mandates that all dependents over the age of one (1) have a valid SSN or ITIN added during Open Enrollment. Please review your Dependent SSN for accuracy to ensure continued coverage for your dependent(s).
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 plan offers medical coverage options. To help you make an informed choice, review each plan’s Summary of Benefits and Coverage (SBC) available by accessing www.bcbstx.com/trsactivecare
Important Contacts
Allen ISD Benefit Call Center
Higginbotham Public Sector 833-505-4538 allenisd@hps.higginbotham.net www.mybenefitshub.com/allenisd
Employee benefits can be complicated. The HPS Call Center can assist you with the following:
Enrollment support
Benefits information
Eligibility issues
Call or text
Claims and billing questions
833-505-4538 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 allenisd@hps.higginbotham.net
Bilingual representatives are available.
Login Process
1. Go to www.mybenefitshub.com/ allenisd or scan the QR code above.
2. Click Login
3. Enter your information:
Last name
Date of birth
Last four digits of your Social Security number
Note: THEbenefitsHUB uses this information to check behind the scenes to confirm your employment status.
4. Once confirmed, the Additional Security Verification page will list the contact options from your profile. Select either the Text, Email, Call, or Ask Admin options to receive a code to complete the final verification step.
5. Enter the code that you receive and click Verify to begin your benefits enrollment.
6. Review your personal information and verify covered dependents. Contact your employer with any discrepancies.
7. Select and confirm the dependent(s) who are to be covered on each benefit screen (medical, dental, etc.). If a dependent is not selected for a benefit, it will not be provided. NOTE: Dependents cannot be double-covered by married spouses within the district as both employees and dependents.
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/ allenisd and click on the benefit plan you need (i.e., Dental). Forms and benefits information are under the Benefits and Form section.
How do I find an in-network provider?
Access www.mybenefitshub.com/ allenisd 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 access digital ID cards by visiting the insurance company’s website.
BENEFIT QUESTIONS?
Call the HPS Call Center at 833-505-4538
Ask your Benefits Department.
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:
Who is Eligible
When to Enroll
When Coverage Starts
• Regular, full-time employee
• Working an average of 15 hours per week
• Enroll by the deadline given by Human Resources
• First day of work concurrent with the plan effective date
• Regular, full-time employee
• Working an average of 15 hours per week
• Enroll during OE or when you have a QLE
• You must be actively at work on the plan effective date for new benefits to be effective
• QLE: Ask Human Resources
About Your Coverage Effective Date
You must be Actively at Work on the date your coverage becomes effective, meaning you are physically capable of performing the functions of your job on the plan effective date. Your coverage must be in effect for your spouse’s and eligible children’s coverage to take effect. If you are not performing your regular occupation on your coverage effective date, please notify your benefits administrator or HPS. See plan documents for specific details.
• 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
• Dependents cannot be double-covered by married spouses within the district as both employees and dependents
• If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your Benefits Office to request a continuation of coverage.
• 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
• 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
Annulment Birth Adoption Placement for adoption Change in benefits eligibility Death
Undergoing COBRA event, judgment, or decree
Becoming eligible for Medicare, Medicaid, or TRICARE
Receiving a Qualified Medical Child Support Order
You have 30 days from the event to notify the Benefits Department and complete your changes. You may need to provide documents to verify the change.
Gain or loss of benefits coverage
Change in employment status affecting benefits
Medical Coverage
Note: The TRS-ActiveCare2 plan is closed to new enrollments, but you may continue in the plan if you are a current participant.
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 specifed percentage of the costs; e.g., you pay 20% while the health care plan pays 80%.
• 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.
Compare Prices for Common Medical Services
Preventive Care
Check Out the Preventive Care You Can Get For $0!
Your benefits plan offers $0 preventive care for every age and sex. 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 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?
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.
Having a doctor who knows you and your medical history is a key part of preventive care.
Children
Autism screening
Blood screening
Depression screening
Developmental screening
Hearing screening
Obesity screening and counseling
Hypothyroidism screening
Behavioral assessments
Well visits
Immunizations
Dental cleanings
Oral health risk assessment
Vision screening
Why did I get a bill for preventive care?
The insurance company has codes that must be met on the doctor’s bill for it to be processed as preventive and covered at 100 percent. 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.
Health Care Options
Becoming familiar with your options for medical care can save you time and money.
Non-Emergency Care
Access to care via phone, online video, or mobile app whether you are at home, work, or traveling; medications can be prescribed
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
Allergies
Cough/cold/flu
Rash
Stomachache
URGENT CARE
Emergency Care
When you need immediate attention; walk-in basis is usually accepted
Generally includes evening, weekend and holiday hours
Infections
Sore and strep throat
Vaccinations
Minor injuries/sprains/ strains
HOSPITAL ER
Life-threatening or critical conditions; trauma treatment; multiple bills for doctor and facility
24 hours a day, 7 days a week
Services do not include trauma care; can look similar to an urgent care center, but medical bills may be 10 times higher
Common infections
Minor injuries
Pregnancy tests
Vaccinations
Sprains and strains
Minor broken bones
Small cuts that may require stitches
Minor burns and infections
Chest pain
Difficulty breathing
Severe bleeding
Blurred or sudden loss of vision
Major broken bones
Most major injuries except trauma
Severe pain
FREESTANDING ER
24 hours a day, 7 days a week
Minimal
Note: Examples of symptoms are not inclusive of all health issues. Wait times described are only estimates. This information is not intended as medical advice. If you have questions, please call the phone number on the back of your medical ID card.
Health Savings Account
The Health Savings Account (HSA) is a type of personal savings account that helps pay for current and future health costs and supplements retirement savings.
HSA Administrator:
An HSA is a type of personal savings account that is yours to keep. The money in your HSA grows tax-free and spends taxfree if used to pay for you or your IRS dependent’s qualified medical expenses. Any unused funds roll over year after year.
Two Ways To Use Your HSA
Use it Now
Make annual HSA contributions.
Pay for eligible medical costs.
Keep HSA funds in cash.
Triple Tax Savings
Let it Grow
Make annual HSA contributions.
Pay for medical costs with other funds.
Invest HSA funds.
2026 Maximum HSA Contributions
$4,400 Individual
$8,750 Family If age 55 or older, you can contribute an extra $1,000
HSA Eligibility
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 FSA
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
Important HSA Information
Have your doctor file your claims and use your HSA debit card to pay any balance due.
Keep ALL reimbursement records and receipts for tax records.
Only HSA accounts opened through our plan administrator are eligible for automatic payroll deductions.
Available funds are limited to the balance of your HSA account.
HSA Contacts
Visit https://www.eecu.org
Call 817-882-0800 for Customer Service.
Call 800-333-9934 for a lost/stolen card.
Download the EECU app
Flexible Spending Accounts
A Flexible Spending Account (FSA) allows you to set aside pretax dollars from each paycheck to pay for certain IRS-approved health and dependent care expenses.
FSA Administrator:
Health Care FSA
The Health Care FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. Eligible expenses include:
Dental and vision expenses
Medical deductibles and coinsurance
Prescription copays
Hearing aids and batteries
You may not contribute to a Health Care FSA if you enrolled in a High Deductible Health Plan (HDHP) and contribute to an HSA.
TWO WAYS TO ACCESS YOUR FSA FUNDS
Use your Higginbotham Health Care FSA Debit Card to pay for qualified expenses, doctor visits, and prescription copays (Health Care FSA only).
Pay out-of-pocket and submit your receipts for reimbursement:
Visit https://flexservices.higginbotham.net
Email flexclaims@higginbotham.net
Fax 866-419-3516
Watch and learn more! Important FSA Rules
FSA Benefits are “use-it or lose-it.”
Dependent Care Funds remaining after the 60-day plan runout will be forfeited on 10/30/2027.
Health Care FSA will roll over up to $640 into the next plan year; funds exceeding $640 will be forfeited at the plan runout.
FSA Elections roll over annually; any changes must be made during Open Enrollment.
You cannot change your election during the year unless you experience a Qualifying Life Event.
The Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses.
NOTE
Keep itemized receipts to verify Debit Card payments.
Higginbotham Portal
The Higginbotham Portal provides information and resources to help you manage your FSAs to:
Access plan documents and account information.
Update your personal information.
Look up qualified expenses.
Submit claims.
REGISTER FOR AN ACCOUNT
Visit https://flexservices.higginbotham.net click Get Started and follow the instructions.
Enter your Social Security number with no dashes or spaces as your Employee ID.
Follow the prompts to navigate the site.
If you have any questions or concerns, contact Higginbotham:
Call 866-419-3519
Email flexclaims@higginbotham.net .
Fax 866-419-3516
Download the Higginbotham app to easily access your Health Care FSA information.
View your account balance
View debit card activity
File a claim and upload receipts
Set up notifications
Register on the Higginbotham Portal first to access the mobile app, and use the same username and password for both.
Dependent Care FSA
The Dependent Care FSA helps pay for expenses associated with caring for elder or child dependents so you or your spouse can work or attend school full-time. You can use the account to pay for daycare or babysitter expenses for your children under age 13 and qualifying older dependents, such as dependent parents. Reimbursement from your Dependent Care FSA is limited to the total amount deposited in your account at that time. To be eligible, you (and your spouse, if married) must be gainfully employed, looking for work, a full-time student, or incapable of self-care.
DEPENDENT CARE FSA GUIDELINES
Dependent Care FSA claims may be submitted as incurred and will be paid as funds become available after monthly payroll contributions are deposited.
Overnight camps are not eligible for reimbursement (only day camps can be considered).
If your child turns 13 midyear, you may only request reimbursement for the part of the year when the child is under age 13.
You may request reimbursement 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.
Annual Maximum FSA Contributions
HSA and FSA Comparison
Knowing the difference between a Health Savings Account (HSA) and Health Care Flexible Spending Account (FSA) can help you choose the best option for you and your family.
Description
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
Permissible Use of Funds
Cash-Outs of Unused Amounts (if no medical expenses)
• $1,700 single • $3,400 family
• $4,400 single
• $8,750 family
• $1,000 age 55+ catch-up $3,400
Use any way you wish. If used for non-qualified medical expenses, funds are subject to the current tax rate plus a 20% penalty.
Reimbursement for qualified medical expenses as defined in Section 213(d) of the Internal Revenue Code.
Permitted, but subject to current tax rate plus 20% penalty (waived after age 65). Not permitted
Year-to-year rollover of account balance? Yes, it will roll over to use for subsequent year’s health coverage. No. Your employer’s plan contains a $640 (2026) rollover provision. Does the account earn interest? Yes No Portable? 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.
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
Telemedicine
Employer Provided Benefit! Family must be enrolled during Open Enrollment to be eligible. Allen ISD provides eligible employees and their enrolled family members telemedicine at $0 copay! Connect anytime day or night with a board-certified doctor via your mobile device or computer.
1. Enroll yourself and eligible family members during Open Enrollment.
2. Watch for a WELCOME email from Recuro to register your account.
3. Access Recuro Online, by phone or Mobile App.
Telemedicine Provider:
While Recuro 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 life-threatening emergencies.
Note: Recuro is not tied to TRS medical plans. Use Recuro for $0 consultations.
Behavioral Health + Psychiatry Buy-Up Option
Employees may add virtual Behavioral Health + Psychiatry to the Recuro Telemedicine plan for their family for only $8 per month. This optional buy-up plan covers enrolled family members over the age of 12 for $0 copay on Behavioral Health visits.
Get support anytime with a licensed counselor or psychiatrist by phone, secure video, or app.
Hospital Cash
Even with the best primary health insurance plan, out-of-pocket costs from a hospital stay can add up. Chubb’s Hospital Cash plan pays a scheduled benefit if you or an insured dependent (spouse or child) is confined in a hospital for a covered illness or injury.
Hospital Cash Administrator:
The benefits are paid to you and can help offset expenses that primary health insurance doesn’t cover (like deductibles, coinsurance amounts or copays).
Cash if admitted into a hospital
No pre-existing limitations
HSA compatible
Newborn nursery benefit
Note: You must be active at work on the effective date for the plan to go into effect.
Hospital Cash Plans
First Hospitalization Benefit
This benefit is payable for the first covered hospital confinement per certificate.
Hospital Admission Benefit
• $500
This benefit is for admission to a hospital or hospital sub-acute intensive care unit. • $1,500
Hospital Admission ICU Benefit
This benefit is for admission to a hospital intensive care unit.
Hospital Confinement Benefit
This benefit is for confinement in hospital or hospital sub-acute intensive care unit.
Hospital Confinement ICU Benefit
This benefit is for confinement in a hospital intensive care unit.
Newborn Nursery Benefit
This benefit is payable for an insured newborn baby receiving newborn nursery care and who is not confined for treatment of a physical illness, infirmity, disease, or injury.
Observation Unit Benefit
This benefit is for treatment in a hospital observation unit for a period of less than 20 hours.
$3,000
• $100 per day • Maximum days per calendar year: 30
$200
• $500 per day
• Maximum days per confinement –normal delivery: 2
• Maximum days per confinement –cesarean section: 2
$200 per day
1
Maximum days per calendar year: 30
• $500 per day
• Maximum days per confinement –normal delivery: 2
• Maximum days per confinement –cesarean section: 2
Dental Coverage
You have the choice of two plans. You have the option to choose any dentist, but for lowest out-of-pocket costs select an in-network dentist.
Dental Benefits Summary
PREVENTIVE SERVICES
Periodic Oral Evaluations
Problem Focused Oral Evaluations
Comprehensive Oral Evaluations
Prophylaxis/Routine Cleanings X-rays
Sealants
Topical Fluoride Space Maintainers BASIC RESTORATIVE SERVICES*
Amalgam and Composite Fillings
Non-surgical Extractions
Periodontic Maintenance
Full Mouth Debridement Scaling Root Planing Denture
Reline/Rebase Repairs – Crown and Bridge Palliative Treatment (emergency care to relieve pain) Deep Sedation/General Anesthesia
MAJOR RESTORATIVE SERVICES*
Bridges and Dentures
Implants
Crowns Inlays/Onlays
Endodontics (root canal)
Oral Surgery
Surgical Extractions
Major Periodontics
Vision Coverage
You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see in-network providers.
Vision Benefits Summary
• Single vision
• Lined bifocal
• Lined trifocal
• Impact-resistant
•
Discounts
Extra $20 frame benefit on Featured Brand Frames.
20% savings on additional pairs of glasses from your VSP provider within 12 months of your exam.
Disability Insurance
Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income if you are unable to work due to a covered accident, illness, or pregnancy. Allen ISD Disability plan combines features of short-term and long-term disability plans allowing you to choose the coverage amount and waiting period that best suits your needs.
2
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 less, 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.
Disability FAQ
What is disability insurance?
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.
Does this plan have pre-existing condition limitations?
Yes. All plans will include pre-existing condition limitations that could impact you if you are a firsttime enrollee in your employer’s disability plan, or if you make changes to your existing plan. 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)
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 Provider:
Watch and learn more!
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 first and second diagnosis of any covered critical illness or cancer. The benefit can help cover expenses such as lost income, out-of-town treatments, special diets, daily living, and household upkeep costs. This coverage is portable. See the plan document for full details.
Critical Illness Insurance Benefits Summary
Benign brain tumor, invasive cancer, coma, loss of speech,
of hearing, loss of sight, heart attack, kidney failure, major organ failure, ALS, Alzheimer’s disease, multiple sclerosis, muscular dystrophy, advanced Parkinson’s disease, severe burns, stroke, and more
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.
Life and AD&D Provider:
Voluntary Group Life insurance is the least expensive way to buy life insurance during your working years. The plan pays a cash benefit to your designated beneficiary in the event of your passing. This money can be used toward anything from final costs to paying off debts. 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 the beneficiary(ies).
Basic Term Life and AD&D
Basic Term Life and AD&D insurance are provided at no cost to you. Benefit-eligible employees are automatically covered at $20,000 for each benefit. Benefit amount reduces by 50% at age 70.
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 at anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
Watch and learn more!
Life and AD&D Insurance
Voluntary Group Term Life
If you need more coverage than Basic Term Life and AD&D, you may purchase additional Term Life for yourself and your dependent(s). You must be covered to obtain coverage for your dependents. If you leave the district, you may be able to take your insurance with you. Benefits reduce by 50% at employee’s age of 75.
NEW HIRES MAY BE ELIGIBLE FOR GUARANTEED ISSUE COVERAGE.
This means No Health Questions! A minimum election of $10,000 reserves the right to annually increase by four increments without providing Evidence of Insurability (EOI) up to the Guaranteed Issue amount. If you decline Voluntary Life when first eligible and wish to elect later, Evidence of Insurability (EOI) – proof of good health – may be required before coverage is approved.
• Increments of $10,000 up to 10 times salary, not to exceed $500,000.
• New hire Guaranteed Issue: $350,000
• AD&D Coverage included equal to Voluntary Life Election.
• Increments of $5,000 up to 100% of employee amount, not to exceed $500,000. New hire Guaranteed Issue: $50,000
• AD&D Coverage included equal to Spouse Voluntary Life Election.
• Day one but under 26 years: $20,000
Voluntary Coverage Highlights
Portable – keep your voluntary coverage if you leave the district.
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 12 months to live. Note: this benefit is not the same as long term care insurance.
Some limitations and exclusions apply, so see the plan documents for details.
Claims: Please contact Allen ISD Benefits Department for assistance in filing a life or AD&D claim.
Spouse
Employee Assistance Program
An Employee Assistance Program (EAP) helps you and family members cope with a variety of personal or work-related issues.
EAP Provider:
Get confidential counseling and support services from licensed professionals at little or no cost to help with:
Relationships
Work/life balance
Stress and anxiety
Grief and loss
Childcare and eldercare resources
Substance abuse
Addiction
And more
Emergency Transport Services
Emergency transport coverage protects you and your family against uncovered costs for emergency transportation to medical facilities. Services include safe transfers, return trips, and care-related transport needs for you, your family, and even your pets.
If you are enrolled in the ActiveCare HD plan, MASA benefits for eligible medical expenses begin after you meet the required minimum deductible.
Accident Insurance
Accident insurance provides affordable protection against a sudden, unforeseen accident.
Choose from two plan options. Both plans pay a scheduled cash benefit for injury and medical treatment resulting from an accident. Benefit levels increase if related to organized and personal sports activities. See the plan document for full details.
Accident Insurance Benefits Summary
1
Legal Protection
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.
Legal Provider:
This plan offers legal help at a fixed and affordable rate to assist with these types of issues:
Family (adoption, juvenile court, prenuptial agreements)
Financial (bankruptcy, affidavits, tax audits)
Home (title disputes, deeds, foreclosures, mortgages)
Auto (traffic violations, injuries, driver’s license restoration)
General (document review, consultations, wills, estates)
And more
Identity Theft Protection
Identity theft is one of the fastest-growing crimes in the country. Millions of people have their identity stolen each year.
Protect yourself and restore your identity with coverage that includes:
Identity consultation and advice
Licensed private investigators
Identity and credit monitoring
Social media monitoring
Identity restoration
Threat and credit alerts
24/7 emergency ID protection access
Individual Life Insurance
Individual Life Insurance is an individually owned plan that you can purchase for you and your family’s needs to provide long-term coverage and complement your group life and AD&D policy.
Individual Life Provider:
Permanent Individual Life insurance can be an ideal complement to your group term life insurance. This life product is yours to keep, even when you change jobs or retire, as long as you pay the necessary premium. Group and voluntary term life insurance may be portable if you change jobs, but even if you can keep them after you retire, they usually cost more and decline in death benefit.
Employees do not have to participate in order to apply for eligible dependent coverage.
Individual Life Highlights
High Death Benefit: One of the highest death benefits available at the worksite, providing financial security for your loved ones.
Minimal Cash Value: Focuses on the death benefit — not cash value — keeping premiums affordable so you can prioritize retirement savings like 403(b), 457, and 401(k) plans.
Long Guarantees: Guaranteed death benefit to age 121 with level premiums for a significant period of time.
Refund of Premium: If your premium ever increases, you may receive a refund of 10 years of premiums upon surrender of the policy (conditions apply).
Accelerated Death Benefit Rider: If you are diagnosed as terminally ill with a life expectancy of 12 months, you may receive up to 92% of the death benefit, less a $150 administrative fee (conditions apply).
Individual Life Rates
Visit www.mybenefitshub.com/allenisd for rates.
Apply with Just Three Questions
You may apply for this permanent, portable coverage for yourself –and for your spouse, children, and grandchildren – by answering just three questions about the past six months:
1. Have you been actively at work full-time, performing your usual duties?
2. Have you been absent from work due to illness or medical treatment for more than five consecutive working days?
3. Have you been disabled or received treatment in a hospital or nursing home, including chemotherapy, radiation, dialysis, or treatment for alcohol or drug abuse?
Retirement Plans
When you consistently save money throughout your career, it lays a secure foundation for your retirement years. Enroll in our 403(b) or a 457(b) plan to help you reach your investment and retirement goals.
Retirement Plan Provider:
457(b) Plan
A 457(b) is an employer-sponsored, voluntary retirement plan that allows you to save money in a pre-tax (Traditional) or after-tax (Roth) account. Contributions to the plan are salarydeducted from your paycheck and automatically deposited into your 457(b) retirement savings account. Once separated from service, withdrawals from a 457(b) account are not subject to a 10% early withdrawal penalty.
The 457(b) plan offers employees personalized guidance and flexible strategies to start the process of saving for retirement.
403(b) Plan
A 403(b) is a voluntary retirement plan that allows you to save money in a pre-tax (Traditional) or after-tax (Roth) account. Contributions to the plan are salary-deducted from your paycheck and automatically deposited into your 403(b) retirement savings account. Early withdrawals from a 403(b) account are subject to a 10% early withdrawal penalty. TCG is the 403(b) plan administrator—managing your contributions, distributions, and personal updates. Money and investments are held with the vendor of your choice.
Contribute up to the annual IRS limit.
Direct your contributions to any investments within the company plan.
Change the amount of your contributions anytime. (Changes are effective as soon as administratively feasible and remain in effect until modified or terminated by you.)
Decide how to invest the assets in your account.
Clever Rx
With Clever Rx, you never have to overpay for prescriptions. When you use the Clever Rx card or app, you get up to 80% off prescription drugs, discounts on thousands of medications, and usage at most pharmacies nationwide.
How to use Clever Rx
All employees have access to Clever Rx’s prescription savings discount card. Unrelated to the TRS medical plans, it can be used at participating pharmacies to check for medication discounts.
1.
2.
Download the free Clever Rx app and enter these numbers during the onboarding process:
Group ID 1085
Member ID 6496
Use your ZIP code to find a local pharmacy with the best price for your medication — up to 80% off!
3. Click the voucher with the lowest price, closest location, and/or at your preferred pharmacy and show the voucher to the pharmacist.
QUESTIONS?
Call 800-873-1195
Advanced Lab Tests and Health Screenings
New! Function Membership
Get a deeper understanding of your body and spot potential issues early.
Your benefit plan includes the opportunity for you and your family to enroll for a Function membership. Function empowers you to own your health through affordable access to advanced lab testing. A Function membership evaluates five times more biomarkers than the average physical, helping you gain a deeper understanding of what’s going on in your body, monitor for early indicators of disease, and track your health as it evolves.
The membership includes:
Access to 100+ lab tests at the start of your membership.
Access to an additional 60+ midyear follow-up tests to track your progress.
Detailed clinician notes highlighting areas of focus.
A targeted action plan to help improve your health.
Results stored on one secure platform for easy access anytime.
HOW THE PROCESS WORKS
After signing up for Function, you will get an email and text message to schedule a convenient time and location for your lab visit. Tests take less than 30 minutes and are done at one of more than 2,000 partner lab locations nationwide. You will then get a detailed summary of your results and a targeted action plan to help you reach your health goals. All results are stored in one secure location for you to access anytime. You can retest in six months to see how you are progressing. Nonroutine tests (e.g., advanced MRI, early detection of multiple cancers, allergies, heavy metals, and more) may be added for an additional cost.
*Function membership includes prepaid access to 160+ lab tests each year at a Quest Diagnostics site. Due to state regulations, members testing in New York and New Jersey will be charged an additional fee directly by Quest for each lab visit. We cannot accommodate lab testing in Hawaii or Rhode Island at this time. You can schedule lab testing in a neighboring state.
How to Enroll
Enroll anytime during the year by accessing https://www.functionhealth.com/aep/ higginbotham
You will pay the membership fee(s) directly to Function.
TEST MORE. KNOW MORE.
Advanced testing across:
Heart
Immunity
Metabolics
Hormones
Nutrients
Heavy Metals
Liver
Kidneys
Pancreas
Prostate
Sexual Health
Electrolytes
Thyroid
Autoimmunity
Urine
Blood
The cost for an individual annual membership* is $335!
FSA/HSA ELIGIBLE
Funds from your Health Care FSA (FSA) Health Savings Account (HSA) may be used to pay for your membership.
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-ofpocket 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:
Allen ISD
Human Resources 612 E. Bethany Drive Allen, TX 75002
972-727-0530
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 Allen 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. Allen ISD has determined that the prescription drug coverage offered by the Allen 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.
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.
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 Allen 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 Allen 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 972-727-0530
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 (1-800-6334227). TTY users should call 877-4862048
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
Allen ISD
Human Resources 612 E. Bethany Drive Allen, TX 75002
972-727-0530
Notice of HIPAA Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Effective Date of Notice: September 23, 2013
Allen ISD’s Plan is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information and to inform you about:
1. the Plan’s uses and disclosures of Protected Health Information (PHI);
2. your privacy rights with respect to your PHI;
3. the Plan’s duties with respect to your PHI;
4. your right to file a complaint with the Plan and to the Secretary of the U.S. Department of Health and Human Services; and
5. the person or office to contact for further information about the Plan’s privacy practices.
The term “Protected Health Information” (PHI) includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form (oral, written, electronic).
Section 1 – Notice of PHI Uses and Disclosures
Required PHI Uses and Disclosures
Upon your request, the Plan is required to give you access to your PHI in order to inspect and copy it.
Use and disclosure of your PHI may be required by the Secretary of the Department of Health and Human Services to investigate or determine the Plan’s compliance with the privacy regulations.
Uses and disclosures to carry out treatment, payment and health care operations.
The Plan and its business associates will use PHI without your authorization to carry out treatment, payment and health care operations. The Plan and its business associates (and any health insurers providing benefits to Plan participants) may also disclose the following to the Plan’s Board of Trustees: (1) PHI for purposes related to Plan administration (payment and health care operations); (2) summary health information for purposes of health or stop loss insurance underwriting or for purposes of modifying the Plan; and (3) enrollment information (whether an individual is eligible for benefits under the Plan). The Trustees have amended the Plan to protect your PHI as required by federal law.
Treatment is the provision, coordination or management of health care and related services. It also includes but is not limited to consultations and referrals between one or more of your providers.
For example, the Plan may disclose to a treating physician the name of your treating radiologist so that the physician may ask for your X-rays from the treating radiologist.
Payment includes but is not limited to actions to make coverage determinations and payment (including billing, claims processing, subrogation, reviews for medical necessity and appropriateness of care, utilization review and preauthorizations).
For example, the Plan may tell a treating doctor whether you are eligible for coverage or what percentage of the bill will be paid by the Plan.
Health care operations include but are not limited to quality assessment and improvement, reviewing competence or qualifications of health care professionals, underwriting, premium rating and other insurance activities relating to creating or renewing insurance contracts. It also includes case management, conducting or arranging for medical review, legal services and auditing functions including fraud and abuse compliance programs, business planning and development, business management and general administrative activities. However, no genetic information can be used or disclosed for underwriting purposes.
For example, the Plan may use information to project future benefit costs or audit
the accuracy of its claims processing functions.
Uses and disclosures that require that you be given an opportunity to agree or disagree prior to the use or release. Unless you object, the Plan may provide relevant portions of your protected health information to a family member, friend or other person you indicate is involved in your health care or in helping you receive payment for your health care. Also, if you are not capable of agreeing or objecting to these disclosures because of, for instance, an emergency situation, the Plan will disclose protected health information (as the Plan determines) in your best interest. After the emergency, the Plan will give you the opportunity to object to future disclosures to family and friends.
Uses and disclosures for which your consent, authorization or opportunity to object is not required.
The Plan is allowed to use and disclose your PHI without your authorization under the following circumstances:
1. For treatment, payment and health care operations.
2. Enrollment information can be provided to the Trustees.
3. Summary health information can be provided to the Trustees for the purposes designated above.
4. When required by law.
5. When permitted for purposes of public health activities, including when necessary to report product defects and to permit product recalls. PHI may also be disclosed if you have been exposed to a communicable disease or are at risk of spreading a disease or condition, if required by law.
6. When required by law to report information about abuse, neglect or domestic violence to public authorities if there exists a reasonable belief that you may be a victim of abuse, neglect or domestic violence. In which case, the Plan will promptly inform you that such a disclosure has been or will be made unless that notice would cause a risk of serious harm. For the purpose of reporting child abuse or neglect, it is not necessary to inform the minor that such a disclosure has been or will be made. Disclosure may generally be made to the minor’s parents or other representatives although there may be circumstances under federal or state law when the parents or other
representatives may not be given access to the minor’s PHI.
7. The Plan may disclose your PHI to a public health oversight agency for oversight activities required by law. This includes uses or disclosures in civil, administrative or criminal investigations; inspections; licensure or disciplinary actions (for example, to investigate complaints against providers); and other activities necessary for appropriate oversight of government benefit programs (for example, to investigate Medicare or Medicaid fraud).
8. The Plan may disclose your PHI when required for judicial or administrative proceedings. For example, your PHI may be disclosed in response to a subpoena or discovery request.
9. When required for law enforcement purposes, including for the purpose of identifying or locating a suspect, fugitive, material witness or missing person. Also, when disclosing information about an individual who is or is suspected to be a victim of a crime but only if the individual agrees to the disclosure or the Plan is unable to obtain the individual’s agreement because of emergency circumstances. Furthermore, the law enforcement official must represent that the information is not intended to be used against the individual, the immediate law enforcement activity would be materially and adversely affected by waiting to obtain the individual’s agreement and disclosure is in the best interest of the individual as determined by the exercise of the Plan’s best judgment.
10. When required to be given to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as authorized by law. Also, disclosure is permitted to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent.
11. When consistent with applicable law and standards of ethical conduct if the Plan, in good faith, believes the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to a person reasonably able to prevent or lessen the threat, including the target of the threat.
12. When authorized by and to the extent necessary to comply with workers’ compensation or other similar programs established by law.
Except as otherwise indicated in this notice, uses and disclosures will be made only with your written authorization subject to your right to revoke such authorization.
Uses and disclosures that require your written authorization.
Other uses or disclosures of your protected health information not described above will only be made with your written authorization. For example, in general and subject to specific conditions, the Plan will not use or disclose your psychiatric notes; the Plan will not use or disclose your protected health information for marketing; and the Plan will not sell your protected health information, unless you provide a written authorization to do so. You may revoke written authorizations at any time, so long as the revocation is in writing. Once the Plan receives 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.
Section 2 – Rights of Individuals
Right to Request Restrictions on Uses and Disclosures of PHI
You may request the Plan to restrict the uses and disclosures of your PHI. However, the Plan is not required to agree to your request (except that the Plan must comply with your request to restrict a disclosure of your confidential information for payment or health care operations if you paid for the services to which the information relates in full, out of pocket).
You or your personal representative will be required to submit a written request to exercise this right. Such requests should be made to the Plan’s Privacy Official.
Right to Request Confidential Communications
The Plan will accommodate reasonable requests to receive communications of PHI by alternative means or at alternative locations if necessary to prevent a disclosure that could endanger you.
You or your personal representative will be required to submit a written request to exercise this right.
Such requests should be made to the Plan’s Privacy Official.
Right to Inspect and Copy PHI
You have a right to inspect and obtain a copy of your PHI contained in a “designated record set,” for as long as the Plan maintains the PHI. If the information you request is in an electronic designated record set, you may request that these records be transmitted electronically to yourself or a designated individual.
Protected Health Information (PHI)
Includes all individually identifiable health information transmitted or maintained by the Plan, regardless of form.
Designated Record Set
Includes the medical records and billing records about individuals maintained by or for a covered health care provider; enrollment, payment, billing, claims adjudication and case or medical management record systems maintained by or for the Plan; or other information used in whole or in part by or for the Plan to make decisions about individuals. Information used for quality control or peer review analyses and not used to make decisions about individuals is not in the designated record set.
The requested information will be provided within 30 days if the information is maintained on site or within 60 days if the information is maintained off site. A single 30-day extension is allowed if the Plan is unable to comply with the deadline.
You or your personal representative will be required to submit a written request to request access to the PHI in your designated record set. Such requests should be made to the Plan’s Privacy Official.
If access is denied, you or your personal representative will be provided with a written denial, setting forth the basis for the denial, a description of how you may appeal the Plan’s decision and a description of how you may complain to the Secretary of the U.S. Department of Health and Human Services.
The Plan may charge a reasonable, costbased fee for copying records at your request.
Right to Amend PHI
You have the right to request the Plan to amend your PHI or a record about you in your designated record set for as long as the PHI is maintained in the designated record set.
The Plan has 60 days after the request is made to act on the request. A single
30-day extension is allowed if the Plan is unable to comply with the deadline. If the request is denied in whole or part, the Plan must provide you with a written denial that explains the basis for the denial. You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of your PHI. Such requests should be made to the Plan’s Privacy Official.
You or your personal representative will be required to submit a written request to request amendment of the PHI in your designated record set.
Right to Receive an Accounting of PHI Disclosures
At your request, the Plan will also provide you an accounting of disclosures by the Plan of your PHI during the six years prior to the date of your request. However, such accounting will not include PHI disclosures made: (1) to carry out treatment, payment or health care operations; (2) to individuals about their own PHI; (3) pursuant to your authorization; (4) prior to April 14, 2003; and (5) where otherwise permissible under the law and the Plan’s privacy practices. In addition, the Plan need not account for certain incidental disclosures.
If the accounting cannot be provided within 60 days, an additional 30 days is allowed if the individual is given a written statement of the reasons for the delay and the date by which the accounting will be provided.
If you request more than one accounting within a 12-month period, the Plan will charge a reasonable, cost-based fee for each subsequent accounting.
Such requests should be made to the Plan’s Privacy Official.
Right to Receive a Paper Copy of This Notice Upon Request
You have the right to obtain a paper copy of this Notice. Such requests should be made to the Plan’s Privacy Official.
A Note About Personal Representatives
You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your PHI or allowed to take any action for you. Proof of such authority may take one of the following forms:
1. a power of attorney for health care purposes;
2. a court order of appointment of the person as the conservator or guardian of the individual; or
3. an individual who is the parent of an unemancipated minor child may generally act as the child’s personal representative (subject to state law).
The Plan retains discretion to deny access to your PHI by a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect.
Section 3 – The Plan’s Duties
The Plan is required by law to maintain the privacy of PHI and to provide individuals (participants and beneficiaries) with notice of the Plan’s legal duties and privacy practices.
This Notice is effective September 23, 2013, and the Plan is required to comply with the terms of this Notice. However, the Plan reserves the right to change its privacy practices and to apply the changes to any PHI received or maintained by the Plan prior to that date. If a privacy practice is changed, a revised version of this Notice will be provided to all participants for whom the Plan still maintains PHI. The revised Notice will be distributed in the same manner as the initial Notice was provided or in any other permissible manner.
If the revised version of this Notice is posted, you will also receive a copy of the Notice or information about any material change and how to receive a copy of the Notice in the Plan’s next annual mailing. Otherwise, the revised version of this Notice will be distributed within 60 days of the effective date of any material change to the Plan’s policies regarding the uses or disclosures of PHI, the individual’s privacy rights, the duties of the Plan or other privacy practices stated in this Notice.
Minimum Necessary Standard
When using or disclosing PHI or when requesting PHI from another covered entity, the Plan will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations. When required by law, the Plan will restrict disclosures to the limited data set, or otherwise as necessary, to the minimum necessary information to accomplish the intended purpose.
However, the minimum necessary standard will not apply in the following situations:
1. disclosures to or requests by a health care provider for treatment;
2. uses or disclosures made to the individual;
3. disclosures made to the Secretary of the U.S. Department of Health and Human Services;
4. uses or disclosures that are required by law; and
5. uses or disclosures that are required for the Plan’s compliance with legal regulations.
De-Identified Information
This notice does not apply to information that has been de-identified. De-identified information is information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual.
Summary Health Information
The Plan may disclose “summary health information” to the Trustees for obtaining insurance premium bids or modifying, amending or terminating the Plan.
“Summary health information” summarizes the claims history, claims expenses or type of claims experienced by participants and excludes identifying information in accordance with HIPAA.
Notification of Breach
The Plan is required by law to maintain the privacy of participants’ PHI and to provide individuals with notice of its legal duties and privacy practices. In the event of a breach of unsecured PHI, the Plan will notify affected individuals of the breach.
Section 4 – Your Right to File a Complaint With the Plan or the HHS Secretary
If you believe that your privacy rights have been violated, you may complain to the Plan. Such complaints should be made to the Plan’s Privacy Official.
You may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, D.C. 20201. The Plan will not retaliate against you for filing a complaint.
Section 5 – Whom to Contact at the Plan for More Information
If you have any questions regarding this notice or the subjects addressed in it, you may contact the Plan’s Privacy Official.
Such questions should be directed to the Plan’s Privacy Official at:
Allen ISD Human Resources
612 E. Bethany Drive Allen, TX 75002
972-727-0530
Conclusion
PHI use and disclosure by the Plan is regulated by a federal law known as HIPAA (the Health Insurance Portability and Accountability Act). You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. The Plan intends to comply with these regulations. This Notice attempts to summarize the regulations. The regulations will supersede any discrepancy between the information in this Notice and the regulations.
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.
To see if any other States have added a premium assistance program since January 31, 2026, or for more information on special enrollment rights, 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
Continuation of Coverage Rights Under COBRA
Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the Allen ISD group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Allen 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
Allen ISD Human Resources
Michelle Lofton 612 E. Bethany Drive Allen, TX 75002 972-727-0530
This brochure highlights the main features of the Allen 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. Allen ISD reserves the right to change or discontinue its employee benefits plans at anytime.
