Group ID 1085, Member ID 1668 800-873-1195 https://cleverrx.com/texarkanaisd
Health Savings Account EECU
817-882-0800 www.eecu.org
Flexible Spending Account(s)
National Benefit Services
855-399-3035 www.nbsbenefits.com
Dental
Lincoln Financial Group Group #00001D041925
800-423-2765
www.lfg.com
Vision
Superior Vision Group #28882 833-393-5433 www.superiorvision.com
Life and AD&D
Lincoln Financial Group Group #10270609 800-423-2765 www.lfg.com
Short Term Disability
Lincoln Financial Group Group #10253169 800-423-2766 www.lfg.com
Long Term Disability
Lincoln Financial Group Group #10253172 800-423-2766 www.lfg.com
Hospital Cash
Lincoln Financial Group Group #HI-0001025064 800-423-2766
www.lfg.com
Cancer
American Public Life Group #13311 800-256-8606 www.ampublic.com
Critical Illness
Lincoln Financial Group Group #CI-0001025063 800-423-2766
www.lfg.com
Accident
Lincoln Financial Group Group #ACC-0001657065 800-423-2766 www.lfg.com
Telehealth with Behavioral Health
Recuro 855-673-2876 www.recurohealth.com
Eligibility
Who is Eligible for Benefits
• A regular, full-time employee working an average of 20 hours or more per week
Who is Eligible
When to Enroll
When Coverage Starts
• By the deadline given by the Benefits Office
• First of the month or coinciding with date of hire
• A regular, full-time employee working an average of 20 hours or more per week
• During Open Enrollment or upon a Qualifying Life Event
• OE: Start of the plan year
• QLE: Ask the Benefits Office
• Your legal spouse
Dependent(s)
• 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
Eligible employees must be actively at work on the plan effective date for new benefits to be effective.
Maximum Dependent Eligibility Age by Plan
Qualifying Life Events
OE: Open Enrollment
QLE: Qualifying Life Event
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:
Marriage
Divorce
Annulment
Death of spouse Birth Adoption/ placement for adoption
Change in benefits eligibility
Death of child
FMLA, COBRA event, judgment, or decree
Becoming eligible for Medicare, Medicaid, or TRICARE
Receiving a Qualified Medical Child Support Order
Gain or loss of benefits coverage
Change in employment status affecting benefits
You have 31 days from the event to notify the Benefits Office and complete your changes. You may need to provide documents to verify the change.
How to Enroll
Enrolling in benefits is simple through THE benefitsHUB.
1. Go to www.mybenefitshub.com/texarkanaisd 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.
SCAN THE QR CODE TO ENROLL
Benefits Questions?
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 833-442-3211 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 texarkanaisd@hps.higginbotham.net . Bilingual representatives are available.
Section 125 Cafeteria Plan Guidelines
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. 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 31 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.
Enrollment F.A.Q.
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 OE, if you have a QLE, 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/texarkanaisd. Click on each benefit (e.g., medical, vision, etc.) for details.
How can I find in-network providers?
Go to www.mybenefitshub.com/texarkanaisd 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.
Benefits Questions?
Call the Higginbotham Public Sector benefits team at 833-442-3211.
Important Limitations and Exclusions Information
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.
Health Care Options
Becoming familiar with your options for medical care can save you time and money.
Health Care Provider
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
When you need immediate attention; walk-in basis is usually accepted
URGENT CARE
HOSPITAL ER
FREESTANDING ER
Generally includes evening, weekend and holiday hours
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
24 hours a day, 7 days a week
• Allergies
• Cough/cold/flu
• Rash
• Stomachache
• Infections
• Sore and strep throat
• Vaccinations
• Minor injuries/sprains/ strains
• Common infections
• Minor injuries
• Pregnancy tests
• Vaccinations
• Sprains and strains
• Minor broken bones
• Small cuts that may require stitches
• Minor burns and infections
15 minutes
• Chest pain
• Difficulty breathing
• Severe bleeding
• Blurred or sudden loss of vision
• Major broken bones
• Most major injuries except trauma
• Severe pain
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.
2026-27 TRS-ActiveCare Plan
How to Calculate Your Monthly Premium
Ask your
Administrator for your
Being Healthy is Easy
• $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
Compare Prices for Common Medical Services
Pharmacy
Express Scripts TRS Pharmacy Benefits Manager
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 TRS-ActiveCare 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.
Prescription Drug Discounts
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.
Lower Your Prescription Costs With Clever RX
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.
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. Questions
3.
• Member ID – 1668
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.
Visit
Preventive Care
Your medical plan offers $0 preventive care for everyone. Preventive care is the care you receive to help prevent chronic illness or disease. It includes exams, lab work, screenings, immunizations, and counseling to prevent health problems, such as diabetes or heart disease.
Preventive Care Coverage May Include
Adults
Cholesterol screening
Blood pressure screening
Colorectal cancer screening
Lung cancer screening
Hepatitis B screening
Well visits
Bone density screening
Obesity screening
Diabetes type 2 screening
Depression screening
Mammograms
Cervical cancer screening
Immunizations
Teens
Physical exam
Blood tests for iron and cholesterol
Anxiety screening
Growth screening
Hearing screening
Hepatitis B screening
Depression screening
Alcohol, tobacco, and drug use assessments
Tuberculosis screening
Immunizations
Children
Autism screening
Blood screening
Depression screening
Developmental screening
Hearing screening
Obesity screening and counseling
Hypothyroidism screening
Behavioral assessments
Well visits
Immunizations
Frequently Asked Questions
Why should I get preventive care?
Preventive care is the fastest and best way to uncover potential risks and avoid chronic health conditions.
Are all screenings, tests, and procedures covered under preventive care?
Having a doctor who knows you and your medical history is a key part of preventive care.
No. Your doctor will be able to advise you as to the preventive care you need or should obtain, based on your medical and family history.
Why did I get a bill for preventive care?
Diagnosis codes on the doctor’s bill must meet certain insurance company conditions for them to be processed as preventive and covered at 100%. If you have a medical complaint, or your doctor finds a specific medical issue during your preventive care doctor’s visit, a diagnosis code for that issue or complaint will be on your bill. As a result, the insurance company may process the bill for a specific medical condition, not preventive care. In this case, you must pay the copay or portion of your deductible.
Watch and learn more!
Health Savings Account
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.
Two Ways to Use Your HSA Funds
Use it Now
Pay for qualified out-of-pocket medical, dental, and vision expenses as they are incurred.
Over Time
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.
How to Pay or Get Reimbursed
• 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.
Contributions
You may contribute up to the IRS annual maximum.
Maximum HSA Contributions
If you are age 55 or older, you can contribute an extra $1,000.
817-882-0800
Flexible AccountsSpending
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).
Health Care FSA
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.
How to Access Funds/Pay or Get Reimbursed
Use your FSA debit card (excludes the Dependent Care FSA).
OR
Pay out-of-pocket, and submit your receipts for reimbursement.
Flexible AccountsSpending
Dependent Care FSA
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.
Dependent Care FSA Guidelines
• 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.
HSA and FSA Comparison
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.
• 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.
Permissible Use of Funds
• Pay for qualified out-of-pocket medical, dental, and vision expenses.
Care FSA – Use funds to pay qualified medical, dental, and vision expenses.
Care FSA – Use funds to pay qualified dependent care expenses and services.
(You) and/or your
• $7,500 (Single parent filing head of household; or married filing jointly)
• $3,750 (Married filing separately)
• If used on nonqualified expenses prior to age 65, subject to income tax plus a 20% penalty. See details in the Description section above.
Year-to-year rollover of account balance? Yes. Funds roll over and can be used anytime or saved for future use. N/A
Does the account earn interest? Yes No
Portable?
Yes. It is always yours to keep, even if you change jobs or medical plans. 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.
Qualified HSA and FSA Expenses
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
* Excludes Dependent Care FSA.
Dermatologist
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
Dental Coverage
NETWORK: Lincoln Financial
Our dental plans help you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work.
DPPO Plans
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-of-network provider.
Dental Benefits Summary
Vision Coverage
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, which include Visionworks, Walmart Vision Center, America’s Best, Sam’s Club Optical, glasses.com, contactsdirect, and more.
• 20% off lens upgrades
• 30% off additional pairs of glasses
• LASIK discount through QualSight (lasik.sv.qualsight.com)
• 40% off brand name hearing aids through Your Hearing Network
Life and InsuranceAD&D
EMPLOYER-PAID
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 75.
Employee Basic Life and AD&D
Eligible employees receive Basic Life and AD&D at no cost. You are automatically covered at one times your annual salary for each benefit.
Designating a Beneficiary
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%).
Life and InsuranceAD&D
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 75.
Designating a Beneficiary
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%).
Accelerated Death Benefit
A lump-sum benefit is available to you if you’re diagnosed with a terminal condition as defined by the plan.
Voluntary Life and AD&D
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).
Disability Insurance
Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. We offer Short Term Disability (STD) for you to purchase.
Voluntary Short Term Disability
STD insurance pays a percentage of your weekly salary if you are temporarily disabled and unable to work due to an illness, pregnancy, or non-work-related injury. STD benefits are not payable if the disability is due to a job-related injury or illness. If a medical condition is job-related, it is considered workers’ compensation, not STD.
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.
In-person help for short-term issues (up to five sessions -- one with a counselor per person, per issue, per year)
In-person consultations with network lawyers, including one free 30-minute in-person consultation per legal issue, and 25% off subsequent meetings
Information and referrals on family matters, such as child and elder care, pet care, vacation planning, moving, car buying, college planning, and more
Disability Insurance
Employer-Paid Long Term Disability
LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for a specific period of time. Benefits begin at the end of an elimination period and continue while you are disabled up to the maximum benefit period.
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.
Texarkana ISD provides this coverage at no cost to you!
Hospital InsuranceIndemnity
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.
Hospital Indemnity Benefits Summary
Cancer Insurance
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.
Cancer Insurance Benefits Summary
Critical Illness Insurance
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 the diagnosis of any covered critical illness or cancer. The benefit can help cover expenses such as lost income, out-oftown treatments, special diets, daily living, and household upkeep costs. This coverage is portable. See the plan document for full details.
Critical Illness Insurance Benefits Summary
and Spouse Rates per $1,000
Critical Illness Insurance
Critical Illness Insurance Benefits Summary
Accident Insurance
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 documents for full details.
Accident Insurance Benefits Summary
Telehealth with Behavioral Health
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:
• Have a non-emergency issue and are considering an afterhours 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
When to Use Telehealth
For common conditions such as:
• Sore throat
• Headache
• Stomachache
• Cold/flu
• Allergies
• Fever
• Urinary tract infections
• Behavioral health
Do not use telehealth for serious or life-threatening emergencies.
Get More Information and Register
Employee Assistance Program
Powered by EmployeeConnect, the Employee Assistance Program (EAP) helps you and family members cope with a variety of personal and work-related issues.
The EAP also offers up to five face-to-face counseling sessions per person, per issue, per calendar year.
This program provides confidential counseling and support services at little or no cost to you to help with:
If you enroll in Voluntary Life insurance, Lincoln TravelConnect services give you timely help and support when you travel. These benefits are available 24/7 and apply if you are 100 or more miles from home.
Emergency Support
• Arrange travel if you are injured and need to be taken for help.
• Plan and pay for evacuations due to natural disasters or threats.
• Board or return pets.
• Transport mortal remains.
• And more.
Travel Support
• Recover lost or stolen items.
• Get translation/interpreter services.
• Replace medical devices or eyewear.
• Deliver medications.
• And more.
Note: On Call International must manage all the planning. Add this contact information to your phone or computer so you have easy access to support when you need it:
• Phone: Within the USA or Canada, call 866-525-1955; from all other locations, call (collect) +1-603-328-1955
• Email: mail@oncallinternational.com. For a complete list of services, go to myoncallportal.com and enter Group ID LFGTravel123.
Support for Life, Estate, and Beneficiaries
LifeKeys from Lincoln Financial offers the following programs and services at no additional cost to you.
For You
• Discounts: Save up to 60% on a variety of products, services, and entertainment via the GuidanceNow app.
• GuidanceResources Online: Access articles, videos, and expert advice on topics like law, money, relationships, health, career, and more.
• Identity Theft Protection: Prevent and address identity theft with resources on spotting fraud, securing personal information, and repairing credit.
• Online will preparation: Create wills online with step-by-step guidance through EstateGuidance. Includes burial instructions, choosing an executor, and choosing a guardian for children.
Contact LifeKeys
Visit www.guideanceresources.com (first time users enter web ID: LifeKeys). Call 855-891-3684. Download the GuidanceNow app.
For Your Beneficiaries
• Grief Counseling and Support: Get up to six in-person sessions and unlimited phone counseling for grief, stress, memorial planning, and more.
• Financial Services: Work with certified specialists on estate planning, budgeting, debt, investments, and more.
• Legal Support: Get a free 30-minute consultation and 25% off rates thereafter for legal issues like estate law, real estate, and survivor benefits.
• Day-to-day Support: Call for a quick answer or comprehensive information about memorial services, childcare, relocation, and major purchases.
Glossary of Terms
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. Company-wide 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 (a.k.a. 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).
Glossary of Terms
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.
Glossary of Terms
HPS (Higginbotham Public Sector) – HPS is the insurance broker that represents your account.
HSA (Health Savings Account) – This is an employee -owned 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-of-pocket 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. Innetwork 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.
Glossary of Terms
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 Texarkana 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. Texarkana ISD reserves the right to change or discontinue its employee benefits plans anytime.
