue coverage without loss of benefits or increase in costs should you terminate your employment.

Policies can be purchased on spouse, children and grandchildren through age 18 without employee coverage.

Contact FBS at 469-385-4640 for an application.

FSA Administrator – National Benefit Services The Cedar Hill ISD Flexible Spending Account (FSA) Plan Year-

September 1, 2013 to August 31, 2014

Plan Maximum- $2,500 each plan year – MUST be re-elected each year.

Services must be incurred in plan year.

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

year.

FSA accounts can be used for all IRS Classified Dependents.

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

Healthcare Reimbursement Flex Card

The flex card is Broker paid for CHISD employees 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.

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. Cards are reloaded on September 1.

Always keep your receipts! In the event of an audit an itemized receipt may be required for substantiation of expenses.

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

Healthcare Reimbursement Account

Examples Are:

Doctor office co-pays

Prescription co-pays

Dental Expenses

Vision – Glasses, Contacts, Etc.

TAX FREE ACCOUNT FOR OUT-OF-POCKETMEDICAL EXPENSES on a PRE-LOADED VISA CARD

Dependent Care Reimbursement Account

Tax Free Account for eligible

Dependent/Child Care

Expenses

Tax Free Deduction via payroll

vs. deduction on income tax

Annual Maximum - $5,000

Must be re-elected every year

How to file a claim with NBS:

Visit www.mybenefitshub.com/cedarhillisd & click forms to download Reimbursement Claim Form

Claim Form may be Faxed, Mailed or Emailed to National Benefit Services

You may receive your reimbursement via check or direct deposit

Claims may be viewed on your benefit website

http://www.mybenefitshub.com/allenisd

MEDlink® – Example of Savings

INPATIENT HOSPITAL EXAMPLE:Illness: $11,000 In-hospital Cost – Emp. Only Age 45

Plan 2 Plan 1-HD

Deductible $ 1,000 $ 2,400 + 20% co-insurance $ 2,000 $ 1,720EE out of pocket $ 3,000 $ 4,120

MEDlink® pays $ 2,500 $ 2,500Total Out of Pocket $ 500 $ 1,620MedLink Gap Premium/Monthly $ 29.04 $ 29.04TRS Medical Premium $304.00 $ 100.00TRS with MedLink Monthly cost $333.04 $ 129.04

Annual Premium Savings AC2 vs AC1HD $ 2,448

For complete benefit information and enrollment instructions log on to: www.mybenefitshub.com/cedarhillisd.

Contact FBS at 469.385.4685 if you have questions or need enrollment assistance. any questions.

Health Coverage for You and Your Family

PPO Plan OverviewActiveCare 1-HD, 2 and 3 Plans

2013-2014 Plan Year

PPO Plan Overview (Network Level of Benefits)

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ActiveCare 1-HD ActiveCare 2 ActiveCare 3

Deductible $2,400 employee only$4,800 family

$1,000 individual$3,000 family

$300 individual$900 family

Out-of-Pocket Maximum(does not include copays or deductibles)

$3,850 employee only$4,200 family

$4,000 individual$8,000 family

$1,000 per individual

Coinsurance(Plan pays/participant pays)

80% / 20% 80% / 20% 80% / 20%

Office Visit Copay 20% after deductible$30 for primary

$50 for specialist$20 for primary

$30 for specialist

Primary means care provided by family practitioners, internists, OB/GYNs and pediatricians. All other physicians are specialists.

Family Deductible IllustrationAmy covers spouse and three dependents

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$4,800

$1,000 $800 $400

Amy Sue Chris

Ted Bob Sue

ActiveCare 1-HD with $4,800 family deductible

• The family deductible may be met by one or more people

• Plan pays benefits once entire $4,800 is met ̶ there is no individual deductible to meet

ActiveCare 2 with a $1,000 individual deductible and a $3,000 family deductible

• Plan pays benefits for an individual as his/her deductible is met

• Everyone helps to meet the family deductible, but no one person pays more than the individual amount

Bob

$600

Amy

Ted

$200

Chris

Out-of-Pocket (OOP) Maximum IllustrationAmy covers spouse and three dependents

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$4,200

$4,000 $2,000 $600

Amy Sue Chris

Ted Bob Sue

ActiveCare 1-HD with $4,200 family OOP maximum

• The family out-of-pocket maximum may be met by one or more people

• Plan pays benefits once entire $4,200 is met ̶ there is no individual amount to meet

ActiveCare 2 with a $4,000 individual and $8,000 family OOP maximum

• Plan pays benefits for an individual as his/her OOP maximum is met

• Everyone helps to meet the family OOP maximum, but no one person pays more than the individual amount

Bob

$1,000

Amy

Ted

$400

Chris


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Preventive Care Clarification

Services ActiveCare 1-HD ActiveCare 2 ActiveCare 3

Preventive Care Plan pays 100% (deductible waived)

Plan pays 100%(no copay required)

Plan pays 100%(no copay required)

Routine eye exam (one per plan year)

Hearing exam20% after deductible

$30 for primary$50 for specialist

$20 for primary$30 for specialist

• 100% coverage for certain age- and gender-specific preventive care services when network providers are used

• Must be billed by provider as “preventive care”


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Benefits (continued)

Services ActiveCare 1-HD ActiveCare 2 ActiveCare 3

High-tech Radiology(CT scan, MRI, nuclear medicine)

20% after deductible

$100 copay per service, plus 20%

after deductible

$100 copay per service, plus 20%

after deductible

Inpatient Hospital 20% after deductible

$150 copay per day, plus 20%

after deductible($750 max copay per

admission; $2,250 max/year)

$150 copay per day, plus 20%

after deductible($750 max copay per

admission; $2,250 max/year)

Emergency Room 20% after deductible

$150 copay, plus 20%

after deductible(copay waived

if admitted)

$150 copay, plus 20% after deductible (copay waived

if admitted)

Outpatient Surgery 20% after deductible

$150 copay per visit, plus 20%

after deductible

$150 copay per visit, plus 20%

after deductible

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New!! Effective Sept. 1, 2013

• MRIs• CAT or CT Scans• Endoscopy procedures• Colonoscopy procedures• Back or spinal surgery

• Knee surgery• Shoulder surgery• Hip or joint replacement

surgery• Bariatric surgery

BVABenefits Value Advisor

Real-time access to current cost and

quality transparency

Appointment scheduling

Clinical decision support tools

Understanding benefits and how to best use them

Referrals to condition management programs

Preauthorizationcoordination

Help get benefits information and find network providers for:

One-Call Solution: 1-866-355-5999 Customer Service

Your Prescription Drug Plan

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• Express Scripts administers your prescription drug plans on behalf of TRS

– ActiveCare 1-HD, 2, and 3 plans

• Benefit includes both a retail and mail component

• Express Scripts has its own mail-order pharmacy where specialist pharmacists focus on compliance and lower cost options for the patient, and the automated filling system ensures the prescription is filled accurately.* Express Scripts buys medication from the most reputable suppliers

*Express Scripts’ mail-order pharmacies fill about 2 million prescriptions per week through a highly automated process that is 99.9997% accurate and is 23 times more accurate than a retail pharmacy

“Dispensing Error Rate in a Highly Automated Mail-Service Pharmacy Practice”; Nov. 2007, Pharmacology, a peer-reviewedjournal of the American College of Clinical Pharmacy

Prescription Drug Benefits – Network Level

30* If you obtain a brand-name drug when a generic equivalent is available, you are responsible for the generic copayment plus the cost difference

between the brand-name drug and the generic drug. Chart illustrates benefits when network pharmacies are used. Non-network benefits are also available; see Enrollment Guide for more information.

Features ActiveCare 1-HD ActiveCare 2 ActiveCare 3Drug Deductible(per person, per plan year)

Subject to plan year deductible

$0 generic; $200 brand $75

Retail Short-Term(up to 31-day supply)Tier 1 (Generic)Tier 2 (Preferred Brand)Tier 3 (Non-Preferred Brand)

20% coinsuranceafter deductible

$20

$40* $65*

$15

$35* $60*

Retail Maintenance(after first fill, up to31-day supply)Tier 1 (Generic)Tier 2 (Preferred Brand)Tier 3 (Non-Preferred Brand)

$25 $50* $80*

$20 $45* $75*

Mail Order and Retail-Plus(up to 90-day supply)Tier 1 (Generic)Tier 2 (Preferred Brand)Tier 3 (Non-Preferred Brand)

$45$105*$180*

$45$105*$180*

Specialty Medications (retail or mail)

20% coinsurance after deductible $200 per fill $200 per fill

Information Resources• TRS Website – www.trs.state.tx.us/trs-activecare

– Pharmacy Benefit Highlights– List of maintenance medications– FAQs– Download forms

• Express Scripts Participant Website – www.express-scripts.com– Prior authorization list– Formulary information– Locate a participating pharmacy– Generics Rx Advantage– My Rx Choices® / Price a Medication– Health and wellness information– Mobile App– Check prescription status– Order mail order refills– Download forms– Express Scripts widget

• Customer Service – 1-866-355-5999 • Benefits Booklet

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Who is Eligible to Enroll?

To be eligible for TRS-ActiveCare coverage, you must:• Be employed by a participating district/entity and

– Be an active, contributing TRS member or– Be employed 10 or more regularly scheduled hours

each week

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Health care coverage for public school employees and their families

Employees NOT Eligible to Enroll

• State of Texas employees or retirees• Higher education employees or retirees• TRS retirees, receiving or who declined coverage under

TRS-Care

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These individuals are not eligible to enroll for TRS-ActiveCare coverage as employees, but they can be covered as a dependent of an eligible employee.

Dependent Eligibility

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Spouse, including common law spouse

A child under age 26: a natural child, an adopted child (or a child who is lawfully placed for legal adoption), foster child, or child under legal guardianship of the employee

“Any other child” under the age of 26 (unmarried) in a regular parent-child relationship with the employee – Must meet residency and support criteria

A grandchild under age 26

Unmarried disabled dependent (age 26+) – Must live with employee

• A dependent does not include a brother or sister of an employee unless the sibling is an unmarried individual under 26 years of age who is either: (1) under the legal guardianship of the employee, or (2) in a regular parent-child relationship with the employee and meets the “any other child” criteria

• Parents and grandparents of the covered employee do not meet the definition of an eligible dependent

Special Eligibility Situations

• If employee and spouse both work for a participating district/entity:– A spouse may be covered as an employee or as a

dependent of an employee – Only one parent can cover dependent children

• A child (under age 26) employed by a district/entity and a contributing TRS member cannot be covered as a dependent – The child must be covered as an employee – If the child is not a contributing TRS member, the child

may be covered as a dependent

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Making Changes/Special Enrollment Events

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Enrollees may be able to enroll for coverage, change plan options, or change the dependents he or she covers during the plan year within 31 days after a special enrollment event occurs

• New dependent– Marriage, birth, adoption or placement for adoption– Special rules apply to newborns

• Loss of other coverageChanging districts/entities is not considered a special enrollment event

Newborns

• Covered first 31 days if employee has coverage– Does not apply to newborn grandchildren

• Must add newborn within 60 days after the date of birth or up to one year after the date of birth if: – Employee has “employee and family” or “employee and

child(ren)” coverage at the time of birth and at the time of enrollment

• Plan changes must be made within 31 days after the newborn’s date of birth

• Not necessary to wait for newborn’s Social Security number– Submit application without SSN to enroll– Re-submit another form after SSN is issued

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Cost for Health Coverage2013-2014 Plan Year

TRS-ActiveCare Medical Premiums TRS-ActiveCare Monthly Premiums

Employee Employer Monthly

Pays Pays Total

TRS ActiveCare 1-HDEmployee Only $100.00 $225.00 $325.00Employee/Spouse $569.00 $225.00 $794.00Employee/Child(ren) $347.00 $225.00 $572.00Employee/Family $835.00 $225.00 $1,060.00

TRS ActiveCare 2 Employee Only $304.00 $225.00 $529.00Employee/Spouse $978.00 $225.00 $1,203.00Employee/Child(ren) $616.00 $225.00 $841.00Employee/Family $1,098.00 $225.00 $1,323.00

TRS ActiveCare 3 Employee Only $571.00 $225.00 $796.00Employee/Spouse $1,585.00 $225.00 $1,810.00

Employee/Child(ren) $1,044.00 $225.00 $1,269.00Employee/Family $1,765.00 $225.00 $1,990.00

Application to Split Premium

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• Married couples working for different participating entities may “pool” funds

• Optional• Requires an Application

to Split Premium form to be completed by both employees and employers

• Form available online

ID Cards (mailed to your home)

• PPO plans (ActiveCare 1-HD, 2 and 3)

– Separate cards for medical and prescription drugs

• Blue Cross and Blue Shield of Texas• Express Scripts

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www.bcbstx.com/trs

Enrollment Info

Blue Access for Members

Blue Access for MembersSM

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Online member management tool• Research health conditions• View claims history and print

Explanation of Benefits (EOB) statements

• Locate a network doctor or hospital• Order additional ID cards,

or print a temporary ID• Take a confidential health assessment

Send secure email messages to BCBSTXCustomer Advocates Monday thru Friday 7 a.m. to 10 p.m. (CT)

EOBs are available online; you must log in and elect to receive paper copies

Blue Access MobileSM

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Public Site – No log-in required

• Health Care 101• Find a Doctor or Hospital• Blue Access for Members Log-in• Contact Information

Provider Finder AppFor iPhone® and Android® phones

A claim has been paid. Please log in to Blue Access for Members for details.



Blue Access for MembersSM Secure Site – Log-in Required• ID Card• My Coverage – Benefits / Eligibility• Visits and Claims• Health and Wellness – Diabetes, Obesity, Nutrition, Fitness, Metabolic

Syndrome, Maternity Care, Member Care Profile• User Profile• Register for Blue Access for Members

Text MessagingStatic – One-Way SMS Messaging Diabetes Management, Claim Status Notification Alerts

Dynamic – Two-Way Messaging member initiates text with keyword (ID Card Management)

What if I Have Questions?

• Call TRS-ActiveCare customer service for:– Claim questions/status– Network provider information– Membership and eligibility – Medical and Rx coverage questions– Inquiries (telephone and email)– ID card requests– Transition of care information– Help with online tools!

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Customer Service

1-866-355-5999

Personalized Service

QuestionsThank you for attending

TRS-ActiveCare is administered by Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of Texas provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits for ActiveCare 1-HD, 2 and 3 plans are administered by Express Scripts, Inc. HMO plans provided by: SHA, L.L.C. dba FirstCare Health Plans, Scott and White Health Plan, and Valley Baptist Insurance Company dba Valley Baptist Health Plans.

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