Pampa ISD Plan Year 2020 2021 Benefit Guide

Pampa ISD Plan Year: 2020 -2021 Benefit Guide and Presentation Presented by: This booklet is an abbreviated version. Please refer to the full benefit summaries and 1 online enrollment portal for all information.

General Information This b o o k l e t is d e s i g n e d t o h i g h l i g h t y o u r b e n e f i t s. It is not a summary plan d e s c r i p t i o n (SPD). O f f i c i a l p l a n and insurance documents govern your rights and benefits u n d e r e a c h p l a n. For m o r e details about your benefits, i n c l u d i n g c o v e r e d expenses, exclusions and limitations please refer t o t h e i n d i v i d u a l SPDs. If any d i s c r e p a n c y exists b e t w e e n this booklet and the official documents, the official d o c u m e n t s SPD w i l l prevail. U. S. E m p l o y e e B e n e f i t s Services G r o u p ( USEBSG) is the nation’s leading independent provider and a d m i n i s t r a t o r of e m p l o y e r sponsored benefits and r e t i r e m e n t p l a n s in t h e s c h o o l d i s t r i c t M a r k e t p l a c e. They serve over 4 0 0 ISDs in Texas a n d are e n d o r s e d by TACS. T h e i r f o c u s is o n d e v e l o p i n g comprehensive programs providing affordable solutions for b e n e f i t s , o n l i n e e n r o l l m e n t a n d r e t i r e m e n t p l a n needs. They have 25 years of e x p e r i e n c e a n d over 1, 0 0 0 c l i e n t s across t h e nation. What’s New for 2020 • • • TRS Active Care will be moving to Blue Cross Blue Shield of Texas. Flexible Spending Account new limitations for 2020. Dependent Day Care new limitations for 2020. HSA new limitations for 2020. GAP Rate Increase MASA Transportation 1. 800 MD S e e B e n e f i t W e b s i t e f o r p l a n d e t a i l s. http: //pampaisdbenefitportal. com. Medical Contribution $275 District provides $10, 000 life insurance, please include dependent information. 403 b NOTICE- You have the opportunity to save for retirement by participating in the School District’s 403(b) plan(“Plan”). A brief, 3 -minute video presentation explaining what a 403(b) plan is, and how to contribute can be reached at http: //403 bwhyme. com/ 12 Registration is required to view the video. If there any questions, you may contact The OMNI Group at 877 -544 -6664

Eligibility and Effective Dates Qualifying Life Event Changes Cafeteria plans, also k n o w n as Section 125 plans (the IRS code that covers them), allow you to deduct certain amounts for benefits from your gross earnings before federal withholding taxes are figured. Benefit elections will remain in effect for the plan year and cannot be revoked or changed unless you experience one of the following qualifying life event changes: Birth or Adoption Marriage Change in the spouse’s employment Divorce Death Change in dependent eligibility Exhausted COBRA coverage Loss of Coverage All required documentation must be submitted to the Benefits Office within 30 days from the event. Eligible Benefits Under Section 125: Medical Dental Vision Health Savings Account (HSA) F l e x i b l e S p e n d i n g A c c o u n t 13 (FSA)

Online Enrollment In Roll Carrier Website: In-Roll. com Carrier Phone Number: 877 -730 -7780 4 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Flexible Spending Account TASC Flexible Spending Account Carrier Website: TASConline. com Carrier Phone Number: 800 -422 -4661 Coverage Type Health Care Spending Dependent Day Care Annual Max $2, 750. 00 $5, 000. 00 Year 2020 Roll Over No No Health Care Spending Brief Information: MEDICAL Allows for a tax savings on most medical, dental, and vision out-of-pocket expenses. Noncovered expenses apply to all dependent family members even if not covered by an insurance plan. A Master. Card debit card will be issued to you to pay for most expenses incurred. Please visit www. tasconline. com for a list of eligible expenses. Dependent Day Care Brief Information: DAY CARE DEPENDENT CARE Allows for a tax savings on day care expenses for children under the age of 13 and for dependent adults unable to care for themselves. The annual election amount is deducted in equal amounts from each paycheck, before taxes are calculated, and then set aside in a special account for the employee. As expenses are incurred, the employee submits a claim and the money is reimbursed to the employee from the employee’s account as the monies come in from each paycheck. The IRS does not allow the Dependent Care Account (DCA) to be pre-funded. Where accepted, the debit card may be used for payment of dependent care expenses. . Please visit www. tasconline. com for a list of eligible expenses. 5 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Flexible Spending Account TASC Flexible Spending Account Carrier Website: TASConline. com Carrier Phone Number: 800 -422 -4661 Coverage Type Health Care Spending Dependent Day Care Annual Max $2, 750. 00 $5, 000. 00 Year 2020 Roll Over No No Health Care Spending Brief Information: MEDICAL Allows for a tax savings on most medical, dental, and vision out-of-pocket expenses. Noncovered expenses apply to all dependent family members even if not covered by an insurance plan. A Master. Card debit card will be issued to you to pay for most expenses incurred. Please visit www. tasconline. com for a list of eligible expenses. Dependent Day Care Brief Information: DAY CARE DEPENDENT CARE Allows for a tax savings on day care expenses for children under the age of 13 and for dependent adults unable to care for themselves. The annual election amount is deducted in equal amounts from each paycheck, before taxes are calculated, and then set aside in a special account for the employee. As expenses are incurred, the employee submits a claim and the money is reimbursed to the employee from the employee’s account as the monies come in from each paycheck. The IRS does not allow the Dependent Care Account (DCA) to be pre-funded. Where accepted, the debit card may be used for payment of dependent care expenses. . Please visit www. tasconline. com for a list of eligible expenses. 6 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Medical HMO Plans- TRS HMO Carrier Website: BCBSTX. com/trsactivecare Carrier Phone Number: 1 -866 -355 -5999 7 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Medical PPO Plan - TRS Active Carrier Website: BCBSTX. com/trsactivecare Carrier Phone Number: 1 -866 -355 -5999 8 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Medical GAP Benefit Connection Carrier Website: Specialinc. com Carrier Phone Number: 800 -767 -6811 Plan Highlights • Coverage is for help with medical costs associated with a hospital stay. • These benefits are available for employees, spouse and eligible dependent children. • Hospital confinement available: $1, 500 Inpatient and $200 Outpatient Annual Benefit. • Hospital confinement available: $1, 500 inpatient and $1, 500 outpatient Annual Benefit. 9 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Dental Low Plan The Standard Dental Low Option Carrier Website: Standard. com/dental Carrier Phone Number: 800 -368 -1135 Coverage Type In Network Out of Network Type A: Preventive 100% Type B: Basic 80% Type C: Major No Coverage Type D: Orthodontia No Coverage Deductible: Ind/Fam $50/$150 Annual Max Benefits $1250 Out of Network Rate 90 th Percentile Coverage Type Monthly Premium Employee Only $21. 71 Employee+ Spouse $41. 97 Employee+ Child (ren) $54. 37 Employee+ Family $71. 62 10 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Dental High Plan The Standard Dental High Option Carrier Website: Standard. com/dental Carrier Phone Number: 800 -368 -1135 Coverage Type In Network Out of Network Type A: Preventive 100% Type B: Basic 80% Type C: Major 50% Type D: Orthodontia 50% Deductible: Ind/Fam $50/$150 Annual Max Benefits $1000 Out of Network Rate 90 th Percentile Coverage Type Monthly Premium Employee Only $39. 64 Employee+ Spouse $77. 26 Employee+ Child (ren) $100. 06 Employee+ Family $137. 55 11 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Vision Superior Vision Carrier Website: Superior. Vision. com Carrier Phone Number: 800 -923 -6766 Coverage Type Frequency In Network Out of Network Exam $10 copay 12 months Covered in Full Up to $35 retail Frames $25 copay 24 months $150 Allowance Up to $70 retail Lenses (standard) 12 months Covered in Full Single 12 months Covered in Full Up to $25 retail Bifocal 12 months Covered in Full Up to $40 retail Trifocal 12 months Covered in Full Up to $45 retail Progressive 12 months See Benefits Up to $45 retail Contact Lenses 12 months $150 Allowance Up to $150 retail Coverage Type Monthly Premium Employee Only $6. 57 Employee+ One $13. 16 Employee+ Family $21. 16 12 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Long Term Disability Insurance The Standard Carrier Website: Standard. com Carrier Phone Number: 800 -368 -1135 Plan Highlights • Coverage is available in increments of $100 from $200 to $8, 000 • Coverage for accident related disabilities to social security retirement age for both accident or sickness. • Benefits are paid year-round, regardless of employee's summer or • holiday breaks. • Maternity is covered the same as illness. • Multiple Elimination Period options. • First Day Hospital benefits on certain plans. • Premiums based on benefit amount and elimination period selection. 13 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Cancer Insurance Colonial Life Carrier Website: Colonial. com Carrier Phone Number: 800 -325 -4368 Plan Highlights • • Cancer Screening/Wellness Test Benefit Inpatient Benefits Treatment Benefit Surgery Benefits/Transportation/Lodging Benefit Chemo/Radiation Treatment Coverage Type- Level 4 Monthly Premium Employee Only $29. 85 Employee+ Spouse $49. 55 14 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Critical Illness Lincoln Carrier Website: Lincoln. com Carrier Phone Number: 800 -487 -1485 Plan Highlights Critical Illness insurance provides cash benefits if you or a covered family member are diagnosed with a critical illness or event while insured under this plan. Premiums are age rated and based on smoker status. Coverage is available for employee, spouse, and dependent children. Some of the covered expenses are shown below: Heart Attack Stroke Invasive Cancer Major Organ Failure Arterial/Vascular Disease End Stage Renal Failure Benign Brain Tumor Quality of Life Many Other Covered Illnesses 15 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Accident Insurance Allstate Carrier Website: Allstate. Benefits. com Carrier Phone Number: 800 -348 -4489 Plan Highlights • • • Ambulance Expense Hospital Admission ICU Daily Confinement for Hospital Fractures Benefits for many other expenses Coverage Type- Low Monthly Premium Named Insured $12. 52 Employee+ Spouse $18. 36 One Parent Family $25. 26 Two Parent Family $31. 58 Coverage Type- High Monthly Premium Named Insured $13. 76 Employee+ Spouse $19. 80 One Parent Family $27. 96 Two Parent Family $34. 96 16 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Permanent Life Insurance Texas Life Insurance Co Carrier Website: Texas. Life. com Carrier Phone Number: 800 -283 -9233 Plan Highlights: • • • Permanent lifetime protection Plan is portable with locked in rates. Coverage is available for employees, spouses and children. Guaranteed acceptance for life insurance. Earns Paid-Up insurance death benefit. 17 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Voluntary Life & AD&D Insurance Lincoln Carrier Website: Lincoln. com Carrier Phone Number: 800 -487 -1485 Plan Highlights: • Additional life insurance that can be enrolled in $10, 000 increments. • Affordable group rates with high volumes of coverage available. • Benefits is for all full-time employees and all bus drivers. • Eligible spouse can also enroll in $5, 000 increments. • Eligible children can be enrolled in $10, 000. 18 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Telemedicine 1. 800 MD Carrier Website: 1800 md. com Carrier Phone Number: 704 -247 -9187 Plan Highlights: • No cost consultations can be placed from home, office or while traveling. • Available 24 hours a day, seven days a week, 365 days a year. • Instant translation access to over 170 languages. • Monthly rate covers your entire family. Coverage Type Monthly Premium Monthly Rate $8. 00 19 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Medical Transport Solutions Carrier Website: Masamts. com Carrier Phone Number: 800 -423 -3226 Plan Highlights: • Emergency Air Medical Transport • Emergency Ground Ambulance Transport Coverage Type Monthly Premium Emergent Plus $14. 00 Platinum $39. 00 20 This Benefit Guide is a brief description of benefits. For additional details please review Plan Documents.

Contact Information Benefit Carrier Phone Number Medical Blue Cross Blue Shield of 866 -355 -5999 Texas Dental The Standard 800 -368 -1135 Vision Superior 800 -923 -6766 Disability The Standard 800 -368 -2859 Life Texas Life 800 -283 -9233 Cancer Colonial Life 800 -325 -4368 Accident Allstate 800 -348 -4489 Critical Illness Lincoln 800 -487 -1485 Medical GAP Benefit Connect 800 -767 -6811 1. 800 MD 704 -247 -9187 Life Lincoln 800 -487 -1485 Flexible Spending TASC 800 -422 -4661 Medical Transport MASA 800 -423 -3226 Online Portal In Roll 877 -730 -7780 Plan Admin. USEBSG- Jack Dickerson 956 -346 -1522 421