We are pleased to offer a full benefits program to you and your eligible dependents. Read this guide to know what benefits are available.
Coverage details for each medical plan offered are available in a Summary of Benefits and Coverage (also referred to as an SBC), which can be viewed at www.mybenefitshub.com/andrewsisd
Higginbotham Public Sector
833-505-4577 www.mybenefitshub.com/andrewsisd andrewsisd@hps.higginbotham.net
TRS ActiveCare
866-355-5999 www.trs.texas.gov/health-benefits/ contacts
Lincoln Financial Group Group # 00001D039766 800-423-2765 www.lfg.com
The Standard Policy # 763263 800-877-7195 www.standard.com
Chubb Policy # 100000215 888-499-0425 www.chubb.com/ workplacebenefitsclaims
Mutual of Omaha Group # GPS3466429 800-775-8805 www.mutualofomaha.com
Experian
855-797-0052 www.experian.com
The Hartford Group # 395333 888-277-4767
www.thehartford.com
Chubb Policy # 100000215 888-499-0425
The Hartford Group # VHI-888093 866-547-4205
www.thehartford.com
The Hartford Group # VCI-888093 866-547-4205 www.thehartford.com
MASA
Group # B2BASD 800-423-3226 www.masamts.com
Recuro Health
855-673-2876
www.recurohealth.com
National Benefit Services
855-399-3035
www.mynbsbenefits.com
Clever RX
800-873-1195
www.cleverrx.com/andrewsisd
5Star Life Insurance Company Group # 2269 866-863-9753
www.5starlifeinsurance.com
(HSA) EECU
817-882-0800 www.eecu.org
OE: Open Enrollment
QLE: Qualifying Life Event
Dependent(s) Who is Eligible
• A regular, full-time employee working an average of 30 hours or more per week
When to Enroll
When Coverage Starts
• By the deadline given by the Benefits Office
• Benefits begin first of the month following or coinciding with date of hire.
• A regular, full-time employee working an average of 30 hours or more per week
• During OE or for a QLE
• OE: Start of the plan year
• QLE: Ask the Benefits Office
• Your legal spouse
• Children under age 26 regardless of student, dependency, or marital status
• Children age 26 or older who are fully dependent on you for support due to a mental or physical disability and who are indicated as such on your federal tax return
• During OE or for a QLE
• When covering dependents, you must enroll for and be on the same plans
• Ask the Benefits Office
You may only enroll for or make changes to coverage during the plan year if you are a new hire or if you have a QLE, such as: You have 30 days from the event to notify the Benefits Office and complete your changes. You may need to provide documents to verify the change.
Enrolling in benefits is simple through THEbenefitsHUB.
1. Go to www.mybenefitshub.com/andrewsisd or scan the QR code.
2. Click Login
3. Enter your:
Last name
Date of birth
Social Security number (last four digits only)
4. Once confirmed, the Additional Security Verification page will list contact options. Select either the Text, Email, Call, or Ask Admin option to receive a code for completing final verification.
5. Enter the code, and click Verify to begin your enrollment.
6. Review your personal information and verify covered dependents. Contact your employer with any discrepancies.
7. After dependent information is confirmed, you may select the benefits shown. To make your selections, click the drop-down list next to the plan name. Once the desired coverage amount is selected, your contribution amount will be displayed. Click Save & Continue. Repeat for each benefit. You may be asked to provide evidence of insurability for certain benefits.
8. If enrolling in life insurance coverage, you must identify your beneficiary(ies).
Select your beneficiary designation.
Click Sign & Continue
Review and confirm your information.
Click Finished
Employee benefits can be complicated. The Higginbotham Public Sector benefits team is available to help you with the following:
Enrollment
Benefits
Eligibility
Claims and Billing
Call or text 833-505-4577 Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you leave a message after 3:00 p.m. CT, your call or text will be returned the next business day. You can also email andrewisd@hps.higginbotham.net
Bilingual representatives are available.
A cafeteria plan enables you to save money by using pretax dollars to pay for eligible group insurance premiums sponsored and offered by your employer. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment become effective on the plan effective date and will remain in effect during the entire plan year.
Changes in benefit elections can occur only if you experience a QLE. You must present proof of the QLE to your Benefits Office within 30 days of the event. Meeting with the Benefits Office to complete and sign the necessary paperwork is also required to make benefit election changes effective. Changes must be consistent with the QLE.
What if I miss the enrollment deadline?
Contact your Benefits Office for guidance if you miss a benefits enrollment deadline. Under normal circumstances, you may only enroll for or make changes to coverage during Open Enrollment, if you have a Qualifying Life Event, or if you are a new hire.
Is there an age limit for dependents to be covered under my benefits?
Yes. See the Eligibility page for details.
Where can I find benefits summaries and forms?
To access medical plan Summary of Benefits and Coverage (SBC) documents, plan documents for other coverages, and forms, go to the Benefit Information section at www.mybenefitshub.com/ andrewsisd . Click on each benefit (e.g., medical, vision, etc.) for details.
Call the Higginbotham Public Sector benefits team at 833-505-4577
How can I find in-network providers?
Go to www.mybenefitshub.com/ andrewsisd and click on the Provider Search link, where you will see all available plan provider searches.
When will I get my ID cards?
If the medical carrier provides ID cards and there is a plan change, new cards usually arrive within four weeks of your effective date. If there are no plan changes, a new card may not be issued.
You may not need or receive an ID card for dental and vision plans. Simply share the carrier name and phone number with your health care provider to have benefits verified.
The following limitations and exclusions may apply when obtaining coverage as a married couple or for your dependents.
Can I cover family members (a spouse and/or dependent) as dependents on my benefits if I and my spouse work for the same employer?
Some benefits may not allow for this type of coverage if you both work for the same employer. Review the benefit plan documents, contact Higginbotham Public Sector, or contact the carrier for eligibility details.
Are there FSA and HSA limitations for married couples?
Yes, generally. Married couples may not enroll in both a Health Care Flexible Spending Account (FSA) and a Health Savings Account (HSA) at the same time. If your spouse is covered under a Health Care FSA that reimburses for qualified health care expenses, then you and your spouse are not HSA-eligible – even if you do not use your spouse’s Health Care FSA to reimburse your expenses. However, there are some exceptions to the general limitation for other types of FSAs (e.g., Limited Purpose Health Care FSA; Dependent Care FSA). Contact the FSA and/or HSA administrator before you enroll, or consult your tax advisor for further guidance.
Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in FSAs and an HSA as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Higginbotham Public Sector, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of your enrollment in spouse and/or dependent coverage, including enrollment in FSAs and an HSA.
Our medical plans protect you and your family from major financial hardship in the event of illness or injury.
All TRS-Active participants may enroll in one of the following plans:
TRS-ActiveCare Primary
TRS-ActiveCare Primary+
TRS-ActiveCare HD
Ask your
Administrator for your district’s
• $0 preventive services
• One-on-one health coaches
• Weight loss programs and nutrition
• TRS Virtual Health
• Member Rewards is even better. Now you’ll get a check when you use Member Rewards and choose low-cost, highquality doctors and facilities – up to $599* per tax year.
• Airrosti Remote Recover y gives you inhome virtual physical therapy to relieve common aches and pains at no cost.*
* Eligibility rules may apply.
the Annual Enrollment Guide for more details.
You have in-office and virtual benefits:
• TRS-ActiveCare Primary Plan: $30 copay for office visits or $0 with Teladoc
• TRS-ActiveCare Primary+ Plan: $15 copay for office visits or $0 with Teladoc
• TRS-ActiveCare HD Plan: 30% coinsurance after deductible or $42 with Teladoc
• TRS-ActiveCare 2 Plan: $20 copay for office visits or $12 with Teladoc
This plan is closed to new enrollees. Current TRS-ActiveCare 2 participants can stay enrolled.
Standalone prescription drug discount programs (which are not insurance) may help to lower your prescription costs. Such discount programs are available to anyone who is interested in saving money on their prescriptions.
Don’t overpay for your prescriptions. Clever RX gives you access to discounts on thousands of medications, and it is accepted at most pharmacies nationwide. Best of all –you can get up to 80% off prescription drugs! Getting started is easy.
Download the free Clever RX app and enter these numbers.
1.
2.
3.
Group ID – 1085
Member ID – 5496
Enter your ZIP code to find local pharmacies with the best prices.
Click the voucher with the lowest price, closest location, and/or at your preferred pharmacy. Then present the voucher to the pharmacist when you pick up your prescription.
Becoming familiar with your options for medical care can save you time and money.
Non-Emergency Care
Access to care via phone, online video, or mobile app whether you are at home, work, or traveling; medications can be prescribed
TELEHEALTH
24 hours a day, 7 days a week
Generally, the best place for routine preventive care; established relationship; able to treat based on medical history
DOCTOR’S OFFICE
RETAIL CLINIC
Office hours vary
Usually lower out-of-pocket cost than urgent care; when you can’t see your doctor; located in stores and pharmacies
Hours vary based on store hours
Allergies
Cough/cold/flu
Rash
Stomachache
URGENT CARE
Emergency Care
When you need immediate attention; walk-in basis is usually accepted
Generally includes evening, weekend and holiday hours
Infections
Sore and strep throat
Vaccinations
Minor injuries/sprains/ strains
HOSPITAL ER
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility
24 hours a day, 7 days a week
Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher
Common infections
Minor injuries
Pregnancy tests
Vaccinations
Sprains and strains
Minor broken bones
Small cuts that may require stitches
Minor burns and infections
Chest pain
Difficulty breathing
Severe bleeding
Blurred or sudden loss of vision
Major broken bones
Most major injuries except trauma
Severe pain
FREESTANDING ER
24 hours a day, 7 days a week
Minimal
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only estimates. This information is not intended as medical advice. If you have questions, please call the phone number on the back of your medical ID card.
Get a deeper understanding of your body and spot potential issues early.
Your benefit plan includes the opportunity for you and your family to enroll for a Function membership. Function empowers you to own your health through affordable access to advanced lab testing. A Function membership evaluates five times more biomarkers than the average physical, helping you gain a deeper understanding of what’s going on in your body, monitor for early indicators of disease, and track your health as it evolves.
The membership includes:
Access to 100+ lab tests at the start of your membership.
Access to an additional 60+ midyear follow-up tests to track your progress.
Detailed clinician notes highlighting areas of focus.
A targeted action plan to help improve your health.
Results stored on one secure platform for easy access anytime.
Carrier:
After signing up for Function, you will get an email and text message to schedule a convenient time and location for your lab visit. Tests take less than 30 minutes and are done at one of more than 2,000 partner lab locations nationwide. You will then get a detailed summary of your results and a targeted action plan to help you reach your health goals. All results are stored in one secure location for you to access anytime. You can retest in six months to see how you are progressing. Nonroutine tests (e.g., advanced MRI, early detection of multiple cancers, allergies, heavy metals, and more) may be added for an additional cost.
Test More. Know More.
Advanced testing across:
Heart
Immunity
Metabolics
Hormones
Nutrients
Blood
Heavy Metals
Liver
Kidneys
Pancreas
Prostate
The cost for an individual annual membership* is $335!
Sexual Health
Electrolytes
Thyroid
Autoimmunity
Urine
Funds from your Flexible Spending Account (FSA) or Health Savings Account (HSA) may be used to pay for your membership. Reimbursement is not guaranteed, so please contact your FSA/HSA provider in advance to confirm the terms of reimbursement. If you do not have an FSA or HSA, use a personal credit card.
*Function membership includes prepaid access to 160+ lab tests each year at a Quest Diagnostics site. Due to state regulations, members testing in New York and New Jersey will be charged an additional fee directly by Quest for each lab visit. We cannot accommodate lab testing in Hawaii or Rhode Island at this time. You can schedule lab testing in a neighboring state.
Enroll anytime during the year. You will pay the membership fee(s) directly to Function. Visit https://www.functionhealth.com/aep/higginbotham
Offset your HDHP health care costs, reduce your taxes, and get a long-term tax-advantaged savings account.
A Health Savings Account (HSA) is like a personal savings account that allows you to pay for current or future health care expenses with pretax dollars or save the funds for retirement. The funds can also be used for your dependents, even if they are not covered by the HDHP. An HSA is always yours to keep, even if you change health plans or jobs.
HSA Administrator:
Pay for qualified out-ofpocket medical, dental, and vision expenses as they are incurred.
Invest and grow your HSA dollars tax-free. You can use the funds to pay for qualified expenses later.
You are eligible to open and contribute to an HSA if you are:
Enrolled in an HSA-eligible HDHP
Not covered by another plan that is not a qualified HDHP (e.g., spouse’s health plan)
Not enrolled in a Health Care Flexible Spending Account
Not eligible to be claimed as a dependent on someone else’s tax return
Not enrolled in Medicare, Medicaid, or TRICARE
Not receiving Veterans Administration benefits
Note: You may have an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deductions.
Use your HSA debit card to pay for qualified expenses.
Pay out-of-pocket and submit your receipts for reimbursement online or through the app.
You may contribute up to the IRS annual maximum.
Visit www.eecu.org
Call 817-882-0800
Download the
Set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer the following FSAs.
FSA Administrator:
The Health Care FSA covers qualified medical, dental, and vision expenses for you and your eligible dependents. Eligible expenses include:
Deductibles, copays, and coinsurance
Prescription drugs
Braces, glasses, and contacts
Hearing aids and batteries
If you enrolled in an HDHP and contribute to an HSA, you may not contribute to a Health Care FSA.
Watch and learn more!
Visit fsastore.com for an array of
FSAs are generally considered “use it or lose it” accounts, and unused remaining funds at the end of the plan year may be forfeited. Your employer may offer some flexibility (e.g., more time via a grace period to incur expenses; or a limited amount of funds that can be carried over in to the next plan year). Because options vary by employer, it’s important to review your specific plan details or check with your employer for more information.
Planning the amount of your contributions carefully can help you make the most of your FSA and avoid losing unused funds. You cannot change your contribution election during the plan year unless you experience a Qualifying Life Event. Keep itemized receipts to verify debit card payments.
The Dependent Care FSA helps pay expenses associated with caring for children under age 13 and elder dependents so you or your spouse can work or attend school full-time.
To be eligible, you (and your spouse, if married) must be gainfully employed, looking for work, a full-time student, or incapable of self-care.
You can use funds for daycare or babysitter expenses for your children under age 13, but only for the part of the year when the child is under 13.
Only day camps – not overnight camps – can be considered for reimbursement.
You can use funds for care of a spouse or dependent of any age who spends at least eight hours a day in your home and is mentally or physically incapable of self-care.
The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
Dependent Care FSA claims may be submitted as incurred and will be paid as funds become available after monthly payroll contributions are deposited.
Visit www.nbsbenefits.com Call 855-399-3035
Fax 844-438-1496
Email service@nbsbenefits.com
Download the Carrier app Participant Portal: www.mynbsbenefits.com
Knowing the difference between an HSA and FSA can help you choose the best option for you and your family.
• Acts as a personal savings account.
Description
Contribution Source
Account Owner
• Funds can be used to pay for current or future health care expenses with pretax dollars; or funds can be saved for retirement.
• Funds can also be used for your dependents, even if they are not covered by the HDHP.
Employee (You) and/or your employer
Employee (You)
Underlying Insurance Requirement HDHP
2026
Maximum Annual Contribution
Permissible Use of Funds
– $8,750
55+ Additional Catch-up – $1,000
• Pay for qualified out-of-pocket medical, dental, and vision expenses.
• If used on nonqualified expenses prior to age 65, subject to income tax plus a 20% penalty.
Year-to-year rollover of account balance? Yes. Funds roll over and can be used anytime or saved for future use.
Health Care FSA – Use funds to pay qualified medical, dental, and vision expenses.
Limited Purpose Health Care FSA – Use funds to pay qualified dental and vision expenses only. Dependent Care FSA – Use funds to pay qualified dependent care expenses and services.
Employee (You) and/or your employer
Employer
None
2026
Health Care FSA – $3,400
Limited Purpose Health Care FSA – $3,400
Dependent Care FSA
• $7,500 (Single parent filing head of household; or married filing jointly)
• $3,750 (Married filing separately)
See details in the Description section above.
2026
Health Care FSA – Allows for carryover of $680 in to the next plan year OR an extended grace period after the end of the plan year (typically 2½ months) to spend remaining funds.
Limited Purpose Health Care FSA – Same as Health Care FSA.
Dependent Care FSA – N/A
Does the account earn interest?
Portable?
Yes. It is always yours to keep, even if you change jobs or medical plans.
* FSAs are generally considered “use it or lose it” accounts, and unused remaining funds at the end of the plan year may be forfeited. Your employer may offer some flexibility (e.g., more time via a grace period to incur expenses; or a limited amount of funds that can be carried over in to the next plan year). Check with your employer for more details.
The products and services listed below are examples of medical expenses eligible for payment from your Health Care FSA or HSA.*
This list is not all-inclusive; additional expenses may qualify, and the items listed are subject to change in accordance with IRS regulations. Please refer to IRS Publication 502 Medical and Dental Expenses at www.irs.gov for complete details.
Abdominal supports
Acupuncture
Ambulance
Anesthetist
Arch supports
Artificial limbs
Blood tests
Braces
Cardiographs
Chiropractor
Crutches
Dental treatment
Dentures
Dermatologist
* Excludes Dependent Care FSA.
Diagnostic fees
Eyeglasses
Gynecologist
Healing services
Hearing aids and batteries
Hospital bills
Insulin treatment
Lab tests
Metabolism tests
Neurologist
Nursing
Obstetrician
Operating room costs
Ophthalmologist/Optician/Optometrist
Orthopedic shoes
Orthopedist
Osteopath
Physician
Postnatal treatments
Prenatal care
Prescription medicines
Psychiatrist
Therapy equipment
Wheelchair X-rays
Exams, cleanings, complete series X-rays, fluoride treatments, sealants, space maintainers
Basic Services
Fillings, extractions, periodontics, root canals, endodontics, oral surgery (High Plan Only)
Major Services
Crowns, dentures, bridges, implants with inlays and onlays
1 Payment for covered services received from an
² The amount you pay after the
Two levels of benefits are available with the DPPO plans: in-network and out-of-network. You may see any dental provider for care, but you will pay less and get the highest level of benefits with in-network providers. You could pay more if you use an out-ofnetwork provider.
Our vision plan offers quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems.
Vision Provider: Network: VSP Choice Network
You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see in-network providers.
Exam (ophthalmologist) Covered in full Up to $45
Exam (optometrist) Covered in full Up to $45
Frames $150 retail allowance Up to $70 retail
Contact lens fitting (standard1) Up to $60 Not covered
Contact lens fitting (specialty1) Up to $60 Not covered
Contact lens: Elective Up to $150 Up to $105
Contact lens: Medically Necessary Covered in full Up to $210
Lenses (standard) per pair
• Single vision
• Bifocal
• Trifocal
Lens Options (participant cost)
• Progressive lens²
• Scratch coat
• Ultraviolet coat
• Polycarbonate – children
• Polycarbonate –adults
$25 copay Covered in full Covered in full Covered in full $25 copay Up to $30 retail Up to $50 retail Up to $100 retail
Covered in full $17-$33 $16 Covered in full $33 Up to lined bifocal allowance. Not covered Not covered Not covered Not covered
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements.
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements.
2 Up
3 Materials co-pay applies to lenses and frames only, not contact lenses.
Life and Accidental Death and Dismemberment (AD&D) insurance are important to your financial security, especially if others depend on you for support or vice versa.
Life and AD&D Provider:
With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies). Life and AD&D coverage amounts reduce by 50% at age 70.
Watch and learn more!
Eligible employees receive Basic Life and AD&D at no cost. You are automatically covered at $50,000 for Basic AD&D.
A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
Voluntary
Life and Accidental Death and Dismemberment (AD&D) insurance are important to your financial security, especially if others depend on you for support or vice versa.
With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies). Life and AD&D coverage amounts reduce by 50% at age 70.
A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
Watch and learn more!
If you need more coverage than Basic Life and AD&D, you may buy Voluntary Life and AD&D coverage for yourself and your dependent(s). If you do not elect Voluntary Life and AD&D coverage when first eligible, or if you want to increase your benefit amount at a later date, you may need to show proof of good health. You must elect Voluntary Life and AD&D coverage for yourself before covering your spouse and/or child(ren).
• $10,000 increments up to a maximum of $500,000
• $300,000
• $5,000 to $500,000 in $5,000 increments not to exceed 100% of employee benefit amount
• New hire Guaranteed Issue
• $100,000
• Live birth to six months: $1,000
• Six months to age 26: $10,000
• New hire Guaranteed Issue
Help protect your family with The Family Protection Plan from 5Star Life Insurance Company. This level term life insurance plan offers level premiums and a level death benefit to age 121, as long as there is no lapse in premium payments. The death benefit is paid in a lump-sum cash payment.
Spouse Coverage: Cover your spouse, even if you do not elect coverage for yourself.
Dependent Coverage: Financially dependent children ages 14 days to 26 years old can get coverage too (under your coverage or your spouse’s coverage).
Portability: If you change jobs or retire, and continue to pay your premium, your coverage continues with no loss of benefits or premium increases. 5Star will bill you directly.
Terminal Illness Benefit: Receive 30% of your coverage in a lump-sum payment if a terminal condition limits your life expectancy to less than 12 months.
Quality of Life Benefit: This optional rider accelerates a portion of your death benefit on a monthly basis –up to 75% – should the following occur:
You have a permanent inability to perform at least two of the six ADLs (Activities of Daily Living) without substantial assistance; or
You suffer from a severe cognitive impairment such as dementia, Alzheimer’s disease, or other forms of senility that require substantial supervision.
Visit www.5starlifeinsurance.com Call 866-914-5202
Educator Disability insurance combines features of short-term and long-term disability into one plan. Disability insurance protects part of your income if you are unable to work due to a covered accident, illness, or pregnancy. We offer Educator Disability insurance for you to purchase and allow you to choose the coverage amount and waiting period that best suits your needs. Educator Disability
Diability Provider:
Are there pre-existing condition limitations?
Yes. All plans include preexisting condition limitations that could impact you if you are a first-time enrollee in your employer’s disability plan (including your initial new hire enrollment). Review the plan documents for full details.
The Hospital Indemnity plans help you with the high cost of medical care by paying you a cash benefit when you have an inpatient hospital stay.
Unlike traditional insurance which pays a benefit to the hospital or doctor, these plans pay you directly. It is up to you how you want to use the cash benefit. These costs may include meals, travel, childcare or eldercare, deductibles, coinsurance, medication, or time away from work. See the plan document for full details.
Treatment for cancer is often lengthy and expensive. While your health insurance helps pay the medical expenses for cancer treatment, it does not cover the cost of non-medical expenses, such as out-of-town treatments, special diets, daily living, and household upkeep. In addition to these non-medical expenses, you are responsible for paying your health plan deductibles and/or coinsurance. Cancer insurance helps pay for these direct and indirect treatment costs so you can focus on your health.
Medical Imaging
Radiation and Chemotherapy Charges Per 12-month period
Internal Cancer First Occurrence*
Air Ambulance
Ambulance
Skin cancer initial diagnosis
Hospice care
Skilled nursing care facility
Home health care
Bone marrow or stem cell transplant
$500 per imaging study maximum studies per calendar year: 2
$10,000 maximum per covered person per calendar year per 12 month period.
$5,000 employee or spouse
$7,500 child(ren)
Watch and learn more!
Cancer Insurance Provider:
Cancer wellness
Genetic tumor testing
Heritable
Heart attack or stroke
$500 per imaging study maximum studies per calendar year: 2
$15,000 maximum per covered person per calendar year per 12 month period.
$10,000 employee or spouse
$15,000 child(ren)
$2,000 per trip Maximum trip per confinement: 2 $2,000 per trip Maximum trip per confinement: 2
$200 per trip Maximum trips per confinement: 2
$100 per diagnosis Lifetime Maximum: 1
$100 per day
$300 per day Maximum days per calendar year: 30
$100 per day not to exceed the number of days confined Maximum days per calendar year: 30
First bone marrow transplant: $6,000
Additional transplant: 50%
Lifetime maximum transplant(s): 2 First stem cell transplant: $600
Additional transplant: 50% Lifetime maximum transplant(s): 2
$50
Maximum days of service, per covered person per calendar year: 1 day(s)
Follow-up test benefit amount: $100 Waiting period: 0 days
$200 per trip
Maximum trips per confinement: 2
$100 per diagnosis Lifetime Maximum: 1
$300 per day
$300 per day not to exceed the number of days confined Maximum days per calendar year: 30
First bone marrow transplant: $9,000
Additional transplant: 50%
Lifetime maximum transplant(s): 2 First stem cell transplant: $900
Additional transplant: 50% Lifetime maximum transplant(s): 2
$50
Maximum days of service, per covered person per calendar year: 1 day(s)
Follow-up test benefit amount: $100 Waiting period: 0 days
$50 per test Maximum tests per calendar year: 2 $50 per
$5,000 employee or spouse $7,500 child(ren) Recurrence benefit: $2,500 Employee or spouse: $3,750 child(ren) Waiting period: 0 days
$10,000 employee or spouse $15,000 child(ren) Recurrence benefit:
Critical Illness insurance helps pay the cost of non-medical expenses related to a covered critical illness or cancer.
The plan provides a lump sum benefit payment to you upon first and second diagnosis of any covered critical illness or cancer. The benefit can help cover expenses such as lost income, out-of-town treatments, special diets, daily living, and household upkeep costs. This coverage is portable. See the plan document for full details.
COVERED ILLNESSES
CANCER CONDITIONS
Benign Brain Tumor*; Invasive Cancer*
Non-invasive Cancer
VASCULAR CONDITIONS
Heart Attack*; Heart Transplant*; Stroke*
Aneurysm; Angioplasty/Stent; Coronary Artery Bypass Graft
OTHER SPECIFIED CONDITIONS
Coma*; End Stage Renal Failure; Loss of Hearing; Loss of Speech; Loss of Vision; Major Organ Transplant*;
Paralysis
Bone Marrow Transplant
NEUROLOGICAL CONDITIONS
Advanced Multiple Sclerosis; Advanced Parkinson’s; Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s);
CHILD CONDITIONS
Cerebral Palsy; Congenital Heart Disease; Cystic Fibrosis; Muscular Dystrophy; Spina Bifida
ADDITIONAL BENEFITS
Recurrence – Pays a benefit for a subsequent diagnosis of conditions marked with an asterisk (*)
Health Screening Benefit $50 once per year per covered person
Maximum – Primary
Maximum – Child(ren)
¹For additional rates look in your enrollment.
& Spouse/Partner
Accident insurance provides affordable protection against a sudden, unforeseen accident.
Accident insurance helps offset the direct and indirect expenses such as copayments, deductibles, ambulance, physical therapy, childcare, rent, and other costs not covered by traditional health plans. You will be paid a specific sum of money directly based on the care and services provided for your covered accident. Use the money any way you see fit. See the plan document for full details.
Watch and learn more!
• Coverage Type
• Express Benefit
• Annual Benefit Maximum (ABM)
• Portability
Initial Care & Emergency
• Emergency Room
• Urgent Care Center
• Initial Physician Office Visit
• Ambulance
Specified Injuries1,2
• Fractures (Surgical / Non-surgical)
• Dislocations (Surgical / Non-surgical)
• Lacerations
• Burns
• Dental
Hospital, Surgical & Diagnostic
• Admission
• Daily Confinement (Up to 365 days per accident)
• ICU Confinement (Up to 15 days per accident)
• Rehabilitation Facility Confinement (Up to 30 days per accident)
• Surgical
• Diagnostic
• Physician Follow-Up Office Visit
• Therapy Services
• Medical Device
• Prosthetic Device(s)
Additional Benefits – Benefits are payable within
• Transportation (Up to 3 trips per accident)
• Lodging (Up to 30 nights per accident)
• Childcare (Up to 30 days per accident)
• Principal Sum (PS)
• Common Carrier Accidental Death
• Transportation of Remains
• Dismemberment & Paralysis
• Reasonable Modifications
• Coma You: $50,000 Spouse: $25,000 Child(ren): $10,000 300% of PS Up to $5,000 Up to 100% of PS Up to 10% of PS 25% of PS
day
You: $10,000
Spouse: $5,000
Child(ren): $5,000
300% of PS
Up to $5,000 Up to 100% of PS Up to 10% of PS 50% of PS *Percentage of
This voluntary telehealth program gives you 24/7 access to board-certified doctors, licensed counselors, and psychiatrists via your mobile device or computer – from home, the office, or on the go. Whether you need medical care or support navigating stress and life changes, confidential help is at your fingertips. It is a standalone program that is NOT tied to your medical plan coverage.
Skip the trip to your doctor! Set up your account so you can get on-demand medical care. Visit www.recurohealth.com Call 855-673-2876 Download the Recuro Care app
with Behavioral Health Provider:
While telehealth with behavioral health does not replace your primary care physician, counselor, or psychiatrist, it is a convenient and cost-effective option when you need care and:
Have a non-emergency issue and are considering an after-hours health care clinic, urgent care clinic, or emergency room for treatment
Are on a business trip, vacation, or away from home
Are unable to see your primary care physician, counselor, or psychiatrist
For minor conditions such as:
Sore throat
Headache
Stomachache
Cold/flu
Allergies
Fever
Urinary tract infections
Behavioral health
MASA Medical Transport Solutions (MASA MTS) helps you prepare for the unexpected with affordable medical emergency air and ground transportation.
Emergency Medical Transport Provider:
If you or your family members need emergency medical transport, your insurance coverage and Medicare may not cover all of the costs. Following your medical crisis, MASA MTS will negotiate with your medical plan provider and cover your remaining balance on your medical transportation bills. Participation in this plan is voluntary.
Visit www.mybenefitshub.com/andrewsisd for rates.
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This plan helps to prevent or minimize the harm caused by identity theft when someone uses your personal information without permission.
Monitoring of credit files, financial accounts, and the dark web for fraudulent activity
Alerts when suspicious activity is detected
Identity restoration services
Fraud resolution services
ACA (Affordable Care Act) – The ACA is comprehensive health care reform law enacted in March 2010.
References to ACA at HPS typically involve reporting requirements, specifically, that obligate employers to report medical coverage for employees and to provide documents for employee tax preparation. HPS partners with ACA service providers to assist clients in meeting these requirements.
Actively-at-work – This term refers to being at work as opposed to being on vacation, leave, or away from work for any other reason. Companywide or position-wide reporting dates (like summer breaks or winter breaks for teachers) do not apply here.
ADL (Activities of Daily Living) – This is a concept related to eligibility for Long Term Care (LTC) benefits. There are six ADLs: bathing, dressing, toileting, transferring, eating, and continence. Most LTC plans require that the covered individual be unable to perform a certain number of these tasks to be eligible for benefits.
Beneficiary – This is who will receive a benefit in the event of the insured’s death. A policy may have more than one beneficiary.
Benefit Duration – This is the maximum period of time in which a claimant can receive benefits.
Benefit Reduction – Some plans may include percentage reductions in benefit amounts when participants reach a certain age.
Cafeteria/Section 125 Plan – This plan provides participants an opportunity to pay for qualified benefits on a pretax basis. Premiums for most medical, dental, vision, FSA, HSA, accident, and cancer plans are deducted on a pretax basis, which reduces participants’ taxable income.
Certificate of Benefits (Certificate of Coverage) – The certificate serves as the primary official plan document for participants of group benefits, as they are not enrolled in an individual policy.
COBRA – COBRA allows participants who lose their health benefits the right to continue group health benefits for limited periods of time under certain circumstances including voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals will have to pay the full premium (including any employer contribution applied when employed) up to 102% of the cost to the plan. Coverage is typically available for 18 months but can be extended in certain situations.
Copay – Also known as a copayment, this is the fixed amount you pay for health care services received at the time of service. A copay typically goes toward your deductible.
Coinsurance – After you have met your deductible, this is your share of the cost of a covered health care service, which is calculated as a percent of the allowed amount for the service. For example, your coinsurance is 20% (while the insurer pays the remaining 80%).
Contingent Beneficiary – This is who will receive a benefit in the event of the beneficiary’s (aka the primary beneficiary) death. A policy may have more than one contingent beneficiary.
Contingent Plans – Contingent plans make benefits available to participants only when another specific benefit has been elected. Examples of contingent plans include voluntary life for dependents (contingent on the election of employee voluntary life) and a Health Saving Account (contingent on the election of a High Deductible Health Plan).
Continuation of Coverage – Many plans offered by HPS clients are continuable under COBRA or portability or conversion options. Standalone clients and cooperatives will have “continuation of coverage” documents that detail plan continuation availability.
Conversion – Conversion is a benefit continuation option that transforms group coverage into individual coverage, separate from the group policy. This typically comes with much higher premiums.
Covered Expenses – These are health care expenses covered under your health plan.
Deductible – This is the amount a participant must cover for health care services before the insurer will share costs and provide coinsurance.
Dental Reimbursement Types – Various types of dental plans (except DHMO plans) will pay out-of-network benefits differently.
MAC/MRC/NAP (Maximum Allowable Charge/ Maximum Reimbursable Charge/Network Access Plan): Participants will receive the same payouts (contracted fees) for services whether they go in or out of network; and they may be balance billed when going out of network.
UCR/R&C(Usual, Customary, and Reasonable/ Reasonable & Customary): When going out of network, the plan will pay an amount determined by the usual cost charged for the service by dentists in a certain geographical area.
Eligibility Waiting Period – This period is the amount of time new hires must wait before they are eligible for benefits. Most HPS clients will allow for new hires to be eligible the first of the month following (or coincident with) their date of hire.
Elimination Period – Also known as a waiting period, this is the number of calendar days that participants in a Disability plan must be disabled before they are eligible to receive benefits.
Employer Contribution – The amount of premium or financial contribution an employer provides to participants for insurance, spending accounts, or retirement.
EOB (Explanation of Benefits) – This statement from your insurance carrier explains which procedures and services were provided, how much they cost, what portion of the claim was paid by the plan, and what portion of the claim is your responsibility. It also includes information on how you can appeal the insurer’s decision. These statements are also posted on the carrier’s website for your review.
EOI (Evidence of Insurability)/Statement of Health (SOH) – Some plans require an application or a “proof of good health” type of statement to obtain coverage. This is commonly referred to as EOI (Evidence of Insurability). Such applications or statements must be submitted electronically or by mail to the carrier for approval.
Evergreen Clause – This clause, written into a client’s Cafeteria/Section 125 Plan, allows a client to roll over Flexible Spending Account elections into the new plan year.
FMLA (Family and Medical Leave Act) – This act ensures employees have job-protected and unpaid leave for qualified medical and family reasons.
FSA (Flexible Spending Account) – An option that allows participants to set aside pretax dollars to pay for qualified expenses (i.e., certain medical care or dependent care expenses) during a specific period (usually a 12-month period). Participants determine how much to contribute to their FSA at the beginning of the plan year. Most funds must be used by the end of the year, depending upon the type of FSA, as there is a limited carryover amount.
Grace Period – As it pertains to FSAs, this is the period immediately following the end of the plan year during which participants can incur new claims to use their remaining FSA funds.
Guaranteed Issue – Some plans may include Guaranteed Issue coverage to new enrollees without EOI.
HDHP (High Deductible Health Plan) – A qualified health plan that combines lower monthly premiums in exchange for higher deductibles and out-of-pocket limits. These plans are often coupled with an HSA.
HMO/DHMO (Health Maintenance Organization/ Dental Health Maintenance Organization) – Medical plans labeled as HMO plans have a specified network of providers, and benefits are generally not available outside of that network except in an emergency. DHMO plans follow this same model for dental coverage.
HPS (Higginbotham Public Sector) – HPS is the insurance broker that represents your account.
HRA (Health Reimbursement Arrangement) – This is an employer-owned savings account to which the company deposits pretax dollars for each of its covered employees. Employees can then use the funds in their HRA to reimburse themselves for incurred qualified health care expenses.
HSA (Health Savings Account) – This is an employeeowned savings account used to pay for eligible health care expenses with pretax dollars. Funds in the account do not have to be used within a specified time period. An HSA must be coupled with qualified HDHP.
In-network – Doctors (e.g., a primary care physician or specialist), hospitals, and other providers that contract with your insurance company provide health care services at discounted rates. These providers are on an outlined list of health care practitioners.
Inpatient – A person who is treated as a registered patient in a hospital or other health care facility.
Medically Necessary – Services or supplies provided by a hospital, health care facility, or physician that meet the following criteria: (1) are appropriate for the symptoms and diagnosis and/or treatment of the condition, illness, disease, or injury; (2) serve to provide diagnosis or direct care and/or treatment of the condition, illness, disease, or injury; (3) are in accordance with standards of good medical practice; (4) are not primarily serving as convenience; and (5) are considered the most appropriate care available.
Medicare – An insurance program administered by the federal government to provide health coverage to individuals age 65 or older, or who have certain disabilities or illnesses.
Member – You and those covered become members when you enroll in a health plan. This includes eligible employees, their dependents, COBRA beneficiaries, and surviving spouses.
Open Enrollment – Open Enrollment refers to the annual period during which employees may enroll in available benefits or make coverage changes without a Qualifying Life Event.
Out-of-network – Doctors, hospitals, and other providers that are not contracted with your insurance company. If you choose an out-of-network provider, you may be responsible for costs over the amount allowed by your insurance carrier.
Out-of-pocket Expense – Amount that you must pay toward the cost of health care services. This includes deductibles, copayments, and coinsurance.
Out-of-pocket Maximum – Also known as an out-ofpocket limit, this is the most you pay during a policy or benefit period (usually a 12-month period) before your health insurance or plan begins to pay 100% of the allowed amount for covered services.
PCP (Primary Care Physician) – A doctor who is selected to coordinate treatment under your health plan. This generally includes family practice physicians, general practitioners, internists, and pediatricians.
Plan Year – A 12-month period of benefits coverage under a group health plan, which may or may not coincide with a calendar year.
Plan Year Maximum – The maximum amount of benefit available to a participant for each plan year.
Portability – Portability is a continuation option available that allows participants to continue group coverage beyond their employment. Premiums typically remain in line with active participants, but coverage depends on the continuation of the group policy. If the group policy terminates, portability will no longer be available.
PPO (Preferred Provider Organization) – Health plans labeled as PPO refer to the network structure and plan availability. In-network PPO plan providers have agreed to offer services at a contracted rate, which means members generally pay less and get the highest level of benefits. Out-of-network services and providers are also available, but you may pay more for care and generally receive fewer benefits.
Preventive Care – The care you receive to help prevent illness or disease. It also includes counseling to prevent health problems.
Pre-existing Condition – A pre-existing condition is a medical event, treatment, or diagnosis that occurs prior to the effective date of insurance coverage.
Pre-existing Condition Limitation – Some plans may limit benefits due to pre-existing conditions for a set period of time.
Premium – A reference to the cost (usually monthly) of insurance/benefits paid by the employer or employee.
QLE (Qualifying Life Event) – These are events that allow changes to pretax benefits outside of Open Enrollment. Changes must typically be made within 30 or 31 days of the event. Examples of QLEs include marriage, birth, divorce, gain or loss of benefits coverage, and change in employment status affecting benefits.
Rate Guarantee – Plan pricing can be under a rate guarantee for a certain amount of time, typically two to four years. The premium rates cannot be changed during this time.
Renewal – When a plan’s rate guarantee expires, a rate renewal will be received from the carrier’s underwriter. This establishes new rates beyond the expiration of the rate guarantee. Clients can either accept the new rates, attempt to negotiate the renewal (usually assisted by HPS), or publish an RFP (Request for Proposal) to shop for a new carrier.
Rollover – As it pertains to a Health Care FSA or Limited Purpose Health Care FSA, a client can establish a limit of $680 (for 2026) of unused funds that can be rolled over to the next plan year, provided the participant re-enrolls in the FSA plan.
Run-out Period – Related to FSAs, this is a period immediately following the end of the plan year in which participants can submit claims incurred within the plan year. For new onboarding clients, this period can be managed by the current or new administrator. The current administrator may charge a fee. If the new administrator manages the run-out period, it will need a report of the FSA participants and their remaining FSA balances.
SSNRA (Social Security Normal Retirement Age) – This is the normal retirement age for an employee under the federal Social Security Act.
SSDI (Social Security Disability Insurance) – Disability benefits are available through Social Security as long as a participant is “insured” (has worked long enough and paid into Social Security) and has been defined as disabled by the federal government.
THEbenefitsHUB – This is the benefits enrollment system used by HPS.
Underwriting – This is the process of evaluating the risks of insuring an individual or group and establishing premium rates and coverage for the individual or group. Clients are subject to underwriting during RFPs and renewals, and their employees are subject to underwriting when submitting EOI statements for coverage.
Usual, Customary and Reasonable (UCR) Allowance
– This is the fee paid for covered services that is: (1) a similar amount to the fee charged by a health care provider to the majority of patients for the same procedure; (2) the customary fee paid to providers with similar training and expertise in a similar geographic area: and (3) reasonable in light of any unusual clinical circumstances.
Waiver of Premium (WOP) – This is a feature in some insurance plans that allows premiums to be suspended for a participant for a period of disability
This brochure highlights the main features of the Andrews ISD employee benefits program. It does not include all plan rules, details, limitations, and exclusions. The terms of your benefit plans are governed by legal documents, including insurance contracts. Should there be an inconsistency between this brochure and the legal plan documents, the plan documents are the final authority. Andrews ISD reserves the right to change or discontinue its employee benefits plans anytime.