Employee Benefit Guide 2022-2023 - Longview ISD Benefits
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2022-2023
Employee Benefit Guide
Improving our wellness together
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
CONTACTS
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
If you have any questions regarding your 2022 – 2023 benefit elections, please contact Professional
Enrollment Concepts’ Benefits Services Center. You may also contact the providers at their given
contact methods below.
BENEFITS SERVICES CENTER Scan QR code to
(866) 332-1287 view electonic
Monday – Friday: 8:00am – 7:00pm CST benefit guide.
Saturday: 9:00am – 3:00pm CST
BROKER
FBMC Benefits Management
(800) 872-0345
WELLNESS MEDICAL TELEHEALTH
VirginPulse TRS ActiveCare WellVia
(888) 671-9395 Blue Cross Blue Shield Group: 13946
www.virginpulse.com Group: 385000 TRS AC HD (855) 935-5842
Group: 385003 TRS AC Primary www.wellviasolutions.com
BASIC LIFE / AD&D Group: 385001 TRS AC Primary +
HSA / FSA / COBRA
VOLUNTARY LIFE Group: 385002 TRS AC 2
Discovery Benefits
The Standard (866) 355-5999
www.bcbstx.com/trsactivecare Group: 32649
Group: 760828
(866) 451-3399
(800) 628-8600
www.discoverybenefits.com
www.standard.com DENTAL
Humana
Group: 673256 DISABILITY
EAP The Standard
Health Advocate (800) 233-4013
www.humana.com Group: 760828
(888) 293-6948
(281) 517-5466 Pre-claim
www.healthadvocate.com/standard3 (866) 757-4717 Post-claim
VISION
TRAVEL ASSISTANCE Humana
Group: 673256 ACCIDENT
The Standard
Group: 760282 (866) 995-9316 CRITICAL ILLNESS
(855) 935-5842 www.humana.com HOSPITAL INDEMNITY
www.standard.com The Standard
MASA Group: 760828
UNIVERSAL LIFE MASA Global (866) 851-2429
Trustmark Group: B2BLVISD www.standard.com
Group: 0443300000 Emergency Assis.: (800) 643-9023
(800) 918-8877 Customer Serv.:(800) 423-3226 LEGALSHIELD
www.trustmarksolutions.com www.masaglobal.com IDSHIELD
LegalShield
Group: 2191
(903) 533-9123
www.mylegalshieldusa.com
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
2
CONTENTS
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
Note: This PDF is interactive, you may click on the above navigation bar to jump to a desired page/
section thruought the guide. The TOC page numbers listed below are also interactive.
Introduction............................................................4
Eligibility...................................................................5
Wellness...................................................................6
Basic Life / AD&D...................................................7
EAP.............................................................................8
Travel Assistance.................................................... 9
Universal Life..........................................................10
Medical......................................................................11
Dental........................................................................15
Vision.........................................................................16
MASA..........................................................................17
Telehealth................................................................18
Health Savings Account........................................ 21
Flexible Spending Account..................................22
Disability..................................................................24
Hospital Indemnity................................................25
Critical Illness.........................................................26
Accident....................................................................27
Identity Theft & Legal Services..........................29
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
3
INTRODUCTION
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
Longview ISD will be utilizing Professional Enrollment Concepts’ (PEC) services for our benefit communication
and enrollment this year. PEC’s Benefit Counselors will provide you with a detailed explanation of your
entire benefit program. They will review your benefits with you on an individual, confidential basis. They
will also be able to discuss any personal situations you may have that could potentially impact your
benefit decision.
Each year, we strive to offer comprehensive and competitive benefit plans to our employees. In the
following pages, you will find a summary of our benefit plan for September 1, 2022 to August 31, 2023.
Please read this Guidebook carefully as you prepare to make your elections for the 2022 – 2023 Plan Year.
This Benefits Guidebook describes the highlights of Longview ISD’s benefits program in non-technical
language. Your specific rights to benefits under the plan are governed solely, and in every respect, by the
official plan documents and not the information in this guidebook. If there is any discrepancy between
the description of the program elements as contained in this Benefits Guidebook and the official plan
documents, the language in the official plan documents shall prevail as accurate. Please refer to the
plan-specific documents published by each of the respective carriers for detailed plan information. Any
and all elements of Longview ISD’s benefits program may be modified in the future, at any time, to meet
Internal Revenue Service rules or otherwise as decided by Longview ISD.
How to Enroll
To enroll in your benefits as a new hire or to make
changes during open enrollment call PEC to speak
with a Benefit Counselor.
Benefits Services Center
(866) 332-1287 Before you speak with a Benefit
Counselor, please have the following
information ready: dependents' names,
Monday – Friday: 8:00am – 7:00pm CST birth dates, social security numbers,
Saturday: 9:00am – 3:00pm CST addresses, and phone numbers.
Online Benefits For online enrollment, use the following format
as your login information:
For your convenience, Employee ID or SSN: Your social security number
you may enroll online by visiting PIN: Last four of your social followed by
last two of your birth year
https://trustmark.benselect.com/enroll
Example:
Follow the login format listed here to access John Smith
your online benefit enrollment. SSN: 123-45-6789 | DOB: 01-27-1993
Emp. ID or SSN: 123456789
PIN: 678993
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
4
ELIGIBILITY
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
HIPAA (Health Insurance Portability and Accountability Act) requires that we comply with certain privacy
issues in order for us to assist you in the future with any claims issues, we will require written authorization
from you on a carrier specific form.
Eligibility
Longview ISD provides Full-Time Team Members who work a minimum of 20 hours per week and are at least
age 18 the opportunity to enroll in the following benefits for you and your eligible dependents: Medical,
Dental, Vision, Voluntary Life and AD&D, Universal Life, Educator Disability, Telehealth, Hospital Indemnity,
Critical Illness with Cancer, Accident, Medical Transport, Identity Theft, Legal Services, Flexible Spending
Accounts, and Health Savings Account. Employer Paid benefit of Basic Life and AD&D in the amount of
$10,000 is also provided.
All Part-Time Team Members who are actively at work and are scheduled to work at least 5 hours weekly
are eligible for the Employer Paid benefit of Basic Life and AD&D in the amount of $10,000.
Benefit Coverage
Benefits are available the first of the month following your date of hire.
Pre-Existing Conditions
Pre-existing conditions may apply to some lines of coverage. Pre-existing condition exclusions on
enrollees of any age no longer apply to the medical plans.
Termination of Coverage
Life, Long Term Disability, EAP and FSA coverage ends as of the date an employee terminates. All other
benefits will stay in effect until the last day of the month in which termination occurs.
Important!
Remember that you are “locked in” to your benefit election for the next plan year unless you have a
change in family status. Some examples of this would include:
• Marriage or Divorce
• Birth or Adoption
• Death of a Dependent
• Loss or Gain of Spouse’s Employment
• CHIPRA (Children’s Health Insurance Program Reauthorization Act)
Changes may NOT be made during the year UNLESS there is a change in family status! Coverage will
begin on the first of the month following the date the event occurs provided the completed enrollment
form and applicable supporting documents are received by Business Office within 30 days of the event
(except for CHIPRA—60 days to notify the Business Office.
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
5
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
NEW
WELLNESS
PROGRAM
NEW FOR 2022: VIRGIN PULSE WELLNESS PROGRAM
Join Longview ISD’s free wellness program to get active, eat better and live well. The best part? It’s fun, with
friends—and you can earn rewards!
We’re excited to announce that we’ve teamed up with Virgin Pulse to offer a new wellbeing program that will
help us make healthy choices, be well together, and inspire all of us to live better every day!
The Virgin Pulse platform makes it easy, giving you access to fun new wellness offerings, challenges and
programs that give you the choice, support and flexibility you need to reach your wellness goals—and it’s all
brought together within the top-rated Virgin Pulse app!
What’s in it for me?
• Create your own wellness journey! Build healthy habits, track your physical activity, take advantage of digital
coaching (Journeys) and much more!
• Feeling up for a challenge? Invite your co-workers or friends and family members to participate in a personal
challenge
• Get a picture of your health. Take the Health Check survey and get recommendations specific to your wellbeing
• Invite your spouse: Did you know your spouse is eligible to join the wellness program? Invite your spouse to join
and create their own personal account like yours.
Join today! Get the Virgin Pulse mobile app or go to join.virginpulse.com/lisd
© Virgin Pulse 2022
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
6
LIFE / AD&D
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
You do everything you can for your loved ones—not because you have to
but because you want to. Whether you’re looking for coverage for a specific
period or a lifetime, with the right Life / AD&D Insurance coverage, you
can rest knowing your loved ones will be able to live out their dreams—no
matter what the future holds.
BASIC TERM
Longview ISD provides all full-time employees working at least 20+ hours weekly a flat coverage amout
for Basic Life and Accidental Death and Dismemberment (AD&D) insurance. This $10,000 coverage is at
no charge to you and is active for the duration of your employment.
Please note: The benefit reduces to 65% at age 65, to 40% at age 70, and to 25% at age 75.
VOLUNTARY
With The Standard’s Voluntary Life and AD&D Insurance, Longview ISD gives you the opportunity to
buy valuable life insurance coverage for yourself, your spouse, and your dependent children — all at
affordable group rates.
Please note: The benefit reduces to 65% at age 65, to 40% at age 70, and to 25% at age 75.
Monthly Deductions (per $1,000)
Age Employee Spouse
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
Note: Free benefit!
A helping hand when
you need it.
Rely on the support, guidance and resources
of your Employee Assistance Program.
There are times in life when you Your program includes up to three
might need a little help coping counseling sessions per issue.
or figuring out what to do. Sessions can be done in person,
Take advantage of the Employee on the phone, by video or text.
Assistance Program,1 which
includes WorkLife Services and EAP services can help with: Contact EAP
is available to you and your family
in connection with your group Depression, grief, loss and 888.293.6948
insurance from Standard Insurance emotional well-being (TTY Services: 711)
Company (The Standard). 24 hours a day,
It’s confidential — information Family, marital and other seven days a week
will be released only with your relationship issues healthadvocate.com/standard3
permission or as required by law.
Life improvement and
Connection to Resources, goal-setting
Support and Guidance
You, your dependents (including Addictions such as alcohol
NOTE: It’s a violation of your
children to age 26)2 and all and drug abuse
company’s contract to share this
household members can contact information with individuals who
the program’s master’s-level Stress or anxiety with work are not eligible for this service.
counselors 24/7. Reach out through or family
the mobile EAP app or by phone,
online, live chat, and email. You Financial and legal concerns
can get referrals to support groups,
Identity theft and fraud With EAP, personal
a network counselor, community
resources or your health plan. If
resolution assistance is immediate,
necessary, you’ll be connected to
Online will preparation and
confidential and available
emergency services. when you need it.
other legal documents
WorkLife Services Online Resources
WorkLife Services are included with the Employee Assistance Visit healthadvocate.com/standard3 to explore a
Program. Get help with referrals for important needs like wealth of information online, including videos, guides,
education, adoption, daily living and care for your pet, articles, webinars, resources, self-assessments
child or elderly loved one. and calculators.
1 The EAP service is provided through an arrangement with Health AdvocateSM, which is not affiliated with The Standard. Health AdvocateSM is solely
responsible for providing and administering the included service. EAP is not an insurance product and is provided to groups of 10–2,499 lives.
This service is only available while insured under The Standard’s group policy.
2 Individual EAP counseling sessions are available to eligible participants 16 years and older; family sessions are available for eligible members
12 years and older, and their parent or guardian. Children under the age of 12 will not receive individual counseling sessions.
Standard Insurance Company | 1100 SW Sixth Avenue, Portland, OR 97204 | standard.com
The Standard is a marketing name for StanCorp Financial Group, Inc. and subsidiaries. Insurance products are offered by Standard Insurance Company of
Portland, Oregon in all states except New York. Product features and availability vary by state and are solely the responsibility of Standard Insurance Company.
Employee Assistance Program-3 EE
SI 17201 (8/21)
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
8
TRAVEL
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
ASSISTANCE Note: Free benefit!
Providing you peace of mind when traveling
The Standard through Assist America, Inc. offers you this service. Travel Assistance can help employees
and their families prepare for trips and during critical situations while away from home. The program can
assist participants with finding qualified medical providers, legal services or with the replacement of lost
credit cards and passports.
Find comfort in knowing you and your loved ones are protected by the Travel Assistance benefit when
traveling more than 100 miles from home on a trip that lasts 180 days or less for business or pleasure. The
Travel Assistance benefit protects you when covered under a The Standard group life insurance contract.
It also extends coverage to your spouse, domestic partner and children, even when they are traveling
without you. The Travel Assistance benefit requires no additional premium; however, exclusions do apply.
Please note: Participants MUST contact Assist America as soon as possible to use Travel Assistance.
Plan Highlights PROGRAM DESCRIPTION
Travel Assistance is not travel insurance. Travel Assistance provides
Travel Assistance
Personal Support
specific support services while traveling. Travel insurance provides
• Pre-trip informational services monetary compensation for losses that occur while traveling.
• Location lost or stolen items Visit full programdescription document for additional explanation of
• Legal referral and bail Select a Topic
• Interpretation and translation services what Travel Assistance covers and how you can use it. Contact Assist
• Crime information America for additional details and questions.
EXPLANATION, MEDICAL EMERGENCY
PERSONAL EMERGENCY
Medical Emergency Support ELIGIBILITY,
SUPPORT
EMERGENCY
SUPPORT
TRANSPORT
ACCESS SUPPORT TRAVELERS
• Medical monitoring
• Medical and dental search and referral
• Dispatch of doctors
• Assistance with replacement of medication, medical devices and eyeglasses or corrective lenses
• Transfer of insurance information and medical records
Mobile App and Service Activation
• Assistance with Vaccine and blood tranfers
• Facilitation of hospital admission
DOWNLOADING THE ASSIST AMERICA MOBILE APP MOBILE
Emergency Support Your Assist America
Participants can get the app by following these Reference Number: The app
• Assistance with Emergency Travel Arragements 01-AA-STD-5201
• Emergency Cash Advance easy steps: assista
• Emergency Message Relay 1) Visit Google Play or the App Store • Tap fo
• Evacuation in Case of Political or Natural 2) Find the Assist America Mobile App Opera
Disaster • Voice
• Emergency Trauma Counseling 3) Enter reference number and participant name
callin
Emergency Transport for Travelers ACTIVATING SERVICES • Pre-T
for yo
• Emergency Medical Evacuation Participants who require assistance while For more information
• Repatriation of Mortal Remains • Trave
traveling more than 100 miles away from home, about Assist America,
• Medical Repariation or in a foreign country, should contact Assist visit assistamerica.com. • Trave
America’s 24/7 Operations Center in one of the for se
Emergency Transport for Others following ways: • Emba
• Care of Minor Children If you have questions
of 23
• Compassionate Visit • Use the Tap for Help button on the mobile app about your insurance
• Return of Traveling Companion • 1-800-872-1414 (Toll-free call within the U.S.) policy, please contact • Mobi
• Return of Pet or Service Animal The Standard at the ap
• 1-609-986-1234 (Collect call outside the U.S.)
• Evacuation Transport for Family Members 888.937.4783. • Availa
• Vehicle Return • Email medservices@assistamerica.com Arabi
Travel Assistance is provided by Assist America, Inc., which is not affiliated with Standard Insurance Company. A
2022is–not
2023 | LONGVIEW | Employee
ISDStandard Benefits Guide
Travel Assistance an insurance product.
Standard Life Insurance Company of New York.
Insurance Company
9
may change providers or terminate
Standard Insurance Company | 1100 SW Sixth Avenue, Portland, OR 97204 | standard.com
UNIVERSAL LIFE
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
WITH LONG-TERM CARE
Trustmark’s fully-portable Universal Life solutions address differing
employee needs for permanent life insurance. This is available for
employees, their spouse, and their children. This plan offers flexible,
comprehensive benefits and enables you to adjust your death benefit,
cash value, and premiums as your financial needs change.
Benefit Range: $5,000 – $300,000
You
• Age range: 18 to 64
• Guaranteed Issuance: $20 per week not to exceed $200,000
Spouse / Domestic Partner
• Age range: 18 to 64
• Guaranteed Issuance: $3 per week or $20,000, whichever is greater
Dependent Children/Grandchildren
• Age range:MEDICAL INSURANCE
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
-ActiveCare Plan Highlights Sept. 1, 2022 – Aug. 31, 2023
All TRS-ActiveCare participants have three plan options. Each includes a wide range of wellness benefits.
veCare PlanTRS-ActiveCare
2022-23 Highlights Sept. 1,Plan
2022 –Highlights
Aug. 31, 2023 Sept. 1, 2022 – Aug. 31, 2023
-ActiveCare Plan Highlights Sept. 1, 2022 – Aug. 31, 2023
TRS-ActiveCare Primary TRS-ActiveCare Primary+ TRS-ActiveCare HD
• Lowest premium of all three plans • Lower deductible than the HD and Primary plans • Compatible with a Health Savings Account (HSA)
• Copays for doctor visits before you meet your deductible • Copays for many services and drugs • Nationwide network with out-of-network coverage
• Statewide network • Higher premium • No requirement for PCPs or referrals
AllHow Plan Summary
TRS-ActiveCare participants have All
to Calculate Your TRS-ActiveCare
three participants
plan options. have three
Each includes planrange
a wide options. Each includes
of wellness
• Primary Care Provider (PCP) referrals required to see
specialists
a wide r
benefits.
• Statewide network
• PCP referrals required to see specialists
• Must meet your deductible before plan pays for non-preventive care
All TRS-ActiveCare participants have three plan options. Each includes a wide range of wellness benefits.
• Not compatible with a Health Savings Account (HSA) • Not compatible with a Health Savings Account (HSA)
Monthly Premium • No out-of-network coverage • No out-of-network coverage
TRS-ActiveCare Primary TRS-ActiveCare Primary+
TRS-ActiveCare Primary
TRS-ActiveCare Primary TRS-ActiveCare Primary+ TRS-ActiveCare HD
Total Monthly Premium • LowestTRS-ActiveCare Primary+
premium of all three plans TRS-ActiveCare
• Lower deductible than the HD and HD Primary plans
• Lowest premium of all three
of allplans • Copays
• •Lower for doctor
deductible visits
thanthe before
theHDHDandand you meet
Primary your
plansdeductible • Copays
•Total foramany
Compatible services
with andSavings
a Health drugs Account (HSA)
Monthly Premiums • LowestTotal
premium
Premium three plans Your Premium Lower deductible than
Total Premium Primary plans
Your Premium • Compatible with Health
Premium Savings Account (HSA)
Your Premium
Your District and State
• Copays for doctorforvisits
• Copays before
doctor visits you meet
before your your
you meet deductible
deductible • Statewide
• •Copays
Copays for manynetwork
for many servicesandand
services drugs
drugs • Higher premium
• Nationwide
• Nationwide network network
with with out-of-network
out-of-network coverage coverage
$ Plan Summary • Primary Care Provider (PCP) $ referrals required to see • Statewide network
Contributions Employee Only • Statewide
• Statewide network $408
network • •Higher
Higher $513
premium
premium
specialists
$423
• No requirement
• No requirement
• PCP
for PCPs or for
referrals required
$
PCPs or referrals
referrals
to see specialists
Plan Summary
Plan Summary • Spouse
Employee and • Primary
Primary Care Care
Provider
$1,151Provider (PCP) referrals
(PCP) referrals required
$required to see
to see • •Statewide
Statewide network
network
$1,254 $ • Must meet yourmeet
• Must
$1,189 deductible
yourbefore plan
$ pays
deductible for non-preventive
before plan pays forcare
non-prev
Your Premium • referrals
Not compatible withsee
a Health Savings Account (HSA) • Not compatible with a Health Savings Account (HSA)
specialistsspecialists $734
Employee and Children $ • •PCP
PCP referrals required
requiredtoto
$825 seespecialists
specialists
$ $759 $
• Not compatible with a Health Savings Account (HSA) • Not•compatible
No out-of-network coverage
with a Health Savings Account (HSA) • No out-of-network coverage
• Not compatible with a Health Savings Account (HSA) • •Not compatible with a Health Savings Account (HSA)
Ask your Benefits Administrator for your•district’s
Employee and Family No out-of-network coverage $ No out-of-network
$1,577 coverage $
specific premiums. • No out-of-network$1,378
coverage • No out-of-network coverage $1,422 $
Monthly Premiums Total Premium Your Premium Total Premium Your Premium
Plan Features
Monthly Premiums Total Premium Your Premium Total Premium Your Premium Total Premium Your Premium
Employee Only $408 $ $513 $
Premiums Type OnlyTotal Premium$408 In-Network Coverage
of Coverage
Employee $ YourOnly
Premium Total$513
Premium
In-Network Coverage
$ Only Your Premium $423 Total Premium
In-Network $ Out-of-NetworkYour Premium
Employee and Spouse $1,151 $ $1,254 $
Wellness Benefits at
Individual/Family
EmployeeEmployee Deductible
Only and Spouse $408 $1,151 $2,500/$5,000
$ $
Employee and Children
$1,254
$513
$734
$1,200/$3,600
$ $
$
$3,000/$6,000
$1,189
$825
$423 $
$
$5,500/$11,000
$
No Extra Cost* Employee
Employee and Spouse
Individual/Family Maximum
Coinsurance
and
Outand
Employee
Children
of Pocket
Family
$1,151 $734You
$1,378
pay 30%
$ after
$ deductible
$8,150/$16,300
$
Employee and Family
$825You pay 20% after
$1,254$1,378
$1,577
$ deductible
$$
$6,900/$13,800
$
You pay 30%$759
after deductible
$7,050/$14,100
$1,422
$1,189
$1,577
$
$
You pay
$
50% $after deductible
$20,250/$40,500
Employee and Children $734 $ $825 $ $759 $
Network Statewide Network Statewide Network Nationwide Network
Employee and Family $1,378 $ $1,577 $ $1,422 $
Being healthy PCP
is Required
easy with: Yes
Plan Features
Yes No
Plan Features
• $0 preventive
Type ofcare
Coverage In-Network Coverage Only Type of Coverage In-Network
In-Network Coverage
Coverage Only Only In-Network In-Network Coverage Only
Out-of-Network
tures
Doctor Visits
Individual/Family Deductible $2,500/$5,000Individual/Family Deductible $2,500/$5,000
$1,200/$3,600 $3,000/$6,000 $1,200/$3,600
$5,500/$11,000
• 24/7 customerCoinsurance
service
Type of CoveragePrimary Care You pay
In-Network $30 after
30%
Coverage copaydeductible
Only
Coinsurance You pay
$3030%
YouIn-Network
pay 20% copay
after after deductible
deductible
Coverage Only
You pay 20% after deductible
You pay 30% after deductible
In-Network You pay 50% after deductible
Out-of-Netwo
Individual/Family Maximum Out Specialist Individual/Family Maximum Out of Pocket $8,150/$16,300 30% after deductible $6,900/$13,800
• One-on-one
Individual/Family health
Deductible
of Pocket
coaches $70 copay
$8,150/$16,300
$2,500/$5,000
Network
$70 copay
$6,900/$13,800
$1,200/$3,600
Statewide Network
You pay$7,050/$14,100
$3,000/$6,000
You pay
Statewide
50% after deductible
$20,250/$40,500
Network
$5,500/$11,0
Network Statewide Network Statewide Network Nationwide Network
Coinsurance You pay 30% after deductible You pay 20% after deductible You pay 30% after deductible You pay 50% after d
• Weight loss programs
PCP Required Yes PCP Required Yes Yes No Yes
FamilyImmediate
Maximum Out of Pocket
Care $8,150/$16,300 $6,900/$13,800 $7,050/$14,100 $20,250/$40,
• NutritionNetwork
programs
Urgent Care Statewide Network
$50 copay Statewide
$50 copayNetwork You pay 30% after deductible Nationwide
You pay 50%Network
after deductible
Doctor Visits Emergency Care
PCP Required Doctor
You pay
Yes Visits
30% after deductible You pay 20% after
Yesdeductible You pay 30% after deductible
No
• OviaTRS Virtual
TM
pregnancy
Health-RediMD
support
Primary Care (TM)
$0 per medical consultation
$30 copay Primary Care $0 per medical
$30 $30consultation
copaycopay You pay 30% after$30 per medical$30
deductible consultation
Youcopay
pay 50% after deductible
• TRS Virtual Health
TRS Virtual Health-Teladoc
Specialist® $12 per medical consultation
$70 copay Specialist $12 per medical
$70 $70 consultation
copaycopay You pay 30% after$42 per medical$70
deductible consultation
Youcopay
pay 50% after deductible
isits
• Mental health benefits
Immediate Primary
Prescription DrugsCare
Care $30 copay
Immediate Care
$30 copay You pay 30% after deductible You pay 50% after d
• And much more!
Specialist
DrugUrgent Care
Deductible $70 copay
$50 with
Integrated copaymedical
Urgent Care
$70
$50
$200 brand copay
copay
deductible
$50 copay
You pay
You pay 30% after30% after deductible
deductible
Integrated withYou You pay
pay 50% after
medical
$50 copay
50% after d
deductible
Emergency
Generics (30-Day Supply/90-Day Care
Supply) $15/$45You pay $0
copay; 30% afterfor
copay deductible
certain generics You pay$15/$45
20% after deductible
copay You pay 20% after You pay 30%$0after
deductible; deductiblefor certain generics
coinsurance
Emergency Care You pay 30% after deductible You pay 20% after deductible
*AvailableTRSforVirtual
all plans.
Health-RediMD (TM)
Preferred Brand $0 per
You pay medical consultation
30% after deductible $0 per
You pay medical consultation
25% after deductible $30 pay
You per 25%
medical
afterconsultation
deductible
See the benefits
TRS Virtual
guide for more
Health-Teladoc
details. TRS Virtual Health-RediMD (TM) $0 per medical consultation $0 per medical consultation
You pay 50% afterconsultation
$12 per medical $12 pay
per 50%
medical
afterconsultation You pay 50% afterconsultation
$42 per medical
®
ate Care Non-preferred Brand deductible
TRS Virtual Health-Teladoc®
You deductible
$12 per medical consultation
deductible
$12 per medical consultation
Urgent Care Specialty $0 ifcopay
$50 PrudentRx eligible; $0 if PrudentRx eligible;
$50 copay You payYou
30%payafter
20% deductible
after deductible You pay 50% after d
You pay 30% after deductible You pay 30% after deductible
Emergency
Prescription Drugs
Insulin Care
Out-of-Pocket Costs $25You payfor30%
copay after
31-day deductible
supply; $75 for 61-90 day supply $25 copay forYou paysupply;
31-day 20% after deductible
$75 for 61-90 day supply You
You pay 25% paydeductible
after 30% after deductible
TRS Virtual Health-RediMDDrug Deductible
(TM) Prescription
$0 per medical consultation
Integrated
Drugs
with medical $0$200
per brand
medical consultation
deductible $30
Integrated withper medical consultation
medical
Things to Know
TRSGenerics
Virtual (30-Day
Health-Teladoc ®
Supply/90-Day Supply) $12 per medical
$15/$45 copay; $0consultation
Drug Deductible
copay for certain generics
Integrated
$12 per medical
$15/$45
with medical
consultation
copay
$200 brand
You pay 20% after deductible;$42
deductible
per medical
$0 coinsurance forconsultation
certain generics
Preferred Brand
Generics (30-Day Supply/90-Day Supply)
You pay 30% after deductible
$15/$45 copay; $0 copay for certain generics
You pay 25% after deductible
$15/$45 copay
You pay 25% after deductible
• TRS’s Texas-sized purchasing
Non-preferred Brand power You pay 50% after deductible Preferred Brand You pay 30%
You pay 50% after after deductible
deductible You50%
You pay pay after
25%deductible
after deductible
enables access to broad networks $0 if PrudentRx eligible; Non-preferred Brand 2022$0You
–if2023 | after
pay 50% deductible ISD | Employee Benefits Guide
LONGVIEW You pay 50% after deductible
tion Drugs
11
PrudentRx eligible;
Specialty You pay 20% after deductible
without county boundaries. You pay 30% after deductible You pay$030% after deductible
if PrudentRx eligible; $0 if PrudentRx eligible;
Drug Deductible Integrated with medical Specialty $200 brand deductible Integrated with medical
Insulin Out-of-Pocket Costs $25 copay for 31-day supply; $75 for 61-90 day supply You
$25 copay for 31-day pay 30%$75
supply; after
fordeductible
61-90 day supply You25%
You pay pay after
30% after deductible
deductible
• Specialty drug insurance meansEmergency Care You pay 30%
*Available for all plans. Your Premium
2022-23 TRS-ActiveCare Plan Highlights Sept. 1, 2022 – Aug. 31,
See the benefits guide for more details. TRS Virtual Health-RediMD (TM) $0 per medic
Ask your Benefits Administrator for your district’s
TRS Virtual Health-Teladoc®
specific premiums. $12 per medi
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITSMonthly Prem
Prescription Drugs
How to Calculate Your All TRS-ActiveCare
Things to Know participants have three
Wellness plan
Benefits
Drug options.
at
Deductible Each incl
Integrated
Monthly Premium No Extra Cost*
Generics (30-Day Supply/90-Day Supply) $15/$45 copay; $0 co
• TRS’s Texas-sized purchasing power TRS-ActiveCare Primary Preferred Brand TRS-ActiveCare
You pay 30% P
enables access to broad •networks Being healthy is easy
Non-preferred Brandwith: You
the pay 50%P
Total Monthly Premium Lowest premium of all three plans • Lower deductible thanPlan HD and
Feature
without county boundaries.
• Copays for doctor visits before you meet your deductible • Copays for many services$0and drugs
if Prude
Your District and State • Statewide network • $0 preventive care
Specialty
• Higher premium
You pay 30%
• Specialty drug insurance•means
Plan Summary Primary Care Provider (PCP) referrals required to see • Statewide network Ind
Contributions • 24/7 customer
Insulin service
Out-of-Pocket Costs $25 required
copay forto31-day supp
you’re covered, no matter specialists
what life • PCP referrals see special
Your Premium • Not compatible with a Health Savings Account (HSA) • Not compatible with a Health Saving
throws at you. • No out-of-network coverage • One-on-one health• coaches
Individual/Famil
No out-of-network coverage
Ask your Benefits Administrator for your district’s
specific premiums. • Weight loss programs
This plan is closed and not accepting new enrollees. If you’re Monthly Premiums Total Premium • Nutrition programs
Your Premium Total Premium
currently enrolled in TRS-ActiveCare 2, you can remain in this plan. Doctor Visits
Employee Only $408 $ • Ovia pregnancy support
TM $513 $
Employee and Spouse $1,151 $ $1,254 $
Wellness
TRS-ActiveCare Benefits 2 at Employee and Children $734 $
• TRS Virtual Health $825 $
NocanExtra
• Closed to new enrollees
• Current enrollees Cost*
choose to stay in plan Employee and Family $1,378 $ • Mental health benefits $1,577 $
• Lower deductible Immediate C
• Copays for many services and drugs • And much more!
•This plan isnetwork
Nationwide closedwith
and not accepting
out-of-network new enrollees. If you’re
coverage
This
Noplan is closed
•currently Being healthy is easy with:
and
enrolled not accepting
referrals new enrollees.
in TRS-ActiveCare 2, youIfcan
you’re
remain in this plan.Plan Features
ACTIVATE YOUR HEALTH:
requirement for PCPs or
currently enrolled in TRS-ActiveCare 2, you can remain in this plan. *Available for all plans.
See the benefits guide for more details. TRS
• $0ofpreventive
e unique needs care in mind.
our members This plan is closed and not accepting new enrollees. If you’re
Type of Coverage
currently enrolled in TRS-ActiveCare 2, you can remain in this plan.
In-Network Coverage Only In-Network Covera
TR
TRS-ActiveCare 2
TRS-ActiveCare 2
TRS-ActiveCare Plan Highlights 2020-21
Individual/Family Deductible $2,500/$5,000 $1,200/$3,60
• Closed
• 24/7 customer service
• Closed Total
to toPremium
new enrollees
new enrollees Your Premium Coinsurance You pay 30% after deductible You pay 20% after d
TRS-ActiveCare Primary+
TRS-ActiveCare 2
Nobody plans on getting Thingssick
to Knowor hurt,
• Current
• Current enrollees can choose
enrollees
$1,013 to stay
can choose $ intoplan
stay in plan Individual/Family Maximum Out of Pocket $8,150/$16,300 Prescription
$6,900/$13,8
• Lower
• Lower • One-on-one health coaches
deductible
• Simpler version of the current Select plan
for deductible
$2,402services and drugs $
• Closed to new enrollees
• Copays many • Current enrollees can choose to stay Network Statewide Network Statewide Netw
but most people will need Medical Care
• Lower deductible than HD and primary plans in plan
• Copays
• Nationwide for many
network services
with and drugs
out-of-network
and$ drugscoverage
• Copays
• Nationwide
• No requirement • Weight loss programs
for many
$1,507
• Higher premium network
for
services
PCPs orwith out-of-network coverage
referrals
• Lower deductible
PCP Required
• Copays for many drugs and services
Yes
• TRS’s Texas-sized purchasing power
Generics (30-Da
Yes
• No $2,841
requirement
• Statewide for PCPs or$referrals
network • Nationwide network with out-of-network coverage
ve care
• Nutrition programs
• PCP referrals required to see specialists
• Not compatible with a health savings account (HSA)
• No out-of-network coverage
at some point in their lives.
• No requirement for PCPs or referrals
Doctor Visits
enables access to broad networks
without county boundaries.
e no If you’re • Ovia pregnancy support
Total currently
TM
Premiumin TRS-ActiveCare Select Your
andPremium
you make no If you’re currently in TRS-ActiveCare 2, and you make no changes during
Primary Care
• Specialty drug insurance means
$30 copay you’re covered, no matter what life $30 copayIn
next year. changes during Annual Enrollment,
In-Network
$1,013 $ this will Longview ISD Specialist
be your plan next year.
Out-of-Network
offers three choices for health insurance. These
Annual Enrollment, you will remain in TRS-ActiveCare 2 next year.
• TRS
Total
$1,000/$3,000
$2,402 Virtual
Premium
$ Health Your Premium
$2,000/$6,000
plans have different levels of
$70 copay throws at you.
copays, deductibles, and out-
$70 copay
This new
$1,013 year brings $ new opportunities to unlock your potential and take charge of your wellness.
You pay 20% after deductible
$1,507
•$2,402
Mental
$ You pay 40% after deductible
Premium health$23,700/$47,400
of-pocket maximums. To make an informed decision, please
m Total
$7,900/$15,800 $benefits
Your Premium Total Premium Your Premium
After connecting
$2,841
with your
$
$514 Nationwide Network
$
district leaders to learn how continue
we could
Immediate Care
$937 reading
enhance $ the for
qualitybrief
of descriptions
your coverage, we’re of your coverage
providing improvedoptions.
pricing, more •$1,507
And much
network more!
choices,
$
simplified coverage and a new plan with a lower premium and copays.
The Medical Urgent program, administered by Blue Cross Blue Shield-
$1,264 No $ $2,222 $ Care $50 copay $50 copay
$2,841 $ $1,393 $
$834 $
TRS,$2,627
provides the Emergency framework for your health and well-being. To
Care You pay 30% after deductible You pay 20% after d
Welcome $1,588to the$ 2020-21
*Available
In-Network
See the
for all plans.
benefits guideOut-of-Network TRS-ActiveCare,
for more details. TRS where
Virtual
$
Health-RediMD you can empower
better meet the varying needs of our employees, Longview ISD
$0 per
(TM)
medical the
consultation best you. $0 per medical con
$1,000/$3,000
$30 copay
$2,000/$6,000
You pay 40% after deductible
offers the following Medical plans.
TRS Virtual Health-Teladoc $12 per
®
medical consultation $12 per medical con
You pay 20% after deductible You pay 40% after deductible
What to Know
$70 In-Network
copay
$7,900/$15,800 You pay 40% afterOut-of-Network
deductible
$23,700/$47,400
rk In-Network Coverage Only In-Network Out-of-Network
Nationwide Network
$1,000/$3,000 $1,200/$3,600 $2,000/$6,000
00 Prescription Drugs
$1,000/$3,000 $2,000/$6,000
No
ThingsYour
How to Calculate to Monthly
eductible You pay 20% afterKnow Premium
Youdeductible You pay 40% after deductible
pay 20% after deductible You pay 20% after deductibleDrug Deductible
Learn the Terms
You pay 40% after deductible Integrated with medical $200 brand dedu
00 $6,900/$13,800
$7,900/$15,800 $23,700/$47,400 $7,900/$15,800
Generics $23,700/$47,400
(30-Day Supply/90-Day Supply) $15/$45 copay; $0 copay for certain generics $15/$45 cop
$50 copay You pay 40% after deductible
Total •Monthly
You payTRS’s Premium
Statewide
Texas-sizedNetwork
Nationwide
a $250 copay plus 20% purchasing
Network
after deductible power Premium:
• Nationwide The monthly amount
Network
Preferred Brand You payyou
30% pay for health care coverage.
after deductible You pay 25% after d
No
Your
$30District
$0 per and
enables
copay State
access
medical Yes
toContributions
pay broad
40% afternetworks
consultation
YouNo deductible Non-preferred Brand You pay 50% after deductible You pay 50% after d
• Deductible: The annual amount for medical expenses you’re
Your without
Premium
$70 copay county
$12 per medical Youboundaries.
consultation
pay 40% after deductible $0 if PrudentRx eligible; $0 if PrudentRx e
responsible to pay before your
Specialty plan
You pay 30%begins to pay its portion.
after deductible You pay 30% after d
• Specialty drug insurance means
eductible you’re covered, no matter what life
$30 copay $30 copay • Copay: The set amount you pay for a covered service at the time$25 copay for 31-day supply; $75
Insulin Out-of-Pocket
YouCosts $25deductible
pay 40% after copay for 31-day supply; $75 for 61-90 day supply
Calculate Your Monthly
throws at you. Premium $70 copay You pay 40% after deductible
eductible $70 copay
$30 copay
$50 copay Youafter
You pay 40%
$200 brand deductible paydeductible
40% after deductible you receive it. The amount can vary by the type of service.
$0 per consultation $0 per consultation
$70a $250
You pay copaycopay 20% after You
pluscopay
$20/$45 pay 40% after deductible
deductible
• Coinsurance: The portion you’re required to pay for services after
You pay 25%$0after
per medical consultation
deductible ($40 min/$80 max)/
You pay 25% after
$12 perdeductible ($105 min/$210 max)
medical consultation
you meet your deductible. It’s often a specified percentage of the
$50 copay costs; i.e.
Youyou payafter20% while the health care plan pays 80%.
You pay 50% after deductible ($100 min/$200 max)/
eductible $50 copay
You pay 50% after deductible ($215 min/$430 max) pay 40% deductible
You pay a $250 copay plus 20% after deductible
You
$0 pay 20% after
if PrudentRx deductible
eligible; • Out-of-Pocket Maximum: The maximum amount you pay each
You pay$50
30%copay
after deductible You pay
($200 min/$900
$0 per consultation
40% after deductible
max)/ $0 per consultation
No 90-day supply of specialty medications
You pay$200a $250
brandcopay plus 20% after deductible
deductible
year for medical costs. After reaching the out-of-pocket maximum,
Ask $25
yourcopay for 31-day supply; $75 for 61-90 day supply
Benefits Administrator
$0 copayfor consultation
per medical
$20/$45 your district’s specific premiums. the plan pays 100% of allowable charges for covered services.
You pay 25% after
$12deductible ($40 min/$80
per medical max)/
consultation
You pay 25% after $200
deductible
brand($105 min/$210 max)
deductible $200 brand deductible
2022($100
–copay
2023 | LONGVIEW
12 ISD | Employee Benefits Guide
You pay 50% after deductible
$15/$45 min/$200 max)/ $20/$45 copay
You pay 50% after deductible ($215 min/$430 max)
You pay 25% after deductible You pay 25% after deductible ($40 min/$80 max)/
$0 if PrudentRx eligible; You pay 25% after deductible ($105 min/$210 max)ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
Compare Prices for Common Medical Services
Log into Blue Access for MembersSM at www.bcbstx.com/trsactivecare to use the cost estimator
REMEMBER: tool. This will help you find the best prices through different providers.
TRS-ActiveCare TRS-ActiveCare
Benefit TRS-ActiveCare HD TRS-ActiveCare 2
Primary Primary+
In-Network Only In-Network Only In-Network Out-of-Network In-Network Out-of-Network
Office/Indpendent Office/Indpendent Office/Indpendent
Lab: You pay $0 Lab: You pay $0 Lab: You pay $0
You pay 30% after You pay 50% after You pay 40% after
Diagnostic Labs*
deductible deductible deductible
Outpatient: You pay Outpatient: You pay Outpatient: You pay
30% after deductible 20% after deductible 20% after deductible
You pay 20% after You pay 40% after
You pay 30% You pay 20% You pay 30% after You pay 50% after
High-Tech Radiology deductible + $100 deductible + $100
after deductible after deductible deductible deductible
copay per procedure copay per procedure
You pay 20% after You pay 40% after
You pay 30% You pay 20% You pay 30% after You pay 50% after deductible ($150 deductible ($150
Outpatient Costs
after deductible after deductible deductible deductible facility copay per facility copay per
incident) incident)
You pay 50% after You pay 40% after
You pay 20% after
You pay 30% You pay 20% You pay 30% after deductible ($500 deductible ($500
Inpatient Hospital Costs deductible ($150
after deductible after deductible deductible facility per day facility per day
facility copay per day)
maximum) maximum)
You pay $500 You pay $500 You pay $500 You pay $500 You pay $500 You pay $500
Freestanding
copay + 30% after copay + 20% after copay + 30% after copay + 50% after copay + 20% after copay + 40% after
Emergency Room
deductible deductible deductible deductible deductible deductible
Facility: You pay 20%
Facility: You pay 30% Facility: You pay 20%
after deductible ($150
after deductible after deductible
facility copay per day)
Professional Services: Professional Services: Professional Services:
You pay $5,000 You pay $5,000 You pay $5,000
Bariatric Surgery Not Covered Not Covered Not Covered
copay + 30% after copay + 20% after copay + 20% after
deductible deductible deductible
Only covered if Only covered if Only covered if
rendered at a BDC+ rendered at a BDC+ rendered at a BDC+
facility facility facility
Annual Vision Exam
(one per plan year;
You pay 30% after You pay 50% after You pay 40%
performed by an You pay $70 copay You pay $70 copay You pay $70 copay
deductible deductible after deductible
ophthalmologist or
optometrist)
Annual Hearing Exam $30 PCP copay $30 PCP copay You pay 30% after You pay 50% after $30 PCP copay You pay 40%
(one per plan year) $70 specialist copay $70 specialist copay deductible deductible $70 specialist copay after deductible
*Pre-certification for genetic and specialty testing may apply. Contact a Personal Health Guide at 1-866-355-5999 with questions.
www.trs.texas.gov
Revised 05/03/22
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
13MEDICAL PREMIUMS
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
Per Paycheck Deductions: ActiveCare Primary
Monthly Custodian(24 Café / Bus (18
Employee Only $183.00 $91.50 $122.00
Employee + Spouse $926.00 $463.00 $617.33
Employee + Child(ren) $509.00 $254.50 $339.33
Family $1,153.00 $576.50 $768.67
Per Paycheck Deductions: ActiveCare HD
Monthly Custodian Café / Bus
Employee Only $198.00 $99.00 $132.00
Employee + Spouse $964.00 $482.00 $642.67
Employee + Child(ren) $534.00 $267.00 $356.00
Family $1,197.00 $598.50 $798.00
Per Paycheck Deductions: ActiveCare Primary +
Monthly Custodian Café / Bus
Employee Only $288.00 $144.00 $192.00
Employee + Spouse $1,029.00 $514.50 $686.00
Employee + Child(ren) $600.00 $300.00 $400.00
Family $1,352.00 $676.00 $901.33
Per Paycheck Deductions: ActiveCare 2
Monthly Custodian Café / Bus
Employee Only $788.00 $394.00 $525.33
Employee + Spouse $2,177.00 $1,088.50 $1,451.33
Employee + Child(ren) $1,282.00 $641.00 $854.67
Family $2,616.00 $1,308.00 $1,744.00
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
14DENTAL
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
Humana gives you the freedom to choose whether you would like
to visit a participating dentist or an out-of-network dentist. There are
considerable cost savings when using a dentist who is in the Humana
Network. The following is a summary of the major plan provisions.
Dental Traditional Plus 09
In-Network Out-of-Network¹
Annual Deductible $50 indv.; $150 family $50 indv.; $150 family
Annual Maximum $1,000 $1,000
Preventive Services
oral exams, cleanings, X-rays 100% no deductible 100% no deductible
sealants, fluoride treatments
Basic Services
fillings, periodontal maintenance, 80% after deductible 80% after deductible
space maintainers, basic extractions
Major Services
crowns, dentures, bridges, root 50% after deductible 50% after deductible
canals, extractions
Orthodontia (Adult/Child) 50% (up to $1,500 lifetime max) 50% (up to $1,500 lifetime max)
1. Members are responsible for coinsurance, co-payments, and any charges above the allowable amounts.
Monthly Deductions
Employee Only $32.42
Employee + Spouse $63.71
Employee + Child(ren) $69.81
Family $104.33
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
15VISION
ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
Your vision health is an important part of complete wellness. Humana
is pleased to present to you vision benefits designed to give you and
your covered family members the care, value, and service to help
maintain good vision and overall health. This plan encourages yearly
exams along with the frames and lenses you want.
Vision PPO
In-Network (Member Cost) Out-of-Network (Reimbursement)
Copays
Exam (yearly) $10 Up to $30
Retinal Imaging1 Up to $39 Not Covered
Contacts Exams
Standard (lens fit & follow-up) Up to $40 Not Covered
Premium (lens fit & follow-up) 10% of retail Not Covered
Lenses (yearly)
Single Vision Up to $25
Bifocals $15 Up to $40
Trifocals Up to $60
1. Member costs may exceed $39
Lenticular Up to $100 with certain providers. Members may
contact their participating provider to
$130 allowance,
Frames (yearly) $65 allowance determine what costs or discounts are
20% off balance over $130 available.
2. Contact lenses are in lieu of
Contacts2 (yearly)
eyeglasses and frames.
Conventional $130 allowance, $104 allowance 3. US Laser Network, owned and
15% off balance over $130 operated by LCA Vision. Since LASIK
$130 allowance $104 allowance or PRK vision correction is an elective
Disposable
procedure, performed by specialty
Medically Necessary Covered in full $200 allowance trained providers, this discount may not
always be available from a provider in
Lasik or PRK3 15% off retail price or 5% off promotional price
your immediate location.
Monthly Deductions
Employee Only $6.88
Employee + Spouse $10.32
Employee + Child(ren) $11.89
Family $17.84
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
16ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
EMERGENCY TRANSPORTATION COSTS HOW MASA IS DIFFERENT
MASA MTS is here to protect its members
and their families from the shortcomings of Across the US there are thousands of ground
health insurance coverage by providing them ambulance providers and hundreds of air
with comprehensive financial protection for ambulance carriers. ONLY MASA offers
lifesaving emergency transportation services, comprehensive coverage since MASA is a
both at home and away fromhome. PAYER and not a PROVIDER!
ONLY MASA provides over 1.6 million
Many American employers and employees members with coverage for BOTH ground
believe that their health insurance policies ambulance and air ambulance
cover most, if notall ambulance expenses. transport, REGARDLESS of which
The truth is, they DO NOT! provider transports them.
Members are covered ANYWHERE in all 50
Even after insurance payments for states and Canada!
emergency transportation, you could receive
a bill up to $5,000 for ground ambulance and Additionally, MASA provides a repatriation
as high as $70,000 for air ambulance. The benefit: if a member is hospitalized more than
financial burdens for medical transportation 100 miles from home, MASA can arrangeand
costs are very real. pay to have them transported to a hospital
closer to their place of residence.
Any Ground. Any Air.
OUR BENEFITS Anywhere.™
Emergent
Benefit * Plus$14/Month
Emergent Ground
Transportation U.S./Canada
Emergent Air U.S./Canada
Transportation
Non-Emergent Air
U.S./Canada
Transportation
Repatriation U.S./Canada
A MASA Membership prepares you for the
unexpected and gives you the peace of
mind to access vital emergency medical
transportation no matter where you live, for
aminimal monthly fee.
• One low fee for the entire family
• NO deductibles
• NO health questions
• Easy claim process
EVERY FAMILY DESERVES A MASA
MEMBERSHIP
* Please refer to the MSA for a detailed explanation of benefits and eligibility,
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
17ENROLLMENT OPTIONS ELIGIBILITY MEDICAL HSA FSA DENTAL VISION LIFE AND AD&D EAP TRAVEL ASSISTANCE UNIVERSAL LIFE DISABILITY VOLUNTARY BENEFITS
Accessible Care • Secure Sessions • Virtual Access
Why WellVia?
24/7/365 Access to Doctors
Primary Care - Pediatrics - Urgent Care
WellVia has a national network of board certified, state licensed
doctors offering medical consultations 24 hours a day, 7 days a
week! WellVia doctors diagnose acute non emergent medical
conditions and prescribe medications when clinically appropriate.
Why choose to use WellVia over Teladoc?
1. If you are on the TRS ActiveCare HD plan Virtual Consults are
$30 a visit, with WellVia all Virtual Consults are $0.
2. Virtual Care through TRS is only available to those employees
and dependents who are on the TRS health plan. WellVia is
available to all legal dependents regardless if they are on the
health plan or not.
HEALTHCARE THAT MAKES CENTS COMMON CONDITIONS TREATED
Type of Visit Average Cost • Acid Reflux • Nausea
Primary Care $100 • Allergies • Rashes
• Asthma • Sinus Conditions
Urgent Care $150
• Bladder Infection • Sore Throat
Emergency Room $1400 • Bronchitis • Thyroid Conditions
$0 • Cold & Flu • Urinary Tract Infection
• Infections • and more...
2013 Medical Expenditure Panel Survey / MEPS
www.WellViaSolutions.com Member Services: (855) WELLVIA
Disclaimer: WellVia Services are for non-emergency conditions only. WellVia does not replace the primary care doctor, services are not
considered insurance or a Qualified Health Plan under the Patient Protection and Affordable Care Act. WellVia doctors do not prescribe DEA
controlled substances (schedule I-IV) and do not guarantee that a prescription will be written. Available nationwide where allowable by law.
For updated full disclosures, please visit www.wellviasolutions.com.
2022 – 2023 | LONGVIEW ISD | Employee Benefits Guide
18You can also read
