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TOMBALL ISD
2016 - 2017
BENEFITS
SUMMARY
MEDICAL
DENTAL
VISION
LIFE AND AD&D
DISABILITY
CANCER
CRITICAL ILLNESS
FLEXIBLE SPENDING ACCOUNTS
403(B) AND (B)(7)
EMPLOYEE ASSISTANCE PROGRAM
GAP PLAN
PET INSURANCE
ID THEFT AND LEGAL SHIELD
Summary of Benefits
Medical Coverage Employees can enroll in one of two PPO plans, TRS ActiveCare 1-HD, AC-2 or the EPO Select plan. The cost of this coverage is shared with the District.
Dental Coverage
Employees can enroll in one of two dental plans – a PPO and DHMO. Both plans cover preventive, basic, major restorative and orthodontia services. The use of Network Providers may be required.
Vision Coverage The District offers two Vision plans – Basic and Buy Up. Both plans cover eye exams, lenses and frames. The use of Network Providers is recommended.
Life and AD&D The District provides all employees with a Basic Life Benefit of 1x their annual salary. Employees can purchase additional amounts of coverage for themselves and dependents on a voluntary basis.
Disability Coverage Employees can purchase voluntary long term disability Insurance that covers up to 70% of their salary in the event of a disabling accident or illness.
Flexible Spending Accounts
Employees can participate in the Medical FSA and Dependent Care FSA on a voluntary basis. The Healthcare Savings Account and Limited Purpose FSA are available to all employees who chose the High Deductible Health Plan.
Cancer Coverage Employees can enroll in voluntary Cancer insurance for themselves and their dependents to assist with out of pocket expenses in the event of a cancer related illness.
Critical Illness Employees can enroll in voluntary Critical Illness insurance for themselves and their dependents to assist with the out of pocket expenses in the event of one of the covered Critical Illnesses.
403(B) and (B)(7) Employees can elect to have additional retirement funds deposited with one of the approved Tomball ISD providers.
GAP Plan Employees can enroll in the SIS Link Gap Plan that provides in hospital and out-patient benefits for you and your dependents for a covered injury or illness.
Pet Insurance Employees can enroll in the Pet Insurance to cover the Wellness and/or Medical needs of their Cats or Dogs.
ID Theft and Legal Shield Employees can enroll in the ID Theft and/or Legal Shield to protect their family against identity theft or to provide assistance with a variety of Legal needs.
TRS Active Care 2016 – 2017 Premiums
Plan Monthly
Rate
Semi Monthly
Rate
18 Pay Rate
Annual Amount
Active Care 1 HD
Employee Only $41.00 $20.50 $27.33 $492.00
Employee/Spouse $614.00 $307.00 $409.33 $7,368.00
Employee/Children $315.00 $157.50 $210.00 $3,780.00
Employee/Family $931.00 $465.50 $620.67 $11,172.00
Active Care Select
Employee Only $184.00 $92.00 $122.67 $2,208.00
Employee/Spouse $847.00 $423.50 $564.67 $10,164.00
Employee/Children $479.00 $239.50 $319.33 $5,748.00
Employee/Family $1,061.00 $530.50 $707.33 $12,732.00
Active Care 2
Employee Only $345.00 $172.50 $230.00 $4,140.00
Employee/Spouse $1,252.00 $626.00 $834.67 $15,024.00
Employee/Children $742.00 $371.00 $494.67 $8,904.00
Employee/Family $1,297.00 $648.50 $864.67 $15,564.00
DENTAL PLANS
–
PPO Schedule of Benefits
Type of Service Benefit
Annual Deductible $50 Ind/ $150 Family
Preventive 100%
Basic 80%
Major 50%
Annual Benefit Maximum
$1,500 Per Person
Orthodontia 50%
Orthodontia Life Time Maximum
$1,000
The dental carrier is Assurant Dental. We offer two plans, a PPO and a DHMO, from which employees can choose. The PPO plan allows you to visit the Dentist of your choice and pay a portion of the expenses for covered procedures. However, there will be significant differences in your out-of-pocket expense if you do not use one of the network providers. The network providers have agreed to charge you less for the same procedures. A partial list of local network providers is below. For a more comprehensive list of Assurant PPO and DHMO network providers, go to www.assurantemployeebenefits.com, enter Tomball’s group ID number in the box on the right, 5464230, and select PPO or DHMO from the drop down menu. There are over 160 network providers within 20 miles of Tomball ISD. The DHMO plan requires you to select a network provider and you pay significantly less for procedures. The full list of your copays is detailed in the Dental booklet at www.tomballisd.net.
DHMO Sample Copays
Type of Service Participant Copay
Office Visit $5
Cleaning $0
Amalgam Filling $10
Root Canal $210
Crown $230
Gingivectomy $30
Ortho - Children $1,800
Ortho - Adult $2,100
DHMO Insurance
2016 – 2017
Coverage Tier
Monthly Semi-Monthly 18 Pay
Emp Only $14.15 $7.08 $9.43
Emp + Spouse $23.59 $11.80 $15.73
Emp + Child(ren) $31.36 $15.68 $20.91
Emp + Family $41.79 $20.90 $27.86
Dental PPO Insurance
2016 - 2017
Coverage Tier Monthly Semi-Monthly 18 Pay
Emp Only $26.63 $13.32 $17.75
Emp + Spouse $56.20 $28.10 $37.47
Emp + Child(ren) $63.48 $31.74 $42.32
Emp + Family $88.92 $44.46 $59.28
Local PPO Providers
Nicholas Camarata
James B Hanigan
Louis A Russell
1113 Alma St
29220 Quinn Rd
29210 Quinn Rd
Tomball, TX 77375
Tomball, TX 77375
Tomball, TX 77375
281-351-0005
281-351-5482
281-351-5458
James D Geer
Josh W Gosnell
Dave K Dorroh
1013 W Main St
616 W Main St
505 W Main Street
Tomball, TX 77375
Tomball, TX 77375
Tomball, TX 77375
281-357-4337
281-290-8000
281-351-0039
VISION PLAN
Coverage Tier Basic Monthly
Basic Semi-Monthly
Basic 18 Pay
Buy-Up Monthly
Buy-Up Semi-Monthly
Buy-Up 18 Pay
Emp Only $5.18 $2.59 $3.46 $7.38 $3.69 $4.92
Emp + Spouse $10.98 $5.49 $7.32 $15.62 $7.81 $10.42
Emp + Child(ren) $11.56 $5.78 $7.71 $16.48 $8.24 $10.99
Emp + Family $17.04 $8.52 $11.36 $24.22 $12.11 $16.15
Type of Service Basic Plan Buy Up Plan
Exams – Every 12 months $10 Copay $10 Copay
Lenses – Every 12 months $15 to $65 Copay $15 to $65 Copay
Frame – Every 24 months $0 Copay to $120 Allowance $0 Copay to $140 Allowance
Contact Lenses (in lieu of eyeglasses)
Every 12 months $0 Copay to $120 Allowance $0 Copay to $120 Allowance
LASIK and PRK 15% Discount 15% Discount
The Basic and Buy-Up Vision plans will now be provided by Vision Service Plan. If you
choose a network provider, you pay the co-pay plus the cost of any non-covered options. If
you choose a non-network provider, you pay the full fee to the provider and submit itemized
receipts to Eye Med Vision in order to receive reimbursement for non-network allowances. To locate a V i s i o n S e r v i c e P l a n network provider, c a l l 1 - 8 0 0 - 8 7 7 - 7 1 9 5 o r v i s i t w w w . V S P . c o m . L o c a l P r o v i d e r s I n c l u d e : C o s t c o W a l - M a r t S a m s C l u b E y e M a s t e r s V i s i o n W o r k s
Basic and Optional Life
Basic Coverage
Tomball ISD provides life insurance through
Assurant Life Insurance Company for all
employees and their dependents.
Employee - 1 times annual salary
Spouse - $5,000
Children - $2,000
Optional Coverage
All employees can elect to purchase
additional coverage for themselves and their
dependents. Premiums are based on
employee's age as of the effective date and
are adjusted when a new age bracket is
reached.
Employee - 5 times annual salary rounded
to the next highest $1,000
(max $180,000)
Spouse - 50% of employee's amount (max
$50,000)
Children - $5,000 or $10,000
Optional coverage is guaranteed issue for all
new employees hired after September 1,
2012 who enroll during the open enrollment
period. Please refer to the complete Life
brochure for specific rates and age brackets.
Long Term Disability
Voluntary Coverage Tomball ISD offers voluntary long term disability (LTD) through American Fidelity Assurance. Employees elect a level of coverage not to exceed 70% of your monthly gross pay. Coverage is available with elimination periods of 14, 30, 60, 90 or 180 days and benefits are paid to age 65 for all covered accidents or illnesses regardless of the elimination period chosen. Pregnancy is treated the same as any other illness. New employees may enroll in the disability in the first 13 months of employment without having to provide evidence of good health. Benefits are guaranteed issue during this period up to a maximum of $4,000 monthly benefit. All existing policy holders may elect to make changes to their plan during the open enrollment period each year. Monthly benefit increases are guaranteed issue up to a maximum of $400. The complete brochure and rates can be accessed at www.tomballisd.net.
Flexible Spending Accounts
Flexible Spending Accounts (FSAs) provide you with an important tax advantage that allows you to pay health care and dependent care expenses on a pre-tax basis and lower your taxable income. Please retain your current card as they are issued with an expiration date. New elections will automatically be loaded to your Visa debit card. TASC will continue to be the FSA provider for Tomball ISD. All expenses must be incurred during the plan year (September 1 to August 31) in order to be eligible for reimbursement.
Medical Flex
You can pay for, with pre-tax dollars, certain IRS-approved medical, dental and vision care expenses for you and your dependents, regardless of whether you participate in the District medical plan. You may contribute up to $2,550 per plan year. As of 1/1/2011, over-the-counter medications require a prescription or a medical note from your physician and cannot be purchased with your TASC debit card.
Dependent Care Flex
You can pay, with pre-tax dollars, qualified dependent care expenses such as caring for children under the age of 13 or caring for the elderly. The maximum amount you may contribute to the DCRA is $5,000 (or $2,500 if married and filing separately) per plan year. Your DCRA account can be set up on "fixed payment" so reimbursements can be direct deposited in your account on each payroll date.
Health Savings Account (HSA)
A Health Savings Account allows you to save and pay for qualified health expenses for you and your dependents on a tax-free basis. You may contribute $3,350 for an individual and $6,650 for families. Unlike the FSA, funds are not available until deposited in your account but balances can be rolled over from year to year. In order to be eligible for the HSA, you must meet the following criteria:
1. You must be enrolled in an IRS "qualified" High Deductible Health Plan (HDHP).
2. You must not be covered by any other medical plan, unless the other plan is a "qualified" HDHP.
3. You must not be enrolled in Medicare Coverage.
Limited Purpose FSA
This account is only available to employees that participate in a High Deductible Health Plan and also contribute to a Health Savings Account. Only expenses for Dental and Vision services can be reimbursed through this account. You may contribute up to $2,500 per plan year.
Other Benefits Cancer Coverage Employees may purchase voluntary Cancer coverage to assist them with the substantial out-of-pocket expenses associated with the treatment of cancer related illnesses. You may purchase family coverage even if your dependents are not covered by Tomball ISD health plans. Coverage is guaranteed issue during this enrollment period.
403(b) Plans A 403(b) Plan allows you to invest tax deferred income in fixed annuities; variable annuities; and/or mutual funds while earning tax deferred interest. The term 403(b) is used synonymously with 403(b)(7), Tax Deferred Annuity (TDA), and Tax Sheltered Annuity (TSA). To contribute to a 403(b) account, you must select an approved vendor are posted online at www.tomballisd.net Distributions are available upon termination of employment, death, disability, retirement, or certain types of hardships. Distributions may be rolled into an IRA, 403(b) or 401(k) plan, or they can be used to buy back years from TRS service. There is a 10% penalty imposed by the IRS for funds withdrawn prior to age 59 1/2, in addition to normal tax consequences, for qualified distributions.
Employee Assistance Plan (EAP) The EAP is provided through New Directions to you and members of your immediate household at no cost. This plan is designed to assist employees and family members in dealing with a variety of personal problems such as depression, marital difficulties, concerns with children, substance abuse, legal questions, or financial planning issues. The details of any personal problems are confidential and remain between the user and the professional EAP counselor. A 24-hour toll free number is provided to receive further information or to receive immediate assistance in a time of crisis.
Long Term Care This coverage may be purchased through the Teacher Retirement System and Genworth Insurance Company. Coverage is portable and designed to assist you in the event that you are confined to a long term care facility or need specialized home health care.
GAP Plan SIS Link Gap Plan is a low-cost program designed to help you pay for covered out-of-pocket expenses you or your family may incur while you are either confined to a hospital or being treated as an out-patient for a covered injury or illness.
Other Benefits
Critical Illness Plan Humana Critical Illness plan provides a lump sum benefit in the event of one of the covered illnesses. These illnesses include Heart Attack, Heart Transplant, Stroke, Coronary Bypass surgery, Other Organ Transplant, Renal Failure, Loss of sight, speech or hearing, Coma, Severe burns, Permanent paralysis or Occupations HIV. This plan is Guaranteed issue during this enrollment period for all employees and their dependents.
Pet Insurance Plan Nationwide’s Pet Insurance will cover your Dog or Cat’s Medical needs as a result of accidents or illnesses. The wellness plan can be added to cover your regular vaccinations as well as routine wellness exams and flea and tick prevention medications.
Identity Theft and Legal Shield Legal Shield’s Identity theft can provide you and your dependent with comprehensive ID theft protection. This protect includes Credit Report monitoring and resolution services. The Legal Shield Plan provides you with access to legal assistance and advice from a licenses attorney. Covered services include Family Matters, Financial Advice, Auto, Home and Estate and Will planning.
INTRODUCTION TO SECTION 125/"CAFETERIA PLAN" The Section 125/"Cafeteria Plan" Benefit refers to Section 125 of the Internal Revenue Code of 1978. Simply put, the "Cafeteria Plan" allows you to deduct certain benefit premiums from your gross earnings, before federal withholding taxes are calculated. The amount you elect to have deducted “pre-tax” actually lowers your taxable income. Please review the following “sample paycheck”, for an illustration of how participating in the Cafeteria plan could work for you. The Plan Year for this benefit is from September 1 to August 31. All “pre-tax” elections will remain in effect and CANNOT be changed during the plan year unless you have one of the following changes in family status:
Marriage or Divorce of Employee or tax dependent
Birth, Adoption or Death of a Family Member
Change in eligibility status of a dependent
Change in employment status for you, your spouse or tax dependent
Change in dependent care provider
Increase or decrease in dependent care provider charges
Spouse’s Open Enrollment
**IRS regulations state that you have 31 days from the date of a qualifying event to provide proper documentation and complete the necessary paperwork to make a qualified family status change. This includes adding, dropping, increasing or decreasing coverages. **
TOMBALL ISD SECTION 125 PLAN DEMONSTRATION
WITHOUT SECTION 125 WITH SECTION 125
Monthly Salary $3,000.00 Monthly Salary $3,000.00
Less TRS -195.00 Less TRS -195.00
Less Insurance/Flex -250.00
Taxable Income 2,805.00 Taxable Income 2,555.00
Less Taxes -252.00 Less Taxes -180.00
Less Insurance/Flex
-250.00
TAKE HOME PAY $2,303.00 TAKE HOME PAY $2,375.00
You saved $72 per month in taxes by paying for your 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 your take home pay.
ELIGIBLE BENEFITS UNDER SECTION 125 Medical Insurance Dental Insurance Vision Insurance Cancer Insurance Critical Illness Medical Flex
Dependent Care Flex
Important Contacts
Type of Coverage
Benefit Provider Contacts and Websites
Flexible Spending Accounts
TASC MaryRohrscheib [email protected] 800-257-0986 x603 (phone) Chris Cramer: [email protected] 713-705-8754 (phone) 713-960-1540 (fax) TASC www/tasconline.com
Long Term Disability American Fidelity 1-800-654-8489 http://www.afadvantage.com/getforms.asp
Dental Assurant DMO Dental 800.443.2995 APP Dental 800.442.7742
Assurant – www.assurantemployeebenefits.com
Cancer Insurance Individual
Allstate/American Heritage
1-800-521-3535 www.ahlcorp.com
Cancer Insurance Group Humana/Bay Bridge 1-800-845-7519 www.
Critical Illness Humana 1-800-327-9728 www.humana.com
Vision Insurance VSP 1-800-877-7195
Annuity – 403(b) & (b)(7) Benefit Elect Chris Cramer: [email protected] 713-705-8754 (phone) 713-960-1540 (fax) Benefit Elect of Texas – www.beoftexas.com Teacher Retirement System – www.trs.state.tx.us
Employee Assistance New Directions 1-800-624-5544 (phone) www.ndbh.com
Life Insurance Assurant HoustonCustomerAdvocacy.com 1-800-733-7879
Pet Insurance Nationwide 1-855-283-6219
ID Theft and Legal Shield Legal Shield 832-860-1786
