2016 - 2017 - denton isd · 2016 - 2017 10-14 hour/vip/substitute ... 556-1555 . beginning right...

2016 - 2017

10-14 Hour/VIP/Substitute Employee Benefits Guide

Denton ISD Insurance Department

P. O. Box 1951 1314 N. Bolivar

Denton, TX 76202

www.usebsg.com

940-369-0028 940-369-4980 fax

[email protected] www.dentonisd.org

http://www.usebsg.com/

mailto:[email protected]

http://www.dentonisd.org/

CONTACT INFORMATION Superior Vision: Group # 31823 PO Box 967, Rancho Cordova, CA 95741 (800) 507-3800 www.superiorvision.com

Lincoln Financial Life: Basic Life Policy # 000010176512 Voluntary Life Policy # 000400176513 P. O. Box 2649, Omaha, NE 68103-2649 (800) 487-1485 Fax (800) 819-1987 www.lincolnfinancial.com

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TRS ActiveCare - Aetna: Customer Service (800) 222-9205 www.trsactivecareaetna.com 24-Hour Nurse Information Line (800) 556-1555 Beginning Right Maternity Management Program (800) 272-3531 Caremark Prescription Benefits: (800) 222-9205 www.caremark.com/trsactivecare Teladoc: (855) 835-2362

Mental Health/Sub Abuse: (800) 424-4047

TRS ActiveCare Scott & White HMO (800)-321-7947 TTY/TTD (800) 735-2989 Fax (254) 298-3385 Nurse Advice Line (877) 505-7947

www.trs.swhp.org

Standard Dental: Group Policy # 160-751174 P.O. Box 82622 Lincoln NE 68501-2622 (800) 547-9515 www.standard.com/dental

Standard Disability: Policy # 751174-A P. O. Box 2800, Portland, OR 97208 (855) 757-4717

www.standard.com

Colonial Cancer: Policy # G0012603 P. O. Box 10095, Columbia, SC 29202 - 3195 (800) 325-4368 Fax (800) 880-9325 www.coloniallife.com

TASC Flexible Spending Accounts 2302 International Lane, Madison, WI 53704

(800) 422-4661 www.tasconline.com

Employee Assistance Program (EAP): (877) 851-1631 www.eapbda.com

U.S. Employee Benefits Services Group: Keith Noel (877) 730-7780 / (972) 772-0900 www.usegsg.com

DENTON ISD INSURANCE DEPARTMENT

P.O. Box 1951, 1314 N. Bolivar Denton, TX 76202

(940) 369-0028 [email protected]

www.dentonisd.org

http://www.superiorvision.com/

http://www.trsactivecareaetna.com/

http://www.caremark.com/trsactivecare

http://www.superiorvision.com/

http://www.coloniallife.com/



http://www.tasconline.com/

http://www.eapbda.com/


INTRODUCTION

This booklet is designed to highlight the benefits. It is not a summary plan description (SPD).

Official plan and insurance documents actually govern your rights and benefits under each plan.

For more details about your benefits, including covered expenses, exclusions and limitations please

refer to the SPD for each benefit plan.

If any discrepancy exists between this booklet and the official documents, the official documents SPD will prevail.

U.S. Employee Benefits Services Group (USEBSG) is the nation’s leading independent provider and administrator of employer-sponsored benefits and retirement plans in the school district

market place. We serve over 400 ISDs in Texas and are endorsed by TACS. Our focus is on developing comprehensive programs providing affordable solutions for

Denton Independent School District benefits, online enrollment and retirement plan needs. We have 25 years of experience and over 1,000,000 clients across the nation.

Keith Noel (877) 730-7780 / (972) 772-0900

www.usebsg.com


GENERAL INFORMATION

Denton ISD offers a wide range of benefits to eligible employees and their family members. All eligible employees will either go online or come to the Insurance Department to enroll or decline/waive.

You will be required to provide the name, date of birth and social security number for any dependents (this includes spouse) that are listed. You will not be allowed to enroll without all the required information.

If you are a new or newly eligible employee, you have 31 days from your date of employment (start date) to enroll in benefits.

In the event that you do not enroll by the

31st day, your next window of opportunity to

enroll in benefits will be during annual open enrollment.

The plan options and coverage levels you select for the 2016 - 2017 plan year will remain in effect from September 1, 2016 through August 31, 2017.

All eligible employees, including active, contributing TRS members, employees regularly working 10 hours per week and Substitutes, MUST either enroll for coverage or decline/waive coverage.

You can only add or change coverage during the year if you have a Qualified Family Status Change/Special Enrollment event such as: marriage, divorce, birth or adoption, death, court order (child(ren) coverage only), gain or loss of coverage due to employment change.

You must submit all required documentation and make your plan changes online within 31 c a l e n d a r days from the date of the event.

As an active, full time or part time, benefits eligible employee you will receive basic life from the district, at no cost.

There are certain benefits that are offered on a guaranteed issue basis. This means that if you sign up as a new employee you will not be denied coverage. If you do not enroll and later decide to, you may be required to answer medical questions and coverage could be denied.

You will enroll in or decline/waive all benefit options through our N E W online enrollment system InRoll Plus, at www.inrollplus.com/dentonisd or come by the Insurance Department.

When signing up online please remember to:

Verify all information for yourselfand all dependents.

Only the dependents listed in In-Roll Plus will be eligible forbenefits.

Under each benefit section, youmust enroll in or decline/waivecoverage for yourself and eachlisted dependent spouse and/orchild.

You MUST click on the CompleteEnrollment Option at the bottom ofyour Confirmation Statement to saveand complete the processing of yourbenefit choices. IF YOU DO NOT, ALLbenefits not elected for theupcoming year will end the last dayin August of the prior plan year.

http://www.inrollplus.com/dentonisd

http://www.in-roll.com/

HOW DO I ENROLL ONLINE?

You will sign up for all benefits through our online enrollment system,

www.inrollplus.com/dentonisd or come by the Denton ISD Insurance Dept. during business hours, no appointment needed.

Creating Your Account

The first time you log in to InRoll Plus, you must enter your last name, last four digits of your social security number and your date of birth under the New User? Section of the Create Your Account page. You may also view the Login Video Tutorial for step by step instructions.

You will then be prompted to Create Your Account. You will choose a User Name and Password as well as two Security Questions in order to register.


TRS ActiveCare Medical Plan NameMonthly

Premium

District

Contribution per

Month

Monthly Paid

Employees

Payroll

Deduction

24 Pay Periods

with Ins.

Deductions

Payroll

Deduction

16 Pay Periods

with Ins.

Deductions

Payroll

Deduction

PART-TIME 10-14

SUBSTITUTES

(NO DISTRICT

CONTRIBUTION)

Ineligible for

payroll deductions

ActiveCare 1HD

EE (employee only) $341.00 $260.00 $81.00 $40.50 $60.75 $341.00

ES (employee + spouse) $914.00 $260.00 $654.00 $327.00 $490.50 $914.00

EC (employee + child(ren) $615.00 $260.00 $355.00 $177.50 $266.25 $615.00FAM (family) $1,231.00 $260.00 $971.00 $485.50 $728.25 $1,231.00ActiveCare 1 Split Premium

ES (employee + spouse) $457.00 $260.00 $197.00 $98.50 $147.75

FAM (family) $615.50 $260.00 $355.50 $177.75 $266.63ActiveCare 1 Pooling


FAM (family) $1,231.00 $520.00 $711.00 $355.50 $533.25

ActiveCare Select

EE (employee only) $484.00 $260.00 $224.00 $112.00 $168.00 $484.00

ES (employee + spouse) $1,147.00 $260.00 $887.00 $443.50 $665.25 $1,147.00

EC (employee + child(ren) $779.00 $260.00 $519.00 $259.50 $389.25 $779.00

FAM (family) $1,361.00 $260.00 $1,101.00 $550.50 $825.75 $1,361.00ActiveCare Select Split Premium


FAM (family) $680.50 $260.00 $420.50 $210.25 $315.38ActiveCare Select Pooling

ES (employee + spouse) $1,147.00 $520.00 $627.00 $313.50 $470.25

FAM (family) $1,361.00 $520.00 $841.00 $420.50 $630.75

ActiveCare 2

EE (employee only) $645.00 $260.00 $385.00 $192.50 $288.75 $645.00

ES (employee + spouse) $1,552.00 $260.00 $1,292.00 $646.00 $969.00 $1,552.00

EC (employee + child(ren) $1,042.00 $260.00 $782.00 $391.00 $586.50 $1,042.00

FAM (family) $1,597.00 $260.00 $1,337.00 $668.50 $1,002.75 $1,597.00ActiveCare 2 Split Premium


FAM (family) $798.50 $260.00 $538.50 $269.25 $403.88ActiveCare 2 Pooling

ES (employee + spouse) $1,552.00 $520.00 $1,032.00 $516.00 $774.00

FAM (family) $1,597.00 $520.00 $1,077.00 $538.50 $807.75

EE (employee only) $530.16 $260.00 $270.16 $135.08 $202.62 $530.16

ES (employee + spouse) $1,192.82 $260.00 $932.82 $466.41 $699.62 $1,192.82

EC (employee + child(ren) $839.16 $260.00 $579.16 $289.58 $434.37 $839.16FAM (family) $1,322.98 $260.00 $1,062.98 $531.49 $797.24 $1,322.98Scott & White Split Premium


FAM (family) $661.49 $260.00 $401.49 $200.75 $301.12Scott & White Pooling

ES (employee + spouse) $1,192.82 $520.00 $672.82 $336.41 $504.62

FAM (family) $1,322.98 $520.00 $802.98 $401.49 $602.24

2016 - 2017 TRS ACTIVECARE RATES

HMO - Scott & White Health Plan

SPOUSE WORKS IN A DIFFERENT PARTICIPATING DISTRICT

BOTH WORK FOR DISD AND ONE DECLINES COVERAGE







abridges

Highlight

2016 – 2017 TRS-ActiveCare Plan Highlights

TRS-0042 Plan Highlights_V11

Effective September 1, 2016 through August 31, 2017 | In-Network Level of Benefits*

Type of Service ActiveCare 1-HD ActiveCare Select or ActiveCare Select Whole Health(Baptist Health System and HealthTexas Medical Group; Baylor Scott & White Quality Alliance; Memorial Hermann Accountable Care Network; Seton Health Alliance)

ActiveCare 2

Deductible (per plan year)

$2,500 employee only$5,000 family

$1,200 individual$3,600 family


Out-of-Pocket Maximum (per plan year; does include medical deductible/any medical copays/coinsurance/any prescription drug deductible and applicable copays/coinsurance)

$6,550 individual$13,100 family (the individual out-of-pocket maximum only includes covered expenses incurred by that individual)



Coinsurance Plan pays (up to allowable amount)Participant pays (after deductible)

80%20%

80%20%

80%20%

Office Visit Copay Participant pays

20% after deductible $30 copay for primary$60 copay for specialist

$30 copay for primary$50 copay for specialist

Diagnostic LabParticipant pays

20% after deductible Plan pays 100% (deductible waived) if performed at a Quest facility; 20% after deductible at other facility

Plan pays 100% (deductible waived) if performed at a Quest facility; 20% after deductible at other facility

Preventive CareSee reverse side for a list of services

Plan pays 100% Plan pays 100% Plan pays 100%

Teladoc® Physician Services $40 consultation fee (applies to deductible and out-of-pocket maximum)

Plan pays 100% Plan pays 100%

High-Tech Radiology (CT scan, MRI, nuclear medicine) Participant pays

20% after deductible $100 copay plus 20% after deductible $100 copay plus 20% after deductible

Inpatient Hospital (preauthorization required) (facility charges)Participant pays

20% after deductible $150 copay per day plus 20% after deductible ($750 maximum copay per admission)

$150 copay per day plus 20% after deductible($750 maximum copay per admission; $2,250 maximum copay per plan year)

Emergency Room (true emergency use)Participant pays

20% after deductible $150 copay plus 20% after deductible (copay waived if admitted)

$150 copay plus 20% after deductible (copay waived if admitted)

Outpatient SurgeryParticipant pays

20% after deductible $150 copay per visit plus 20% after deductible

$150 copay per visit plus 20% after deductible

Bariatric SurgeryPhysician charges (only covered if performed at an IOQ facility)Participant pays

$5,000 copay plus 20% after deductible Not covered $5,000 copay (does not apply to out-of-pocket maximum) plus 20% after deductible

Prescription Drugs Drug deductible (per plan year)

Subject to plan year deductible $0 for generic drugs$200 per person for brand-name drugs

$0 for generic drugs$200 per person for brand-name drugs

Retail Short-Term (up to a 31-day supply)Participant pays• Generic copay• Brand copay (preferred list)• Brand copay (non-preferred list)

20% after deductible

$20$40**50% coinsurance**

$20$40**$65**

Retail Maintenance (after first fill; up to a 31-day supply)Participant pays• Generic copay• Brand copay (preferred list)• Brand copay (non-preferred list)



$35$60**$90**

Mail Order and Retail-Plus (up to a 90-day supply)Participant pays• Generic copay• Brand copay (preferred list)• Brand copay (non-preferred list)



$45$105**$180**

Specialty DrugsParticipant pays

20% after deductible 20% coinsurance per fill $200 per fill (up to 31-day supply)$450 per fill (32- to 90-day supply)

A specialist is any physician other than family practitioner, internist, OB/GYN or pediatrician. *Illustrates benefits when in-network providers are used. For some plans non-network benefits are also available; there is no coverage for non-network benefits under the ActiveCare Select or ActiveCare Select Whole Health Plan; see Enrollment Guide for more information. Non-contracting providers may bill for amounts exceeding the allowable amount for covered services. Participants will be responsible for this balance bill amount, which maybe considerable. **If the patient obtains a brand-name drug when a generic equivalent is available, the patient will be responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug.

TRS-ActiveCare Plans – Preventive Care

Preventive Care Services

In-Network BenefitsWhen Using In-Network Providers

(Provider must bill services as “preventive care”)

ActiveCare 1-HD ActiveCare Select or ActiveCare Select

Whole Health(Baptist Health System and

HealthTexas Medical Group; Baylor Scott & White Quality Alliance;

Memorial Hermann Accountable Care Network; Seton Health Alliance)

ActiveCare 2 Network

Evidence−based items or services that have in effect a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force (USPSTF) http://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations.Immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) with respect to the individual involved.Evidence−informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) for infants, children and adolescents. Additional preventive care and screenings for women, not described above, as provided for in comprehensive guidelines supported by the HRSA http://www.hhs.gov/healthcare/facts-and-features/fact-sheets/preventive-services-covered-under-aca/index.html#CoveredPreventiveServicesforAdults.For purposes of this benefit, the current recommendations of the USPSTF regarding breast cancer screening and mammography and prevention will be considered the most current (other than those issued in or around November 2009).The preventive care services described above may change as USPSTF, CDC and HRSA guidelines are modified.

Plan pays 100% (deductible waived)

Some examples of preventive care frequency and services:• Routine physicals – annually age

12 and over• Well-child care – unlimited up to

age 12• Well woman exam & pap smear –

annually age 18 and over• Mammograms – 1 every year age

35 and over• Colonoscopy – 1 every 10 years

age 50 and over• Prostate cancer screening –

1 per year age 50 and over• Smoking cessation counseling –

8 visits per 12 months• Healthy diet/obesity counseling –

unlimited to age 22; age 22 and over-26 visits per 12 months

• Breastfeeding support – 6 lactation counseling visits per 12 months

Plan pays 100% (deductible waived; no copay required)











Plan pays 100% (deductible waived; no copay required)











Examples of covered services included are:Routine annual physicals (one per year); immunizations; well-child care; breastfeeding support, services and supplies; cancer screening mammograms; bone density test; screening for prostate cancer and colorectal cancer (including routine colonoscopies); smoking cessation counseling services and healthy diet counseling; and obesity screening/counseling.Examples of covered services for women with reproductive capacity are:Female sterilization procedures and specified FDA-approved contraception methods with a written prescription by a health care practitioner, including cervical caps, diaphragms, implantable contraceptives, intra-uterine devices, injectables, transdermal contraceptives and vaginal contraceptive devices. Prescription contraceptives for women are covered under the pharmacy benefits administered by Caremark. To determine if a specific contraceptive drug or device is included in this benefit, contact Customer Service at 1-800-222-9205. The list may change as FDA guidelines are modified.

Annual Vision Examination (one per plan year; performed by an opthalmologist or optometrist using calibrated instruments)Participant pays

After deductible, plan pays 80%; participant pays 20%

$60 copay for specialist $50 copay for specialist

Annual Hearing ExaminationParticipant pays

After deductible, plan pays 80%; participant pays 20%



2016 – 2017 TRS-ActiveCare Plan Highlights

Note: Covered services under this benefit must be billed by the provider as “preventive care.” If you receive preventive services from a non-network provider, you will be responsible for any applicable deductible and coinsurance under the ActiveCare 1-HD and ActiveCare 2. Non-network preventive care is not paid at 100%. There is no coverage for non-network services under the ActiveCare Select plan or ActiveCare Select Whole Health.

TRS-ActiveCare is administered by Aetna Life Insurance Company. Aetna provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits are administered by Caremark.

Some of the new and exciting changes effective September 1, 2016:

ActiveCare 1-HD Enhanced Generic Preventive Drug Coverage

Effective September 1, 2016, certain generic preventive drugs are available at no

cost to participants enrolled in the ActiveCare 1-HD plan. The deductible and

coinsurance do not apply to these generic medications. The list of preventive generic

medications that are covered at no cost to participants enrolled in the ActiveCare 1-

HD plan is available on Aetna’s website at www.trsactivecareaetna.com/coverage.

Please know this list is maintained by Caremark based upon interpretation of Internal

Revenue Service regulations and may change from time to time.

ActiveCare 1-HD Out-of-Pocket Maximum

The ActiveCare 1-HD out-of-pocket maximum will work the same as the maximum in the other plan options. That is, it will apply to each covered person individually, up to the maximum per family. The individual out-of-pocket maximum only includes covered expenses incurred by that individual. After each covered person meets his or her individual out-of-pocket maximum, the plan pays 100 percent of the benefits for that person.

Part-time to Full-time Employee Enrollment If a current employee transitions into full-time status (e.g., from below 10 hours per week into full-time status or from part-time status into full-time status) during the plan year, the employee will have a 31-day opportunity to enroll in TRS-ActiveCare.

ALEX is an online tool you can use to learn more about TRS-ActiveCare plan options available. ALEX collects some simple information and walks you through benefits, features and costs – without all the insurance jargon.

ALEX can:

Help you understand and compare plan options

Explain health benefits terms

Show how different plan features work – deductibles, coinsurance, out-of-pocket maximums

To use the tool, visit https://www.myalex.com/trsactivecare/2016

Meet Alex…

8

https://urldefense.proofpoint.com/v2/url?u=http-3A__www.trsactivecareaetna.com_coverage&d=CwMGaQ&c=wluqKIiwffOpZ6k5sqMWMBOn0vyYnlulRJmmvOXCFpM&r=qvOob9B4uSlborZG9O97yyErF6MEKIq_4j4g8tfG2kI&m=oX3vzYYpXXPgmy85gbZQv0vslaoXcQdaVZ-1iZbrZwY&s=UYr6rLDltSgkxETC2W2UOyGn6Cly-x-EDAjrD8It-fs&e=

http://www.myalex.com/trsactivecare/2016

Scott & White Health Plan

Summary of Benefits for TRS-ActiveCare

4$750 maximum copay per admission and 20% after deductible55 visits max per month, 35 max visit per year 6Copay waived if admitted within 24 hours7If a brand name drug is dispensed when a generic is available, 50% copay applies

t r s . swhp .o rg

Inpatient Services Copay

Overnight hospital stay: includes all medical services including semi-private room or intensive care

$150 per day4 and 20% of charges after deductible

Diagnostic & Therapeutic Services Copay

Physical and Speech Therapy $50 copay

Manipulative Therapy520% without office visit

$40 plus 20% with office visit

Equipment and Supplies Copay

Preferred Diabetic Supplies and Equipment $3 copay; no deductible

Non-Preferred Diabetic Supplies and Equipment 30% after Rx deductible

Durable Medical Equipment/ Prosthetics 20% after deductible

Outpatient Services Copay

Primary Care1

$20 Copay (First Primary Care Visit for

Illness $0 Copay2)

Specialty Care $50 copay

Other Outpatient Services 20% after deductible3

Diagnostic/Radiology Procedures


Eye Exam (one annually) No Charge

Allergy Serum & Injections 20% after deductible

Outpatient Surgery $150 copay and 20% of charges after deductible

Fully Covered Health Care Services Copay

Preventive Services No Charge

Standard Lab and X-ray No Charge

Disease Management and Complex Case Management

No Charge

Well Child Care Annual Exams No Charge

Immunizations (age appropriate) No Charge

Plan Provisions Copay

Annual Deductible $1,000 Individual/ $3,000 Family

Annual out-of-pocket maximum (including medical and prescription copays and coinsurance)

$5,000 Individual/ $10,000 Family

(includes combined Medical and RX copays, deductibles

and coinsurance)

Lifetime Paid Benefit Maximum None

Home Health Services Copay

Home Health Care Visit $50 copay

Worldwide Emergency Care Copay

Nurse Advice Line 1-877-505-7947

Online Services No Charge — go to trs.swhp.org

After Hours Primary Care Clinics $20 copay

Ambulance and Helicopter $40 copay and 20% of charges after deductible

Emergency Room6 $150 copay and 20% of charges after deductible

Urgent Care Facility $55 copay

Prescription Drugs

Annual Benefit Maximum Unlimited

Rx Deductible Does not apply to preferred generic drugs $100

Ask an SWHP Pharmacy representative how to save money on your prescriptions.

Retail Quantity (Up to a 30-day supply)

Maintenance Quantity BSWH Pharmacies Only(Up to a 90-day supply)

Preferred Generic7 $3 copay $6 copay

Preferred Brand 30% after Rx deductible 30% after Rx deductible

Non-Preferred 50% after Rx deductible 50% after Rx deductible

Non-Formulary Greater of $50 or 50% after Rx deductible Not available

Mail Order 1-800-707-3477 Maternity Care Copay

Prenatal Care No Charge

Inpatient Delivery$150 per day4 and 20% of charges after deductible

1Including all services billed with office visit2Does not apply to wellness or preventive visits3Includes other services, treatments, or procedures received at time of office visit

Specialty Medications(up to a 30-day supply)

Copay

20% after Rx deductible

Teacher Retirement System - Scott & White Health Plan Service Area

SW_57_2016(844) 216-4150 • trs.swhp.org

Our provider search tool allows you to:

• Search by name, specialty, and/or ZIP code

• Add filters for gender, board certification, accepting new patients, and more

• See practice locations, contact information, and maps

• Get details, including network participation and hospital affiliations

• Customize your own profile

Finding a health care provider has never been easier.

Try it out. Go to trs.swhp.org and scroll down the page to “Find a Provider,”and you will be on your way.

N

EW

S

Howard

Glasscock Sterling

Crocket t

Schleicher

Val Verde Edwards

Kinney

Real

Kerr

Bandera

Gillespie Blanco

Kendall

Menard

McCulloch

Mason

San SabaLampasas

Williamson

Hays

Comal

Guadalupe

Gonzales

Caldwell

Bastrop

Lee

BurnetLlano

Coryell

Brown

Comanche

Hamilton

ErathSomervell

Hood

Parker Tarrant Dallas

Mills

Kimble

Coke RunnelsColeman

Concho

Mitchell Nolan Taylor CallahanEastland EllisJohnson

BosqueHill

McLennan

BellFalls

Limestone

Navarro

Freestone

Leon

Robertson

Brazos

Madison

Walker

Grimes

Milam

Burleson

Washington

Colorado

Waller

Montgomery

Harris

Trinity

HoustonIrionReagan

Tom Green

Travis

Denton Collin

Rockwall

Frequently Asked Questions

What is a plan year?

The period between the date your benefit plans begin and end. The Denton ISD plan year is from September 1st through August 31st. This

plan year applies to all insurance benefits, as well as the Flexible Spending Account plan options. The deductible on the medical and

dental plans also start and end on the same dates as the plan year

does.

Who is my Insurance carrier?

Health/Medical – TRS ActiveCare

Prescription – Caremark Dental – Standard Dental

Vision – Superior Vision Flexible Spending Accounts – TASC

Disability – Standard Insurance Co. Supplemental Cancer – Colonial

Basic & Supplemental Life Ins. – Lincoln Life Employee Assistance Plan (EAP) – Standard Insurance Co.

Where can I find phone numbers for the Insurance carriers?

You can find contact information on the insurance dept. webpage or

the contact page in this guide. In the left-hand column, click on the “Insurance” link, then click on the ”Providers Contact Information”

link.

I did not receive my insurance card, or I need a new one. How can I get one?

You will need to call the insurance carrier directly, they issue the

cards. You can find their contact information on the insurance dept. webpage.

Do deductibles, coinsurance and copays apply to my out of pocket

maximum?

Yes, effective 9/1/2015 deductibles, coinsurance and copays apply to the plan year out of pocket maximum.

Am I required to use in network providers?

*On the TRS medical plans ActiveCare 1HD and ActiveCare 2, you dohave out of network benefits if you decide to use out of network

providers. However, they are a reduced benefit amount and are based on out of network allowable amount for the charges. This can

increase your portion of the costs.

*On the TRS medical plan ActiveCare Select there are no benefits if

you decide to use out of network providers. Also, if you reside in one of the specified counties (Bexar, Collin, Comal, Dallas, Denton, Ellis,

Ft. Bend, Guadalupe, Harris, Hays, Kendall, Montgomery, Parker, Rockwall, Tarrant, Travis, Williamson) you must use only the

providers listed under the network identified for that county.

Where do I find network providers on the medical plans?

To locate an in network provider for a TRS ActiveCare medical plan go to: www.trsactivecareaetna.com or call Aetna at 1-800-222-

9205.

To locate an in network provider for the Scott & White HMO medical plan go to: www.trs.swhp.org or call 1-800-321-7947.

Can I sign up for or drop insurance at any time?

No. There are only certain times you can add or drop insurance plans:

· During the annual Open Enrollment· Within 31 calendar days of your official Start Date with DISD

· Within 31 calendar days of the loss of other eligible insurancecoverage(s)

· Within 31 calendar days of a life changing event (marriage, divorce,

child birth, death)

Documentation of the event is required. Please contact the Insurance Dept. or visit our website for information.

Where can I see what benefits I’m signed up for?

You can log onto the online enrollment system and view the benefits

you signed up for at any time. www.inrollplus.com/dentonisd You will log in with the username and password you initially set up on

this site. If you have not registered, you must do so at that time.

Who do I contact for assistance in filing a disability claim? The Denton ISD insurance department. 940-369-0028 or

[email protected]

http://www.trsactivecareaetna.com/

http://www.trs.swhp.org/


mailto:[email protected]

2016 - 2017 - denton isd · 2016 - 2017 10-14 hour/vip/substitute ... 556-1555 . beginning right...

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