Plan Year 2020
Employee Benefits Program
Killeen ISD 2020 BENEFITS
Th i ngs t o know abou t your 201 7 Bee f i t s Th i ngs t o Know Abou t Your 2020 Bene f i t s
employee.benefits@killeenisd.org
Wha t ’ s I n The Gu i de
In this Open Enrollment Guide you will find information about the following……
Who is eligible for benefits Online Enrollment Information Open Enrollment Dates and Meeting information
o Benefit and Premium Information o HSA information
o
o
o Retirement information o Annual Benefit Notices
o
Benefits Package Overview
o
Wha t ’ s New? Who ’ s E l i g i b l e?
Current Full Time Employees (Full time is defined as 17.5 Hours or more per week). If you are a Full time employee hired on or after January 1, 2020 you will have a 30 day enrollment period for benefits. Benefits become effective the 1 st of the month following the 30 day enrollment period. Eligible Dependents are defined as Legal Spouse, Legal Child dependents are considered under age 26 and can be either natural, adoption or Step Children by legal marriage.
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CITY OF COPPERAS COVE
City Built for Family Living
Killeen ISD 2020 BENEFITS
On l i ne Open En r o l lme n t P r oces s
Killeen ISD will, once again, use TEAMS as the Benefits Administration system for enrollment. Employees will be able to review and enroll in their benefits online from the comfort of their own home or during work hours. If you do not have access to a computer, please email the Benefits Department at employee.benefits@killeenisd.org to obtain the schedule of open computer times that can be utilized to complete your enrollment. Informational packets will be available for all benefits that are offered. If you have any questions, contact the Employee Benefits Office at (254) 336-0165.
Online Open Enrollment Training and Review of Benefits Sessions:
Main Transportation Department - 9:30am-11:00am 110 N. WS Young Dr. Killeen, TX Killeen High School - 4:30pm-6:00pm 500 N. 38 th St. Killeen, TX Harker Heights High School - 4:30pm-6:00pm 1001 E. FM 2410 Rd. Harker Heights, TX Sheridan Transportation South - 9:30am- 11:00am 9132 W. Trimmier Rd. Killeen, TX Ellison High School - 4:30pm-6:00pm 909 E. Elms Rd. Killeen, TX
Monday, September 23
Tuesday, September 24
Wednesday, September 25
Shoemaker High School - 4:30pm-6:00pm 3302 S. Clear Creek Rd. Killeen, TX
Thursday, September 26
REPRESENTATIVES AND BENEFIT INFORMATION WILL BE PROVIDED AT THE MEETINGS. ATTENDEES WILL BE ENTERED INTO A RAFFLE AND HAVE THE OPPORTUNITY TO WIN PRIZES AT EACH SESSION.
ELIGIBLE EMPLOYEES WILL BE ABLE TO ELECT BENEFITS ONLINE THROUGH TEAMS
FROM ANY COMPUTER BEGINNING
TUESDAY, OCTOBER 1, 2019 THROUGH WEDNESDAY, OCTOBER 30, 2019
MORE INFORMATION ON HOW TO ACCESS TEAMS WILL BE PROVIDED AT THE BENEFIT MEETINGS
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CITY OF COPPERAS COVE
City Built for Family Living
Killeen ISD 2020 BENEFITS
Open En r o l lmen t Bene f i t s Package
Killeen ISD provides the following Employer Paid Benefit to eligible Employees:
$20,000 of Basic Term Life and AD&D
Killeen ISD offers the following benefits selection to eligible Employees:
Before Tax Deduction*
Employee & Dependent Medical Insurance (F ive Plan options available) Employee & Dependent Dental Insurance (Two Plan options available)
Health Savings Account (if eligible)
Flexible Spending Account (if eligible)
Voluntary Vision Insurance
Dependent Care Spending Account
**Voluntary Term Life & AD&D Insurance (Amounts up to $30,000)
Voluntary Short- and Long-Term Disability Insurance
Post Tax Deduction
**Voluntary Term Life & AD&D Insurance (Amounts over $30,000)
Voluntary Dependent Life & AD&D Insurance
*Before Tax deductions are elected for the entire policy year unless there is a benefit qualifying event (see page 14 for more information). **Voluntary Life deductions will be split. KISD deducts the first $30,000 before tax, and any remaining amounts are deducted post tax.
Emp l oye r Pa i d Bene f i t
GROUP LIFE INSURANCE Killeen ISD provides $20,000 of Group Term Life Insurance and Accidental Death & Dismemberment through Unum. You will need to elect a beneficiary at time of online enrollment. Benefit reduces to 65% at age 65 and again to 50% at age 70. This plan also has a Work Life Assistance program (EAP) – available 24/7 via an 800#. Information is included on page 12-13
Killeen ISD provides this benefit to all employees working at least 17.5 hours per week at $0.00 cost.
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Killeen ISD 2020 BENEFITS
Med i ca l Bene f i t s
Killeen ISD offers FIVE Medical Plan Options through Scott & White Health Plan to eligible employees. Plan Highlights and Costs Structures are listed on the next pages and will also be shown in the TEAMS portal during Open Enrollment.
What should I expect? • If you are not changing your plan, please keep your current card as a new card will not be sent. • If you are changing plans, you will receive a new ID card close to the effective date of 1/01/2020. Please note that ID cards come in a plain envelope and many individuals overlook them as junk mail. • We recommend you fill any prescriptions, prior to the new coverage start date, if possible • Once you receive your Medical ID card, on or after January 1st, we encourage you to register for your Carrier Name Member Account at https://swhp.org/kisd
Why Register? Once you've registered, you can:
✓ Find doctors, hospitals and other providers
Pay bills
✓
Check claims
✓
✓ See how much you have met of the Deductible and Out of Pocket maximum
✓ Get cost estimates for services and perceptions
✓ Download the Carrier App in the App Store, search… MyBSWHealth
Review your benefits
✓
Scott & White Health Plan offers additional benefits that allow you to: • Connect with a physician via e-visits for an office visit copay, this amount is based on your Medical plan choice. • Ask-A-Nurse Line available 24 hours a day, 7 days a week from any location.
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Killeen ISD 2020 BENEFITS
Med i ca l Bene f i t s , con t ’ d…
Plan 1 – BSW Preferred HMO Network $500 Deductible $500 Individual Deductible / 20% Coinsurance / $35 Primary Care Copay / $50 Specialist Copay Urgent Care $75 Copay/ ER $300/$7,350 Individual Out of Pocket Maximum/RX $10-$45-$90
Monthly Cost (Total)
KISD Monthly Contribution
State Monthly Contribution
Monthly Cost
TIER Election
Employee Only
$641.88
$325.00 $325.00 $325.00 $325.00
$75.00 $75.00 $75.00 $75.00
$241.88
Employee & Spouse
$1,668.89 $1,181.06 $2,015.51
$1,268.89
Employee & Child(ren)
$781.06
Employee & Family
$1,615.51
*Plan 2 – BSW Preferred HMO Network $2,700 deductible (HSA Qualified Plan) $2,700 Individual Deductible* / 20% Coinsurance after Deductible $6,650 Individual Out Of Pocket Maximum**
** All claims, including prescriptions ( Not Including claims coded as Preventive Care ) are subject to the deductible. ***Once the Out of Pocket Maximum is met, covered benefits are received at 100% for the remainder of the calendar year.
Monthly Cost (Total)
KISD Monthly Contribution
State Monthly Contribution
Monthly Cost
TIER Election
Employee Only
$520.78
$325.00 $325.00 $325.00 $325.00
$75.00 $75.00 $75.00 $75.00
$120.78 $954.04 $558.24
Employee & Spouse
$1,354.04
Employee & Child(ren)
$958.24
Employee & Family
$1,635.26
$1,235.26
Plan 4 – SWHP HMO Network $1,000 Deductible $1,000 Individual Deductible / 0% Coinsurance / $35 Primary Care Copay / $80 Specialist Copay Urgent Care $75 Copay/ ER $500/$7,350 Individual Out of Pocket Maximum/RX $10-$45-$90
Monthly Cost (Total)
KISD Monthly Contribution
State Monthly Contribution
Monthly Cost
TIER Election
Employee Only
$665.86
$325.00 $325.00 $325.00 $325.00
$75.00 $75.00 $75.00 $75.00
$265.86
Employee & Spouse
$1,731.22 $1,225.17 $2,090.78
$1,331.22
Employee & Child(ren)
$825.17
Employee & Family
$1,690.78
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Killeen ISD 2020 BENEFITS
Med i ca l Bene f i t s , con t ’ d…
*Plan 5 – BSW Preferred HMO Network $5,000 deductible(HSA qualified plan) $5,000 Individual Deductible** / 20% Coinsurance after Deductible $6,650 Individual Out Of Pocket Maximum***
** All claims, including prescriptions ( Not Including claims coded as Preventive Care ) are subject to the deductible. ***Once the Out of Pocket Maximum is met, covered benefits are received at 100% for the remainder of the calendar year.
Monthly Cost (Total)
KISD Monthly Contribution
State Monthly Contribution
Monthly Cost
TIER Election
Employee Only
$432.73
$325.00 $325.00 $325.00 $325.00
$75.00 $75.00 $75.00 $75.00
$32.73 $727.14 $397.68 $961.24
Employee & Spouse
$1,127.14
Employee & Child(ren)
$797.68
Employee & Family
$1,361.24
Plan 6 - PPO Choice Network (Tier 1 ICSW PPO/ Tier 2 Cigna PPO) $0 deductible in-network Tier 1 - $30 Primary Care Copay / $70 Specialist Copay/ Urgent Care $75 Copay/ ER $500/$6,500 Individual Out of Pocket Maximum/RX $10-$45-$90 Tier 2 - $35 Primary Care Copay / $80 Specialist Copay/ Urgent Care $75 Copay/ ER $500/$7,350 Individual Out of Pocket Maximum/RX $10-$45-$90
Monthly Cost (Total)
KISD Monthly Contribution
State Monthly Contribution
Monthly Cost
TIER Election
Employee Only*
$723.80
$325.00 $325.00 $325.00 $325.00
$75.00 $75.00 $75.00 $75.00
$323.80
Employee & Spouse**
$1,881.89 $1,331.80 $2,272.73
$1,481.89
Employee & Child(ren)**
$931.80
Employee & Family**
$1,872.73
For 2020, the maximum contribution as set by the IRS for an individual HSA account is $3,550 and the maximum contribution for family coverage is $7,100. People over the age of 55 can make an additional “catch-up” contribution of $1,000. These limits are the same regardless of the source of the contribution.
Employees that make / receive contributions to an HSA cannot also make contributions to the FSA
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Killeen ISD 2020 BENEFITS
Med i ca l Bene f i t s , con t ’ d…
MEDICAL CASH OUT OPTION
• You must submit an original Certificate of Coverage or Proof of Insurance Letter from your health insurance provider to the Employee Benefits Office. The information must include the following: Your name, type of coverage and date of coverage. No photocopies will be accepted. • The original Certificate of Coverage or Proof of Insurance Letter must be provided to the district on the following dates: o Annual Open Enrolment: During the annual open enrollment, October 01 st – 30 th . No later than the last day of open enrollment. o Hire Date: Information must be provided within 30 days of your start date.
• Failure to submit the proper documentation to the district on the above dates, will result in your selection being defaulted to the FSA Healthcare Reimbursement Account.
• Please note, if you select the “Cash Out” option, you will not be eligible for qualifying events for the remainder of the current benefit plan year.
• After your benefit selections have been made the “Remaining Amount” will be reflected in your monthly paycheck and will be taxed at your payroll tax rate.
• The above changes will be reflected in your paycheck following your effective date of coverage.
If you have questions, please contact the Employee Benefits Office at 254-336-0165
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Killeen ISD 2020 BENEFITS
Vo l un t a r y Bene f i t s
DENTAL INSURANCE
KISD will be offering 2 dental options this year. Killeen ISD will contribute $11.12 towards the dental premium.
• Low Plan - $1000 annual max, 100% preventive services, 80% Basic services, 50% Major Services (Endo/Perio) • High Plan - $2500 annual max, 100% preventive services, 80% Basic services (Endo/Perio), 50% Major Services, $1000 Child Orthodontia Please refer to the Summary of Benefits for complete details on both dental plans. Low Dental Plan Insurance Costs
Monthly Cost To Employee
TIER Election
Monthly Cost (Total)
KISD Monthly Allocation
Employee Only
$15.83 $41.14 $61.27 $84.80
$11.12 $11.12 $11.12 $11.12
$4.71
Employee & Spouse Employee * Child(ren) Employee & Family
$30.02 $50.15 $73.68
High Dental Plan Insurance Costs
Monthly Cost (Total)
KISD Monthly Allocation
Monthly Cost To Employee
TIER Election
Employee Only
$19.08 $49.58 $73.85 $102.21
$11.12 $11.12 $11.12 $11.12
$7.96
Employee & Spouse Employee * Child(ren) Employee & Family
$38.46 $62.73 $91.09
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Killeen ISD 2020 BENEFITS
n t a r y Bene f i t s
Vo l un t a r y Bene f i t s , con t ’ d…
VOLUNTARY VISION INSURANCE $10 exam copay/ $130 Frame allowance, 20% discount exceeding allowance/ $130 Contact allowance, 10% discount exceeding allowance Maximum of $130 benefit per member per year for either Glasses or Contacts Exams are available once in 12 months, Lenses are available once in 12 months, frame allowance is available once in 24 months. (Optional items like Anti-Reflective lenses, Scratch Resistant Coating are an additional cost)
Voluntary Vision
Monthly Cost (Total)
TIER Election
Employee Only
$5.97
Employee & Spouse Employee & Child(ren) Employee & Family
$11.94 $10.45 $16.42
Please refer to the Summary of Benefits for complete details on the Vision plan. Please visit www.avesis.com or contact Avesis' Customer Service Monday through Friday, 7 a.m. to 8 p.m. (EST) at 800-828-9341 to receive a listing of providers in your area.
VOLUNTARY LIFE INSURANCE/ACCIDENTAL DEATH & DISMEMBERMENT (AD&D) What would your loved ones do without you? Term life insurance is an affordable way to provide financial security if you are gone. They can use it to help pay for housing and other expenses, including your final arrangements. The plan includes a matching amount of Accidental Death and Dismemberment (AD&D) benefit, the policy pays additional money if you die due to a covered accident. If you survive a serious accident, it can pay you money for certain severe injuries, such as loss of vision, hearing and limbs. • The coverage choices for Employees are 1-4 times salary up to $300,000 maximum (Opt A, B, C, or D) • Spouse Coverage Available – Opt A $1,000/Opt B $5,000/Opt C $10,000/Opt D $15,000 • Child Coverage Available – Opt A $500/Opt B $1,000/Opt C $5,000/Opt D $10,000 • Reduced amount of coverage for children live birth to 6 months of age • Premiums are based on age and amount of benefit elected • If you did not elect when you were first eligible, amounts elected will be subject to evidence of insurability requirements
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Killeen ISD 2020 BENEFITS
Vo l un t a r y Bene f i t s , con t ’ d…
VOLUNTARY SHORT-TERM DISABILITY INSURANCE
Short Term Disability Insurance protects a portion of your salary should you become unable to work for a short period of time due to a non-work related covered injury or illness. Short term disability insurance can provide you up to 60% of your pre-disability income on a weekly basis up to a maximum of $1,000 per week. The Maximum Benefit Duration is 9 weeks as long as you are considered disabled according to the policy. There is an elimination period of 30 days for injury/ sickness that must pass prior to the benefits being paid. Any leave used during the benefit duration period may offset your benefit. • Premiums are based on your age at time of enrollment • Premiums will increase due to age • Employees who did not elect coverage at time of eligibility, will be subject to Evidence of Insurability.
LONG-TERM DISABILITY INSURANCE Long term disability insurance protects a portion of your income. For disabilities occurring before age 60, it can pay you a monthly benefit up to normal retirement age if you can’t work for an extended period of time due to a covered injury or illness. Long term disability insurance can pay a benefit as long as you are considered disabled according to the policy. The amount of benefit you receive from the plan may be reduced or offset by income from other sources such as Social Security Disability Insurance. You will be covered for up to 60% of your monthly income with a maximum of $5,000. There is an elimination period of 90 days that must pass before benefits will be paid.
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Killeen ISD 2020 BENEFITS
Hea l t h Sav i ngs Ac coun t (HSA)
HSA’s are designed to help you save and pay for qualified medical expenses, now or in the future. • Deposit money into your HSA. • Use your HSA to pay for qualified medical expenses… Including, but not limited to, Medical Deductibles, Dental and Vision care expenses. • Save on taxes by electing to have your contributions deducted pre-tax from your paycheck • You will have the option to Invest some of your savings in mutual funds and let it grow faster • Any unused funds in your HSA rollover from year to year, and you do NOT lose them. This allows you to save for future medical needs as well.
You will need to save all receipts for items you used your HSA funds for in a tax file each year. You will need to provide this if you are ever audited by the IRS.
*Note that HSA funds that are used for non-qualified medical expenses are taxable as income and subject to a 20% tax penalty. The 20% tax penalty does not apply to account holders age 65+, those who become disabled or enroll in Medicare.
If you have questions , prior to enrolling or after, you may Call Optum Bank customer service (844) 326-7967
Once you have an account you can Visit optumbank.com or download the Mobile App. This will give you access to your account to see your balance as well as other things.
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Killeen ISD 2020 BENEFITS
Emp l oyee Va l ue Added Bene f i t s
LIFE PLANNING FINANCIAL & LEGAL RESOURCES
Dealing with the death of a family member is difficult enough — even before worrying about the personal, legal and financial decisions that need to be made. That’s why Unum group Life Insurance includes Life Planning Financial & Legal Resources. This service provides financial and legal guidance and emotional support for beneficiaries, as well as for employees and spouses who are terminally ill. Counselors offer customized, objective, personal advice to each covered individual. And regardless of their recommendations, the consultants don’t receive any commission. • Comprehensive, personalized financial plan with 12 months of follow up • Personalized service through a toll-free telephonic counseling session with specially trained Ceridian counselors. No sales pitches! • Available to survivors or to insured individuals if terminally ill _________________________________________________________________________________________
EMPLOYEE ASSISTANCE PROGRAM (EAP)
Turn to us when you don’t know where to turn. Everyone grapples with personal and work-related issues from time to time. Don’t do it alone. Take advantage of your Employee Assistance Program and Work/Life Balance services, included free of charge with your Unum benefits.
We can help you get help with:
Personal, family and work issues •
Work/Life balance issues • Finding childcare • Accessing legal help •
Stress, anxiety and depression Relationship issues, divorce Family and parenting problems
• • •
Locating eldercare services Managing your finances
Anger, grief and loss
• •
• Addiction, eating disorders, mental illness • And More
Reducing medical bills (ask about our Medical Bill Saver™ service
And More
•
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Killeen ISD 2020 BENEFITS
Emp l oyee Va l ue Added Bene f i t s , con t ’ d…
What’s included in the EAP
Unlimited help over the phone Talk to a Licensed Professional Counselor of Work/Life Specialist over the phone. Compassionate professionals are there to listen, help you define your issues, and put you in touch with expert resources in your community for additional support. Just call 1-800-854-1446. Three free in-person counseling sessions When phone support isn’t enough, you can take advantage of three in-person visits with a Licensed Professional Counselor, included at no additional chare with your EAP. Your counselor will provide short-term support and advices, and help you find local resources for ongoing care, if necessary.
Other Valuable Benefits • Monthly webinars • Education materials • Provider serach tool
Who’s covered • You •
Your spouse
Your dependent children
• •
Your parents and parents-in-law
Help, when you need it most…..
Visit https://www.unum.com/employees/services/life-balance or call 1-800-854-1446
(User ID/password: lifebalance)
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Killeen ISD 2020 BENEFITS
Fami l y S t a t us Changes
BENEFIT QUALIFYING EVENTS
What are the applicable changes in status events? The following events are "Change in Status" events, which permit an election change.
• Change in employee's legal marital status. A change in the employee's marital status due to marriage, divorce, death of spouse, legal separation, and annulment. [ Treas. Reg. §1.125- 4(c)(2)(i)]
• Change in number of dependents. A change in the number of dependents resulting from birth, adoption, placement for adoption, and death. [ Treas. Reg. §1.125-4(c)(2)(ii)]
• Dependent satisfies (or fails to satisfy) dependent eligibility requirements under an employer plan. An event that causes a dependent to satisfy or cease to satisfy the requirements for coverage due to attainment of age, marriage or any similar circumstances. For example, if the child reaches the limiting age under the accident or health plan, a change in status occurs and the participant may make an election change that is consistent with the event.
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Killeen ISD 2020 BENEFITS
RET IREMENT BENEF ITS
TEACHER RETIREMENT SYSTEM (TRS)
All regular KISD employees are required to participate in the Teacher Retirement System (TRS). Employees contribute 7.7% of their before tax salary to TRS. TRS retirement plan benefits may include the following, depending on your eligibility: • monthly service retirement annuity payments for the life of the retiree, with a choice at time of retirement of standard annuity, joint and survivor annuity (Option One, Two or Five), or guaranteed 29 period annuity (Option Three or Four) payment plans, • monthly disability retirement annuity payments • Partial Lump Sum Option (PLSO) payment in addition to a reduced monthly service retirement annuity • distribution of a DROP account, • survivor benefits payable on the retiree’s behalf to a beneficiary. Benefits are subject to change by law or by rules of the TRS Board of Trustees Additional information is available from TRS at Teacher Retirement System of Texas, 1000 Red River Street, Austin, TX 78701-2698, or call 800-223-8778 or 512-542-6400. TRS information is also available on the web (www.trs.texas.gov).
Page 15
Annual Notices
Health Insurance Portability and Accountability Act (HIPAA) requires a group health plan to provide a Notice of Special Enrollment Rights annually to all employees who are eligible to participate in the plan.
NOTICE OF SPECIAL ENROLLMENT RIGHTS
Loss of Other Coverage – If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage). New Dependent as a Result of Marriage, Birth, Adoption or Placement for Adoption - if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. Medicaid or CHIP - If you are declining enrollment for yourself or your dependents (including your spouse) while coverage under Medicaid or a state Children’s Health Insurance Program (CHIP) is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 30 days after your or your dependents’ Medicaid or CHIP coverage ends. If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or a CHIP program with respect to coverage under this plan, you may be able to enroll yourself and your dependents (including your spouse) in this plan. However, you must request enrollment within 30 days after you or your dependents become eligible for the premium assistance. Health Insurance Portability and Accountability Act (HIPAA) Killeen ISD, in accordance with HIPAA, protects your Protected Health Information (PHI). Killeen ISD will only discuss your PHI with medical providers and third party administrators when necessary to administer the plan that provides your medical and dental benefits or as mandated by law. HIPAA Privacy Notice Update HIPAA requires Killeen ISD to notify you that the Privacy Notice is available from the Employee Benefits Department. To request a copy of Killeen ISD’s Privacy Notice or for additional information, please contact the Employee Benefits Department. To request special enrollment or obtain more information, contact Employee Benefits Department.
Annual Notices (continued)
NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT NOTICE Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). WOMEN’S HEALTH AND CANCER RIGHTS ACT The Women’s Health and Cancer Rights Act requires group health plans that provide coverage for mastectomy to provide coverage for certain reconstructive services. This law also requires that written notice of the availability of the coverage be delivered to all plan participants upon enrollment and annually thereafter. This language serves to fulfill that requirement for this year. If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
• All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan.
Genetic Information Nondiscrimination Act (GINA) The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. ‘Genetic information' as defined by GINA, includes an individual's family medical history, the results of an individual's or family member's genetic tests, the fact that an individual or an individual's family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual's family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.
Annual Notices (continued)
Continuation Required by Federal Law for You and Your Dependents Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than for gross misconduct). Federal law also enables your dependent(s) to continue health insurance if their coverage ceases due to your death, divorce, legal separation, or with respect to dependent children, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your employer’s group health plan(s) and is subject to federal law, regulations and interpretations. For additional information, contact the Employee Benefits Department.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov .
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance . If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272) .
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2019. Contact your State for more information on eligibility –
ALABAMA – Medicaid
FLORIDA – Medicaid
Website: http://myalhipp.com/ Phone: 1-855-692-5447
Website: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268
ALASKA – Medicaid
GEORGIA – Medicaid
The AK Health Insurance Premium Payment Program Website: http://myakhipp.com/ Phone: 1-866-251-4861 Email: CustomerService@MyAKHIPP.com Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
Website: Medicaid www.medicaid.georgia.gov - Click on Health Insurance Premium Payment (HIPP) Phone: 404-656-4507
ARKANSAS – Medicaid
INDIANA – Medicaid
Website: http://myarhipp.com/ Phone: 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website: http://www.in.gov/fssa/hip/ Phone: 1-877-438-4479 All other Medicaid Website: http://www.indianamedicaid.com Phone 1-800-403-0864
IOWA – Medicaid
KANSAS – Medicaid
Website: http://dhs.iowa.gov/hawk-i Phone: 1-800-257-8563
Website: http://www.kdheks.gov/hcf/ Phone: 1-785-296-3512
KENTUCKY – Medicaid
NEW HAMPSHIRE – Medicaid
Website: https://chfs.ky.gov Phone: 1-800-635-2570
Website: https://www.dhhs.nh.gov/oii/hipp.htm Phone: 603-271-5218 Toll-Free: 1-800-852-3345, ext 5218
LOUISIANA – Medicaid
NEW JERSEY – Medicaid and CHIP
Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: 1-888-695-2447
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710
MAINE – Medicaid
NEW YORK – Medicaid
Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html Phone: 1-800-442-6003 TTY: Maine relay 711
Website: https://www.health.ny.gov/health_care/medicaid/ Phone: 1-800-541-2831
MASSACHUSETTS – Medicaid and CHIP
NORTH CAROLINA – Medicaid
Website: http://www.mass.gov/eohhs/gov/departments/masshealth/ Phone: 1-800-862-4840
Website: https://dma.ncdhhs.gov/ Phone: 919-855-4100
MINNESOTA – Medicaid
NORTH DAKOTA – Medicaid
Website: https://mn.gov/dhs/people-we-serve/seniors/health-care/health-care- programs/programs-and-services/other-insurance.jsp Phone: 1-800-657-3739 or 651-431-2670
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/ Phone: 1-844-854-4825
MISSOURI – Medicaid
OKLAHOMA – Medicaid and CHIP
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005
Website: http://www.insureoklahoma.org Phone: 1-888-365-3742
MONTANA – Medicaid
OREGON – Medicaid and CHIP
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 1-800-694-3084
Website: http://healthcare.oregon.gov/Pages/index.aspx http://www.oregonhealthcare.gov/index-es.html Phone: 1-800-699-9075
NEBRASKA – Medicaid
PENNSYLVANIA – Medicaid
Website: http://www.ACCESSNebraska.ne.gov Phone: (855) 632-7633 Lincoln: (402) 473-7000 Omaha: (402) 595-1178
Website: http://www.dhs.pa.gov/provider/medicalassistance/healthinsuran cepremiumpaymenthippprogram/index.htm Phone: 1-800-692-7462
NEVADA – Medicaid
RHODE ISLAND – Medicaid
Medicaid Website: http://dhcfp.nv.gov Medicaid Phone: 1-800-992-0900
Website: http://www.eohhs.ri.gov/ Phone: 855-697-4347
SOUTH CAROLINA – Medicaid
VIRGINIA – Medicaid and CHIP
Website: https://www.scdhhs.gov Phone: 1-888-549-0820
Medicaid Website: http://www.coverva.org/programs_premium_assistance.cfm Medicaid Phone: 1-800-432-5924 CHIP Website: http://www.coverva.org/programs_premium_assistance.cfm CHIP Phone: 1-855-242-8282 Website: http://www.hca.wa.gov/free-or-low-cost-health- care/program-administration/premium-payment-program Phone: 1-800-562-3022 ext. 15473 WASHINGTON – Medicaid
SOUTH DAKOTA - Medicaid
Website: http://dss.sd.gov Phone: 1-888-828-0059
TEXAS – Medicaid
WEST VIRGINIA – Medicaid
Website: http://gethipptexas.com/ Phone: 1-800-440-0493
Website: http://mywvhipp.com/ Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
UTAH – Medicaid and CHIP
WISCONSIN – Medicaid and CHIP
Medicaid Website: https://medicaid.utah.gov/ CHIP Website: http://health.utah.gov/chip Phone: 1-877-543-7669
Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdf Phone: 1-800-362-3002
VERMONT– Medicaid
WYOMING – Medicaid
Website: http://www.greenmountaincare.org/ Phone: 1-800-250-8427
Website: https://health.wyo.gov/healthcarefin/medicaid/ Phone: 307-777-7531
To see if any other states have added a premium assistance program since January 31, 2019, or for more information on special enrollment rights, contact either:
U.S. Department of Labor
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services
Employee Benefits Security Administration
www.dol.gov/agencies/ebsa
www.cms.hhs.gov
1-866-444-EBSA (3272)
1-877-267-2323, Menu Option 4, Ext. 61565
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.
OMB Control Number 1210-0137 (expires 12/31/2019)
Medicare Part D Notice Important Notice from Killeen ISD About Your Prescription Drug Coverage and Medicare This Notice Applies to You (or Dependent) ONLY if such person is (1) enrolled in a group medical plan offered by Killeen ISD AND (2) eligible for Medicare. Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Killeen ISD and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage: 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Killeen ISD has determined that the prescription drug coverage offered by Scott & White Health Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Killeen ISD coverage will not be affected. Your current coverage pays for other health expenses in addition to prescription drugs. If you enroll in a Medicare prescription drug plan, you and your eligible dependents will still be eligible to receive all of your current health benefits. If you do decide to join a Medicare drug plan and drop your current coverage, be aware that you and your dependents may not be able to get this coverage back.
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with Killeen ISD and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. For More Information About This Notice or Your Current Prescription Drug Coverage … Contact the person listed below for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Killeen ISD changes. You also may request a copy of this notice at any time. For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Date:
September 17, 2019
Name of Entity/Sender: Contact--Position/Office:
Killeen Independent School District Employee Benefits Office 2301 Atkinson Ave Killeen, TX 76543
Address:
Phone Number:
254-336-0165
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