Helpful Resources
www.eecu.org
888-416-4313 www.legaleaseplan.com
888-499-0425 www.chubb.com
866-355-5999 www.bcbstx.com/trsactivecare
Welcome
We are pleased to offer a full benefits package to you and your eligible dependents. Read this guide to know what benefits are available to you. You may only enroll for or make changes to your benefits during Open Enrollment or when you have a Qualifying Life Event.
Availability of Summary Health Information
Your employee benefits program offers medical plan coverage options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage (SBC) available by accessing www.mybenefitshub.com/ galvestonisd
Your New Benefits Begin and End September 1, 2026 – August 31, 2027
If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, federal law gives you more choices for your prescription drug coverage. Please see page 38 for more details.
How to Enroll
Enrolling in benefits is simple through THEbenefitsHUB.
1. Go to www.mybenefitshub.com/galvestonisd 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 833-955-8423 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 galvestonisd@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. Enrollment is automatic unless you decline this benefit. Elections made during annual enrollment become effective on the plan effective date and will remain in effect during the entire plan year.
Changes in benefit elections can occur only if you experience a QLE. You must present proof of the QLE to your Benefits Office within 30 days of the event. Meeting with the Benefits Office to complete and sign the necessary paperwork is also required to make benefit election changes effective. Changes must be consistent with the QLE.
How to Enroll
Enrollment FAQs
What if I miss the enrollment deadline?
You may only enroll for or change your benefits during Open Enrollment or if you have a Qualifying Life Event.
Is there an age limit for dependents to be covered under my benefits?
You may cover dependents up to age 26 on most benefit plans, but there are exceptions. See the Eligibility section for more details.
Where do I find benefit summaries and forms?
Access www.mybenefitshub.com/galvestonisd and click on the benefit plan you need (e.g., Dental). Forms and benefits information are under the Benefits and Forms section.
How do I find an in-network provider?
Access www.mybenefitshub.com/galvestonisd and click on the benefit plan for the provider you need to find. Click on the Quick Links section to find provider search links.
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 a card for dental and vision plans. Simply give your provider the insurance company’s name and phone number to verify benefits. You can also print a temporary card by visiting the insurance company’s website.
Benefit questions?
Ask your Benefits Department.
Call Higginbotham Public Sector at 833-955-8423.
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 my family – a spouse or a dependent – as dependents on my benefits if we work for the same employer?
Some benefits may not allow you to do this if you work for the same employer. Review the applicable plan documents, contact Higginbotham Public Sector, or contact the insurance carrier for spouse and dependent eligibility.
Are there FSA/HSA limitations for married couples?
Yes, generally. Married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA-eligible – even if you would not use your spouse’s FSA to reimburse your expenses. However, there are some exceptions to the general limitation for specific types of FSAs. Contact the FSA and/or HSA provider before you enroll or reach out to 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 Flexible Spending Accounts and a Health Savings Account 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 an FSA and HSA.
Eligibility
Who is Eligible for Benefits
You are eligible for coverage if you are a regular, full-time employee. You may only enroll for coverage when:
• You are a new hire
• It is Open Enrollment (OE)
• You have a Qualifying Life Event (QLE)
See Important Limitations and Exclusions section.
New Hire
Who is Eligible
• A regular, full-time employee working a minimum of 18.75 per week
When to Enroll
• Enroll by the deadline given by Human Resources
When Coverage Starts
• Next first of the month after the date of hire
Employee
Who is Eligible
About Your Coverage Effective Date
You must be actively at work on the date your coverage becomes effective. Your coverage must be in effect for your spouse’s and eligible children’s coverage to take effect. See plan documents for specific details.
• A regular, full-time employee working a minimum of 18.75 per week
When to Enroll
• Enroll during OE or when you have a QLE
When Coverage Starts
• You must be actively at work on the plan effective date for new benefits to be effective
• QLE: Ask Human Resources
Dependent(s)
Who is Eligible
• Your legal spouse
• Child(ren) under age 26, regardless of student, dependency, or marital status
• Child(ren) over age 26 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
When to Enroll
• You must enroll the dependent(s) during OE or when you have a QLE
• When covering dependents, you must enroll for and be on the same plans
• Dependents cannot be double-covered by married spouses within the district as both employees and dependents
When Coverage Starts
• Based on OE or QLE effective dates
Qualifying Life Events
You may only change coverage during the plan year if you have a Qualifying Life Event, such as:
Marriage
Divorce
Legal separation
Annulment
Birth
Adoption
Placement for adoption
Change in benefits eligibility
Death
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.
Undergoing FMLA, COBRA event, court 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 Significant change in cost of spouse’s coverage
Medical Coverage
Our medical plans protect you and your family from major financial hardship in the event of illness or injury. You have a choice of three plans:
• TRS-ActiveCare Primary – This plan is a PPO.
• TRS-ActiveCare Primary+ – This plan is a PPO.
• TRS-ActiveCare HD – This plan is an HDHP.
The TRS-ActiveCare 2 plan is closed to new enrollments, but you may continue in the plan if you are a current participant.
TRS Region 4 Monthly Medical Rates
TRS is committed to accessibility. If you have trouble accessing this content, contact TRS at WebAccessibility@trs.texas.gov to request an alternative format.
LEARN THE TERMS
• 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.
How to Calculate Your Monthly Premium
Being Healthy is Easy
• 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.
• 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
Diagnostic Labs
High-Tech Imaging (like CT Scan, Mammogram and MRI) Outpatient (like colonoscopy, cataract surgery and steroid injections) Inpatient (like childbirth, complex joint replacement and cardiac surgery) Freestanding Emergency Room
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. This pharmacy benefits coverage is available ONLY to those enrolled in one of the TRSActiveCare 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.
Visit www.express-scripts.com/trsactivecare
Call 844-367-6108
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:
1.
2.
3.
• Group ID – 1085
• Member ID – 5835
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 https://cleverrx.com/galvestonisd Call the Clever RX Help Line at 800-873-1195
Telemedicine
Your benefit coverage offers access to quality telemedicine services. Connect anytime day or night with a board-certified doctor.
While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
• Have a non-emergency issue and are considering an after hours health care clinic, urgent care clinic, or emergency room for treatment
• Are on a business trip, vacation, or away from home
• Are unable to see your primary care physician
When to Use Telemedicine
Use telemedicine for minor conditions such as:
• Sore throat
• Headache
• Stomachache
• Cold
• Flu
• Allergies
• Fever
• Urinary tract infections
Do not use telemedicine for serious or lifethreatening emergencies.
Behavioral Health
Managing stress or life changes can be overwhelming, but it’s easier than ever to get help right in the comfort of your own home. Visit a counselor or psychiatrist by phone, secure video, or the app.
• Talk to a licensed counselor or psychiatrist from your home, office, or on the go!
• Find affordable, confidential online therapy for a variety of counseling needs.
Registration is Easy
Register today so you are ready to use this valuable service when and where you need it.
Visit www.recurohealth.com
Call 855-673-2876
Download the Recuro app to your mobile device.
Health Care Options
Becoming familiar with your options for medical care can save you time and money.
Access to care via phone, online video, or mobile app whether you are at home, work, or traveling; medications can be prescribed
TELEMEDICINE
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
Generally includes evening, weekend and holiday hours
• 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
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
• Chest pain
• Difficulty breathing
• Severe bleeding
• Blurred or sudden loss of vision
• Major broken bones
• Most major injuries except trauma
• Severe pain
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only
If you have questions, please call the phone number on the back of your
Health Savings Account
A Health Savings Account (HSA) is more than a way to help you and your family cover health care costs – it is also a tax-exempt tool to supplement your retirement savings and cover health expenses during retirement. An HSA can provide the funds to help pay current health care expenses as well as future health care costs.
A type of personal savings account, an HSA is always yours even if you change health plans or jobs. The money in your HSA (including interest and investment earnings) grows tax-free and spends tax-free if used to pay for qualified medical expenses. There is no “use it or lose it” rule – you do not lose your money if you do not spend it in the calendar year – and there are no vesting requirements or forfeiture provisions. The account automatically rolls over year after year.
HSA Eligibility
You are eligible to open and contribute to an HSA if you are:
• Enrolled in an HSA-eligible HDHP (High Deductible Health Plan)
• Not covered by another plan that is not a qualified HDHP, such as your spouse’s health plan
• Not enrolled in a Health Care Flexible Spending Account, nor should your spouse be contributing towards a Health Care Flexible Spending Account
• Not eligible to be claimed as a dependent on someone else’s tax return
• Not enrolled in Medicare or TRICARE
• Not receiving Veterans Administration benefits
You can use the money in your HSA to pay for qualified medical expenses now or in the future. You can also use HSA funds to pay health care expenses for your dependents, even if they are not covered under your HDHP.
Having an HSA is a smart financial move!
Watch and learn more!
Health Savings Account
If you are 55 or older, you may make a yearly catch-up contribution of up to $1,000 to your HSA.
If you turn 55 anytime during the plan year, you are eligible to make the catch-up contribution for the entire plan year.
Opening an HSA
If you meet the eligibility requirements, you may open an HSA administered by EECU. You will receive a debit card to manage your HSA account reimbursements. Keep in mind, available funds are limited to the balance in your HSA.
Important HSA Information
• Always ask your health care provider to file claims with your medical provider so network discounts can be applied. You can pay the provider with your HSA debit card based on the balance due after discount.
• You, not your employer, are responsible for maintaining ALL records and receipts for HSA reimbursements in the event of an IRS audit.
• You may open an HSA at the financial institution of your choice, but only accounts opened through EECU are eligible for automatic payroll deduction and company contributions.
HSA Contacts
Visit www.eecu.org or download the mobile app to check your balance, pay bills, and more. To find a local financial center, visit www.eecu.org/locations.
Call/Text 817-882-0800 for EECU member service.
• Monday through Friday from 8:00 a.m. to 7:00 p.m. CT
• Saturday 9:00 a.m. to 1:00 p.m. CT Call 800-333-9934 for lost or stolen debit cards.
Your HSA contributions may not exceed the annual maximum amount established by the Internal Revenue Service.
Flexible Spending Accounts
Set aside pretax dollars from each paycheck to pay for certain IRSapproved 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.
Important Reminders!
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.
Flexible Spending Accounts
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.
Download the NBS app
Mail: National Benefit Services, LLC P.O. Box 219393 Kansas City, MO 64121-9393
HSA and FSA Comparison
Knowing the difference between a Health Savings Account (HSA) and a Flexible Spending Account (FSA) can help you choose the best option for you and your family.
Revenue Code
Description
Employer Eligibility
Contribution Source
An HSA is an actual bank account in your name that allows you to save and pay for unreimbursed qualified medical expenses tax-free.
An FSA allows you to pay out-of-pocket expenses tax-free for:
• copays, deductibles, and certain services not covered by medical plan
• qualifying dependent care
A qualified High Deductible Health Plan All employers
You and/or your employer You and/or your employer
Underlying Insurance Requirement High Deductible Health Plan
Maximum Contribution 2026
• $4,400 individual
• $8,750 family
• $1,000 age 55+ catch-up
Permissible Use of Funds
Cash-Outs of Unused Amounts (if no medical expenses)
Year-to-year rollover of account balance?
Does the account earn interest?
Portable?
$3,400
Use any way you wish. If used for nonqualified medical expenses, funds are subject to the current tax rate plus a 20% penalty.
Permitted, but subject to current tax rate plus 20% penalty (waived after age 65).
Yes, it will roll over to use for subsequent year’s health coverage.
Reimbursement for qualified medical expenses as defined in Section 213(d) of the Internal Revenue Code.
Not permitted
No. Your employer’s plan contains a 75-day grace period.
Yes No
Yes, it is portable year-to-year and between jobs.
No
Qualified HSA and FSA Expenses
The products and services listed below are examples of medical expenses eligible for payment under 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 a complete description of eligible medical and dental expenses.
Abdominal supports
Acupuncture
Ambulance
Anesthetist
Arch supports
Artificial limbs
Blood tests
Braces
Cardiographs
Chiropractor
Crutches
Dental treatment
Dentures
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
DPPO Plan
Two levels of benefits are available with the DPPO plans: in-network and out-of-network. You may select 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.
DHMO Plans
If you enroll in the DHMO plan, you must select a Primary Care Dentist (PCD) from the DHMO network directory to manage your care. Each eligible dependent may choose their own PCD. Dental services are unlimited, you pay fixed copays, there are no deductibles, and there are no claim forms to file. There is no coverage for services provided without a referral from your PCD or if you seek care from out-of-network providers.
Vision Coverage
Life and AD&D Insurance
Life and Accidental Death and Dismemberment (AD&D) insurance is 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).
Basic Term Life and AD&D
Basic Term Life and AD&D insurance are provided at no cost to you. You are automatically covered at $10,000.
Supplemental Term Life
If you need more coverage than Basic Term Life and AD&D, you may buy Supplemental Term Life for yourself and your dependent(s). If you do not elect Supplemental Term Life insurance 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 (Evidence of Insurability).
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%). The total must add up to 100%.
Watch and learn more!
Life and AD&D Insurance
Supplemental AD&D
Supplemental AD&D coverage is separate and apart from your Basic and Supplemental Term Life insurance coverage. It provides benefits beyond your Disability or Life insurance for covered losses that are the result of an accidental injury or loss of life. The full amount of AD&D coverage you select is called the Full Amount and is equal to the benefit payable for the loss of life. Benefits for other losses – such as loss of sight, speech, or hearing; coma; or paralysis – are payable as a predetermined percentage of the full amount.
Supplemental AD&D Coverage Amounts
Your Supplemental AD&D amount is equal to your Supplemental Term Life amount. You can also cover your dependent spouse and child(ren). Dependent coverage amounts will be equal to their Dependent Term Life coverage amounts.
Supplemental Coverage Highlights
• Portable – Keep your supplemental coverage if you leave your current employer.
• Convertible – Convert your Group Term Life insurance benefits to an Individual Whole Life policy if your coverage ends.
• Accelerated Benefits Option – Get up to 75% of your Life insurance benefit if you (or your spouse) are terminally ill and have less than 24 months to live. Note: this benefit is not the same as long term care insurance.
Some limitations and exclusions apply. See the plan documents for details.
Programs Included with Life and AD&D Plans
• Employee Assistance Program
• Travel Assistance
Educator Disability Insurance
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 suit your needs.
Educator Disability
Benefits Begin
The first number indicates the number of days you must be disabled due to Injury, and the second number indicates the number of days you must be disabled due to Sickness
of Earnings You Receive Up to 66 2/3%
Educator Disability FAQ
What is Disability insurance?
1 If your elimination period is 30 days or less and you are confined to a hospital for 24 hours or more, the elimination period will be waived, and benefits will be payable from the first day of hospitalization.
2 Depending on the age at which disability occurs, the maximum duration may vary. Please see the applicable schedule on plan summary.
3 Benefits may not be paid for any condition treated within three months prior to your effective date until you have been covered under this plan for 12 months. If your disability is a result of a pre-existing condition, we will pay benefits for a maximum of 90 days.
Disability insurance protects one of your most valuable assets: your paycheck. This insurance replaces part of your income if you are physically unable to work due to sickness or injury for an extended period of time. The Educator Disability plan is unique in that it includes both short- and long-term coverage in one convenient plan.
Does this plan have pre-existing condition limitations?
Yes. However, all plans will 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.
Will I get all of my disability benefit?
Your disability benefit may be reduced by other income you receive or are eligible to receive due to your disability, such as:
• Social Security Disability Insurance
• State teacher retirement disability plans
• Workers’ compensation
• Other employer-based Disability insurance coverage you may have
• Unemployment benefits
• Retirement benefits that your employer fully or partially pays for (such as a pension plan)
Educator Disability Insurance
What is the best way to choose which disability plan option to enroll in?
Your disability plan selection should be a two-step approach.
Step One:
Choose your elimination period, or waiting period. This is how long you are disabled and unable to work before your benefit will begin. It will be displayed as two numbers, such as 0/7, 14/14, 60/60, etc.
The first number indicates the number of days you must be disabled due to Injury, and the second number indicates the number of days you must be disabled due to Sickness.
When choosing your elimination period, determine how long you could go without a paycheck. Choose your elimination period based on your answer.
Note: Some plans will waive the elimination period if you choose 30/30 or other lesser option and you are confined as an inpatient to the hospital for a specific time period. Review your plan details to see if this feature is available to you.
Step Two:
Choose your benefit amount. This is the maximum amount of money you would get from the carrier on a monthly basis once your disability claim is approved by the carrier.
When choosing your monthly benefit, consider how much money you need to pay your monthly bills. Choose your monthly benefit amount based on your answer.
Accident Insurance
Accident insurance provides affordable protection against a sudden, unforeseen accident. This benefit helps offset the direct and indirect expenses resulting from an accident such as copayments, deductible, ambulance, physical therapy, childcare, rent, and other costs not covered by traditional health plans. See the plan document for full details.
Critical Illness Insurance
Critical Illness insurance helps pay the cost of non-medical expenses related to a covered critical illness. The plan provides a lump-sum benefit payment to you upon the diagnosis of any covered critical illness. It helps 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.
Critical Illness Insurance
Employee
$10,000; $20,000; $30,000; $40,000
Spouse 100% of employee amount
Children Included at 100% of employee amount
Full Coverage
Heart Attack; Stroke; Advanced Multiple Sclerosis; Advanced Parkinson’s Disease; ALS (aka Lou Gehrig’s disease); Alzheimer’s Disease; Benign Brain Tumor; Coma/Brain injury; End-Stage Renal Failure; Heart, Kidney, or Organ failure; Loss of Sight, Speech, or Hearing; Major Burns; Paralysis
Partial Coverage
Coronary Artery Disease, Coronary Artery Bypass, Angioplasty
Childhood Diseases
Type 1 Diabetes, Down Syndrome, Congenital Defects, Cerebral Palsy, Cystic Fibrosis, Muscular Dystrophy
1 Spouse rate is based on employee’s age.
Watch and learn more!
Hospital Indemnity Insurance
The Hospital Indemnity plan helps 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, this plan pays 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.
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.
Breast TRAM flap: $2,000; Breast Reconstruction: $500; Breast Symmetry: $500; Facial Reconstruction: $500
Breast TRAM flap: $2,000; Breast Reconstruction: $500; Breast Symmetry: $500; Facial Reconstruction: $500
Permanent Life Insurance
Help protect your family with the Family Protection Plan from 5Star Life Insurance Company. This Level Term Life insurance plan offers level premiums and a level death benefit to age 121, as long as there is no lapse in premium payments. The death benefit is paid in a lump-sum cash payment.
Plan Highlights
• Spouse Coverage: Cover your spouse, even if you do not elect coverage for yourself.
• Dependent Coverage: Financially dependent children and grandchildren ages 14 days to 26 years old can get coverage too.
• Portability: If you change jobs or retire, and continue to pay your premium, your coverage continues with no loss of benefits or premium increases. 5Star will bill you directly.
• Terminal Illness Benefit: Receive 30% of your coverage in a lump-sum payment if a terminal condition limits your life expectancy to less than 12 months.
• Quality of Life Benefit: This optional rider accelerates a portion of your death benefit on a monthly basis – up to 75% – should the following occur:
• You have a permanent inability to perform at least two of the six ADLs (Activities of Daily Living) without substantial assistance; or
• You suffer from a severe cognitive impairment such as dementia, Alzheimer’s disease, or other forms of senility that require substantial supervision.
• Convenient Payment: Your premium can be payroll-deducted.
2026 Plan Year Enrollment
The following Guaranteed Issue benefit amounts are available to eligible applicants, regardless of their health status, with no doctor exam or physical required.
• Employee: $150,000
• Spouse: $30,000
• Child: $10,000
Watch and learn more!
Legal Services
At many points in your life, you may need legal assistance. Getting legal help can be a stressful and expensive process – many firms may charge up to $350 an hour. For these reasons, your employer offers a legal assistance plan to help you get the guidance you need.
A legal insurance plan can ease the biggest stresses – finding and paying for legal expertise when you need it most. LegalEASE offers an insurance plan that provides support and protection from unexpected personal legal issues.
Plan Details
Home & Residential
Purchase of Primary Residence, Sale of Primary Residence, Refinancing of Primary Residence, Vacation or Investment
Home Sale/Purchase/Refinancing, Tenant Dispute, Tenant
Security Deposit Dispute, Landlord Dispute with Tenant, Security Deposit Dispute with Tenant, Construction Defect Dispute, Neighbor Dispute, Noise Reduction Dispute, Foreclosure
Auto & Traffic
Traffic Ticket, Serious Traffic Matters (Resulting in Suspension or Revocation of License), Administrative Proceeding (Regarding Suspension or Revocation of License), First-time Vehicle Buyer, Vehicle Repair and Lemon Law Litigation, DUI/ DWI Defense
Estate Planning & Wills
Will or Codicil, Living Will, Health Care Power of Attorney, Living Trust Document, Probate of Small Estate
Financial & Consumer
Debt Collection: Pre-litigation Defense & Trial Defense, Bankruptcy (Chapter 7 or 13), Tax Audits, Student Loan Refinancing/Collection Defense, Document Preparation, Consumer Dispute, Small Claims Court, Financial Advisor, Mail Order or Internet Purchase Dispute, Bank Fee Dispute, Cell Phone Contract Dispute, Warranty Dispute, Healthcare Coverage Disputes and Records, Identity Theft Defense
Family
Separation, Divorce, Post-Divorce Proceedings, Prenuptial Agreement, Name Change, Guardianship/Conservatorship, Adoptions, Juvenile Court Proceedings
General
Civil Litigation Defense, Incompetency Defense, Initial Law Office Consultation, Review of Simple Documents, Discounted Contingency Fees, Mediation, Misdemeanor Defense
ID Theft Protection
Identity theft continues to grow more complex, and it is becoming harder for consumers and identity theft victims to manage the intricacies on their own. Fraudsters are taking advantage of consumers’ increased digital dependence to steal personal and financial information.
Theft Protection
ID Theft Protection
Glossary of Terms
Beneficiary – Who will receive a benefit in the event of the insured’s death. A policy may have more than one beneficiary.
Coinsurance – Your share of the cost of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service, typically after you meet your deductible.
Copay – The fixed amount you pay for health care services received.
Deductible – The amount you owe for health care services before your health insurance begins to pay its portion. For example, if your deductible is $1,000, your plan does not pay anything until you meet your $1,000 deductible for covered health care services. The deductible may not apply to all services, including preventive care.
Employee Contribution – The amount you pay for your insurance coverage.
Employer Contribution – The amount your employer contributes to the cost of your benefits.
Explanation of Benefits (EOB) – A statement sent by your insurance carrier that explains which procedures and services were provided, how much they cost, what portion of the claim was paid by the plan, what portion of the claim is your responsibility, and information on how you can appeal the insurer’s decision. These statements are also posted on the carrier’s website for your review.
Flexible Spending Account (FSA) – An option that allows participants to set aside pretax dollars to pay for certain qualified expenses during a specific time period (usually a 12-month period).
Generic Drugs – Drugs approved by the U.S. Food and Drug Administration (FDA) to be chemically identical to corresponding brand name versions. The color or flavor of a generic medicine may be different, but the active ingredient is the same. Generic drugs are usually the most cost-effective version of any medication.
Health Savings Account (HSA) – A personal savings account that allows you to pay for qualified medical expenses with pretax dollars.
High Deductible Health Plan (HDHP) – A medical plan with a higher deductible in exchange for a lower monthly premium. You must meet the annual deductible before any benefits are paid by the plan.
In-Network – Doctors, hospitals, and other providers that contract with your insurance company to provide health care services at discounted rates.
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 Maximum – Also known as an out-of-pocket limit. The most you pay during a policy period (usually a 12-month period) before your health insurance or plan begins to pay 100% of the allowed amount. The limit does not include your premium, charges beyond the Reasonable and Customary (R&C) Allowance, or health care your plan does not cover. Check with your health insurance carrier to confirm what payments apply to the out-of-pocket maximum.
Over-the-Counter (OTC) Medications – Medications typically made available without a prescription.
Prescription Medications – Medications prescribed by a doctor. Cost of these medications is determined by their assigned tier.
Preventive Care – The care you receive to prevent illness or disease. It also includes counseling to prevent health problems.
Reasonable and Customary (R&C) Allowance – Also known as an eligible expense or the Usual and Customary (U&C). The amount your insurance company will pay for a medical service in a geographic region based on what providers in the area usually charge for the same or similar medical service.
SSNRA – Social Security Normal Retirement Age.
Important Legal Notices
Women’s Health and Cancer Rights Act of 1998
In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully.
As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:
• All stages of reconstruction of the breast on which the mastectomy was performed;
• Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
• Prostheses and treatment of physical complications of the mastectomy, including lymphedema.
Health plans must determine the manner of coverage in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
Special Enrollment Rights
This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.
Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP)
If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage).
If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is terminated from, or determined to be eligible for, such assistance.
Marriage, Birth or Adoption
If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption.
For More Information or Assistance
To request special enrollment or obtain more information, contact:
Galveston ISD
Human Resources 3904 Avenue T Galveston, TX 77550 409-766-5100
Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Galveston ISD and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Galveston ISD has determined that the prescription drug coverage offered by the Galveston ISD medical plan is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Creditable Coverage. The HSA plan is not considered Creditable Coverage.
Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods.
Important Legal Notices
You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to enroll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D after first becoming eligible to enroll, you may have to pay a higher premium (a penalty).
You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Galveston ISD at the phone number or address listed at the end of this section.
If you choose to enroll in a Medicare prescription drug plan and cancel your current Galveston ISD prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to determine if and when you are allowed to add coverage.
If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage.
For more information about this notice or your current prescription drug coverage:
Contact the Human Resources Department at 409-766-5100
NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy.
For more information about your options under Medicare prescription drug coverage:
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778
Remember: Keep this Creditable Coverage notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
September 1, 2026 Galveston ISD Human Resources 3904 Avenue T Galveston, TX 77550 409-766-5100
Notice of HIPAA Privacy Practices
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (the “Notice”) describes the legal obligations of Galveston ISD’s Group Health Plan (the “Plan”) and your legal rights regarding your protected health information held by the Plan under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH Act). Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law.
We are required to provide this Notice of Privacy Practices to you pursuant to HIPAA.
The HIPAA Privacy Rule protects only certain medical information known as “protected health information.” Generally, protected health information (PHI) is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to:
Important Legal Notices
1. Your past, present, or future physical or mental health or condition;
2. The provision of health care to you; or
3. The past, present, or future payment for the provision of health care to you.
I. Contact Information
If you have any questions about this Notice or about our privacy practices, and for any correspondence or requests related to the contents of this Notice, please contact:
Galveston ISD
Human Resources
3904 Avenue T Galveston, TX 77550
409-766-5100
II. Effective Date
This Notice is effective February 15, 2026.
III. Our Responsibilities
We are required by law to:
1. maintain the privacy of your PHI;
2. provide you with certain rights with respect to your PHI;
3. provide you with a copy of this Notice of our legal duties and privacy practices with respect to your PHI; and
4. follow the terms of the Notice that is currently in effect.
We reserve the right to change the terms of this Notice and to make new provisions regarding your PHI that we maintain, as allowed or required by law. If we make any material change to this Notice, we will provide you with a copy of our revised Notice of Privacy Practices.
IV. How We May Use and Disclose Your PHI
Under the law, we may use or disclose your PHI under certain circumstances without your permission. The following categories describe the different ways that we may use and disclose your PHI. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. Note that we will use and disclose PHI as described below unless otherwise prohibited or restricted by applicable state or other law, and that information can lose its protected status as PHI once re-disclosed by a recipient.
For Treatment. When and as appropriate, we may use or disclose medical information about you to facilitate medical treatment or services by health care providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, we might disclose information about you with physicians who are treating you.
For Payment. We may use or disclose your protected health information to determine your eligibility for Plan benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For example, we may tell your health care provider about your medical history to determine whether a particular treatment is experimental, investigational, or medically necessary, or to determine whether the Plan will cover the treatment. We may also share your protected health information with a utilization review or pre-certification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.
For Health Care Operations. We may use and disclose your protected health information for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information in connection with conducting quality assessment and improvement activities; underwriting, premium rating, and other activities relating to Plan coverage; submitting claims for stop-loss (or excess-loss) coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities. However, we will not use your genetic information for underwriting purposes.
Substance Use Disorder (SUD) Treatment Information. Some of your health information may be part of a SUD patient record and subject to additional protections under federal law (42 CFR Part 2) governing confidentiality of SUD patient records.
Important Legal Notices
If we receive or maintain any information about you from a SUD treatment program that is covered by 42 CFR Part 2 (a “Part 2 Program”) through a general consent you provide to the Part 2 Program to use and disclose the SUD patient record for purposes of treatment, payment or health care operations, we may use and disclose your SUD patient record for treatment, payment and health care operations purposes as described in this Notice. If we receive or maintain your SUD patient record through specific consent you provide to us or another third party, we will use and disclose your SUD patient record only as expressly permitted by you in your consent as provided to us. In no event will we use or disclose your SUD patient record, or testimony that describes the information contained in your SUD patient record, in any civil, criminal, administrative, or legislative proceedings by any Federal, State, or local authority, against you, unless authorized by your consent or the order of a court after it provides you notice of the court order.
To Business Associates. We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, transmit, use, and/or disclose your PHI, but only after they agree in writing with us to implement appropriate safeguards regarding your PHI. For example, we may disclose your PHI to a Business Associate to process your claims for Plan benefits or to provide support services, such as utilization management, pharmacy benefit management, or subrogation, but only after the Business Associate enters into a Business Associate contract with us.
Treatment Alternatives or Health-Related Benefits and Services. We may use and disclose your protected health information to send you information about treatment alternatives or other health-related benefits and services that might be of interest to you.
As Required by Law. We will disclose your PHI when required to do so by federal, state, or local law. For example, we may disclose your PHI when required by national security laws or public health disclosure laws.
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may disclose your PHI in a proceeding regarding the licensure of a physician.
To Plan Sponsors. For the purpose of administering the plan, we may disclose PHI to certain employees of the Employer. However, those employees will only use or disclose that information as necessary to perform plan administration functions or as otherwise required by HIPAA, unless you have authorized further disclosures. Your PHI cannot be used for employment purposes without your specific authorization.
V. Special Situations
In addition to the above, the following categories describe other possible ways that we may use and disclose your PHI without your specific authorization. For each category of uses or disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
Organ and Tissue Donation. If you are an organ donor, we may release your PHI after your death to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation. We may release your PHI for workers’ compensation or similar programs, but only as authorized by, and to the extent necessary to comply with, laws relating to workers’ compensation and similar programs that provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose your PHI for public health activities. These activities generally include the following:
1. to prevent or control disease, injury, or disability;
2. to report births and deaths;
3. to report child abuse or neglect;
4. to report reactions to medications or problems with products;
5. to notify people of recalls of products they may be using;
6. to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
7. to notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.
Important Legal Notices
Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone involved in a legal dispute, but only if efforts have been made to tell you about the request or to obtain a court or administrative order protecting the information requested.
Law Enforcement. We may disclose your PHI if asked to do so by a law-enforcement official.
1. in response to a court order, subpoena, warrant, summons, or similar process;
2. to identify or locate a suspect, fugitive, material witness, or missing person;
3. about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement;
4. about a death that we believe may be the result of criminal conduct; and
5. about criminal conduct.
Coroners, Medical Examiners, and Funeral Directors. We may release PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors, as necessary to carry out their duties.
National Security and Intelligence Activities. We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Inmates. If you are an inmate of a correctional institution or are in the custody of a law-enforcement official, we may disclose your PHI to the correctional institution or law-enforcement official if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Research. We may disclose your PHI to researchers when:
1. The individual identifiers have been removed; or
2. When an institutional review board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of the requested information and approves the research.
VI. Required Disclosures
The following is a description of disclosures of your PHI we are required to make.
Government Audits. We are required to disclose your PHI to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule.
Disclosures to You. When you request, we are required to disclose to you the portion of your PHI that contains medical records, billing records, and any other records used to make decisions regarding your health care benefits. We are also required, when requested, to provide you with an accounting of most disclosures of your PHI if the disclosure was for reasons other than for payment, treatment, or health care operations, and if the PHI was not disclosed pursuant to your individual authorization.
VII. Other Disclosures
Personal Representatives. We will disclose your PHI to individuals authorized by you, or to an individual designated as your personal representative, attorney-in-fact, etc., so long as you provide us with a written notice/authorization and any supporting documents (i.e., power of attorney). Note: Under the HIPAA privacy rule, we do not have to disclose information to a personal representative if we have a reasonable belief that:
1. You have been, or may be, subject to domestic violence, abuse, or neglect by such person; or
2. Treating such person as your personal representative could endanger you; and
3. In the exercise of professional judgment, it is not in your best interest to treat the person as your personal representative.
Spouses and Other Family Members. With only limited exceptions, we will send all mail to the employee. This includes mail relating to the employee’s spouse and other family members who are covered under the Plan and includes mail with information on the use of Plan benefits by the employee’s spouse and other family members and information on the denial of any Plan benefits to the employee’s spouse and other family members. If a person covered under the Plan has requested Restrictions or Confidential Communications (see below under “Your Rights”), and if we have agreed to the request, we will send mail as provided by the request for Restrictions or Confidential Communications.
Important Legal Notices
Authorizations. Other uses or disclosures of your PHI not described above will only be made with your written authorization. For example, in general and subject to specific conditions, we will not use or disclose your psychiatric notes; we will not use or disclose your PHI for marketing; and we will not sell your PHI, unless you give us a written authorization. You may revoke written authorizations at any time, so long as the revocation is in writing. Once we receive your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.
VIII. Your Rights
You have the following rights with respect to your PHI:
Right to Inspect and Copy. You have the right to inspect and copy certain PHI that may be used to make decisions about your Plan benefits. If the information you request is maintained electronically, and you request an electronic copy, we will provide a copy in the electronic form and format you request, if the information can be readily produced in that form and format; if the information cannot be readily produced in that form and format, we will work with you to come to an agreement on form and format. If we cannot agree on an electronic form and format, we will provide you with a paper copy.
To inspect and copy your PHI, you must submit your request in writing. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request.
Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan.
To request an amendment, your request must be made in writing. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
1. is not part of the medical information kept by or for the Plan;
2. was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
3. is not part of the information that you would be permitted to inspect and copy; or
4. is already accurate and complete.
If we deny your request, you have the right to file a statement of disagreement with us and any future disclosures of the disputed information will include your statement.
Right to an Accounting of Disclosures. You have the right to request an “accounting” of certain disclosures of your PHI. The accounting will not include (1) disclosures for purposes of treatment, payment, or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to your authorization; (4) disclosures made to friends or family in your presence or because of an emergency; (5) disclosures for national security purposes; and (6) disclosures incidental to otherwise permissible disclosures.
To request this list or accounting of disclosures, you must submit your request in writing. Your request must state the time period you want the accounting to cover, which may not be longer than six years before the date of the request. Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12-month period will be provided free of charge. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on your PHI that we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on your PHI that we disclose to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had.
Except as provided in the next paragraph, we are not required to agree to your request. However, if we do agree to the request, we will honor the restriction until you revoke it or we notify you.
We will comply with any restriction request if (1) except as otherwise required by law, the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (2) the PHI pertains solely to a health care item or service for which the health care provider involved has been paid in full by you or another person.
Important Legal Notices
To request restrictions, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply-for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Right to Be Notified of a Breach. You have the right to be notified in the event that we (or a Business Associate) discover a breach of unsecured PHI.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
IX. Complaints
If you believe that your privacy rights have been violated, you may file a complaint with the Plan or with the Office for Civil Rights of the United States Department of Health and Human Services. To file a complaint with the Plan, contact the person listed in the Contact Information section of this Notice. All complaints must be submitted in writing.
You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office for Civil Rights or with us.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www. insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www. askebsa.dol.gov or call 1-866-444-EBSA (3272)
If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, 2026. Contact your State for more information on eligibility.
Texas – Medicaid
Website: https://www.hhs.texas.gov/services/financial/healthinsurance-premium-payment-hipp-program
Phone: 1-800-440-0493
To see if any other States have added a premium assistance program since January 31, 2026, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa 1-866-444-EBSA (3272)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu Option 4, Ext. 61565
Important Legal Notices
Continuation of Coverage Rights Under COBRA
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the Galveston ISD group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Galveston ISD plan after you have left employment with the company. If you wish to elect COBRA coverage, contact your Human Resources Department for the applicable deadlines to elect coverage and pay the initial premium.
Plan Contact Information
Galveston ISD Human Resources
3904 Avenue T Galveston, TX 77550
409-766-5100
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-ofnetwork provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that have not signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-ofnetwork provider.
You are protected from balance billing for:
• Emergency services – If you have an emergency medical condition and get emergency services from an out-ofnetwork provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You cannot be balance billed for these emergency services. This includes services you may get after you are in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
• Certain services at an in-network hospital or ambulatory surgical center – When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers cannot balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, outof-network providers cannot balance bill you, unless you give written consent and give up your protections.
You are never required to give up your protections from balance billing. You also are not required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing is not allowed, you also have the following protections:
• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and outof-pocket limit.
If you believe you have been wrongly billed, you may contact your insurance provider. Visit www.cms.gov/nosurprises for more information about your rights under federal law.
Important Legal Notices
New Health Insurance Marketplace Coverage Options
and Your Health Coverage
PART A: General Information
Even if you are offered health coverage through your employment, you may have other coverage options through the Health Insurance Marketplace (“Marketplace”). To assist you as you evaluate options for you and your family, this notice provides some basic information about the Health Insurance Marketplace.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options in your geographic area.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium and other out-of-pocket costs, but only if your employer does not offer coverage, or offers coverage that is not considered affordable for you and doesn’t meet certain minimum value standards (discussed below). The savings on your premium that you’re eligible for depends on your household income. You may also be eligible for a tax credit that lowers your costs.
Does Employment-Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards, you will not be eligible for a tax credit, or advance payment of the tax credit, for your Marketplace coverage and may wish to enroll in your employment-based health plan. However, you may be eligible for a tax credit, and advance payments of the credit that lowers your monthly premium, or a reduction in certain cost-sharing, if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards. If your share of the premium cost of all plans offered to you through your employment is more than 9.12%1 of your annual household income, or if the coverage through your employment does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit, and advance payment of the credit, if you do not enroll in the employment-based health coverage. For family members of the employee, coverage is considered affordable if the employee’s cost of premiums for the lowest-cost plan that would cover all family members does not exceed 9.12% of the employee’s household income.1, 2
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment, then you may lose access to whatever the employer contributes to the employment-based coverage. Also, this employer contribution – as well as your employee contribution to employment-based coverage – is generally excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. In addition, note that if the health coverage offered through your employment does not meet the affordability or minimum value standards, but you accept that coverage anyway, you will not be eligible for a tax credit. You should consider all of these factors in determining whether to purchase a health plan through the Marketplace.
When Can I Enroll in Health Insurance Coverage through the Marketplace?
You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period. Open Enrollment varies by state but generally starts November 1 and continues through at least December 15.
Outside the annual Open Enrollment Period, you can sign up for health insurance if you qualify for a Special Enrollment Period. In general, you qualify for a Special Enrollment Period if you’ve had certain qualifying life events, such as getting married, having a baby, adopting a child, or losing eligibility for other health coverage. Depending on your Special Enrollment Period type, you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan.
There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children’s Health Insurance Program (CHIP) coverage on or after March 31, 2023, through July 31, 2024. Since the onset of the nationwide COVID-19 public health emergency, state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18, 2020, through March 31, 2023. As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices, many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31, 2023. The U.S. Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage.
Important Legal Notices
Marketplace-eligible individuals who live in states served by HealthCare.gov and either submit a new application or update an existing application on HealthCare.gov between March 31, 2023 and July 31, 2024, and attest to a termination date of Medicaid or CHIP coverage within the same time period, are eligible for a 60-day Special Enrollment Period. That means that if you lose Medicaid or CHIP coverage between March 31, 2023, and July 31, 2024, you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage. In addition, if you or your family members are enrolled in Medicaid or CHIP coverage, it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility. To learn more, visit www.HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-8894325.
What about Alternatives to Marketplace Health Insurance Coverage?
If you or your family are eligible for coverage in an employmentbased health plan (such as an employer sponsored health plan), you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances, including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage. Generally, you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment-based health plan. Confirm the deadline with your employer or your employment-based health plan.
Alternatively, you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency. Visit https://www.healthcare.gov/medicaid-chip/getting-medicaidchip/ for more details.
How Can I Get More Information?
For more information about your coverage offered through your employment, please check your health plan’s summary plan description or contact Human Resources.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit www.HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
PART B: Information About Health Coverage Offered by Your Employer
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
3. Employer Name: Galveston ISD
5. Employer Address: 3904 Ave T
7. City: Galveston
4. Employer Identification Number (EIN):
6. Employer Phone Number: 409-766-5100
8. State: TX 9. ZIP Code: 77550
10. Who can we contact at this job?: Micaela Mirelez
11. Phone Number (if different from above):
12. E-Mail Address: micaelamirelez@gisd.org
As your employer, we offer a health plan to all eligible employees (see the Eligibility section of this guide). This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.
1 Indexed annually; see https://www.irs.gov/pub/irs-drop/rp-22-34.pdf for 2023.
2 An employer-sponsored or other employment-based health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs. For purposes of eligibility for the premium tax credit, to meet the “minimum value standard,” the health plan must also provide substantial coverage of both inpatient hospital services and physician services.
This brochure highlights the main features of the Galveston 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. Galveston ISD reserves the right to change or discontinue its employee benefits plans anytime.