EMPLOYEE BENEFITS GUIDE
2026
A comprehensive guide to understanding your employee benefits program
IMPORTANT CONTACTS Program
Provider
Phone/Fax
Website/Email
Medical
Assured Benefits Administrators
800-247-7114
www.abadmin.com
Pharmacy Benefits
Liviniti (formerly Southern Scripts)
800-710-9341
www.liviniti.com
Pain Therapy
Hinge Health
855-902-2777
hello@hingehealth.com
Patient Navigator/ FREE Care
Trinity Care
423-824-2273
free@tcnavigator.com
24/7 Telemedicine
MediOrbis
N/A
Access via TC Navigator App
Dental
Guardian Group #00073439
888-600-1600
www.guardianlife.com
Vision
Guardian/Davis Group #00073439
877-393-7363
www.guardianlife.com
Flexible Spending Accounts
Higginbotham
Phone – 866-419-3519 Fax – 866-419-3516
https://flexservices.higginbotham.net flexclaims@higginbotham.net
Virtual Behavioral Health
BetterHelp
888-688-9296
https://www.betterhelp.com/scs contact@betterhelp.com
Life and AD&D Insurance
Guardian Group #00073439
800-525-4542
www.guardianlife.com
Long Term Disability Short Term Disability
Guardian Group #00073439
800-538-4583 800-268-2525
www.guardianlife.com
Accident Insurance
Guardian Group #00073439
800-541-7846
www.guardianlife.com
Critical Illness
Guardian Group #00073439
800-541-7846
www.guardianlife.com
Hospital Indemnity
Guardian Group #00073439
800-541-7846
www.guardianlife.com
ID Theft Protection
LegalShield/IDShield
888-807-0407
memberservices@pplsi.com shieldbenefits.com/swchristianschool
Employee Assistance Program
ComPsych Guidance Resources/Guardian
855-239-0743
guidanceresources.com
Travel Assistance
Assist America/ Guardian Reference number 01-AA-GLI-10231
800-872-1414 (within the US) 609-986-1234 (outside the US)
medservices@assistamerica.com
Pet Insurance
Nationwide
877-738-7874
https://benefits.petinsurance.com/ southwestchristian
403(b) Retirement Plan
Principal
800-547-7754
www.principal.com
Employee Response Center Employee benefits can be complicated. The Higginbotham Employee Response Center can assist you with the following: Enrollment Benefits information 2
Southwest Christian School
Claims or billing questions Eligibility issues
Call 888-418-7271 to speak with a representative Monday through Friday from 7:00 a.m. to 6:00 p.m. CT. If you leave a voicemail message after 3:00 p.m. CT, your call will be returned the next business day. You can also email questions or requests to scsbenefits@higginbotham.net. Bilingual representatives are available.
WHAT’S INSIDE THIS GUIDE Contents Important Contacts
2
Welcome
4
Eligibility
5
Enrollment
6
Medical Coverage
7
Navigating Your Medical Benefits
9
Medical Benefits
10
24/7 Telemedicine
11
Dental Coverage
12
Vision Coverage
14
Flexible Spending Accounts
15
List of Qualified FSA Expenses
17
Life and AD&D Insurance
18
Disability Insurance
19
Supplemental Insurance
20
Counseling Services
22
Pet Health Insurance
23
Legal and ID Theft Services
24
Additional Benefits
25
Luann Yarberry
Retirement Plan
26
940-228-0338
Glossary of Terms
27
Your Contributions
28
Important Notices
29
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 29 for more details. If you are Medicare-eligible, a dedicated team will help you with Medicare Supplements, Medicare Advantage plans, and Part D drug analysis and quotes. The team will guide you through the Medicare enrollment process and any analysis needed when comparing your group benefits to Medicare.
Contacts If age 65+, contact:
lyarberry@higginbotham.net If under age 65, contact: Megan Neff 940-228-0414 mneff@higginbotham.net
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WELCOME What’s New in 2026 You must enroll for coverage this year as some of our benefits changed. Starting in 2026, there will be one medical plan available — the Prime PPO. Please review the details carefully during enrollment.
We are pleased to offer a full benefits package to help protect your well-being and financial health. Read this guide to learn about the benefits available to you and your eligible dependents. Each year during Open Enrollment, you may make changes to your benefit plans. The benefit choices you make this year will remain in effect from January 1, 2026, through December 31, 2026. Take time to review these benefit options and select the plans that best meet your needs. After Open Enrollment, you may only make changes to your benefit elections if you have a Qualifying Life Event.
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Availability of Summary Health Information Your plan offers one health coverage option. To help you make an informed choice and compare your options, Summary of Benefits and Coverage documents (SBCs) are available at www.benefitsinhand.com or by contacting Human Resources.
ELIGIBILITY You are eligible for benefits if you are a regular, full-time employee scheduled to work at least 30 hours per week. If you are a new hire, your coverage is effective on the first of the month following your date of hire. You may also enroll eligible dependents for benefits coverage. The cost for coverage depends on the number of dependents you enroll and the benefits you choose. When covering dependents, you must select and be on the same plans.
Eligible Dependents Your legal spouse Children under the age of 26 regardless of student, dependency, or marital status Children over the age of 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
Qualifying Life Events Once you elect your benefit options, they remain in effect for the entire plan year until the following Open Enrollment. You may only change coverage during the plan year if you have a Qualifying Life Event, some of which include: Marriage, divorce, legal separation, or annulment Birth, adoption, or placement for adoption of an eligible child Death of your spouse or child Change in your spouse’s employment status that affects benefits eligibility Change in your child’s eligibility for benefits Significant change in benefit plan coverage for you, your spouse, or child FMLA leave, COBRA event, or court judgment or decree Becoming eligible for Medicare, Medicaid, or TRICARE Receiving a Qualified Medical Child Support Order If you have a Qualifying Life Event and want to change your elections, you must notify Human Resources and complete your changes within 30 days of the event. You may be asked to provide documentation to support the change. Contact Human Resources for details.
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ENROLLMENT Online Enrollment Instructions To begin the enrollment process, go to www.benefitsinhand.com. First-time users, follow steps 1-4. Returning users, log in and start at step 5. 1. If this is your first time to log in, click on the New User Registration link. Once you register, you will use your username and password to log in. 2. Enter your personal information and Company Identifier of SouthwestCS and click Next. 3. Create a username (work email address recommended) and password, then check the I agree to terms and conditions box before you click Finish. 4. If you used an email address as your username, you will receive a validation email to that address. You may now log in to the system. 5. Click the Start Enrollment button to begin the enrollment process.
Assured Benefits Administrators Member Portal Register for an account on the Assured Benefits Administrators (ABA) member portal to have one place to go to view claims, view deductibles and maximums, access ID cards, download important documents, update member information, and more. To create a user account, complete the following steps: 1. Visit www.abadmin.com and click Register.
6. Confirm or update your personal information and click Save & Continue.
2. Choose Member from the dropdown menu.
7. Edit or add dependents who need to be covered on your benefits. Once all dependents are listed, click Save & Continue.
3. Read and accept the statement, then click Next to continue.
8. Follow the steps on the screen for each benefit to make your selection. Please notice there is an option to Decline Coverage. If you wish to decline, click the Don’t want this benefit? button and select the reason for declining. 9. Once you have elected or declined all benefits, you will see a summary of your selections. Click the Click to Sign button. Your enrollment will not be complete until you click the Click to Sign button.
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Have questions about your benefits or need help enrolling? Call the Employee Response Center at 888-418-7271 or email scsbenefits@higginbotham.net. Benefits experts are available to take your call Monday through Friday from 7:00 a.m. to 6:00 p.m. CT.
Southwest Christian School
4. Complete all required fields with your information and create your login credentials. Click Next. Get the MyABA mobile app to make it even easier and more convenient to access your account information. For assistance, call ABA Customer Service at 800-247-7114 Monday through Friday from 8:00 a.m. to 6:00 p.m. CT.
MEDICAL COVERAGE The medical plan option through Assured Benefits Administrators (ABA) protects you and your family from major financial hardship in the event of illness or injury. You have the option of one Preferred Provider Organization (PPO) plan that uses the UnitedHealthcare Choice Plus provider network.
Your Health Care Concierge Call TC Patient Navigator first! Whenever you need medical services or care, call Patient Navigator at 423-824-2273 first to help you find the best care for little to no cost and to be your health care advocate. See details on page 9.
Prime Plan A PPO allows you to see any provider when you need care. When you see in-network providers for care, you will pay less and get the highest level of benefits. You will pay more for care if you use out-of-network providers.
Find an In-Network Provider Online – www.welcometouhc.com
Contact ABA Online – www.abadmin.com Phone – 800-247-7114
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MEDICAL COVERAGE The medical benefits below show your cost for using the UnitedHealthcare Choice Plus provider network. Out-of-network benefits will cost more. See page 9 for details on $0 out-of-pocket benefits through Patient Navigator.
Prime Plan In-Network Network Calendar Year Deductible Individual Family
UnitedHealthcare Choice Plus $3,000 $6,000
Calendar Year Out-of-Pocket Maximum (includes deductible) Individual Family
Coinsurance
$7,500 $15,000 20% You Pay
Preventive Care
$0
Virtual Care
$10
Primary Care Physician
$20
Specialist
$20
Urgent Care
$25
Diagnostic X-ray and Lab
$0*
Complex Imaging (CT/PET scan, MRI)
20%**
Emergency Room
Copay waived if admitted
$300 + 20%**
Inpatient Hospital Services
20%**
Outpatient Services
20%**
Retail Pharmacy (up to a 30-day supply) Tier 1 Tier 2 Tier 3 Specialty
$15 $40 $75 applicable cost share
Mail Order Pharmacy (up to a 90-day supply) Tier 1 Tier 2 Tier 3 Specialty
* $0 if done in a provider’s office ** What you will pay after your deductible is met.
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$45 $120 $225 applicable cost share
NAVIGATING YOUR MEDICAL BENEFITS
Eligibility, Billing, and Claims
Assured Benefits Administrators (ABA) ABA administers all of our medical benefits and claims. You have access to UnitedHealthcare’s network of providers. ABA Member Website and App Visit www.abadmin.com or download the MyABA app to: View claims and Explanation of Benefits (EOB) Check your eligibility View deductibles, out-ofpocket maximums, copays, and coinsurance Access ID cards Download important documents Update member information Questions about a bill or claim?
Your One-stop Benefits App
$0 Cost Treatment and Procedures!
TC Navigator
Patient Navigator
Download the TC Navigator App
Need one of the following treatments or procedures? Call ahead and get it at NO COST. A Trinity Care patient navigator will help you find a provider, set up appointments, and take care of all billing and claims.
Chat with a Care Guide to: • Save time and money on services • Get a referral • Schedule an appointment • Answer your benefits questions Get on-demand virtual care See your medical information Digital ID cards View and download documents Scan the code to download the TC Navigator app.
Surgery Imaging Colonoscopy Upper endoscopy test Physical therapy Durable medical equipment Specialty medication Maternity program (free diapers and wipes!) Mammogram Call 423-824-2273 or email free@tcnavigator.com to learn more or get started.
If you used the ABA website or app and still need help, call 800-247-7114.
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MEDICAL BENEFITS Pharmacy Coverage You have prescription benefits through Liviniti using the FirstChoice pharmacy network. To get the most benefits at the lowest cost, register on the Liviniti member portal at www.liviniti.com. Log in to manage all aspects of your prescription drug benefits and to access: FirstChoice Pharmacies – Use the local and national pharmacies that participate in this preferred network to get products and services at discounted rates. Use the Pharmacy Locator on the portal to find a FirstChoice, specialty, or mail order pharmacy near you. Price-check Tool – Get price estimates at any pharmacy in a few easy steps. Formulary – See a comprehensive list of preferred medications covered under our medical plans. Mail order is available through Postal Prescription Services (PPS) for new prescriptions, transfers, refills, and order status. You must register for an account at www.ppsrx.com. Call 800-552-6694 if you have questions.
Contact Liviniti Visit www.liviniti.com. Call 800-710-9341. Download the Liviniti app. Log in with your Liviniti BIN: 015433; Group Code: On your Insurance/ Rx card.
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Joint and Muscle Pain Management Hinge Health can help relieve your joint and muscle pain with personalized exercise therapy – at no cost to you! Your remote care may be done in the comfort of your own home. Get unlimited 1-on-1 health coaching and free motiontracking technology for instant form correction. Average results show 68% pain reduction. Learn more and apply at free@tcnavigator.com or call 423-824-2273. Also available in Spanish.
24/7 TELEMEDICINE Your medical coverage offers telemedicine services through MediOrbis. Connect anytime day or night with a board-certified doctor via your mobile device or computer for about the same or lower cost as a visit to your regular physician.
Use telehealth services for minor conditions such as:
When to Use MediOrbis
Fever
While telemedicine does not replace your primary care physician, it is a convenient and cost-effective option when you need care and:
Sore throat Headache Stomachache Cold/Flu Allergies Urinary tract infections Do not use telemedicine for serious or lifethreatening emergencies.
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
Registration is Easy You can access MediOrbis telemedicine through the TC Navigator app. Be sure to register so you are ready to use this valuable service when you need it. Scan the code to download the TC Navigator app to your phone or mobile device.
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DENTAL COVERAGE Our dental plans through Guardian help you maintain good oral health through affordable options for preventive care, including regular checkups and other dental work. Both dental plan options offer access to large dental networks and two reimbursement levels. Base Plan – When you see an in-network provider, you will get the highest level of benefits. You will always save money with any dentist in Guardian’s network. If the dentist belongs to a tier in the Tier 1 reimbursement level, you will maximize your savings. Reimbursement for covered services received from a non-contracted dentist is based on Guardian’s fee schedule. Buy Up Plan – When you see an in-network provider, you will get the highest level of benefits. If the Guardian dentist belongs to a tier in the Tier 1 reimbursement level, you will maximize your savings. Reimbursement for covered services received from a non-contracted dentist will be based on a percentile of the prevailing fee data for the dentist’s ZIP code.
Maximum Rollover Program If you enroll in our dental plan, you will automatically be enrolled in the Guardian Maximum Rollover Program. This program rewards you for going to the dentist regularly to prevent or detect the early signs of serious diseases. If you submit a claim (without exceeding the paid claims threshold of a benefit year), Guardian will roll over part of your unused annual maximum into a Maximum Rollover Account (MRA). This can be used in future years if your plan’s annual maximum is reached. View your MRA statement at www.guardiananytime.com.
Example of How the Maximum Rollover Program Works Plan Annual Maximum
Threshold
Maximum Rollover Amount
Maximum Rollover Account Limit
$700 Claims amount that determines rollover eligibility
$350 $1,250 Additional dollars added to The limit that cannot be a plan’s annual maximum exceeded within the MRA for future years
HIGH PLAN $1,500 Maximum claims reimbursement
Find an In-Network Provider Look for Guardian DentalGuard Preferred network providers. Visit www.guardiananytime.com. Call 888-600-1600.
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DENTAL COVERAGE Base Plan Calendar Year Deductible Individual Family
In-Network
Out-of-Network
In-Network
Out-of-Network
$50 $150
$50 $150
$50 $150
$50 $150
Calendar Year Benefit Maximum Per Individual
Preventive and Diagnostic Care
Exams, cleanings, X-rays, fluoride treatments, sealants, space maintainers
Buy Up Plan
$750
$1,500
You Pay
You Pay
10%
10%
$0
$0
30%
30%
20%
20%
N/A
N/A
50%
50%
N/A
N/A
50%
50%
N/A
N/A
Basic Restorative Care
Fillings, simple extractions, oral surgery, endodontics, periodontics, repairs of bridges, crowns, and inlays
Major Restorative Care
Crowns, dentures, bridges, implants, TMJ
Orthodontia
Children before age 26
Maximum Rollover
Rollover Threshold Rollover Amount Rollover Account Limit
Orthodontia Lifetime Maximum
N/A
$700 $350 $1,250 $1,500
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VISION COVERAGE The Guardian vision plan offers quality care to help preserve your health and eyesight. Regular exams can detect certain medical issues such as diabetes and high cholesterol, in addition to vision and eye problems. You may seek care from any vision provider, but the plan will pay the highest level of benefits when you see in-network providers. Coverage is provided through the Davis Vision Network (Full Feature Plan).
Find an In-Network Provider Visit: www.guardianlife.com
Vision Plan In-Network
Out-of-Network
You Pay
Reimbursement
$10 copay
Up to $50
$10 copay $10 copay $10 copay $10 copay
Up to $48 Up to $67 Up to $86 Up to $126
$135 allowance; 20% off balance
Up to $48
$135 allowance; 15% off balance $0
Up to $105 Up to $210
EXAM
Once every 12 months Routine Examination
LENSES
Once every 12 months Single Vision Lined Bifocal Lined Trifocal Lenticular
FRAMES
Once every 24 months
CONTACTS (in lieu of eyeglasses) Once every 12 months Elective Necessary
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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. We offer two FSAs: one for health care expenses and one for dependent care expenses. Higginbotham administers our FSAs.
Health Care FSA The Health Care FSA covers qualified medical, dental, and vision expenses for you or your eligible dependents. You may contribute up to $3,400 annually to a Health Care FSA, and you are entitled to the full election from day one of your plan year. 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 a Health Savings Account (HSA).
How the Health Care FSA Works Use your Higginbotham Benefits Debit Card to pay for qualified expenses, doctor visits, and prescription copays. Pay out-of-pocket, and submit your receipts for reimbursement: • Fax – 866-419-3516 • Email – flexclaims@higginbotham.net • Online – https://flexservices.higginbotham.net
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 Overnight camps are not eligible for reimbursement (only day camps can be considered). If your child turns 13 mid-year, 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.
Important FSA Rules Qualified Expenses For an abbreviated list of qualified expenses, see page 17 or visit www.irs.gov for a complete description of eligible medical and dental expenses.
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FLEXIBLE SPENDING ACCOUNTS The maximum per plan year you can contribute to a Health Care FSA is $3,400. The maximum per plan year you can contribute to a Dependent Care FSA is $7,500 when filing jointly or head of household and $3,750 when married filing separately. You cannot change your election during the year unless you experience a Qualifying Life Event.
Your Health Care FSA debit card can be used for health care expenses only. It cannot be used to pay for dependent care expenses. Your Health Care FSA has a grace period. This allows you to incur and submit eligible expenses up to March 15, 2027.
Higginbotham Portal
Register on the Higginbotham Portal
The Higginbotham Portal provides information and resources to help you manage your FSAs.
Visit https://flexservices.higginbotham.net and click Get Started. Follow the instructions and scroll down to enter your information.
Access plan documents, letters and notices, forms, account balances, contributions, and other plan information. Update your personal information. Look up qualified expenses. Submit claims.
Enter your Employee ID, which is your Social Security number with no dashes or spaces. Follow the prompts to navigate the site. If you have any questions or concerns, contact Higginbotham: • Phone – 866-419-3519 • Email – flexclaims@higginbotham.net • Fax – 866-419-3516
Higginbotham Benefits Debit Card The Higginbotham Benefits Debit Card gives you immediate access to funds in your Health Care FSA when you make a purchase without needing to file a claim for reimbursement. If you use the debit card to pay for anything other than a copay amount, you will need to submit an itemized receipt or an Explanation of Benefits (EOB). If you do not submit your receipts, you will receive a request for substantiation. You will have 60 days to submit your receipts after receiving the request for substantiation before your debit card is suspended. Check the expiration date on your card to see when you should order a replacement card(s).
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LIST OF QUALIFIED FSA EXPENSES The products and services listed below are examples of medical expenses eligible for payment under your Health Care FSA and Dependent Care FSA. 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
Diathermy
Acupuncture
Drug addiction therapy
Nursing (including board and meals)
Obstetrician
Drugs (prescription)
Operating room costs
Elastic hosiery (prescription)
Ophthalmologist
Air conditioner (when necessary for relief from difficulty in breathing)
Psychotherapy
Radium therapy
Registered nurse
Special school costs for the handicapped
Optician
Spinal fluid test
Optometrist
Splints
Oral surgery
Surgeon
FICA and FUTA tax paid for medical care service
Organ transplant (including donor’s expenses)
Telephone or TV equipment to assist the hard-of-hearing
Orthopedic shoes
Therapy equipment
Fluoridation unit
Orthopedist
Transportation expenses (relative to health care)
Ultraviolet ray treatment
Vaccines
Vitamins (if prescribed)
Wheelchair
X-rays
Alcoholism treatment
Ambulance
Eyeglasses
Anesthetist
Arch supports
Fees paid to health institute prescribed by a doctor
Artificial limbs
Autoette (when used for relief of sickness/ disability)
Blood tests
Guide dog
Osteopath
Blood transfusions
Gum treatment
Braces
Gynecologist
Oxygen and oxygen equipment
Cardiographs
Healing services
Pediatrician
Chiropractor
Contact lenses
Physiotherapist
Hearing aids and batteries
Physician
Convalescent home (for medical treatment only)
Hospital bills
Podiatrist
Hydrotherapy
Postnatal treatments
Insulin treatment
Practical nurse for medical services
Prenatal care
Prescription medicines
Psychiatrist
Crutches
Lab tests
Dental treatment
Dental X-rays
Dentures
Lodging (away from home for outpatient care)
Dermatologist
Diagnostic fees
Metabolism tests
Psychoanalyst
Neurologist
Psychologist
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LIFE AND AD&D INSURANCE Life and Accidental Death and Dismemberment (AD&D) insurance through Guardian are important to your financial security, especially if others depend on you for support or vice versa. With Life insurance, you or your beneficiary(ies) can use the coverage to pay off debts such as credit cards, loans, and bills. AD&D coverage provides specific benefits if an accident causes bodily harm or loss (e.g., the loss of a hand, foot, or eye). If death occurs from an accident, 100% of the AD&D benefit would be paid to you or your beneficiary(ies).
Voluntary Life and AD&D You may buy more Life and AD&D insurance for you and your eligible dependents. If you do not elect Voluntary Life and AD&D 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. You must elect Voluntary Life and AD&D coverage for yourself before you may elect coverage for your spouse or children. If you leave the company, you may be able to take the insurance with you.
Life and AD&D Available Coverage
Basic Life and AD&D Basic Life and AD&D insurance are provided at no cost to you. You are automatically covered at 1x your annual salary, not to exceed $150,000 for each benefit.
Designating a Beneficiary A beneficiary is the person or entity you elect to receive the death benefits of your Life and AD&D insurance policies. You can name more than one beneficiary, and you can change beneficiaries at anytime. If you name more than one beneficiary, you must identify how much each beneficiary will receive (e.g., 50% or 25%).
Employee
Spouse
Child(ren)
•
Increments of $10,000 up to $500,000, not to exceed 5x annual salary
•
Guaranteed Issue: $100,000
•
Reduces 35% at employee’s age 65 and 50% at employee’s age 70
•
Increments of $5,000 up to $250,000, not to exceed 100% of employee’s benefit amount
•
Guaranteed Issue: $25,000
•
Coverage terminates at age 70
•
Increments of $2,000 up to $10,000
•
Birth to 13 days – $0
•
14 days to age 26 – $10,000
•
Guaranteed Issue: $10,000
Annual Increase (Employee Only)
Contact Guardian Call – 800-525-4542 Scan – Scan the QR code Visit – www.guardianlife.com
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You may annually elect to increase the amount of your insurance by $10,000 (one increment) without providing Evidence of Insurability. To be eligible, you must be insured under the policy at the time of request and actively employed. The election can only be made once a year at Open Enrollment and is subject to the Guaranteed Issue limit.
DISABILITY INSURANCE Disability insurance provides partial income protection if you are unable to work due to a covered accident or illness. We provide Short Term Disability (STD) and Long Term Disability (LTD) insurance at no cost to you through Guardian.
Short Term Disability
Long Term Disability LTD insurance pays a percentage of your monthly salary for a covered disability or injury that prevents you from working for more than 90 days. Benefits begin at the end of an elimination period and continue while you are disabled up to Social Security Normal Retirement Age (SSNRA).
Long Term Disability
STD coverage pays a percentage of your weekly salary if you are temporarily disabled and unable to work due to an illness, non-work-related injury, or pregnancy. STD benefits are not payable if the disability is due to a job-related injury or illness. If a medical condition is job-related, it is considered workers’ compensation, not STD.
Short Term Disability Benefits Begin
*
8th day
Percentage of Earnings You Receive
60%
Maximum Weekly Benefit
$2,000
Maximum Benefit Period
12 weeks
Pre-existing Condition Exclusion
Benefits Begin
91st day
Percentage of Earnings You Receive
60%
Maximum Monthly Benefit
$7,500
Maximum Benefit Period
SSNRA
Pre-existing Condition Exclusion
3/12*
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.
N/A
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SUPPLEMENTAL INSURANCE Voluntary Accident Insurance Accident insurance from Guardian provides affordable protection against a sudden, unforeseen accident that occurs on or off the job. This coverage helps offset the direct and indirect expenses resulting from an accident such as copayments, deductibles, ambulance, physical therapy, and other costs not covered by traditional health plans. The following includes a few examples of the benefits paid for covered services.
Service
Benefit
Emergency Room Treatment Ambulance – Ground/Air
$250 $300/$1,500
Hospital Admission Hospital Confinement
$1,500 $300 per day – up to a year
Intensive Care Unit Admission
$3,000
Intensive Care Unit Confinement
$600 per day – up to 15 days
Specific Sum Injuries
Dislocations, ruptured discs, eye injuries, fractures, lacerations, concussions, etc.
$50 - $12,500
Employee
$40,000
Spouse
$20,000
Child
$10,000
*Percentage of benefit paid for dismemberment is dependent on type of loss.
covered person per year)
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The Hospital Indemnity plan provided through Guardian helps you with the high cost of medical care by paying you a set amount when you have an inpatient hospital stay. Unlike traditional insurance, which pays a benefit to the hospital or doctor, this plan pays you directly based on the care or treatment that you receive. These costs may include meals and transportation, childcare, or time away from work due to a medical issue that requires hospitalization.
Service
Benefit
Hospital Admission
$1,000 per admission (limit 2 per insured)
ICU Admission
$2,000 per admission (limit 2 per insured)
Hospital/ICU Confinement*
$100/$200 per day
Newborn Nursery Care Confinement
Payable only if child is admitted to the Neonatal ICU
Health Screening Benefit
$50 per insured per calendar year
* Limited to a combined total of 30 days per policy year.
Accidental Death & Dismemberment*
Wellness benefit (one per
Voluntary Hospital Indemnity Insurance
$50
SUPPLEMENTAL INSURANCE Voluntary Critical Illness Insurance Critical Illness insurance from Guardian helps pay the cost of nonmedical 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 pay for out-of-pocket costs and daily cost of living such as lost income, out-of-town treatments, special diets, household upkeep costs, home modifications, and more. When you turn 70, the original amount of insurance will reduce to 50% for both you and your spouse.
Benefit Amounts Available Employee Spouse Child(ren)
$10,000 to $30,000 (in increments of $10,000) $10,000 to $30,000 (up to 100% of employee’s coverage) 50% of employee’s benefit
Condition
Benefit
Advanced Alzheimer’s Disease or Parkinson’s Invasive Cancer Heart Attack Stroke Coma Kidney or Organ Failure ALS
100% of benefit amount
Childhood/Developmental benefits for children only Cerebral Palsy Autism Spectrum Disorder Cleft Lip/Palate Down Syndrome Muscular Dystrophy Spina Bifida Type 1 Diabetes
100% of benefit amount
Carcinoma in Situ BRCA 1 & BRCA 2 Pulmonary Embolism Addison’s Disease Crohn’s Disease Lupus Ulcerative Colitis
30% of benefit amount
Health Screening Benefit one per covered person per year
$50
No health questions are required for Guaranteed Issue amounts! 2026 Employee Benefits Guide
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COUNSELING SERVICES Christian-Based Online Counseling
Employee Assistance Program
BetterHelp offers individual, couples, and teen therapy through the world’s largest online therapy platform. This service is available to ALL employees, regardless of your medical plan election.
The Employee Assistance Program (EAP) from ComPsych GuidanceResources helps you and family members cope with a variety of personal and work-related issues. This program provides confidential counseling and support services at little or no cost to you to help with:
This benefit is free of charge up to 12 sessions! Simply complete a brief questionnaire to find a therapist that suits your needs and preferences. Then, you can communicate weekly by phone, video, or life chat. Or text your therapist whenever you want.
Work-life balance Stress and anxiety Will preparation and estate resolution
12 annual therapy sessions – message, live chat, call and video chat with your therapist
Legal issues
Journaling – daily entries that may be shared with your therapist
Grief and loss
Classes – 65+ rotating topics with Listen & Learn style Groups – 500+ available via therapistfacilitated conversations
24 MINUTES
Average time for first available appointments
Financial issues Childcare and eldercare Parenting Substance abuse And more Get up to three face-to-face or virtual sessions per person, per issue, per year for emotional support. You can also get up to five coaching sessions to make positive lifestyle changes that support a healthy life and wellness.
Get Support Now
Contact the EAP
Visit https://www.betterhelp.com/help.
Call 855-239-0743 TRS: Dial 711, visit guidanceresources.com (Web ID: Guardian), or download the GuidanceNow app for support at any hour of the day or night.
Call 888-688-9296. Email contact@betterhelp.com.
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Relationships
Southwest Christian School
PET HEALTH INSURANCE You can purchase medical and preventive wellness insurance for your pets through Nationwide. Coverage is available for cats, dogs, birds, rabbits, reptiles, and other exotic animals. You can visit any veterinary clinic to receive a 50-80% reimbursement on your bills after a $250 deductible ($15,800 maximum annual benefit).
Optional Wellness Coverage
Pet Rx Express
You can adjust coverage by category or choose an accident-only plan.
Pet Rx Express can save you time and money at Walmart or Sam’s Club pharmacies. Download a digital pet insurance card at www.mypetinsurance.com and show the card at checkout for savings.
Preventive wellness coverage for dogs and cats includes vaccinations, flea protection, deworming, and the option of spay and neuter services or teeth cleaning. Coverage for birds is also available.
Flexible Plans and Pricing
Get Started •
Visit https://benefits.petinsurance.com/southwestchristian.
•
Call 877-738-7874.
•
Download the Nationwide VetHelpline app.
Plan Comparison Accident and Illness
Accident, Illness and Wellness
Customizable
Annual deductible
$250
$250
$100 to $500
Reimbursement
80%
80%
50%, 70%, or 80%
Accident coverage Annual maximum
$5,000
$5,000
$2,500 or $5,000
Get the Nationwide VetHelpline App
Illness coverage Annual maximum
Optional
$5,000
$5,000
$2,500 or $5,000
Hereditary and congenital conditions
Annual maximum
Optional when purchased with illness coverage
$2,500
$2,500
$2,500 or $5,000
Google Play
Wellness coverage (for dogs and cats)
Annual maximum
N/A
Optional Also available: Spay/neuter or dental and one additional test
$450
$450 or $800
App Store
Wellness coverage (for birds) Optional Annual maximum
N/A
N/A
$200, $300, or $500
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LEGAL AND ID THEFT SERVICES If you need guidance and assistance with legal consultation, family matters, or small claims court assistance, work with local plan attorneys through LegalShield. Protect your identity with IDShield. Legal Protection
Identity Theft Protection
Put a law firm in the palm of your hand with LegalShield. Get legal consultation on these types of issues:
Millions of people have their identity stolen each year. IDShield provides identity theft protection and identity restoration services for you, your spouse, and up to 10 dependents in these areas:
Family matters (adoption, elder care, juvenile court, prenuptial agreements) Financial (affidavits, consumer protection, tax audit and collection service, bankruptcy) Home (boundary or title disputes, deeds, foreclosure, mortgages) Estate planning (probate, trusts, wills and codicils, living wills) Auto (driver’s license restoration, moving traffic violations, motor vehicle property damage) General (24/7 emergency access, document review, demand letters and phone calls on your behalf, consultations)
Monitored information (email, phone, account numbers, names) Privacy and security monitoring (internet and dark web, social media) Comprehensive source monitoring (global black market, online chat rooms, social feeds) Unlimited consultation (child identity theft, credit reports, data breaches) Complete identity restoration ($1 million protection policy, unlimited service guarantee) General (24/7 emergency access, alerts, access to licensed private investigators) Financial account monitoring and a $1 million identity fraud protection plan
For More Information Call – Call a Member Services representative at 888-807-0407, Monday – Friday, 7:00 a.m. – 7:00 p.m. CT. Email – Email memberservices@pplsi.com with Group number 304293. Online – Access our microsite at shieldbenefits.com/swchristianschool.
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Southwest Christian School
ADDITIONAL BENEFITS The following programs and services are available through Guardian at no cost to you.
Travel Assistance You have emergency medical and travel assistance through Guardian and Assist America. The program is available when traveling 100 miles or more from your home. Services include: 24/7 Travel emergency assistance 24/7 ID theft protection services Medical emergency assistance Additional emergency assistance services (lost luggage, interpreter, etc.) And much more! See plan documents for full details.
Travel Emergency Assistance •
Reference number: 01-AA-GLI-10231
•
Call 800-872-1414 (within the US) or 609-986-1234 (outside the US)
•
Email: medservices@ assistamerica.com
•
Download: Assist America mobile app
Assist America must coordinate the services and support.
ID Theft Assistance
•
Access code: 18327
•
Call: 877-409-9597 (within the US) or 816-396-9192 (outside the US)
Cancer Support Get personal, empathetic support to help you navigate a cancer diagnosis. Guardian partners with Osara Health to bring cancer support services that can help you focus on your holistic well-being throughout your treatment. Because you have Guardian Long Term Disability Insurance as a benefit through Southwest Christian School, you have access to this unique 6- to 12-week program at no additional cost to you. The program offers a dedicated health coach, digital resource modules, and tailored well-being information. Guardian will proactively provide details about this service as part of the Disability claims process.
Estate Guidance Secure your wishes with a legally binding will. EstateGuidance makes drafting a will easy with online tools that walk you through the process in minutes. Draft a living will to ensure you get the end-of-life care you desire and a final arrangements document that states your wishes for your funeral services. There is a nominal fee for drafting and printing the legal documents. To learn more, call 855-239-0743, visit estateguidance.com, or get the GuidanceNow app (promo code: Guardian).
Caregiving Service The caregiving support offered through Guardian + Wellthy will tailor a plan for your caregiving needs. With the help of Guardian + Wellthy caregiving support services, you can plan for future care duties, get guidance for your current needs, or connect with others who are navigating care for similar situations. These may include childcare, eldercare, mental health and well-being, end of life issues, financial hardships, and more. Visit www.guardian-well.com to register for an account and access self-serve tools, resources, and dedicated support. Look for the Guardian + Wellthy page for more details.
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RETIREMENT PLAN A 403(b) plan can be a powerful tool to help you be financially secure in retirement. Our 403(b) plan through Principal can help you reach your investment goals. You are eligible to participate in the plan immediately after becoming a Southwest Christian School employee if you work 20 or more hours per week. You may contribute up to 100% of your salary with a maximum deferral of $23,000 for the current calendar year. If you are age 50 or older, you may make additional catchup contributions up to $7,500. You may increase or decrease your contributions at anytime online at www.principal.com. Southwest Christian School will match dollar for dollar up to 3% of your compensation, with the exclusion of catch-up contributions. You are 100% vested in your employee contributions, any rollover contributions, and the earnings they generate. Southwest Christian School contributions are also fully and immediately vested.
Contact Human Resources if you have any questions or need more information about the 403(b) retirement plan.
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Southwest Christian School
GLOSSARY OF TERMS Beneficiary – The person or entity that 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 Southwest Christian 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.
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 Allowance (R&C), 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. Reasonable and Customary Allowance (R&C) – 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.
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). In-Network – Doctors, hospitals, and other providers that contract with your insurance company to provide health care services at discounted rates. 2026 Employee Benefits Guide
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All benefit premiums are deducted over 26 pay periods, except the medical, dental, and vision benefits. These benefits get a “benefit holiday” and are only taken out 24 times a year.
YOUR CONTRIBUTIONS Medical
Prime Plan
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
$92.24 $503.70 $285.40 $715.17
$
Dental
Employee Only Employee + 1 Employee + 2
Low Plan
High Plan
$7.73 $13.71 $24.16
$22.32 $45.58 $74.21
$
Vision
Employee Only Employee + 1 Employee + 2
$3.02 $5.18 $9.07
$
Paid for by Southwest Christian School
$0
Basic Life and AD&D Insurance Voluntary Life and AD&D Insurance
$
See rates in BenefitsInHand
Voluntary Short Term and Long Term Disability Insurance Paid for by Southwest Christian School
$0
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
$6.24 $10.37 $10.77 $14.89
$
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
$9.49 $17.19 $15.30 $22.99
$
Voluntary Accident Insurance
Voluntary Hospital Indemnity Insurance
Voluntary Critical Illness Insurance
Employee* Monthly Rates per $1,000 $
See rates in BenefitsInHand
LegalShield / IDShield Employee Only Employee + Family
LegalShield Only
IDShield Only
LegalShield and IDShield
$7.52 $7.52
$3.00 $5.19
$10.06 $11.79
Pet Insurance
See page 23 for how to enroll and get a quote.
Total Per-paycheck Contributions * Employee/member and spouse premiums are calculated with the employee/member’s age.
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Southwest Christian School
$ $ $
IMPORTANT NOTICES Women’s Health and Cancer Rights Act of 1998
Your Prescription Drug Coverage and Medicare
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.
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Southwest Christian School 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.
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.
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.
Southwest Christian School has determined that the prescription drug coverage offered by the Southwest Christian School 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.
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: Southwest Christian School Heather Porter, Director of Human Resources 6801 Dan Danciger Rd Fort Worth TX, 76133 817-294-0350
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 Southwest Christian School 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 Southwest Christian School 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
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IMPORTANT NOTICES 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 817-294-0350 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 877486-2048.
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). January 1, 2026 Southwest Christian School Heather Porter, Director of Human Resources 6801 Dan Danciger Rd Fort Worth TX, 76133 817-294-0350
Notice of HIPAA Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan – whether received in writing, in an electronic medium or as oral communication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by Southwest Christian School, hereinafter referred to as the plan sponsor.
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Southwest Christian School
The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules apply to the Plan, not the plan sponsor as an employer. You have the right to inspect and copy protected health information which is maintained by and for the Plan for enrollment, payment, claims and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask the Human Resources Department to amend the information. For a full copy of the Notice of Privacy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources Department. Complaints: If you believe your privacy rights have been violated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer. Southwest Christian School Heather Porter, Director of Human Resources 6801 Dan Danciger Rd Fort Worth TX, 76133 817-294-0350
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
IMPORTANT NOTICES assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866444-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 July 31, 2025. Contact your State for more information on eligibility.
Texas – Medicaid Website: https://www.hhs.texas.gov/services/financial/ health-insurance-premium-payment-hipp-program Phone: 1-800-440-0493
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-of-network provider.
You are protected from balance billing for: •
Emergency services – If you have an emergency medical condition and get emergency services from an out-of-network 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.
To see if any other States have added a premium assistance program since July 31, 2025, 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
Continuation of Coverage Rights Under COBRA Under the Federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), if you are covered under the Southwest Christian School group health plan you and your eligible dependents may be entitled to continue your group health benefits coverage under the Southwest Christian School 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 Southwest Christian School Heather Porter, Director of Human Resources 6801 Dan Danciger Rd Fort Worth TX, 76133 817-294-0350
Your Rights and Protections Against Surprise Medical Bills
If you get other services at these in-network facilities, out-of-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-ofnetwork providers and facilities directly.
•
Your health plan generally must:
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
•
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
•
Cover emergency services by out-of-network providers.
What is “balance billing” (sometimes called “surprise billing”)?
•
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-ofnetwork services toward your deductible and out-of-pocket limit.
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
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.
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This brochure highlights the main features of the Southwest Christian School 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. Southwest Christian School reserves the right to change or discontinue its employee benefits plans at anytime.