Open Enrollment Benefits
2014-2015
August 1_31, 2014
Wylie ISD
PPO Dental Plan
Lincoln Benefit- High Option
100/80/50 Plan design option with $1000 maximum annual benefit
Benefits for oral surgery, surgical extractions, and anesthesia will move from Type 2
coverage, covered at 80%, to type 3 coverage, covered at 50%
Claims paid at 90th percentile of usual & customary fees
Coverage for dependent children up to age 26
Orthodontia included for children
Premiums
• Employee Only
$35.34 per month
• Employee & Spouse
$76.44 per month
• Employee & Child
$70.28 per month
• Employee & Family
$123.28 per month
PPO Dental Plan
Lincoln Benefit- Low Option
Provides a lower more basic level of coverage.
100/70/40 Plan design option with $750 maximum annual benefit
Benefits for oral surgery, surgical extractions, and anesthesia will be covered as Type 3
coverage, covered at 50%
Claims paid at 90th percentile of usual & customary fees
Coverage for dependent children up to age 26
No Orthodontia coverage
Premium are guaranteed for 2 years
• Employee Only
$25.18 per month
• Employee & Spouse
$54.02 per month
• Employee & Child
$48.50per month
• Employee & Family
$85.22 per month
DHMO Dental Plan
Lincoln Benefit- DHMO
No co-pay on office visit; many other deeply discounted services
No annual maximum benefits or deductibles
Members must choose a provider from the network to receive benefits
• Employee Only
$14.69 per month
• Employee & Spouse
$28.62 per month
• Employee & Child
$30.97 per month
• Employee & Family
$44.76 per month
Cancer Plan
Colonial Cancer
Single plan option including Cancer coverage, ICU rider, Specified Disease Coverage, and
1st Occurrence Benefit
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Hospital Confinement Benefit
Radiation/Chemo
Surgery Schedule Benefit
Initial Diagnosis
Screening Rebate
$300 per day
$300 per day with $10,000 per year
Up to $4,500 max
$5,000
$100
Open Enrollment, Guarantee issue coverage.
Employee Only
$29.85 per month
Employee & Family
$49.55 per month
Vision Plan
Block Vision
Exam and eyewear co-pay of $15
Elective Contact lens allowance of $150; Paid in full if medically necessary
Frame allowance up to $125 retail value
$200 allowance on Lasik
Employee Only
$7.40 per month
Employee & Spouse
$12.58 per month
Employee & Child
$13.30 per month
Employee & Family
$19.98 per month
Basic & Voluntary Group Term Life Plan
Lincoln Benefit
$15,000 Life Insurance Coverage for all Employees- Provided at no cost by Wylie ISD
Additional voluntary coverage available at group rates.
ex: $50,000 Coverage
•Age 25- $4.75
•Age 35- $6.25
•Age 45- $13.00
•Age 55- $30.00
•Age 65- $65.50
Spouse Coverage also available, Child Life up to age 26
Guaranteed Issue Coverage to $200,000 employee, $50,000 Spouse
Annual increases of $20,000 up to the guaranteed issue limit on voluntary life each
year at open enrollment.
Coverage good while employed with Wylie ISD.
Disability Insurance
Standard Insurance
Open enrollment, guaranteed issue opportunity in 2014
Protects against a loss of income due to sickness or accident
1st Day hospital confinement benefit- Waives elimination period on 0/7, 14/14,
30/30 elimination period plans.
Insure up to 66.67% of annual salary- $8000 maximum monthly benefit.
Elimination Period
Rate Per $1000
0/7
$37.80
14/14
$33.30
30/30
$28.20
60/60
$18.30
90/90
$15.80
Permanent Life Plan
Fidelity Life
Permanent, Guaranteed Issue, Life Time Protection, Term Life Insurance Policy.
Plus- Long Term Care Rider equal to 4% of death benefit, payable for 75 months.
Ex: $25,000 death benefit or $1000 monthly LTC benefit payable for 75 Months.
75 month LTC benefit is new for 2013, current policies include a 25 month LTC
benefit
Portable upon termination of employment- Premium remains the same.
Insure yourself, spouse, and children.
Guaranteed issue for all employees up to $100,000.
Rates Based on age at issue, guaranteed for life
ex: $25,000 Non-Smoker Benefit, monthly premium:
• Age 35- $15.77
• Age 45- $26.27
• Age 55- $47.50
Medical Gap Plan
Specialty Insurance Services
Bridges the gap between Active Care 1HD and Active Care 2 benefits by:
• Paying $1,500 per year for each covered person for hospital confinement
• Paying $4,500 ($1,500 per occurrence) max per year for 3 occurrences of
outpatient services – includes ER visit, MRI, x-ray, lab, outpatient surgery (excludes
doctor office visit cost)
• Guaranteed issue
• No pre-existing condition if not subject to pre-existing condition on medical plan
• Also bridges the gap between Active Care 2 and Active Care 3 benefits
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Employee Only
>40
$25.98
40-49 $34.21
50+
$71.85
Employee Spouse
$47.76
$62.85
$132.02
•Employee Children
$62.45
$67.22
$123.81
Employee Family
$83.64
$95.11
$182.41
Flexible Spending Account
TASC
Medical Expense Reimbursement and Dependent Care Reimbursement
Debt Card
Smart Phone and Tablet Apps
MyCash Account
Medical Expense Reimbursement
Dependent Care Expense Reimbursement
Dr. Visit Co-pays
Day Care Expenses
Deductible expenses
Elderly Care Expenses
Rx Co-pays
Uninsured Dental/Vision Expenses
Open Enrollment - Enrollers Onsite
Date
Time
Location
August 4th
11a.m. – 6p.m.
ESC Building
August 5th – August 7th
8a.m. – 5p.m.
ESC Building
August 8th
11a.m. – 6p.m.
ESC Building
August 11th – August 15th
8a.m. – 5p.m.
ESC Building
Third Party Administrator, US Employee Benefits 972-636-9944