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The content of this CD is designed only for communication purposes and is not to be

The content of this CD is designed only for communication purposes and is not to be considered a contract, nor does it guarantee or imply coverage. Consult your plan booklet or Benefit Administrator for detailed coverage or pre-existing limitations. 2012 Benefit Open Enrollment

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The content of this CD is designed only for communication purposes and is not to be

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  1. The content of this CD is designed only for communication purposes and is not to be considered a contract, nor does it guarantee or imply coverage. Consult your plan booklet or Benefit Administrator for detailed coverage or pre-existing limitations.

  2. 2012Benefit Open Enrollment Plan Overview FRENSHIP ISD

  3. Online Benefit Access 24/7 • Visit www.birdvilleisdbenefits.com for all of your benefit needs. • Review the Employee Benefit Guide. • Find important links to all benefit carriers.

  4. Section 125 Cafeteria Plan There are special rules and requirements to receive the pre-tax benefit election plan privileges: • Birdville ISD must set a plan year. The plan year is • September 1 – August 31 of each year. • Although coverage is voluntary, every employee is required to review their current elections, make changes as desired, by completing the Birdville ISD online enrollment. • Any pre-tax elections will remain in effect unless you have a qualified event change in family status. Qualifying event benefit changes must be made within 30 days of the event and changes must be consistent with the event. • Qualifying Event Examples: Marriage, Divorce, Birth or Adoption, Death, Change in Dependent Eligibility Status, etc.

  5. Medical Out-of-Pocket Expenses

  6. Understanding Prescription Benefits • Did you know… • Most pharmacies will charge you the co-pay amount for a generic drug even if it is offered on • their discount plan for less. • The following are a few pharmacies that offer discount generic drug plans: • CVS • Walgreens • Wal-Mart/Sam’s • Kroger • Ask your Pharmacy to “use the list” for applicable generic drugs and you could save • approximately $120.00 per year on just 1 generic maintenance medication by using the • pharmacy discount plans instead of your insurance co-pay!

  7. NEW THIS YEAR: • American Public Life MEDlink® Plan • *MEDlink is designed to supplement your employer’s medical plan. This plan provides • supplemental coverage to help offset out-of-pocket costs that you may experience due to • deductibles and coinsurance for an inpatient hospital stay. • In-Hospital Benefit • Pays expenses you incur as an Inpatient (at least 18 continuous hours) up to $2,500 or $1,500 per confinement (based on plan you select). • Out-patient Benefit • Pays up to $200.00 per treatment in: • Hospital Emergency Room • Outpatient surgery in a Hospital Outpatient Facility • Outpatient surgery in a free-standing Outpatient Surgical Center • Diagnostic testing in a Hospital Outpatient Facility • Diagnostic testing in a MRI Facility • All benefits for the same or related conditions will be subject to the maximum benefit, unless such conditions are separated by 90 consecutive days, then a new maximum out-patient benefit will apply. • Physician Benefit: • Physician visits for sickness or injury due to an accident: $25.00 per visit, maximum five visits per family per calendar year, for treatment received in a: • Physician’s office • Hospital Outpatient Clinic • Free-standing Emergency Care Clinic • *This policy has limitations and exclusions. Please refer to the policy and brochure for benefits and provisions.

  8. MEDlink® – Example of Savings INPATIENT HOSPITAL EXAMPLE: Hospital Stay + Surgery = $28,500 total expenses Employee only, age 45

  9. MEDlink®Eligibility • You are not eligible for the MEDlink plan if any • of the following apply to you: • Employees (or their dependents) who are not covered under the school’s major medical plan. • Anyone covered by TRS-Care (retiree plan), Medicare, Medicaid or Medical Savings Accounts. • Employees who have an HSA that is being actively funded. • Non-residents of the United States. • Employees not actively at work on the plan effective date.

  10. MetLife PPO Dental Insurance • NEW PROVIDER: MetLife offers two PPO plan options: • PPO plans allow the freedom to choose any dentist, however, if you go to a network provider, benefits will be based on a reduced fee schedule. Utilizing a network provider gives you “more bang for your buck”. • If you choose to go to an out-of-network provider, the High PPO plan has less out of pocket cost / balance billing versus the Low PPO option. • High PPO Plan – $1,250 calendar year maximum, $50 Deductible. Orthodontics for • children to age 19: $1,000 lifetime maximum. PPO In-Network Benefits: 100% Preventive • services, 80% Basic services, 50% Major services and 50% Orthodontics. Out-of-Network • reimbursement at 90% of usual and customary charges. • Low PPO Plan – $1,250 calendar year maximum, $50 Deductible. Orthodontics for • children to age 19: $1,000 lifetime maximum. PPO In-Network Benefits: 100% Preventive • services, 50% Basic services, 50% Major services and 50% Orthodontics. Out-of-Network • reimbursement is based on the in-network fee schedule. • Employees currently enrolled in Guardian’s NAP plan will rollover to MetLife High PPO plan. Employees currently enrolled in Guardian’s Value plan will rollover to MetLife Low plan. • MetLife will takeover current deductible and calendar year benefits you have met under Guardian prior to 9/1 for the current calendar year.

  11. MetLife DHMO Dental Insurance MetLife offers a cost effective DHMO dental plan : • The DHMO plan requires you to select a primary care dentist. No benefits are payable if you visit a dentist out-of-network or a dentist who is not your assigned primary care dentist. • DMHO Plan – This plan offers dental benefits through a network of participating primary and • specialty care dentists with co-pays for services. This plan has no waiting periods or plan • maximums. • All Employees must select a MetLife primary care dentist in the enrollment system. • If a covered participant is banded and in active Orthodontic treatment as of 9/1/2012, you must complete a transition of care form and return to Babs within 30 days of 9/1/2012 to receive DHMO Orthodontic benefits under the MetLife plan. When searching for a network provider, the MetLife DHMO Managed Dental Care Plan is: MET335

  12. MetLife Optional Life Insurance • Eligible employees receive $10,000 employer-paid life and AD&D insurance from Birdville ISD. • Employees cannot be enrolled as both an employee and a spouse. If both parents are employees, only one may elect coverage on dependent children. • *This Year Only Employees can enroll new or increase coverage for the lesser of $100,000 or 5 times salary/up to $400,000 with no health questions asked! • *Employees can increase spouse coverage by one $5,000 increment as long as current spouse coverage is less than $30,000. All increases for spouse will require a statement of health if your spouse has $30,000 or more of current coverage . *Must meet Actively at Work Requirement • New coverage for a spouse or child requires a statement of health.

  13. National Benefit Services – FSA • National Benefit Services (NBS) is the new TPA for flexible spending accounts beginning September 1, 2012. • The Birdville ISD Flexible Spending Account (FSA) Plan Year: September 1, 2012 to August 31, 2013 • Plan Maximum- decreasing to $2,500/plan year due to PPACA. • Eligible services must be incurred in the plan year. • FSA accounts can be used for all IRS Classified Dependents. • FSA accounts are “Use it or lose it” – plan contributions carefully! • Participants have a 90 day grace period to file claims following plan year.

  14. Healthcare Reimbursement Flex Card • The NBS Flex Card makes using your FSA quick and easy – just swipe it as a payment for your eligible expenses (doctor’s visits, prescriptions, etc.) and the funds are automatically deducted from your FSA. • There is no cost for the flex card fee for healthcare reimbursement participants! • All participating employees will receive 2 NBS flex cards; additional cards may be ordered for family members for $5.00. Keep your cards, flex cards are valid for four years. • Always keep your receipts! An itemized receipt may be required for substantiation of certain expenses. • The best form of substantiation for medical expenses is your Explanation of Benefits form (EOB) from BC/BS (see Babs). • There is a $5 replacement fee for lost/stolen cards.

  15. Additional Supplemental Benefits The following benefits will remain with the same carrier and same rates for the 2012-2013 plan year: • Superior Vision • UNUM Educator Disability – all new or increases in coverage are subject to a 12 month pre-existing condition exclusion. • American Public Life (APL) Cancer • IDWatchdog Identity Theft Protection

  16. For complete benefit information go to: www.birdvilleisdbenefits.com. Enrollment assistance will be available on various campuses April 30th – May 18th. Contact Babs at 817.547.5782 or FBS at 800.583.6908 if you have questions. any

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