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/ruskisd
HPS Benefits Call Center
Higginbotham Public Sector
833-872-4753
ruskisd@hps.higginbotham.net
Medical
TRS Active Care
866-355-5999
www.bcbstx.com/trsactivecare
TRS Pharmacy Manager
Express Scripts
844-367-6108
https://www.express-scripts.com/ trsactivecare
Prescription Savings
Clever RX
Bin: 020529 Group: 1085
Member ID: 1665
800-873-1195
https://cleverrx.com/ruskisd
Telehealth
Recuro
855-6RECURO
customerservice@recurohealth.com
Dental
Cigna
Group #3338017
800-244-6224
www.mycigna.com
Vision
Superior Group #321860
800-507-3800 www.superiorvision.com
Health Savings Account
EECU
817-882-0800 www.eecu.org
Flexible Spending Accounts
NBS
800-274-0503
service@nbsbenefits.com
Basic and Voluntary Life and AD&D
Chubb Group #1000000225
888-499-0425
Educator Disability
Chubb Group #1000000225
888-499-0425
CWBSpecialMarket Service@chubb.com
Employee Assistance Program
Guidance Resources
Web ID: CHUBB
844-266-0712
www.guidanceresources.com
Accident
Chubb Group #1000000225
888-499-0425
CWBSpecialMarketService@chubb.com
Cancer
Chubb Group #1000000225
888-499-0425
CWBSpecialMarket Service@chubb.com
Critical Illness
Chubb Group #1000000225
888-499-0425
CWBSpecialMarket Service@chubb.com
Hospital Cash
Chubb Group #1000000225 888-499-0425
CWBSpecialMarket Service@chubb.com
Identity Theft Protection
ID Watchdog
866-513-1518
Retirement Plan
TCG Group Holdings, LLP
800-943-9179
www.ramsretirement.com
Pet Insurance
Healthy Paws
855-898-8991
www.healthypawspetinsurance.com
Who is Eligible
When to Enroll
When Coverage Starts
• A regular, full-time employee working an average of 20 hours or more per week
• By the deadline given by Human Resources
• First of the month following date of hire
• A regular, full-time employee working an average of 20 hours or more per week
• During OE or for a QLE
• OE: Start of the plan year
• QLE: Ask Human Resources
• Your legal spouse
OE: Open Enrollment
QLE: Qualifying Life Event
• 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 Human Resources
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 Human Resources 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/ruskisd or scan the QR code.
2. Click Login
3. Enter your:
z Last name
z Date of birth
z 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).
z Select your beneficiary designation.
z Click Sign & Continue
z Review and confirm your information.
z Click Finished
Employee benefits can be complicated. The Higginbotham Public Sector benefits team is available to help you with the following:
z Enrollment
z Benefits
z Eligibility
z Claims and Billing
Call or text 833-872-4753 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 ruskisd@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 Human Resources office within 30 days of the event. Meeting with Human Resources 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 Human Resources 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/ruskisd. Click on each benefit (e.g., medical, vision, etc.) for details.
z Call the Higginbotham Public Sector benefits team at 833-872-4753 or email ruskisd@hps.higginbotham.net .
How can I find in-network providers?
Go to www.mybenefitshub.com/ ruskisd 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.
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.
Watch and learn more!
Eligible employees receive Basic Life and AD&D at no cost. You are automatically covered at $10,000 for each benefit.
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).
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%).
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:
z TRS-ActiveCare Primary
z TRS-ActiveCare Primary+
z TRS-ActiveCare HD
The TRS-ActiveCare 2 plan is closed to new enrollments, but you may continue in the plan if you are a currently enrolled participant.
TRS is committed to accessibility. If you have trouble accessing this content, contact TRS at WebAccessibility@trs.texas.gov to request an alternative format.
• PREMIUM: The monthly amount you pay for health care coverage.
• DEDUCTIBLE: The annual amount for medical expenses you’re responsible to pay before your plan begins to pay.
• COPAY: The set amount you pay for a covered service at the time you receive it. The amount can vary based on the service.
• COINSURANCE: The portion you’re required to pay for services after you meet your deductible. It’s often a specified percentage of the costs; e.g., you pay 20% while the health care plan pays 80%.
• TIERING: Grouping doctors and facilities into tiers based on quality, cost and best practice clinical guidelines. This helps you compare choices. Tier 1 providers and facilities offer top performance and best value. You pay less when you choose Tier 1 and may pay more when you choose Tier 2.
• OUT-OF-POCKET MAXIMUM: The maximum amount you pay each year for medical costs. After reaching the out-of-pocket maximum, the plan pays 100% of allowable charges for covered services.
Ask your
Administrator for your
• $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.
See 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
As part of your TRS medical plan coverage, you also have pharmacy benefits coverage through Express Scripts, our pharmacy benefits manager (PBM). This pharmacy benefits coverage is available ONLY to those enrolled in one of the TRS-ActiveCare medical plans.
Express Scripts helps you understand your pharmacy benefits and makes it convenient and affordable for you and your family to access the medications you need. New enrollees will be issued ID cards effective for the upcoming plan year. If you do not receive a card, or if yours is misplaced, you may download a temporary ID card. You can also contact the Express Scripts TRSActiveCare Customer Support team for assistance.
Once your plan year deductible is met, you will pay the applicable copay or coinsurance for each prescription until your out-of-pocket maximum is reached. The Express Scripts website allows you to download a temporary ID card, check medication costs, and explore options for home delivery, specialty medications, and retail pharmacies.
Please note that when utilizing prescription drug resources outside of Express Scripts, your prescription costs may not be applied toward your pharmacy coverage deductible or copays.
CONTACT EXPRESS SCRIPTS
z Visit https://www.express-scripts.com/ trsactivecare
z Call 844-367-6108.
Visit https://partner.cleverrx.com/ruskisd
Call the Clever RX Help Line at 800-873-1195.
Aside from the pharmacy benefits coverage included with your TRS medical plan, 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.
z Group ID – 1085
z Member ID – 1665
3.
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.
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:
z Enrolled in an HSA-eligible HDHP
z Not covered by another plan that is not a qualified HDHP (e.g., spouse’s health plan)
z Not enrolled in a Health Care Flexible Spending Account
z Not eligible to be claimed as a dependent on someone else’s tax return
z Not enrolled in Medicare, Medicaid, or TRICARE
z 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.
z Use your HSA debit card to pay for qualified expenses.
z Pay out-of-pocket and submit your receipts for reimbursement online or through the app.
You may contribute up to the IRS annual maximum.
z Visit www.eecu.org
z Call 817-882-0800
z Download the EECU app
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/ruskisd for full plan details.
1 United States only
2 United States and Canada
3 United Sates, Canada, Mexico, the Caribbean (excluding Cuba), the Bahamas, and Bermuda
4 Worldwide coverage to include any region with the exclusion of Antarctica and not prohibited by U.S. law or U.S. travel advisories
Disclaimer: This material is for informational purposes only and does not provide any coverage. The benefits listed, and the descriptions thereof, do not guarantee
and do not represent the full terms and conditions applicable for usage and may only be offered in some memberships or policies. Premiums, benefits, and coverage vary depending on the plan selected. For a complete list of benefits, premiums, terms, conditions, and restrictions, please refer to the applicable member services agreement or policy for your state. For additional information and disclosures about MASA plans, visit: https://info.masaglobal.com/disclaimers
The Hospital Cash 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.
Hospitalization Benefit
This benefit is payable for the first covered hospital confinement per certificate.
This benefit is for admission to a hospital or hospital subacute intensive care unit.
Admission ICU Benefit
This benefit is for admission to a hospital intensive care unit.
Confinement Benefit
This benefit is for confinement in hospital or hospital subacute intensive care unit.
Hospital Confinement ICU Benefit
This benefit is for confinement in a hospital intensive care unit.
Newborn Nursery Benefit
This benefit is payable for an insured newborn baby receiving newborn nursery care and who is not confined for treatment of a physical illness, infirmity, disease, or injury.
Observation Unit Benefit
This benefit is for treatment in a hospital observation unit for a period of less than 20 hours.
• $500 per Day
• Maximum Days per ConfinementNormal Delivery: 2
• Maximum Days per ConfinementCaesarean Section: 2
$500 per Day
Maximum Days per ConfinementNormal Delivery: 2
Maximum Days per ConfinementCaesarean Section: 2
waives
when the employee or spouse is confined for more than 30 continuous days.
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.
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:
z Have a non-emergency issue and are considering an after-hours health care clinic, urgent care clinic, or emergency room for treatment
z Are on a business trip, vacation, or away from home
z Are unable to see your primary care physician, counselor, or psychiatrist
For minor conditions such as:
z Sore throat
z Headache
z Stomachache
z Cold/flu
Allergies
Fever
Urinary tract infections
Behavioral health
The Employee Assistance Program (EAP) helps you and family members cope with a variety of personal and work-related issues.
EAP Provider:
This program provides confidential counseling and support services at little or no cost to you to help with:
z Relationships
z Work-life balance
z Stress and anxiety
z Will preparation and estate resolution
z Grief and loss
z Childcare and eldercare issues
z Substance abuse
z Financial and legal matters
z And more
The EAP also offers up to six face-to-face counseling sessions per person, per issue, per calendar year.
Two levels of benefits are available with the DPPO plan: 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-of-network provider.
Oral Evaluations
Prophylaxis: Routine Cleanings; X-rays: Routine X-rays: Non-routine Fluoride Application Sealants: per Tooth
Restorative: Fillings
Periodontics: Minor
Oral Surgery: Minor Space Maintainers: Non-orthodonic Emergency Care to Relieve Pain (In-network Coinsurance Applies)
Inlays and Onlays
Prosthesis Over Implant
Crowns: Prefabricated Stainless Steel/Resin Crowns: Permanent Cast and Porcelain
Bridges and Dentures
Anesthesia: General and IV Sedation
Endodontics: Minor and Major Denture Relines, Rebases, and Adjustments
Repairs: Dentures
Periodontics: Major
Oral Surgery: Major
Non-network Reimbursement: For services provided by an out-of-network dentist, Cigna Dental reimburses based on the Maximum Reimbursable Charge (MRC), which is set at the 90th percentile of provider charges in the same geographic area. If dentists’ fees exceed the MRC, they may balance bill the patient for the difference.
*Visit https://my.cigna.com/web/public/guest to find a contracting dentist near you. This plan lets you choose any dentist you wish. However, your out-of-pocket costs are likely to be lower when you choose a contracting dentist.
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.
You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see in-network providers.
(The eye exam copay is a single payment made to the provider at the time of service.)
Lenses (Standard) per Pair
• Single Vision Covered in Full Up to $25 Retail
• Bifocal Covered in Full Up to $40 Retail
• Progressive The plan covers standard lined trifocals. If you choose progressives, you pay the difference plus your copay. Up to $45 Retail
• Trifocal Covered in Full Up to $45 Retail Contact Lenses Instead of Glasses $175 Retail Allowance Up to $80 Retail
Medically Necessary Contact Lenses Covered in full Up to $150 Retail
LASIK Vision Correction in Lieu of Eyewear Benefit (subject to routine regulatory filings and certain exclusions and limitations)
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
$200 to $7,500 available in $100 increments to a maximum of 66 2/3% of the employee's monthly earnings
of gross disability payment
You can elect one of the following elimination periods under this plan: 0/7*; 14/14*; 30/30*; 60/60; 90/90; or 180/180
Pre-existing Condition Exclusion 3/12**
*If your elimination period is 30 days or less and you are confined to a hospital for 24 hours or more due to a disability, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.
** If a condition was treated during the 3 months prior to your effective date and disability begins within the first 12 months of coverage, benefits will be limited to 4 weeks.
Under the 60-, 90-, and 180-day elimination periods, you must satisfy the full elimination period before disability benefits become payable. This means you must be continuously disabled for 60, 90, or 180 days, respectively, before coverage begins. No disability benefits are payable during the elimination period.
The elimination period functions like a deductible in time rather than dollars; you must complete the waiting period before the benefits are paid.
Watch and learn more!
z Visit www.chubb.com/ workplacebenefitsclaims
z Call 888-499-0425 z Email CWBSpecialMarketService@ chubb.com
z Group #1000000225
Are there pre-existing condition limitations?
Yes. All plans include pre-existing 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.
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.
Watch and learn more!
Diagnosis of cancer
Hospital confinement
Hospital confinement ICU
Radiation therapy, chemotherapy, immunotherapy
Attending physician
Private full-time nursing services
Prescription drug in-patient
Home health care
Blood, Plasma, and Platelets
Heart Attack or Stroke
$100 paid upon receipt of first covered claim for cancer; only one payment per certificate
$2,500 employee or spouse
$3,750 child(ren)
Waiting period: 0 days
Benefit reduction: none
$100 per day – days 1 through 30
Additional days: $200
Maximum days per confinement: 31
$600 per day – days 1 through 30
Additional days: $600
Maximum days per confinement: 31
Maximum per covered person per 12-month period: $10,000
$30 per visit
Maximum visits per confinement: 2
Maximum visits per calendar year: 4
$150 per day
Maximum days per confinement: 5
Per confinement: $150
Maximum confinements per calendar year: 6
$100 per day not to exceed the number of days confined
Maximum days per calendar year: 30
$300 per transfusion
Maximum transfusions per calendar year: 2
$2,500 employee or spouse
$3,750 child(ren)
Recurrence benefit: $1,205
Employee or spouse: $1,875 child(ren)
Waiting period: 0 days
Benefit reduction: none
$100 paid upon receipt of first covered claim for cancer; only one payment per certificate
$5,000 employee or spouse
$7,500 child(ren)
Waiting period: 0 days
Benefit reduction: none
$200 per day – days 1 through 30
Additional days: $400
Maximum days per confinement: 31
$600 per day – days 1 through 30
Additional days: $600 Maximum days per confinement: 31
Maximum per covered person per 12-month period: $20,000
$30 per visit
Maximum visits per confinement: 2 Maximum visits per calendar year: 4
$150 per day
Maximum days per confinement: 5
Per confinement: $150
Maximum confinements per calendar year: 6
$100 per day not to exceed the number of days confined
Maximum days per calendar year: 30
$300 per transfusion
Maximum transfusions per calendar year: 2
$2,500 employee or spouse
$3,750 child(ren)
Recurrence benefit: $1,250
Employee or spouse: $1,875 child(ren)
Waiting period: 0 days
Benefit reduction: none
Surgery Up to $4,125 Up to $4,125
Outpatient Surgery Facility Service
Portability
Continuity
$200 per day
Maximum benefits per calendar year: 4
$200 per day Maximum benefits per calendar year: 4
Pre-existing Limitation A pre-existing condition is any medical condition for which you received treatment, care, or medical advice during the 12 months before your coverage became effective or was changed.
Accident insurance provides affordable protection against a sudden, unforeseen accident.
This plan 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. Do you have kids playing sports? Are you a weekend warrior? Are you accident prone? With this accident plan, 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.
and learn more!
•
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.
Occupational Package
Pays 100% of the face amount; benefits payable for HIV or Hepatitis B, C, or D, MRSA, Rabies, Tetanus, or Tuberculosis contracted on the job.
CHILDHOOD CONDITIONS
Autism Spectrum Disorder; Cerebral Palsy; Congenital Birth Defects; Heart, Lung, Cleft Lip, Palate, etc; Cystic Fibrosis; Down Syndrome; Gaucher Disease; Muscular Dystrophy; and Type 1 Diabetes).
RECURRENCE BENEFIT
Benefits are payable for a subsequent diagnosis of Aneurysm – Cerebral or Aortic, Benign Brain Tumor, Cancer, Coma, Coronary Artery Obstruction, Heart Attack, Major Organ Failure, Severe Burns, Stroke, or Sudden Cardiac Arrest
Waives premium while the insured is totally disabled.
Pre-existing Limitation: No benefits are paid for diagnoses made before coverage begins. For cancer claims, the insured must have been treatment-free and in complete remission for 12 months before the diagnosis date.
ADDITIONAL PLAN BENEFIT
Wellness Benefit – payable once per insured per year. $50
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.
Voluntary 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). Term 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%).
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).
Set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses. We offer the following Flexible Spending Accounts (FSAs).
FSA Administrator:
The Health Care FSA covers qualified medical, dental, and vision expenses for you and your eligible dependents. Eligible expenses include:
z Deductibles, copays, and coinsurance
z Prescription drugs
z Braces, glasses, and contacts
z 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.
z 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.
z 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.
z Only day camps – not overnight camps – can be considered for reimbursement.
z 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.
z The dependent care provider cannot be your child under age 19 or anyone claimed as a dependent on your income taxes.
z Dependent Care FSA claims may be submitted as incurred and will be paid as funds become available after monthly payroll contributions are deposited.
z Visit www.nbsbenefits.com
z Call 855-399-3035
z Fax 844-438-1496
z Email service@nbsbenefits.com
z Download the Carrier app
z Participant Portal: www.mynbsbenefits.com
z Mail: National Benefit Services, LLC P.O. Box 219393 Kansas City, MO 64121-9393
Knowing the difference between a Health Savings Account (HSA) and Flexible Spending Account (FSA) can help you choose the best option for you and your family.
Description
Contribution Source
Account Owner
Underlying Insurance Requirement
• Acts as a personal savings account.
• 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
(You)
Deductible Health Plan
Maximum Annual Contribution 2026
• Pay for qualified out-of-pocket medical, dental, and vision expenses.
Health Care FSA – Use funds to pay qualified medical, dental, and vision expenses.
Dependent Care FSA – Use funds to pay qualified dependent care expenses and services.
Employee (You) and/or your employer
Permissible Use of Funds
Year-to-year rollover of account balance?
• If used on nonqualified expenses prior to age 65, subject to income tax plus a 20% penalty.
Yes. Funds roll over and can be used anytime or saved for future use.
Does the account earn interest? Yes
Portable?
Yes. It is always yours to keep, even if you change jobs or medical plans.
2026
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. Dependent Care FSA – N/A
No
* 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
A 403(b ) plan can be a powerful tool to help you reach your investment goals and be financially secure in retirement.
Retirement Plan Provider:
You are eligible to participate in the plan if you are a fulltime employee, age 18 or older. You may contribute up to the IRS annual limits.
You decide how much you want to contribute, and you can change your contribution amount anytime. All changes are effective as soon as administratively feasible and remain in effect until you update or stop your contributions. You also decide how to invest the assets in your account.
Pets are family, and unexpected vet bills can happen anytime. Pet insurance through Healthy Paws helps protect your budget while ensuring your pets receive the care they need and deserve.
With Healthy Paws, you can be reimbursed for a wide variety of eligible veterinary treatments.
z Accidents
z Illnesses
z Cancer
z Hereditary and congenital conditions
z Hip dysplasia
z Alternative care
z Diagnostic treatment
z X-rays, blood tests, and ultrasounds
z Prescription medications
Healthy Paws plans have no per-incident, annual, or lifetime payout caps. If your pet needs treatment for a new accident or illness that isn’t pre-existing or is otherwise excluded, eligible bills from any licensed veterinarian can be covered.
Each pet’s quote is customized based on pet type, breed, age, ZIP code, reimbursement, and deductible selections.
z Customizable reimbursement levels: 80%, 70%, 60%, 50%*
z Customizable annual deductibles: $250, $500, $750, $1,000*
*Choice will vary depending on pet’s age and/or breed.
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:
z Access to 100+ lab tests at the start of your membership.
z Access to an additional 60+ midyear follow-up tests to track your progress.
z Detailed clinician notes highlighting areas of focus.
z A targeted action plan to help improve your health.
z 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:
z Heart
z Immunity
z Metabolics
z Hormones
z Nutrients
z Blood
z Heavy Metals
z Liver
z Kidneys
z Pancreas
z Prostate
The cost for an individual annual membership* is $335!
z Sexual Health
z Electrolytes
z Thyroid
z Autoimmunity
z 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.
How to Enroll
Enroll anytime during the year. You will pay the membership fee(s) directly to Function.
Visit https://www.functionhealth.com/aep/higginbotham .
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.
z 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.
z 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 Rusk 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. Rusk ISD reserves the right to change or discontinue its employee benefits plans anytime.
