2015
ANNUAL ENROLLMENT
DISCOVER THE POSSIBILITIES
new for
2015
HISD
perks
provider
networks
medical
plan types
coverage
comparisons
voluntary
options
enroll
benefits
features
coverage costs
+ contacts
Say hello to your 2015
benefits guide
It’s brimming with information about the great health
and wellness options available in the coming year.
We’re pleased to let you know that things are going to look very familiar in 2015.
• Premiums, which decreased 20% in 2014, are staying the same thanks to
your successful efforts to use your health plan wisely.
• You have your choice of affordable coverage options and free, easy-to-use
health tools and resources.
• HISD Employee Health & Wellness Centers continue to offer medical care
at no cost to plan enrollees.
• It’s simple to enroll and manage your plan online.
The benefits we offer are about more than covering you when you get sick.
They’re also about helping you get healthy and stay that way. That’s why
it’s important to take advantage of the special features that come with your
plan, things like RedBrick Health, free preventive care and the 24/7 Nurse
Line. Plus, don’t forget about the money you can earn for taking a Health
Assessment and participating in healthy activities.
Be in control of your benefits—and your health—by following the steps
outlined in this guide. Whether your goal is to lose weight, lower your blood
pressure, relieve stress, start an exercise program or just generally feel better,
your possibilities are endless. And so are your resources.
Let’s get started.
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DISCLAIMER: This guide provides an overview of your benefits options. The complete provisions of the plans,
including legislated benefits, exclusions and limitations, are set forth in the plan documents or insurance
contracts. The insurance contracts are available for your review in the HISD Benefits Office. If the information
in this guide is not consistent with the plan documents or insurance contracts or state and federal regulations,
the plan documents, insurance contracts and state and federal regulations will prevail. This guide is not
intended as a contract of employment or a guarantee of current or future employment.
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new for
2015
HISD
perks
provider
networks
medical
plan types
coverage
comparisons
voluntary
options
enroll
benefits
features
coverage costs
+ contacts
A look at what’s new
for 2015
OUT-OF-POCKET MAXIMUMS: LOWER FOR MEDICAL PLANS,
NEW FOR PRESCRIPTION DRUGS
For 2015, our medical plan options have lower out-of-pocket maximums,
and all options include a new prescription drug plan out-of-pocket maximum.
Now, once you reach your prescription drug out-of-pocket maximum, you no
longer have to make copays for your prescriptions. This means you have an
annual limit on what you might have to spend for your medications, making
it easier to plan for those expenses.
VOLUNTARY PLAN HIGHLIGHTS
Good news for our voluntary plans. All the rates remain the same in 2015
except for the Dental PPO rates, which are going down 3%. There are no
changes to the plan benefits, either, with the exception of the accident plan.
The wellness benefit is going away because our medical plan offers similar
benefits already. In its place, we’ve increased the benefits you can receive
for emergency room and medical fees.
WEIGHT LOSS CHALLENGE
Following the success of this year’s HealthyWage 4 for $40 weight loss
challenge, we’re offering a new competition in the spring that can earn
you up to $160 for your successful participation. When you combine it with
the $125 you get for completing the online Health Assessment by January 31,
and the $150 you can earn in wellness incentives over the year, you have the
opportunity to pocket $435 for being healthy.
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NEW PRESCRIPTION DRUG LIST FOR CERTAIN CONDITIONS
For 2015, the prescription drug plan includes CVS Caremark’s standard
formulary. A formulary is a list of generic and brand name drugs that are
preferred by your health plan for certain conditions. If you choose drugs
that aren’t on the list, you may be responsible for the full cost, which can
be significantly higher. To avoid this issue, please print the formulary list to
review with your doctor when deciding on your medications.
MAKE SURE YOU UNDERSTAND WHO’S CONSIDERED
AN ELIGIBLE DEPENDENT
There can be serious consequences if you cover someone who doesn’t
meet eligibility guidelines, including loss of coverage and more.
For information about dependent eligibility, visit HISD Benefits.
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new for
2015
HISD
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provider
networks
medical
plan types
voluntary
options
enroll
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coverage costs
+ contacts
THE AFFORDABLE CARE ACT
ENROLLMENT OPTIONS
The Affordable Care Act requires everyone to have health care coverage that
meets minimum guidelines for affordability and value. If you don’t, you may
have to pay a fee on your federal tax return.
Be sure to check out HISD Benefits as you consider your coverage for 2015.
The site was designed to make it easy to find friendly, helpful answers
and information about all your HISD benefits, along with tips and tools
for staying healthy.
HISD plans meet the guidelines. If you’re eligible for benefits, you can simply
enroll or continue in any HISD health care plan to avoid the fee and enjoy the
generous contributions HISD makes on your behalf.
For complete details about the Affordable Care Act and
how it affects you, go to healthcare.gov.
The Affordable Care Act rates health plans based on
their actuarial value (the percentage of expenses paid for
by the plan versus the consumer). Plans are distinguished
by metal levels, from bronze to platinum.
Here’s how HISD’s coverage options are rated.
HISD MEDICAL PLAN OPTION
5
coverage
comparisons
Then, when you’re ready, you can complete your 2015 enrollment online
or by phone. Just go to the HISD employee portal to get started. If you have
no changes for 2015, you don’t have to do a thing unless you have a flexible
spending account (FSA). FSA enrollment isn’t automatic.
THIS IS YOUR OPPORTUNITY TO SEE A NEW, HEALTHIER YOU UNFOLD
HISD provides a wide array of great benefits, from health insurance to life
insurance, and from dental plans to wellness programs. Take your time.
Study your options. Everyone has different needs, health issues, budgets
and goals. By choosing your options carefully, you and your family can get
the coverage you need, and maybe even transform your health.
METAL LEVEL
Consumer Basic—Limited and Choice
SILVER
Consumer Plus—Limited and Choice
GOLD
Open Access
PLATINUM
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A step-by-step
guide to
personalized
benefits
4
Compare
coverage options
See how your choices
affect your bottom line.
7
voluntary
options
benefits
features
enroll
3
2
See how HISD helps
you pay for the basics
HealthFund contributions
are just the beginning.
Take a good look
at provider networks
6
Consider your
voluntary options
Now you’re
ready to enroll
Add on the extras
that make sense for your family.
Find the plan
that works best for you
Pay a little more to have more options,
or vice versa.
5
Go to HISD Benefits
and make it official.
coverage costs
+ contacts
You have several choices.
Compare and save.
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Make the most
of your benefits
Your plan comes with special features.
Use them.
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new for
2015
HISD
perks
provider
networks
medical
plan types
coverage
comparisons
voluntary
options
enroll
benefits
features
coverage costs
+ contacts
1
See how HISD helps
you pay for the basics
HealthFund contributions are just the beginning.
FREE FROM HISD, YOUR OWN PERSONAL HEALTHFUND
How it works:
• If you’re enrolled in a Consumer option, you have a HealthFund.
• HISD contributes money annually into your HealthFund.
• There’s no card to use; HealthFund money is automatically used to pay
claims for eligible medical expenses, like office visits, lab work and tests.
• Any unused funds automatically roll over to the next year, building a
nest egg for future health care expenses, as long as you stay enrolled in
an HISD Consumer option.
• Once you’ve used all the money in your HealthFund, you can
begin using your health care flexible spending account for eligible
medical expenses.
• HealthFund contributions are prorated, depending on when during
the year you sign up for coverage.
2015 HEALTHFUND CONTRIBUTIONS
$500
EMPLOYEE ONLY
(CONSUMER PLANS)
$750
EMPLOYEE + SPOUSE
(CONSUMER PLANS)
$750
EMPLOYEE + CHILD(REN)
(CONSUMER PLANS)
$1,000
EMPLOYEE + FAMILY
(CONSUMER PLANS)
FREE PREVENTIVE CARE
As a medical plan member, your annual physical and certain preventive screenings
are covered at 100%, so they cost you nothing. The same goes for your covered
dependents. Take advantage of this great opportunity to stay on top of your
health and identify potential health issues before they become serious.
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FREE MEDICAL CARE AT HISD EMPLOYEE
HEALTH & WELLNESS CENTERS
Even better, if you’re enrolled in one of our medical plans, you and your
covered dependents age five and up pay nothing for your medical care at
the HISD Employee Health & Wellness Centers. It’s free. If you’re eligible
for benefits but not enrolled in an HISD medical plan, you can still use
these centers for high-quality care at very affordable rates.
With two onsite locations, they provide a great alternative to high-cost
emergency centers or urgent care facilities for low-cost, non-emergency
services, including:
• Preventive care
• Routine immunizations
• Flu shots
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LOCATIONS
HATTIE MAE WHITE
EDUCATIONAL SUPPORT
CENTER
4400 West 18th Street
Houston, Texas 77092
713-957-3908
Monday 7 a.m. to 4 p.m.
Tuesday – Thursday 9 a.m. to 6 p.m.
Friday 7 a.m. to 4 p.m.
Saturday 8 a.m. to noon
ATTUCKS MIDDLE SCHOOL
4330 Bellfort Street
Houston, Texas 77051
713-732-3532
Monday 7 a.m. to 4 p.m.
Tuesday and Wednesday 9 a.m. to 6 p.m.
Thursday 9 a.m. to 1 p.m.
Friday 7 a.m. to 4 p.m.
Both centers closed daily from 1 to 2 p.m.
• Acute and urgent care for infections, minor burns and more
The centers offer convenient hours after work and on Saturday mornings.
Concentra, a leading provider of workplace health care clinics, operates
the HISD Employee Health & Wellness Centers to bring you professional
medical services in complete confidentiality.
OFFICE VISIT PRICES
Covered employees and
covered dependents age
five and up
FREE
Employees who are eligible
but not enrolled in an HISD
medical plan
$65
I get it.
On to Step 2.
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new for
2015
HISD
perks
provider
networks
medical
plan types
coverage
comparisons
voluntary
options
enroll
benefits
features
coverage costs
+ contacts
2
Take a good look
at provider networks
Pay a little more to have more options, or vice versa.
It’s all up to you. Here’s help making your selection.
CONSUMER PLAN NETWORK OPTIONS
BASIC
PLUS
If you enroll in a Consumer medical plan option, you have two provider
networks to choose from: Limited or Choice.
Limited network basics
OPEN ACCESS MEMBERS
If you enroll in Open Access, you have just one network.
This plan is all about keeping things simple. Just remember,
you pay a much higher price tag for this.
Open Access basics
• Choose any primary care physician, hospital or specialist in the
Aetna network.
• Choose specialists in the 12 designated categories from the Aetna
designated specialist network.
• Choose any primary care physician in the Aetna network.
• You’re “limited” to Memorial Hermann hospitals and facilities for inpatient
or outpatient hospital care.
• You must choose from specialists in the 12 designated categories, plus
oncologists and hematologists who have admitting privileges and will
arrange for hospital procedures at a Memorial Hermann hospital.
• Outside these designated specialties, you’re free to choose any physicians
in the Aetna network.
Choice network basics
• Choose any primary care physician in the Aetna network.
• Choose from two tiers of hospitals and specialists in the 12 designated
categories.
• Tier I hospitals and specialists cost you less because they have been
designated as the most efficient providers based on quality of service
and cost of care.
• Outside these designated specialties, you’re free to choose any physicians
in the Aetna network.
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THE 12 DESIGNATED SPECIALTIES
b cardiology
c cardiothoracic surgery
d gastroenterology
e general surgery
f neurology
g neurosurgery
h obstetrics & gynecology
i orthopedics
j otolaryngology/ENT
1) plastic surgery
1! urology
1@ vascular surgery
Limited network members must also choose oncologists and
hematologists who have admitting privileges and will arrange
for hospital procedures at a Memorial Hermann hospital.
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new for
2015
FACILITIES
BASIC
PLUS
HISD
perks
provider
networks
coverage
comparisons
medical
plan types
voluntary
options
enroll
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features
coverage costs
+ contacts
CONSUMER PLAN NETWORKS COMPARISON
For the most current and complete list of providers in both networks,
log on to the HISD employee portal, go to Employee Services, then
click on HISD Benefits and select Aetna Navigator.
LIMITED NETWORK
CHOICE NETWORK
MEMORIAL HERMANN
TIER I
TIER II
You must use Memorial Hermann hospitals exclusively for your inpatient
and outpatient hospital care.
To pay the lowest out of pocket, use
one of these hospitals for your care:
You pay more when you choose one
of these hospitals:
•
•
•
•
•
•
•
•
•
Memorial Hermann
CHI St. Luke’s Health
Christus
St. Joseph’s
Tenet
Texas Children’s
Methodist
MD Anderson
HCA
You can choose from a wider range of hospitals that are divided into two tiers.
The amount you pay out-of-pocket for your care (in deductibles, coinsurance
and copays) depends upon which tier your provider is in.
Freestanding outpatient facilities: Check DocFind or contact Aetna.
PHYSICIANS
There is no out-of-network care, except in the case of an emergency.
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For physicians in the 12 designated specialties (see list), you must choose
from a list of select physicians who have admitting privileges to Memorial
Hermann facilities.
Members must choose oncologists and hematologists who have admission
privileges or can make arrangements for hospital procedures at a Memorial
Hermann hospital.
You pay less to see a specialist
from the 12 designated specialties
(see list) in Tier I.
Your out-of-pocket costs are
greater if you see a specialist
in the 12 designated specialties
(see list) in Tier II.
You still have access to any primary care physician in the larger Aetna
network.
You still have access to any primary care physician in the larger Aetna network.
All primary care physicians are considered Tier I providers.
Outside the designated specialties, you may see any specialist in the larger
Aetna network.
Outside the 12 designated specialties, you may see any specialist in the larger
Aetna network and your visit will be covered as Tier I.
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DOCFIND MAKES CHOOSING PROVIDERS EASY
Go through HISD Benefits to use Aetna’s online DocFind tool to search
for network doctors, labs or facilities, including X-ray and scanning
locations. If you have providers already, you can check Aetna Navigator
through HISD Benefits before you enroll to be certain you have access
to them with the plan you choose.
STAY INSIDE YOUR NETWORK
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BE SURE YOUR SPECIALIST
IS IN-NETWORK
Some of the specialists in our network
may have changed. To make sure your
provider is still in-network, log on to the
HISD employee portal, go to Employee
Services, then click on HISD Benefits
and select Aetna Navigator or call Aetna
at 877-224-6857.
• You are not covered for out-of-network services. The only exception
is an emergency when an out-of-network hospital emergency room
is the nearest facility. In this case, your stay is covered only until the
doctor decides you are stable enough to go home or be moved to
an in-network hospital.
• Out-of-network emergency room care for non-emergency medical
attention can result in excessive charges that increase health care costs
for everyone and are not covered.
• Know which urgent care and walk-in clinics are near your home in case
you need quick medical care. Aetna Navigator is a great tool for that.
• If you’re enrolled in the Limited network, remember to use Memorial
Hermann facilities for inpatient or outpatient care, or you won’t be
covered. For diagnostic services such as an MRI, X-ray, mammogram,
colonoscopy or CT scan, you can also use any in-network freestanding
facilities, whether you are in the Limited or Choice network.
AVOID SURPRISES. ESTIMATE YOUR COSTS BEFORE YOU GET CARE.
Go through HISD Benefits to Aetna Navigator and use the Member
Payment Estimator to compare cost estimates for more
than 550 common services and procedures, from office visits,
high-tech scans and lab tests to surgeries and more.
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I get it.
On to Step 3.
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new for
2015
HISD
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provider
networks
medical
plan types
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3
Find the plan that works
best for you
You have several choices. Compare and save.
COMMON GROUND MAKES SOME CHOICES EASIER
CONSUMER BASIC AND PLUS OPTIONS IN MORE DETAIL
All HISD medical plan options feature:
Now that you’ve chosen your network, you have two Consumer plan
options to choose from. These options give you great flexibility, allowing
you to control how you spend your health care dollars. The main
differences between the two options are the premium rates and your
potential out-of-pocket costs.
• Preventive care covered at 100%—no charge to you
• Freedom to choose any doctor in your plan’s network, with no referral needed
• Prescription drug benefits through CVS Caremark, available at CVS
and other participating pharmacies and through mail order
$0 COPAY = FREE FOR YOU
• $0 copay for a 90-day supply of generic maintenance medications for high
blood pressure, diabetes (including injectable insulin) and high cholesterol
through mail order or at any CVS retail pharmacy
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It’s a tradeoff, basically. If you choose a Consumer Basic option, your rates
are lower, but your annual deductibles and coinsurance percentages are
higher. With a Consumer Plus option, you pay a little higher premiums,
but your annual deductibles and coinsurance percentages are lower.
BASIC
LOWER PREMIUMS
HIGHER DEDUCTIBLES
HIGHER COINSURANCE
HIGHER PREMIUMS
PLUS
LOWER DEDUCTIBLES
LOWER COINSURANCE
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new for
2015
BASIC
HISD
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plan types
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options
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PLUS
BOTH CONSUMER OPTIONS HAVE:
OPEN ACCESS IN MORE DETAIL
A HealthFund
• This is money HISD contributes each year to medical plan
members to help cover your medical expenses. For details,
see page 10.
• This money should be used to pay for covered medical
expenses before your health care flexible spending account
(FSA), if you have one. Once your HealthFund is exhausted,
you can use your FSA to pay for eligible expenses.
The Open Access option works differently than the Consumer options.
There’s no annual deductible. Instead, you have a fixed copay for
each in-network doctor’s visit and pay 15% coinsurance for most other
services. This means your costs are more predictable. However, this
option has much higher premiums than the Consumer options. An
individual employee, for example, would pay about 10 times higher
premiums for the Open Access than the Consumer Basic Limited option.
An annual deductible
• This is the amount you’re responsible for paying before the
plan begins to pay a percentage of covered expenses.
• The money in your HealthFund and/or FSA can help you meet
part or all of your deductible.
• If you’ve previously been enrolled in a Consumer option, you
may have saved enough money in your HealthFund to cover
your deductible.
SELECT OPTION
Coinsurance for major medical coverage
• This is the percentage of covered medical expenses that you
pay, after you’ve met your annual deductible.
• You can use money from your HealthFund and/or FSA to help
pay coinsurance.
An out-of-pocket maximum
• Your annual out-of-pocket maximum is the most you have
to pay each year out of your own pocket to cover expenses,
including your deductible, copays and coinsurance.
The Select option is a low-cost medical plan option for qualified
employees. You must be eligible for benefits and earn
$25,000 or less per year to qualify for this plan. With the Select
option, you receive a $500 HealthFund
contribution from HISD. You can receive
free medical care at HISD Employee
Health & Wellness Centers and at Central
Care Community Health Centers. You
may choose Memorial Hermann hospitals
and facilities from Aetna’s Limited
network instead, and pay a deductible
and coinsurance for services. Prescription
drug benefits are available through retail
CVS Caremark stores but are limited to
generic medications and some brand
names when a generic is not available.
You can also use the Platinum network
of physicians for a discounted fee.
• Once you reach your out-of-pocket maximum, the plan pays
100% of your remaining covered expenses.
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PRESCRIPTION DRUG BENEFITS
All medical plan options include prescription drug benefits through CVS
Caremark, available at CVS and other participating pharmacies and through
mail order.
Retail prescriptions
For short-term prescriptions or the first two months of a newly prescribed
maintenance medication, take your prescription and your CVS Caremark
ID card to a participating pharmacy. After you meet your annual $50 perperson prescription drug deductible, you pay the lesser of the actual drug
cost or a copay for each prescription. For specialty drug prescriptions, use
the CVS Caremark specialty mail program.
BE CAREFUL: If you or your physician request a brand-name drug
when a generic is available, you pay the brand copay, PLUS the
difference in cost between the two drugs, along with any remaining
prescription deductible.
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Mail or CVS pharmacy for maintenance medications
For long-term, maintenance medications, the Maintenance Choice program
allows you to receive a 90-day supply of your medications in two ways—
either through the CVS Caremark Mail Service Pharmacy (ordered online,
by phone or by mail) or at a CVS retail pharmacy near you.
No matter which option you choose, your copay remains the same. You can
still get two 30-day supplies of newly prescribed maintenance medications
at any network pharmacy. After that, you can save money by ordering a
90-day supply through CVS Caremark, delivered either by mail or to a local
CVS pharmacy. Be sure to ask for a 90-day prescription from your physician
to qualify for the lower cost.
To fill a prescription using the mail service, complete a prescription drug
order form, available through the CVS Caremark link on HISD Benefits,
and mail to the address on the form.
New prescription drug list for certain conditions
For 2015, the prescription drug plan includes CVS Caremark’s standard
formulary. A formulary is a list of generic and brand name drugs that are
preferred by your health plan for certain conditions. If you choose drugs
that aren’t on the list, you may be responsible for the full cost, which can
be significantly higher.
To avoid this issue, please print the formulary list to review with your doctor
when deciding on your medications.
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ANNUAL PRESCRIPTION DEDUCTIBLE
No-cost prescriptions for high blood pressure, high cholesterol and diabetes
If you take medications for high blood pressure, high cholesterol or diabetes
(including injectable insulin), it’s important to take them as your doctor
prescribes, and on time.
• $50 per covered person per year
• This is separate from your medical plan deductible
• You may also be asked to pay a copay
Annual prescription out-of-pocket maximum
New for 2015: Your prescription drug coverage features an annual
out-of-pocket maximum that’s separate from your medical plan out-of-pocket
maximum. Now, once you’ve reached your prescription maximum, you no
longer have to pay copays for your prescriptions for the rest of the plan year.
That’s why HISD makes generic drugs for these conditions available at no
cost to you, as long as you’re enrolled in an HISD medical plan. Just be sure
to order a 90-day supply from the CVS Caremark mail service or any CVS
retail pharmacy.
HISD plans also cover women’s generic contraceptives at 100%, as well as
those that have no generic available.
PRESCRIPTION OUT-OF-POCKET MAXIMUMS
(includes $50 annual prescription deductible per person)
Consumer Basic
LIMITED
Consumer Basic
CHOICE*
Consumer Plus
LIMITED
Consumer Plus
CHOICE*
Employee only
Family
$1,200
$2,400
$850
$1,700
$500
$1,000
BASIC
Automatic maintenance prescription refills and renewals
Here’s an easy way to handle maintenance drug prescriptions. When you sign
up for the automatic prescription refill program, CVS Caremark’s mail service
pharmacy automatically sends your refills and requests a new prescription
from your doctor when a maintenance prescription is about to expire or the
last refill has been used.
BASIC
PLUS
PLUS
Open Access
*Applies to Tier I and Tier II
For details, visit HISD Benefits
or contact your provider directly.
I get it.
On to Step 4.
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HISD
perks
new for
2015
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networks
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plan types
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comparisons
voluntary
options
Compare coverage options
4
PER PAY PERIOD COSTS
To compare the premium rates
for these options, go to page 55.
See how your medical plan choices affect your bottom line.
Consumer Basic
LIMITED
Memorial Hermann
network only
BASIC
Consumer Basic
CHOICE
Tier I
Consumer Plus
LIMITED
BASIC
Memorial Hermann
network only
Tier II
$500 per employee only
$750 per employee + spouse
$750 per employee + child(ren)
$1,000 per employee + family
Annual HealthFund
coverage costs
+ contacts
benefits
features
enroll
PLUS
Consumer Plus
CHOICE
Tier I
PLUS
Open Access
Tier II
In-network only
$500 per employee only
$750 per employee + spouse
$750 per employee + child(ren)
$1,000 per employee + family
N/A
YOU PAY
Annual deductible—
medical1
$2,500 individual
$5,000 family
$2,500 individual
$5,000 family
$2,750 individual
$5,250 family
$1,750 individual
$3,500 family
$1,750 individual
$3,500 family
$2,000 individual
$4,000 family
N/A
Annual out-of-pocket
maximum—medical1
$4,800 individual
$9,600 family
$4,800 individual
$9,600 family
$5,050 individual
$10,100 family
$3,400 individual
$6,800 family
$3,400 individual
$6,800 family
$3,650 individual
$7,300 family
$2,000 individual
$4,000 family
Preventive care exams
Free
Free
Free
Primary care (PCP)
25%
25% (all PCPs are Tier I)
20%
20% (all PCPs are Tier I)
$20 copay
Non-designated
specialists (NDS)2
25%
25% (all NDSs are Tier I)
20%
20% (all NDSs are Tier I)
$40 copay
Designated
specialists
25%3
25%
45%
20%3
20%
35%
$40 | $50 copay4
Inpatient—hospital5
25%6
25%
45% plus $500 copay
per admission
20%6
20%
35% plus $500 copay per
admission
15% | 25%4
Outpatient—hospital5
25%6
25%
45%
20%6
20%
35%
15% | 25%4
Outpatient—freestanding
and surgical center5
25%
Office
visit
Emergency care
Non-emergency care
in an emergency room
Urgent care facility
25%
20%
20%
15% | 25%4
25% plus $150 copay (waived if admitted)
20% plus $150 copay (waived if admitted)
15%
Not covered
Not covered
15%
25%
20%
15%
Lab, X-ray, diagnostic
mammogram
25%
25%
45%7
20%
20%
35%7
15%
Diagnostic scans
(MRI, MRA, CAT, PET)
25%
25%
45%7
20%
20%
35%7
15%
Maternity—delivery
25%6
25%
45%
20%6
20%
35%
15%
Mental health & substance
abuse—inpatient
25%
25% (no Tier II facilities)
20%
20% (no Tier II facilities)
15%
Mental health & substance
abuse—outpatient
25%
25% (no Tier II facilities)
20%
20% (no Tier II facilities)
$20 copay
1. Medical deductible and copays do not count toward prescription deductible or annual out-of-pocket maximum.
2. If you are enrolled in a Consumer option, you pay this amount when you see an in-network specialist outside of the designated specialty areas.
3. Specialist must be within the Memorial Hermann network in designated specialties.
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4.
5.
6.
7.
Higher copays and coinsurance apply if you use an in-network specialist within the 12 specialties who is not a designated specialist.
Pre-certification may be required.
Must exclusively use Memorial Hermann facilities.
Only applies to outpatient hospital services. All in-network freestanding and surgical centers are Tier I facilities.
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Prescription drug coverage
Consumer Basic
LIMITED
Memorial Hermann
network only
BASIC
Consumer Basic
CHOICE
Tier I
Consumer Plus
LIMITED
BASIC
Tier II
Memorial Hermann
network only
PLUS
Consumer Plus
CHOICE
Tier I
PLUS
Open Access
Tier II
In-network only
Prescription drugs – retail
Annual deductible
—pharmacy
$50 individual
$50 individual
—
Annual out-ofpocket maximum
—pharmacy
$1,200 individual
$2,400 family
$850 individual
$1,700 family
$500 individual
$1,000 family
Generic
$20
$15
$20
Preferred brand
$50
$40
$30
Non-preferred brand
$70
$60
$60
Generic
$50
$37.50
$40
Preferred brand
$125
$100
$60
Non-preferred brand
$175
$150
$120
Prescription drugs – mail
Prescription deductible and copays do not count toward medical deductible or annual out-of-pocket maximum.
PER PAY PERIOD COSTS
To compare the premium rates
for these options, go to page 55.
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I get it.
On to Step 5.
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enroll
5
Consider your
voluntary options
Add on the extras that make sense for your family.
HERE’S WHERE YOU PERSONALIZE YOUR PLAN
There are lots of ways you can customize your plan with voluntary options
for added financial protection to meet your individual needs.
Dental
plans
Disability
Accident
plan
Vision
plans
Flexible spending
accounts (FSA)
Cancer and
specified diseases
Personal
legal plan
Life and accidental death
and dismemberment (AD&D)
Hospital
indemnity
Critical
illness
Long-term
care insurance
This guide provides a brief overview. To compare rates, see page 55.
For details, visit HISD Benefits or contact your provider directly.
See page 65 for provider contact list.
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MANAGED COST DENTAL
DENTAL PPO
• You pay a deductible before the plan begins to pay its share
of covered expenses.
• You may use any provider you choose, but keep in mind, you generally
save money by using an in-network provider. If you use an out-of-network
provider, you are responsible for costs that may exceed the usual, customary
and reasonable guidelines; in this case, you must file a claim form.
• This plan includes a Consumer MaxMultiplier benefit. If you have less
than $500 in paid claims, you can carry over up to $250 to your maximum
coverage amount for the next plan year. If you go to an in-network
provider, you can earn an additional $100 to carry over. You can then
use these funds for future dental expenses.
• This option is provided free of charge for employee-only coverage.
• You pay set fees for selected services and receive a 20% discount
for other services.
• You agree to use QCD network providers for your care.
• You don’t pay deductibles, file claim forms or have restrictions
for pre-existing conditions or number of visits.
DENTAL PPO
DENTAL HMO
MANAGED COST
DENTAL
Deductible
$50 individual
$150 family
$50 orthodontia/
individual
$0
$0
• For new enrollees, there’s a 12-month waiting period for certain major
and orthodontia services.
Annual
maximum
benefit
$1,250 individual
Unlimited
Unlimited
DENTAL HMO
COVERED
SERVICES
• There is an annual maximum benefit of $1,250 per person.
• The DHMO plan is provided by UnitedHealthcare Dental, underwritten
by National Pacific Dental, Inc.
Preventive &
diagnostic care
DEPENDING ON THE SERVICES, YOU PAY:
$0 after annual
deductible
$0 – $45
$5 – $75
Basic care
20% of covered
expenses after annual
deductible
$5 – $230
$16 – $350
• You must be referred for specialty services through your PCD and
receive an authorization number from UHC Dental before specialty
services can be rendered. For more information, refer to the Specialty
Process guidelines, available on HISD Benefits.
Major care
50% of covered
expenses after annual
deductible*
$10 – $300
$15 – $420
• You agree to use the specialty care provider assigned to you.
Orthodontia
50% of covered
expenses, up to
$2,000 individual
lifetime max (under
age 19)*
24-month case copay:
$2,100 child
$2,200 adult
QCD general dentist:
$2,200 child
$2,400 adult
QCD orthodontist:
20% discount
• You must choose a primary care dentist (PCD) and use only providers
in the UnitedHealthcare network. The cutoff for choosing or changing
your PCD is the 20th of each month in order to be effective the first
of the following month.
• You pay the set copays when you receive covered services, but you
don’t pay deductibles or have to file claim forms.
• Services outside the network are covered only in emergencies
and require prior approval from UHC Dental.
*New PPO enrollees have a 12-month waiting period for major and orthodontia expenses. If you previously participated in a UHC
plan with HISD or another employer with no break in coverage, the waiting period is reduced by the number of months you had
coverage. If you or your dependents were covered by another carrier with no break in coverage and can supply documentation
of months covered, the waiting period is reduced by the number of months you or your dependent had coverage.
For details, visit HISD Benefits or contact your provider directly.
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PLEASE NOTE:
You have to enroll in your FSA each
year. There’s no automatic enrollment.
If you join HISD after January 1, 2015,
your deductions are allocated over the
remaining pay periods for the calendar
year to reach your annual goal amount.
VISION
You may choose between Plus and Basic options.
• Both offer in- and out-of-network benefits.
• Both cover an annual in-network eye exam for a $10 copay.
• Both cover eyeglasses or contact lenses every 12 months after a set
materials copay—$10 for Plus and $20 for Basic.
• Vision Plus covers new frames every 12 months; Vision Basic covers
new frames every 24 months.
•
•
•
•
FLEXIBLE SPENDING ACCOUNTS (FSA)
Flexible spending accounts allow you to set aside money to pay for eligible
health and dependent day care expenses.
Your contributions are taken out of your paycheck before taxes, which means
your money goes further because it’s tax-free. That’s why an FSA can be a
smart choice for anyone who has regular, predictable health or dependent
day care costs.
You decide the amount ahead of time, based on your expected out-ofpocket expenses for the entire calendar year.
BE CAREFUL: Estimate the amount you expect to spend carefully.
You lose any funds you don’t use.
For more information, visit the IRS website at irs.gov/publications for a full list
of eligible expenses.
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•
Health care FSA
You can set aside up to $2,550, pre-tax, to pay for eligible
medical expenses that are not reimbursable from any other source.
You can use your FSA for all eligible health care costs for you and your
dependents, including vision and dental, even if your dependents are not
covered under an HISD medical plan.
You may use your 2015 health care FSA for expenses incurred through
March 15, 2016, as long as you submit documentation of those expenses
by May 15, 2016.
The full amount you set aside is available to you on January 1, 2015, even
though it is deducted from your paycheck over 24 benefit pay periods.
New for 2015: When you use your health care FSA, you have to submit
documentation to Aetna that shows your funds were spent on qualified
medical expenses.
IMPORTANT: You must use your HealthFund first to pay for eligible
medical expenses before using your FSA.
Dependent day care FSA
• You and your spouse can set up a combined total of up to $5,000, pre-tax,
to pay for day care expenses for a qualified person so you can work or look
for work.
• Unlike the health care FSA, you can only be reimbursed funds that have
already been withheld from your paycheck.
• Eligible expenses include day care, nursery school, after-school care and
summer day camp. You cannot use this account to pay for dependent
medical expenses.
For details, visit HISD Benefits or contact your provider directly.
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LIFE AND ACCIDENTAL DEATH
AND DISMEMBERMENT (AD&D)
HISD provides $10,000 each of life and AD&D coverage at no cost to all employees
who are eligible for benefits. You can purchase supplemental coverage for up
to five times your annual base salary, up to a maximum of $600,000.
• If you enroll in supplemental life with a matching AD&D benefit amount for
yourself, you can also purchase supplemental life with a matching AD&D
benefit amount for your spouse and dependent child(ren). Spouse coverage
is available at one to three times your salary, equal to your coverage amount
or $100,000, whichever is less.
DISABILITY
• If your spouse also works for HISD, only one of you can be covered by
supplemental or spouse life and AD&D.
• You have a choice of elimination periods (30, 60, 90 or 180 days) before
benefits begin, and you select the percentage of annual base salary
(40%, 50% or 66 2/3%) that you want to replace each month.
This plan pays up to a maximum monthly benefit of $8,000, after a set
elimination period, if you are disabled and unable to work due to an injury,
illness or pregnancy.
• Child life and AD&D options are available at $5,000, $10,000, $15,000
and $20,000.
• No evidence of insurability is required to enroll or increase coverage.
• A child may not be covered by more than one employee.
• 3/12 pre-existing condition and actively-at-work provisions apply.
See page 44 for definitions.
• You must designate or update your beneficiary online.
• Actively-at-work provision applies. See page 44 for definitions.
Evidence of insurability (EOI)
EOI is not required:
• If you or your spouse enroll as a new employee or within 31 days of
becoming eligible.
• When you or your spouse increase coverage by one multiple of your salary
(i.e., 1x to 2x or 2x to 3x), subject to the plan maximum.
• When you increase coverage by one multiple of your salary (i.e., 1x to 2x
or 2x to 3x) due to a family status change, such as marriage, or to add
dependent child coverage.
EOI is required in all other cases.
Employee
1x, 2x, 3x, 4x or 5x annual base salary up to $600,000
Spouse
1x, 2x or 3x employee’s annual base salary up to amount of employee life or
$100,000, whichever is less
Child
$5,000, $10,000, $15,000 or $20,000 per child up to age 26
For details, visit HISD Benefits or contact your provider directly.
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CANCER AND SPECIFIED DISEASES
HOSPITAL INDEMNITY
This plan includes a wellness benefit per calendar year for screening tests
and provides a cash benefit for covered procedures and other care related
to the diagnosis and treatment of cancer and 36 specified diseases. This
plan pays you in addition to any other coverage you may have.
This plan provides a cash payment to help you pay your portion of hospital
expenses, including deductibles and coinsurance amounts. This plan pays
you in addition to any other coverage you may have.
• You must be under age 70 to enroll.
• Benefits are paid for hospital admission and hospital stays, including ICU,
of up to 365 days.
• The cancer and specified diseases plan offers three coverage options:
high, medium and low.
• You must provide evidence of insurability for all elections, including
increases in plan options (low to medium, low to high or medium to high)
or changes in coverage level (for example, employee only to employee
plus spouse).
• 12-month pre-existing condition and actively-at-work provisions apply.
See page 44 for definitions.
Low Option
First
occurrence
Wellness
screening
Medium Option
High Option
$1,500
$2,000
$5,000
$50
$75
$100
• You must be under age 70 to enroll.
• When you experience a hospital confinement, you submit a claim form,
along with the receipts for services received, to receive your lump-sum
payment as described in the policy.
• No evidence of insurability is required.
• 12-month pre-existing condition and actively-at-work provisions apply.
See page 44 for definitions.
Per hospital admission
Per day per hospital confinement
Hospital intensive care per day per
confinement
Low Option
High Option
$300
$500
$75
$150
$150
$300
For details, visit HISD Benefits or contact your provider directly.
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enroll
CRITICAL ILLNESS
ACCIDENT PLAN
This plan pays you a $50 wellness screening benefit, along with a
lump-sum cash benefit when you’re first diagnosed with a covered
critical illness. This plan pays you in addition to any other coverage
you may have.
This plan covers emergency treatment, hospital admissions,
confinements and diagnostic exams, as well as other expenses related
to you or an insured family member injured in a covered accident. This
plan pays you in addition to any other coverage you may have.
• You must be under age 70 to enroll.
• You must be under age 70 to enroll.
• If you choose spouse coverage, the spouse benefit is 50% of your
employee benefit. If you choose employee + child or employee
+ family coverage, your dependent children are automatically
covered at no additional charge. The dependent children’s benefit
is 50% of your employee benefit.
• If you have a covered accident, you receive cash benefits for
expenses that may not be fully covered by your medical plan.
• You have a choice of low or high options.
coverage costs
+ contacts
• No evidence of insurability is required.
• 12-month pre-existing condition and actively-at-work
provisions apply. See page 44 for definitions.
• No evidence of insurability is required for the low option.
• 12-month pre-existing condition and actively-at-work provisions
apply. See page 44 for definitions.
Low Option
High Option
Accidental death (within 90 days)
Employee
Low Option
High Option
$10,000
$25,000
Spouse
$5,000
$12,500
Child
$5,000
$12,500
Wellness screening
$50
$50
Accidental death
$25,000
$50,000
Accidental common carrier* death
$50,000
$100,000
Catastrophic accident benefit
$50,000
$100,000
Other accident benefits
Accidental dismemberment
Emergency room/medical fees
$100 minimum
$100 minimum
$12,500
maximum
$25,000
maximum
$125
$250
*The term “common carrier” means any motorized air, land or water conveyance operated under
a license for the transportation of passengers for hire for which a ticket has been issued.
For details, visit HISD Benefits or contact your provider directly.
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IMPORTANT VOLUNTARY PLAN EXCLUSIONS:
PERSONAL LEGAL PLAN
This plan provides personal legal guidance on a variety of issues and
services, such as will preparation, traffic ticket defense and consumer
matters. Issues related to your employment are excluded.
3/12 PRE-EXISTING CONDITION
Disability coverage only
New or increased disability coverage is subject to a 3/12 pre-existing
condition exclusion. This means that if you have a condition that was
treated or medically advised in the three months before your coverage
effective date, you are not covered for that condition for the first 12 months.
12-MONTH PRE-EXISTING CONDITION
Cancer and specified diseases, critical illness, hospital indemnity
and accident coverage
This 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.
LONG-TERM CARE INSURANCE
Offered through Teachers Retirement System of Texas, this comprehensive,
affordable coverage can help protect you and your family from the high
costs of long-term care. This plan covers long-term care services in your
home, your community or assisted-living facilities, including Alzheimer’s
facilities and nursing homes.
For plan and enrollment information, contact Genworth Financial
at 866-659-1970.
For details, visit HISD Benefits or contact your provider directly.
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ACTIVELY AT WORK
Life and AD&D, disability, cancer and specified diseases, critical illness,
hospital indemnity and accident coverage
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. Paid leave and paid vacation are not considered being
actively at work.
I get it.
On to Step 6.
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6
Now you’re ready to enroll
DEPENDENT VERIFICATION
Go to HISD Benefits and make it official.
It’s important that you understand who can and can’t
be considered a dependent on your plan. Starting in
January 2015, you’re required to provide documentation,
such as a birth certificate, marriage license or federal
tax return, to support the eligibility status of each of
your dependents. If you don’t, your dependents lose
their coverage and can’t be added back until you show
proof of eligibility during the next enrollment period
or qualifying life event. Look for detailed information
about this beginning January 7. For information about
dependent eligibility, visit HISD Benefits.
ONLINE ENROLLMENT, MADE EASY
Once you’ve studied your options and made your
selections, it’s time to let us know about them.
Here’s how you get there:
Log on to the HISD employee portal.
Go to Employee Services.
Click HISD Benefits.
Click the Annual Enrollment button and follow the prompts.
BENEFITS ELIGIBILITY
You’re eligible for HISD benefits if:
•
You’re a regular part-time or full-time employee, as defined by HISD
•
You’re a contributing member of the Teachers Retirement System (TRS) or, if retired
ENROLLMENT DATES
November 6 – 20, 2014
FOR NEW EMPLOYEES
If you’re a new employee, look for your benefits confirmation email on the
Friday following the date that you submit your benefits elections on HISD
Benefits. Please don’t put off your enrollment. Unless you enroll when you’re
first eligible, you have to provide evidence of insurability for life insurance.
Be sure to check your statement for accuracy. Your confirmation
statement is available online. If your confirmation statement
is incorrect, call the HISD Benefits Service Center at
877-780-HISD (4473) immediately. You can’t make corrections after
December 31, 2014.
from TRS, you are rehired into a benefits-eligible position
To the extent you qualify as a full-time employee as defined under
Section 4980H(c)(4) of the Internal Revenue Code, you will be treated
as being in an eligible class for purposes of the benefits plan.
For more information, visit hisdbenefits.org.
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I get it.
On to Step 7.
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7
Make the most
of your benefits
Your plan comes with special features.
Use them.
READY TO TAKE CHARGE OF YOUR HEALTH?
YOU HAVE PLENTY OF OPPORTUNITY.
HISD wants you and the entire HISD team to be as healthy and strong as
possible. We give you lots of resources to help you reach your personal best.
RedBrick Health®
Offers free, personalized tools, resources and cash rewards to help
you and your family improve your health
DiabetesAmerica®
Provides complete, personalized diabetes care, from doctor visits,
diagnostic testing and lab work to treatment and education,
all under one roof
Beginning Right® maternity management
Helps give your baby a healthy start in life by offering educational
materials and support services for moms- and dads-to-be,
in English and Spanish
Free
preventive
care.
Do it.
If you’re covered by an HISD
medical plan, your annual
preventive checkup costs
you nothing. Be smart.
Take advantage of that.
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Aetna Informed Health Line
Help from a registered nurse, day or night
Aetna Resources For LivingSM
Aetna Resources For Living administers our employee assistance
program (EAP), which offers free and confidential 24-hour support for
all kinds of personal life challenges.
Advance Medical
Advance Medical’s Expert Medical Opinion provides a free,
confidential second opinion to help you make health care decisions.
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EARN COLD, HARD CASH FOR DOING THE HEALTHY THING
RedBrick Health is a complete online resource designed to help you on your
path to greater health and fitness.
RedBrick Health makes it easy and fun to see where you stand and get started
making positive Journeys to improve your health and prevent future illness. It’s
free and valuable to any employee or dependent 18 or older who is covered by
an HISD medical plan.
How to make money getting healthy
You can earn up to $275 in cash rewards for taking a quick and easy online
Health Assessment and participating in healthy activities. The rewards are
prorated, so hurry to earn the highest cash rewards.
Health Assessment—earn up to $125 cash
• A fun and interactive series of online questions to show you the current
state of your overall health
• Free to employees and adult dependents enrolled in the plan,
but only employees can earn cash rewards
COMPLETION
DATE
November 1–January 31
HEALTH
ASSESSMENT
$125
February 1–April 30
$75
May 1–July 31
$50
August 1–October 31
$25
Throughout the year, participate in healthy
activities to earn points for $150 more
(considered taxable income).
HealthMap
Based on the results of your Health Assessment, your HealthMap
creates a customized Journey for you, including recommended
programs to help you reach your health goals.
For details, visit HISD Benefits or
contact your provider directly.
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Healthy activities for extra rewards—up to $150 more cash*
Programs and activities that can help you lower stress, eat healthier,
exercise more, reach your goal weight and manage chronic conditions:
• Use the Boost online tracker—Earn points for tracking your workouts
of 30 minutes or more.
• Complete a Journey—In as little as a minute a day, your Journey gives
you fun, new things to try at each step.
*You have to complete the Health Assessment to be eligible to earn points toward this
extra cash reward. Cash reward is taxable.
coverage
comparisons
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options
enroll
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benefits
features
Share the fun, spread the health
Your covered family members age 18 and up can use RedBrick Health,
too, by going to redbrickhealth.com/login and setting up their own
personal access. They’re just not eligible for cash rewards.
But wait, there’s more
Participate in HISD’s spring weight loss challenge, and you may be able
to earn up to $160—that’s on top of what you can earn for completing
the Health Assessment and healthy activities. We’ll share more
information about the challenge and how you can earn money
for getting healthy in early 2015.
designed by Freepik.com
designed by Freepik.com
designed by Freepik.com
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designed by Freepik.com
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DIABETES SUPPORT
EMPLOYEE ASSISTANCE PROGRAM (EAP)
Offering broad support for people with diabetes
DiabetesAmerica, free to employees enrolled in an HISD medical plan
and their covered adult dependents, provides specialized treatment
and support so that people with diabetes can more easily manage their
day-to-day needs. Convenient Houston care centers provide all diabetes
services under one roof, from doctor’s visits and labs to education,
including lifestyle and nutrition coaching at no charge. Your generic
diabetes medications are free, too.
Free and confidential professional counseling
The EAP offers guidance for some of life’s most pressing problems, including
mental health and well-being, life and work balance, relationships, substance
abuse and stress. Administered by Aetna Resources For LivingSM, the service is
available 24 hours a day to all employees, dependents, family and household
members. There’s no limit to the number of calls you can make. You can also
take advantage of short-term counseling with a licensed clinician for you and
each household member.
MATERNITY MANAGEMENT
Supporting you through your pregnancy
From the start of your pregnancy until your baby is born, Beginning
Right maternity management provides expectant mothers with
educational materials and access to nurse case managers. For more
information call 800-CRADLE1 (272-3531).
24/7 NURSE LINE
Help finding the right level of care
The Nurse Line is your direct, toll-free connection to a registered nurse,
any time of the day or night. Aetna Informed Health Line nurses are
specially trained to help you choose the appropriate level of care for
any illness or injury. The Nurse Line is available to all employees who
are eligible for benefits at 877-780-HISD (4473).
The EAP offers resources and self-help tools online at mylifevalues.com. Use
these to help you identify and understand health issues and to create an
action plan based on the results. The username is HISD. The password is EAP.
EXPERT MEDICAL OPINION
Get an expert second opinion from Advance Medical.
Advance Medical’s Expert Medical Opinion provides support and information
to help manage a wide array of health conditions. This access to a large
network of medical experts is free to all employees, spouses and dependent
children covered by an HISD medical plan. It’s completely confidential.
A physician case manager discusses your concerns and gathers relevant
medical records, with your permission. An expert then conducts a full review
of your diagnosis and treatment plan and works with you and your doctor to
determine the best course of treatment. To get started, simply call Advance
Medical at 866-778-9219 or visit advance-medical.com/HISD.
Sounds great.
On to a healthy 2015.
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54
new for
2015
8
HISD
perks
provider
networks
medical
plan types
coverage
comparisons
voluntary
options
coverage costs
+ contacts
benefits
features
enroll
Coverage costs
MEDICAL PLAN
Per pay period cost, based on 24 pay periods per year
BASIC
Consumer Basic
LIMITED
Employee only
BASIC
Consumer Basic
CHOICE
Consumer Plus
LIMITED
PLUS
Consumer Plus
CHOICE
Open Access
$22.82
$28.54
$45.97
$57.46
$232.86
Employee + spouse
$115.70
$144.63
$149.25
$186.56
$477.70
Employee + child(ren)
$111.30
$139.14
$144.05
$180.06
$466.77
Employee + family
$200.10
$250.14
$242.05
$302.56
$687.09
DENTAL PPO
3%
DENTAL PLAN
VISION PLAN
Per pay period cost, based on 24 pay periods per year
Dental HMO
Dental PPO
Managed
Cost Dental
Employee only
$5.19
$15.51
No charge
Employee + spouse
$9.86
$30.74
Employee + child(ren)
$9.86
$12.68
Employee + family
Per pay period cost, based on 24 pay periods per year
Vision Plus
Vision Basic
Employee only
$3.03
$2.07
$4.00
Employee + spouse
$6.00
$3.90
$30.66
$4.00
Employee + child(ren)
$6.31
$4.08
$47.96
$6.00
Employee + family
$9.67
$7.62
HEALTH CARE FLEXIBLE SPENDING ACCOUNT (FSA)
Per pay period cost, based on 24 pay periods per year
55
PLUS
DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT (FSA)
Per pay period cost, based on 24 pay periods per year
Minimum contribution
$48 per year or $2 per pay period
Minimum contribution
$48 per year or $2 per pay period
Maximum contribution
$2,550 per year or $106.25 per pay period
Maximum contribution
$5,000 per year or $208.33 per pay period
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new for
2015
HISD
perks
provider
networks
medical
plan types
coverage
comparisons
voluntary
options
benefits
features
enroll
coverage costs
+ contacts
SUPPLEMENTAL LIFE AND AD&D INSURANCE
1x, 2x, 3x, 4x or 5x annual base salary ($600,000 maximum)
Rate mode
Your age January 1 of plan year
Per 24 pay period cost
per $1,000
<30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
$0.0245
$0.0245
$0.0245
$0.0395
$0.0645
$0.0945
$0.1595
$0.1895
$0.3245
$0.4895
AD&D rate of $0.019 per $1,000 included in Employee rates. If your spouse also works for the district, you may each
have Employee Supplemental Life and AD&D or one of you may have Employee Supplemental Life and AD&D
and the other have Spouse Life and AD&D, but not both.
SPOUSE LIFE AND AD&D INSURANCE
1x, 2x, 3x annual earnings ($100,000 maximum)
Rate mode
Spouse’s age January 1 of plan year
Per 24 pay period cost
per $1,000
<30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
$0.0395
$0.0495
$0.0545
$0.0745
$0.1295
$0.1995
$0.3295
$0.3845
$0.6695
$1.0395
AD&D rate of $0.019 per $1,000 included in Spouse rates. The benefit is based on your benefit level and your salary,
up to the maximum benefit—the lesser of employee Supplemental Life and AD&D coverage or $100,000.
CHILD LIFE INSURANCE
Benefit level
Per 24 pay period cost
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Option A
Option B
Option C
Option D
$5,000
$10,000
$15,000
$20,000
$0.27
$0.55
$0.82
$1.09
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HISD
perks
new for
2015
provider
networks
medical
plan types
coverage
comparisons
30 days
60 days
90 days
180 days
Cost
40%
$0.2370 X Annual Salary ÷ 1200
50%
$0.3040 X Annual Salary ÷ 1200
66 2/3%
$0.8190 X Annual Salary ÷ 1200
40%
$0.1750 X Annual Salary ÷ 1200
50%
$0.2625 X Annual Salary ÷ 1200
66 2/3%
$0.5150 X Annual Salary ÷ 1200
40%
$0.1595 X Annual Salary ÷ 1200
50%
$0.2165 X Annual Salary ÷ 1200
66 2/3%
$0.4170 X Annual Salary ÷ 1200
40%
$0.0825 X Annual Salary ÷ 1200
50%
$0.1030 X Annual Salary ÷ 1200
66 2/3%
$0.2420 X Annual Salary ÷ 1200
No evidence of insurability is required. A pre-existing condition exclusion applies to any condition that
was treated or medically advised in the three months prior to the effective date of coverage and will
not be covered for the first 12 months of coverage.
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benefits
features
coverage costs
+ contacts
Per pay period cost, based on 24 pay periods per year
Per pay period cost, based on 24 pay periods per year
Option
enroll
CANCER AND SPECIFIED DISEASES PLAN
DISABILITY PLAN
Elimination period
voluntary
options
Low
Option
+ Specified
Diseases
Low
Option
+ ICU
Medium
Option
Medium
Option
+ ICU
High
Option
High
Option
+ ICU
Employee
only
$5.18
$8.18
$8.28
$11.28
$9.42
$12.42
Employee
+ spouse
$8.64
$14.81
$14.28
$20.46
$17.10
$23.28
Employee
+ child(ren)
$6.63
$12.82
$10.62
$16.80
$12.48
$18.66
Employee
+ family
$8.64
$14.81
$14.28
$20.46
$17.10
$23.28
Evidence of insurability is required.
60
HISD
perks
new for
2015
provider
networks
medical
plan types
coverage
comparisons
voluntary
options
benefits
features
enroll
coverage costs
+ contacts
HOSPITAL INDEMNITY PLAN
Per pay period cost, based on 24 pay periods per year
Low Option
High Option
Age January 1 of plan year
Age January 1 of plan year
18-39
40-49
50-59
60-69
18-39
40-49
50-59
60-69
Employee
only
$2.17
$2.72
$3.89
$6.06
$4.01
$5.07
$7.31
$11.45
Employee
+ spouse
$3.97
$5.17
$7.52
$11.75
$7.37
$9.62
$14.13
$22.16
Employee
+ child(ren)
$4.04
$4.59
$5.76
$7.93
$7.42
$8.48
$10.72
$14.86
Employee
+ family
$5.84
$7.04
$9.39
$13.62
$10.78
$13.03
$17.54
$25.57
No evidence of insurability required.
CRITICAL ILLNESS PLAN
Per pay period cost, based on 24 pay periods per year
Low Option
High Option
Age January 1 of plan year
Age January 1 of plan year
18-34
35-39
40-44
45-49
50-54
55-59
60-69
18-34
35-39
40-44
45-49
50-54
55-59
60-69
Employee
only
$2.07
$3.53
$4.65
$7.11
$8.97
$10.39
$15.77
$4.41
$8.06
$10.86
$17.02
$21.66
$25.22
$38.66
Employee
+ spouse
$3.36
$5.55
$7.23
$10.92
$13.71
$15.84
$23.91
$6.87
$12.35
$16.55
$25.78
$32.75
$38.08
$58.25
Employee
+ child(ren)
$2.07
$3.53
$4.65
$7.11
$8.97
$10.39
$15.77
$4.41
$8.06
$10.86
$17.02
$21.66
$25.22
$38.66
Employee
+ family
$3.36
$5.55
$7.23
$10.92
$13.71
$15.84
$23.91
$6.87
$12.35
$16.55
$25.78
$32.75
$38.08
$58.25
No evidence of insurability is required for the low option.
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62
new for
2015
HISD
perks
provider
networks
medical
plan types
coverage
comparisons
voluntary
options
enroll
benefits
features
coverage costs
+ contacts
ACCIDENT PLAN
Per pay period cost, based
on 24 pay periods per year
Low Option
High Option
Employee only
$3.08
$5.33
Employee + spouse
$4.95
$8.45
Employee + child(ren)
$5.99
$10.10
Employee + family
$7.86
$13.22
PERSONAL LEGAL PLAN
Per pay period cost, based
on 24 pay periods per year
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Employee only
$4.55
Employee + family
$6.20
64
new for
2015
HISD
perks
provider
networks
medical
plan types
coverage
comparisons
voluntary
options
enroll
benefits
features
coverage costs
+ contacts
Provider contacts
For comprehensive benefits information and resources, including provider
call-center hours, visit HISD Benefits, or call the HISD Benefits Service Center
at 877-780-HISD (4473).
24/7 Nurse Line
877-780-HISD (4473)
Aetna Member Services
Medical plan types
aetnanavigator.com
877-224-6857
Affordable Care Act/Health care
reform information
healthcare.gov
Beginning Right Maternity
Management
800-CRADLE1 (272-3531)
Cancer and specified diseases, critical
illness, hospital indemnity, accident
plans
AFLAC
800-433-3036
Central Care Community Health
Center
centralcarechc.org
Main location: 713-734-0199
Riverside location: 713-831-9663
COBRA
ADP COBRA
benedirect.adp.com
800-526-2720
Dental PPO
UnitedHealthcare Dental
myuhcdental.com
800-996-7505
Dental HMO
UnitedHealthcare Dental
myuhcdental.com
800-996-7505
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DiabetesAmerica
diabetesamerica.com
888-877-8427
Disability
Unum
unum.com
800-858-6843
Employee assistance program
Aetna Resources For Living
mylifevalues.com
1-855-574-HISD (4473)
Expert Medical Opinion
Advance Medical
advance-medical.com/HISD
1-866-778-9219
Flexible spending accounts
Aetna/PayFlex FSA
Customer service: 888-678-8242
Claims fax: 888-238-3539
HISD Employee Health
& Wellness Centers
Hattie Mae White Educational
Support Center
4400 West 18th Street
Houston, Texas 77092
713-957-3908
Attucks Middle School
4330 Bellfort Street
Houston, Texas 77051
713-732-3532
IRS
irs.gov/publications
800-TAX-FORM (829-3676)
Life and accidental death and
dismemberment
Minnesota Life
securian.com
Medical underwriting: 800-872-2214
Claims: 888-658-0193
Managed cost dental
QCD of America
qcdofamerica.com
800-229-0304
Personal legal
Hyatt Legal
legalplans.com
800-821-6400
Passwords for login
3720010 (family coverage)
3730010 (single coverage)
Platinum Physician Associates
platinumipa.com
713-900-4450
Prescription drug benefits
CVS Caremark
caremark.com
800-378-8651
RedBrick Health
redbrickhealth.com/login
855-824-6439
Vision
UnitedHealthcare Vision
myuhcvision.com
Customer service: 800-638-3120
Lasik Vision Network of America:
888-563-4497
SPECIAL ONLINE RESOURCES
To see HISD-specific benefits
information, start at the HISD
employee portal, click Employee
Services, click HISD Benefits, and
then follow these steps to reach
the following sites:
Aetna Navigator
• Click Aetna Navigator.
Aetna Member
Payment Estimator
• Click Aetna Navigator.
• Click Use Member Payment
Estimator under Cost of Care.
CVS Caremark automatic
prescription refill program
• Click CVS Caremark.
• Click Manage automatic refills
and renewals.
DocFind
• Click Aetna Navigator.
• Click DocFind.
Enroll
• Click Annual Enrollment and
follow the prompts.
RedBrick Health
• For first-time visitors, click
Register Now and follow the
prompts.
• There’s a free mobile app, too.
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