Benefits » Benefits Available (Detailed Information)

Benefits Available (Detailed Information)

TRS-ActiveCare Blue Cross and Blue Shield of Texas | Provider Website | 1-866-355-5999
 
 

 

CVS Caremark | www.caremark.com | 1-866-355-5999
When you enroll in one of the three medical plan options, you automatically receive prescription drug coverage through CVS Caremark which gives you access to a large, national network of retail pharmacies.

 

Ameritas www.ameritas.com 1.800.487-5553
 

LOW PLAN

BOTH

HIGH PLAN

Annual max benefit $1,000 per person

Basic Restorative covered at 80% (Fillings, Extractions)

Annual max benefit $1,500 per person

Orthodontia lifetime max $750 per person

Major Restorative covered at 50% (Bridges, Dentures, etc.)

Orthodontia lifetime max $1,000 per person

 

 

 

Ameritas |www.ameritas.com  | 1.800.877.7195
 
  • Eye exams - $10 copay
  • Frames every 24 months
  • Contact lenses every 12 months
  • Eye surgeries
  • Vision correction
  • Frames covered in full when using a Davis Vision provider
  • $130 for contacts or frames when using an out of network provider 

 

VISION INSURANCE

PER PAYCHECK PREMIUM

EMPLOYEE ONLY

$3.02

EMPLOYEE + SPOUSE

$5.44

EMPLOYEE + CHILD(REN)

$5.74

EMPLOYEE + FAMILY

$9.06

 

 

If you have not received your cards, please call or log-into the carrier website starting 9/1 to create an account and print temporary cards or request new ones.  Current participants may login at any time.

A Health Flexible Spending Account (Health FSA) is an IRS-approved program to help you save taxes and pay for out-of-pocket medical expenses not covered under your medical plan. If your plan includes a grace period option, you have additional time to incur and claim against unused funds in the new plan year. Keep in mind that remaining balances after the grace period is exhausted will be forfeited under the use-it-or-lose-it rule.

Your maximum contribution amount for 2022 is $2,750.

  • Contributions are automatically deducted from your paycheck on a pre-tax basis, which helps reduce your taxable income and increase your spendable income.
  • Your full election will be available to you at the beginning of the plan year.
  • Be conservative – any money left in your account at the end of the plan year with be forfeited.
  • Use your benefits card to pay for qualified expenses upfront so you don’t have to spend money out of pocket.
  • Keep all receipts in case you need to substantiate a claim for tax purposes

 

A Health Savings Account (HSA) is a great way to help you control your healthcare costs. It works in conjunction with a qualified High Deductible Health Plan (HDHP) to combine tax-free savings earmarked for qualified medical expenses. An HSA allows you to set aside money to pay for higher deductibles associated with a lower monthly premium HDHP. The money you save in monthly insurance premiums is reserved for eligible medical expenses you incur in the future. Eligible expenses include things like co-pays and deductibles, prescriptions, vision expenses, dental care, therapy and medical supplies.

 

HIGHLIGHTS

  • Balances roll over from year to year and earn interest along the way.
  • Portable – you keep it even after you leave employment.
  • Tax advantages – invest money in mutual funds to grow your tax savings for either future healthcare costs or retirement.
  • Pay for expenses with a benefits debit card that gives you immediate access to your money at the time of purchase.
  • Expenses also can be reimbursed through our online portal, online bill pay directly to your provider or submitting a distribution request form.

 

If you or a family member find yourself in the hospital due to a sudden accident or illness, you may struggle financially, even if you have a good medical plan. With a hospital indemnity plan, you can rest assured those extra expenses won’t be a financial burden.

Unlike medical plans, there are no deductibles to meet with a hospital indemnity plan. As soon as you incur a qualified event, you can file a claim and start receiving benefits*.

The plan pays a lump sum benefit in a previously specified amount. The money can be used for medical costs, insurance deductibles, groceries, transportation, childcare – the choice is up to you!

Low Plan:                                                                                           High Plan:

Admission- $1,000                                                                      Admission - $2,000

Confinement - $100 (per day)                                              Confinement - $200 (per day)

ICU - $100 (per day)                                                                   ICU - $200 (per day)

 

Observation Unit is not considered eligible for claim. 

This benefit covers childbirth and includes small benefit for the newborn’s stay.

HOSPITAL INDEMNITY INSURANCE

PER PAYCHECK PREMIUM

LOW

HIGH

EMPLOYEE ONLY

$11.16

$17.65

EMPLOYEE + SPOUSE

$20.27

$33.40

EMPLOYEE + CHILD(REN)

$16.54

$26.56

EMPLOYEE + FAMILY

$25.65

$42.31

 

Unum | www.unum.com | 1.866.679.3054

EMPLOYER-PAID TERM LIFE INSURANCE

Life insurance protects your loved ones. It pays a benefit so they can afford to pay for funeral expenses, pay off debt and maintain their current standard of living. It is one of the best ways to show you care. Your employer provides all eligible employees a $10,000. The cost of this policy is paid for 100% by your employer. This is a term life policy that is in effect while you are employed and does not continue beyond employment with Sheldon ISD.

VOLUNTARY TERM LIFE INSURANCE

Voluntary life insurance is term life coverage you can purchase in addition to the basic life plan provided by your employer. It will cover you for a specific period of time while you are employed. Plan amounts are offered in tiers so you can choose the amount of coverage that works best for you and your family. Because it's a group plan, premiums are typically lower, so it's more affordable to gain the peace of mind that life insurance provides. Limitations apply, please see policy for details. Visit the Employee Benefits Center for more details.

Working couples

If you and your spouse both work for SISD, each of you may have coverage, but only one of you can cover your eligible dependents. In addition, only one employee can enroll in life insurance on their spouse.

TEXAS LIFE INSURANCE - PERMANENT, PORTABLE LIFE INSURANCE

The peace of mind voluntary, permanent life insurance provides is unmatched. It is a solid companion to your group life insurance plan. Texas Life provides life insurance that you can keep for a lifetime. The plan is easy to purchase, pay for, and keep through the convenience of payroll deduction. Coverage is affordable and dependable. Plus, Texas Life has over a century of experience protecting families and giving the peace of mind only permanent life insurance can provide.

 

HIGHLIGHT

  • You own the policy, even if you change jobs or retire.
  • The policy remains in force until you die or up to age 121, as long as you pay the necessary premium on time.
  • It is a permanent, universal life policy which means you can rest easy knowing your loved ones will be well taken care of when you’re gone.

American Fidelity | www.americanfidelity.com | 1.800.654.8489

Have you ever wondered what would happen to your income if you had an accidental injury, sickness, or pregnancy? That is why you need disability coverage. It replaces a portion of income for the period of time you are unable to work due to those reasons. You are able to choose the benefit amount, which is the amount of your income to replace, and the waiting period, which is the amount of time before you begin receiving payments.

 

 

How do you decide if you need disability insurance? Consider these questions when making your decision:
How much employer leave do you have?
Do you have savings?
Do you have other income you can rely on, such as from your spouse or from child support?
How close are you to retirement?
Could you go on Social Security Disability or take a Disability Retirement?
What are your other sources of income?
 

CORE PLAN

ENHANCED PLAN

No pre-existing conditions will be covered for the first 24 months

A limited one-month benefit is payable for pre-existing conditions

 

Includes 1st day hospital at 60% of salary

 

Maximum Benefit Period to Age 65

Physicians expense benefit, $150-injury, $50-sickness

 

Maximum Benefit Period to Normal Social Security Retirement Age

 

 

 

 

12/24 pre-existing condition Disability coverage only
New or increased disability coverage is subject to a 12/24 pre-existing condition exclusion. This means that if you have a condition that was treated or medically advised in the twelve months before your coverage effective date, you are not covered for that condition for the first 24 months.

Actively at work
If you are not actively at work when coverage is scheduled to become effective, your coverage does not take effect until you complete your first day at work.

American Fidelity | www.americanfidelity.com | 1.800.654.8489

BASIC PLAN

ENHANCED PLUS

$10K Chemotherapy Benefit

$15k Chemo Benefit

$2,500 Initial diagnosis Benefit

$5,000 Initial diagnosis Benefit

$25 Wellness Visit Benefit

$5k Heart Attack or Stroke diagnosis

 

 

 

CANCER INSURANCE

PER PAYCHECK PREMIUM

BASIC

ENHANCED PLUS

EMPLOYEE

$7.90

$15.81

EMPLOYEE + FAMILY

$13.43

$26.90

 

12-month pre-existing condition

Cancer and specified diseases coverage only

The plan doesn’t cover pre-existing conditions. A pre-existing condition is any sickness or loss for which medical advice or treatment was received or recommended within 12 months prior to the effective date of coverage.

Actively at work
If you are not actively at work when coverage is scheduled to become effective, your coverage does not take effect until you complete your first day at work.

Aflac | www.aflacgroupinsurance.com | 1.800.433.3036

 

If you’ve heard of heart attacks, strokes, organ transplants or paralysis, then you’re familiar with critical illness. It’s likely you or someone you know has experienced one of these life-altering events. Often, times, a critical illness has a powerful impact on people’s lives, affecting their livelihood and finances. A critical illness plan can help with the treatment costs of covered illnesses. Benefits are paid directly to you, unless otherwise assigned, giving you the choice of how to spend the money. Plus, there are plans available to provide coverage for you, your spouse and dependent children. Prepare now for the unexpected with a critical illness insurance plan. The plan helps you focus on getting well rather than worrying about finances. Visit the Employee Benefits Center  http://benefits.ffga.com/sheldonisd and view policy for more details.

 

CRITICAL ILLNESS INSURANCE

PER PAYCHECK PREMIUM

$5,000

$10,000

$20,000

EMPLOYEE – NON TABACCO

 

 

 

18-29

$2.60

$3.74

$6.01

30-39

$3.22

$4.98

$8.50

40-49

$4.76

$8.06

$14.66

50-59

$7.42

$13.37

$25.28

60-69

$11.22

$20.97

$40.48

 

CRITICAL ILLNESS INSURANCE

PER PAYCHECK PREMIUM

$5,000

$10,000

$20,000

SPOUSE – NON TABACCO

 

 

 

18-29

$2.46

$3.46

$5.45

30-39

$3.09

$4.71

$6.33

40-49

$4.63

$7.79

$10.95

50-59

$7.29

$13.12

$18.94

60-69

$11.11

$20.75

$30.39

 

No health exams required. Tobacco User rates are available. Child coverage included in rates above. Maximum coverage level is $50,000 for employee and spouse

12-month pre-existing condition

Critical Illness and specified diseases coverage only

The plan doesn’t cover pre-existing conditions. A pre-existing condition is any sickness or loss for which medical advice or treatment was received or recommended within 12 months prior to the effective date of coverage.

Actively at work
If you are not actively at work when coverage is scheduled to become effective, your coverage does not take effect until you complete your first day at work.

Guardian | www.guardiananytime.com | 1.888.600.1600

The costs associated with an injury can add up. Between hospital visits, exams and treatment, out-of-pocket costs could put you in a financial hardship. An accident plan pays benefits directly to you so you can determine where to spend the money. It’s comforting to know that an accident insurance policy can be there through all stages of your care, from initial treatment to follow-up care. Accident coverage is available to you through payroll deduction and may provide a benefit for costs associated with:

  • Concussions
  • Lacerations
  • Broken teeth
  • Emergency room visits
  • Ambulance, ground or air
  • Intensive care unit

 

 

ACCIDENT INSURANCE

PER PAYCHECK PREMIUM

BRONZE

GOLD

EMPLOYEE

$5.12

$8.89

EMPLOYEE + SPOUSE

$7.60

$13.74

EMPLOYEE + CHILD(REN)

$7.75

$13.61

EMPLOYEE + FAMILY

$10.24

$18.45

 

 

 

BRONZE PLAN

GOLD PLAN

Ambulance $100

Ambulance $200

Coma $5,000

Coma $10,000

Concussion $50

Concussion $200

ER Treatment $150

ER Treatment $200

American Fidelity | www.americanfidelity.com | 1.800.654.8489

You may think major medical insurance is enough to cover your needs, but the reality is that many plans may only cover a portion of your overall expenses. It’s important to protect yourself in the event of a sudden hospitalization.

 

A Hospital Gap Insurance plan pays benefits directly to you and is designed to help cover the gap between what your traditional medical plan will cover and the out-of-pocket expenses you will pay. The plan may include benefits you can use to help pay for inpatient hospital stays and surgeries, doctor’s office treatments and diagnostic testing costs.

 

With Hospital Gap Insurance, you can have peace of mind knowing that unexpected medical expenses will less of a financial burden for you and your family members.

 

 

LOW PLAN

MID PLAN

HIGH PLAN

$400 outpatient surgery benefit

$800 outpatient surgery benefit

$1,200 outpatient surgery benefit

$100 outpatient diagnostic testing

$200 outpatient diagnostic testing

$300 outpatient diagnostic testing

$50 outpatient treatment

$100 outpatient treatment

$150 outpatient treatment

 

 

GAP INSURANCE

PER PAYCHECK PREMIUM

$1,500

$3,500

$4,000

UNDER 55

 

 

 

EMPLOYEE ONLY

$13.30

$27.20

$29.30

EMPLOYEE + SPOUSE

$22.55

$47.60

$51.35

EMPLOYEE + CHILD(REN)

$20.30

$42.55

$45.90

EMPLOYEE + FAMILY

$29.55

$62.95

$67.95

Rates available for ages 55+

Questions / Contact Information
 
 
Mayra Gonzalez
Benefits Specialist
P: 281-727-2079

Visit www.bcbstx.com/trsactivecare or call BCBS Customer Service at 866-355-5999

• Select “Doctors and Hospitals”

• Select the desired medical plan

• Enter your city or zip code

• Select search criteria

• Enter your doctor’s name

• Click “view profile” and the 10-digit PCP ID will be located under the Doctors name

You can receive a list of these participating dentists/vision providers online at https://www.ameritas.com/employee-benefits/find-a-provider/