Galena Park ISDEmployee Benefits

2015 - 2016

Presented By: Colleen MartinDirector of Employee Benefits

Open Enrollment

• Open Enrollment Dates July 20 –August 28

• Effective Date of Changes September 1, 2015

• First Paycheck AffectedSeptember 15, 2015

Urgent Information• Open enrollment is mandatory this year even if you are

going to decline coverage. • To enroll you must have all of your dependents social

security numbers and dates of birth even if you are not adding your dependents onto the plan.

• You also must list all dependents, even if you are not covering them on a plan.

• Only those employees that add or change their Aetna plan will receive a new Aetna card.

• Flexible Spending Account cards are good for 3 years so do not throw away your card if it has not been 3 years

Health InsuranceTRS ActiveCare / Aetna

5

Coverage Tier

Monthly Premium

District Contribution per Pay Period

Employee Cost

Employee Cost per Pay Period

2014-2015 Year

Employee Only

$341.00 $275.00 $66.00 $33.00 $37.50

Employee Child(ren)

$615.00 $292.00 $323.00 $161.50 $153.50

Employee Spouse

$914.00 $330.00 $584.00 $292.00 $275.00

Employee Family

$1,231.00

$330.00 $901.00 $450.50 $422.50

the entire amount of the $5,000 family deductible must be met first before insurance will pay any benefits. This deductible can be met by one family member or a combination of family members.

ActiveCare 1 HD2015-2016

6

Coverage Tier

Monthly Premium

District Contribution per Pay Period

Employee Cost

Employee Cost per Pay Period

2014-2015 Year

Employee Only

$614.00 $275.00 $339.00 $169.50 $152.50

Employee Child(ren)

$992.00 $292.00 $700.00 $350.00 $305.00

EmployeeSpouse

$1,478.00

$330.00 $1,148.00

$574.00 $493.50

Employee Family

$1,521.00

$330.00 $1,191.00

$595.50 $511.50The deductible applies to each covered person individually, up to the maximum per family.

ActiveCare 22015-2016

Coverage Tier

Monthly Premium

District Contribution per Pay Period

Employee Cost

Employee Cost per Pay Period

2014-2015 Year

Employee Only

$473.00

$275.00 $198.00 $99.00 $100.00

Employee Child(ren)

$762.00

$292.00 $470.00 $235.00 $222.00

Employee Spouse

$1,122.00

$330.00 $792.00 $396.00 $372.00

Employee Family

$1,331.00

$330.00 $1,001.00

$500.50 $469.00

The deductible applies to each covered person individually, up to the maximum per family.

ActiveCare Select2015-2016

ActiveCare SelectImportant Information about this

Plan!

• Similar to an HMO.• You may only see an In-Network provider or

your benefits will not be paid.Absolutely NO benefits if you go out of network

• The Network Servicing Harris, Fort Bend and Montgomery counties is:

Hermann Accountable Care NetworkPlease make sure you look to see if your doctor is in the network before you choose this plan!

Pool and Split Premiums

• Married couples both working for Galena Park ISD may “Pool” the District contributions for their insurance coverage

OR

• Married couples working for different employers that both participate in TRS ActiveCare may “Split” the cost of the premiums between each employer.

•This requires an “Application to Split Premium” form

• The form must be completed by both employees and both employers

**If you are eligible for “Pool” or “Split” premiums, please see our Benefit Specialists to help you enroll.

Plan Overview (Network Level of Benefits)

ActiveCare 1-HD ActiveCare Select ActiveCare 2

Deductible $2,500 employee only$5,000 family*

$1,200 individual$3,600 family*

$1,000 individual$3,000 family*

Coinsurance(Plan pays/participant pays)

80% / 20% 80% / 20% 80% / 20%

Out-of-Pocket Maximum(does include medical deductible/any medical copays/coinsurance)

$6,450 employee only$12,900 family*

$6,600 individual$13,200 family*

$6,600 per individual$13,200 family*

Office Visit Copay 20% after deductible$30 for primary

$60 for specialist$30 for primary

$50 for specialist

Quest Diagnostics (Network Level of Benefits)

Benefits (continued)

Services ActiveCare 1-HD ActiveCare Select ActiveCare 2

Diagnostic Lab 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 Benefits(Network Level of Benefits)

Preventive Care Clarification

Services ActiveCare 1-HD ActiveCare Select ActiveCare 2

Preventive Care Plan pays 100% (deductible waived)

Plan pays 100%(no copay required)

Plan pays 100%(no copay required)

Prescription BenefitsCaremark

Prescription Drug Benefits

14

Features ActiveCare 1-HD ActiveCare Select ActiveCare 2

Drug Deductible(per person, per plan year)

Subject to plan year deductible

$0 generic; $200 per individual for brand

name drugs

$0 generic; $200 per individual for brand

name drugs

Retail Short-Term(up to 31-day supply)GenericPreferred BrandNon-Preferred Brand

20% coinsuranceafter deductible

$20

$40**50% coinsurance

$20

$40** $65**

Retail Maintenance(after first fill, up to31-day supply)GenericPreferred BrandNon-Preferred Brand

$25$50**

50% coinsurance

$25$50**$80**

Mail Order and Retail-Plus(up to 90-day supply)GenericPreferred BrandNon-Preferred Brand

$45$105**

50% coinsurance

$45$105**$180**

Specialty Medications 20% coinsurance per fill$200 per fill (up to 31-day supply)

$450 per fill (32-day to 90-day supply)

Teladoc

What is Teladoc?• Founded in ‘2002• Board certified doctors/pediatricians available

for medical issues via telephone or video consult• Available 24/7/365 from where ever you are• For non-emergency medical issues such as

• Cold & flu symptoms• Bronchitis• Allergies• Poison ivy• Pink eye• Urinary tract infection• Respiratory infection• Sinus problems• Ear infection • & more!

Contact Teladoc…

• Step 1: Contact Teladoc – online or by phoneo Request a phone or online video consult with doctor (avg. call back

time is 16 minutes or you can schedule a time for the doctor to call you back)

• Step 2: Talk with a doctor

• Step 3: Resolve your issue o The doctor will recommend treatment and write a prescription (if

necessary)

There is no cost to the employee for using Teladoc.

Set up your account today!

• Go ahead and set up your account with Teladoc so that it is ready for you to use when you need it!

• Visit www.Teladoc.com or download the Teladoc app!

Dental Insurance

Humana Dental www.humanadental.com

Humana DentalDHMO PPO High

Preventive (Cleanings, Exams, X-Rays, etc.) $15 Office Fee Plan Pays 100%

Basic (Fillings, Extractions, etc.) Fixed Co-PaysPlan Pays 80%

Deductible Applies

Major (Crowns, Bridges, Dentures, etc.) Fixed Co-Pays

Plan Pays 50%Deductible Applies

Orthodontics (Children under 19) Fixed Co-PaysPlans Pays 50%

up to $1,000

Out of Network None: You must choose an in network provider

Yes, butit could result in higher costs for

all services

Deductible Per Calendar Year None$50 Per Person

$150 Family

Annual Maximum Benefit(Maximum amount the insurance will pay per person per calendar year)

None $1,000

Rates per Pay Period Rates per Pay Period

Employee Only $0.83 $14.21

Employee + Spouse $4.65 $31.73

Employee + Child(ren) $5.60 $30.54

Employee + Family $9.81 $44.98

Vision PlanDavis Vision

www.Davisvision.com

Participating Provider

Examination (Once Every Plan Year) $10 co-pay

Spectacle Lenses-every Sept. 1, Standard single vision, lined bifocal, or trifocal lenses. Includes plastic lenses, oversized lenses, tinting of plastic, scratch coating.

$25 copayment

Frames-every Sept 1, covered in full any fashion or designer frame from Davis Vision’s Collection(up to $160) OR $130 retail allowance to ward any frame from provider OR $180 allowance, +20% off balance to go toward any frame from Visionworks

See Allowance

Contact Lens Eval, Fitting & Follow-up - every Sept 1, collection contacts covered in full after co pay. Non collection contacts $60 allowance

$60 Allowance

Contact Lenses (in lieu of eyeglasses) - every Sept 1, covered in full contact lenses from Davis Vision’s Contact Lens Collection OR $130 allowance toward provider supplied contact lenses

$130 Allowance

Tier LevelRates Per Pay

Period

Employee Only $2.40

Employee + Spouse $4.31

Employee + Child(ren) $4.55

Family $7.19

Davis Vision

Disability Insurance

Disability Insurance

• Disability Income - Replaces a portion of your income when you are sick or injured and cannot work.

• Benefit Waiting Periods available: 7, 14, 30, 60, 90, and 150 days – the period of time that you must be continuously disabled before benefits become payable. Benefits are not payable during the benefit waiting period!

• Eligible to select a benefit amount up to 70% of annual wage.

• During the 1st 60 days, you will receive 100% of the benefit amount you purchased. After 60 days, AFA will take into account all income sources and adjust your benefit amount so that your income is no greater thank 70% or your wage with Disability.

• The plan pays a minimum benefit of $100 or 10% of your benefit whichever is greater.

• Pre-existing condition exclusion – any condition you had 12 months prior to the effective date of your insurance will be considered pre-existing.

Benefit amount up to 70% annual

wage.

Life Insurance

Basic Life Insurance

• Galena Park ISD provides each employee:

o $25,000 Life Insurance

o 100% Employer Paid

o Through Dearborn National Life

o Make certain to complete a beneficiary form

Dearborn National Supplemental Life

Who is eligible - All active, full-time employees working at least 20 hours per week.

• Allowable Employee Benefit - $10,000 - $300,000 in increments of $10,000, not to exceed 3 times basic annual salary. Guarantee issue of $200,000. (Cost $2.16 per $10,000 coverage)

• Spouse Benefit - $10,000 - $50,000, not to exceed 50% of the employee’s benefit. Guarantee issue of $30,000. (Cost $2.96 per $1,000 coverage).

• Child Benefit - Birth to 6 months-$100. Cost $0.28 for $5,000 or $0.56 for $10,000.

Supplemental Life is available for purchase while employed at GPISD, and is not portable.

Portable Life Insurance

Texas Life

Texas Life• Offers permanent life insurance through age

121.

• Coverage is available for you, as well as other family members, (spouse, children and grandchildren).

• Guaranteed base life insurance premiums NEVER INCREASE

• Accelerated Death Benefit Rider for Terminal Illness

AllState Cancer Plan

o Poliomyelitiso MSo Encephalitiso Rabieso Tetanuso TBo Osteomylitiso Diphtheriao Scarlet Fevero Cerebrospinal

Meningitiso Brucellosiso Lou Gehrig’s

o Sickle Cell Anemia

o Thalassemiao Rocky Mountain

Spotted Tick Fever

o Legionnaires’o Addison’s

Diseaseo Hansen’s

Diseaseo Tularemiao Hepatitis-

Chronic B or C,

or Hepatomao Typhoid Fevero Myasthenia

Graviso Reye’s

Syndromeo Walter Payton’s

Liver Diseaseo Lyme Diseaseo Systemic Lupus

Erythematosuso Cystic Fibrosiso Primary Biliary

Cirrhosis

The Allstate Cancer Plan covers cancer and 29 other dreaded

diseases.

Allstate coverage can help provide added financial support when it is needed most.

Allstate Cancer coverage can help offer you and your family financial support.

• Benefits paid directly to you unless otherwise assigned

• Coverage for you or your entire family• No evidence of insurability required at initial

enrollment• Waiver of premium after 90 days of disability due to

cancer for as long as your disability lasts for the primary insured.

• Portable

Allstate Cancer Plan

Cancer Plan Options

Tier Low Plan Rate per Pay Period

High Plan Rate per Pay Period

Employee Only $10.17 $16.34

Employee & Spouse

$16.33 $25.44

Employee & Child(ren)

$14.25 $23.11

Employee & Family

$20.40 $32.21

Health Savings Accounts (HSA)

American Fidelity

Benefits of an HSAThe HSA at GPISD is funded by the employee

It is a tax-free contributionEarns interest once depositedRolls-Over year to year ( you do not use it or lose it)Follows you wherever you goYou can change how you contribute at any timeThe money is accessible as soon as it is depositedContributions are tax deductibleYour account can be passed onto your spouse upon your death

•  

Who is Eligible for HSA• You must be covered by a qualified high deductible health plan

(HDHP) – ActiveCare 1HD;

• You cannot be enrolled in Medicare;

• You cannot be covered by other health insurance;

• You cannot be claimed as a dependent on someone else's tax return; and

• You cannot be enrolled in a Flexible Spending Account (FSA).

Yearly Maximum Contributions

You May Fund Your HSA through• Payroll deductions• Online transfers• Personal check

2015 Age under 55 Age 55+

Individual $3,350 $4,350

Family Coverage

$6,550 $7,550

Example: Financial Comparison ActiveCare 1HD verses ActiveCare 2Year 1

ActiveCare 1HD ActiveCare 2 Difference Between

Plans

Employee Only Premium 792.00 4,068.00  

Health Savings Account (Rolls Over if Unused) 3,276.00 -  

Total Premiums/Savings 4,068.00 4,068.00 -

 

Assume you visit the doctor 4 times  

Copays/Office Visits (assume 3 office Visits @ $150 per visit) 450.00 90.00  

Annual Check Up (Wellness visit) - -  

Prescriptions (estimate 3 prescriptions @ $75 each) 225.00 75.00  

Total Expense for Doctors and Prescriptions 675.00 165.00  

Less Amount Paid for from Health Savings (675.00) -

Total Out of Pocket for Doctors/Prescription - 165.00

Total Out of Pocket for the Year 4,068.00 4,233.00 165.00

Amount of Savings that rolls over to next year 2,601.00 -

Example: Financial Comparison of ActiveCare 1HD verses ActiveCare 2Year 2

ActiveCare 1HD ActiveCare 2 Difference Between Plans

Employee Only Premium                                                       792.00                                                    4,068.00   

Health Savings Account (Rolls Over if Unused)                                                   3,276.00                                                                 -     

Total Premiums/Savings 4,068.00 4,068.00 -

Plus amount rolled over from Year 1                                                   2,601.00   

Total amount available in Health Savings for year 2 5,877.00  

 

Assume you visit the doctor 4 times  

Copays/Office Visits (assume 3 office Visits @ $150 per visit)                                                       450.00                                                          90.00   

Annual Check up (wellness visit)                                                                -                                                                   -     

Prescriptions (estimate 3 prescriptions @ $75 each)                                                       225.00                                                          75.00   

Total Expense for Doctors and Prescriptions                                                       675.00                                                        165.00   

Less Amount Paid for from Health Savings                                                     (675.00) -

Total Out of Pocket for Doctors/Prescription - 165.00

Total Out of Pocket for the Year 4,068.00 4,233.00 165.00

Amount Remaining in Health Savings (after doctors visits) 5,202.00 -

 

Catastrophic Event $6,450 Annual Out of Pocket Max $6,600 Annual Out of Pocket Max  

Assume you get really sick or injured and max out the total out of pocket expense for the year (after this point, TRS pays 100% of additional expenses for that plan year)                                                   5,775.00                                                    6,435.00   

Less Amount Paid from Health Savings Account                                                 (5,202.00)                                                                -     

Total Out of Pocket Expense for Worst Case Scenario 573.00 6,435.00 5,862.00

Total Out of Pocket Expense for Year 2 4,641.00 10,668.00 6,027.00

Total Amount to Rollover in Health Savings Account for Year 3 - -

Flexible Spending PlanFirst Financial

Medical Reimbursement• Employee can pay for out-of-pocket medical expenses with

before tax dollars o Use the debit card that is provided oro File claims for reimbursement

• Deductibles, co-insurance, co-pays, vision care, dental care etc.

• This is a “Use it or Lose it” plan!!

• Plan year is September 1st through August 31st.

• You must enroll every year

• Funds are available in full on the first day of the plan year

• The maximum allowed for 2015-2016 is $2,550.00

Dependent Care Reimbursement Plan

Dependent Care Reimbursement Plan• The plan allows you to set aside money on a pre-tax basis that can

be used to cover certain costs associated with providing care for children age 13 and under, handicapped dependents, and elderly parents needing day care while you and your spouse work away from the home.

• Dependent care centers must be qualified according to the Internal Revenue Code

• Funds are available only as deposits are made and not before

• The maximum allowable contribution is $5,000 per year.

• This is a “Use it or lose it” plan

• File claims for reimbursement

• If you choose Dependent Care Reimbursement, you may not claim the Federal Dependent Care Tax Credit

LegalEASE (prepaid legal)LegalEASE offers prepaid legal services through Legal Guard and provides in network attorney’s to assist you with such matters as

Consumer issues - small claims, bank fee disputes etc. Criminal matters - traffic tickets, civil litigation etc. Financial matters - debt collection defense, bankruptcy,

tax audits, credit coaching Identity Theft Elder and Family Law Estate Planning and Wills Legal Consultations

LegalEase Rate: $7.89 PER PAY PERIOD.

Life Works

Life Works…Resources for Work and Life

GPISD is providing to all employees, Life Works which offers: Telephonic Life Coaching-3 phone

sessions with a masters’ level certified life coach

24/7 Resources-online and mobile apps, access to legal, financial, and work life libraries as resources.

Work-Life Program-telephonic support

For more information call 1-800-456-0018

Retirement Planning403(b) or 457

What is a 403b or 457b?403(b) Plan

Contributions are tax deferred, that means you are taxed when you being withdrawing money

Amounts are taxable when distributed Employees can contribute to both a 403b

and 457b Maximum annual contribution for 2015 is

$18,000 Additional $6,000 is permitted for those

50 and over as a savings “catch-up” May access funds if you separate from

employment, you are age 59 ½, retire, are disabled, have a QDRO, the plan terminates, or upon your death.

There is a 10% early withdrawal penalty before age 59 ½ unless financial hardship

457(b) Plan Contributions are tax deferred, that

means you are taxed when you being withdrawing money

Employees can contribute to both a 403b and 457b

Maximum annual contribution for 2015 is $18,000

Additional $6,000 is permitted, for those age 50 and over as a savings “catch-up”

May access funds if you separate from employment, at the age of 59 ½, retire, are disabled, have a QDRO, the plan terminates or upon death

No early penalty withdrawal on distributions regardless of age only if there has been separation of service

Roth 403(b) and Roth 457(b) are also offered.

Maximum Contributions

• $18,000• Participants who reach age 50 by

calendar year-end can make an additional $6,000 (2015) contribution if allowed by the plan

• 2016 Maximums–No decision has been made by the IRS

• $18,000• Participants who reach age 50 by

calendar year-end can make an additional $6,000 (2015) contribution if allowed by the plan

• 2016 Maximums–No decision has been made by the IRS

403(b) Plan 457(b) Plan

Online Enrollment Instructions

• To use the “Self-Service Enrollment” system, please visit https://ffga.benselect.com/enroll

• The Default Login – Your User Name is your social security number (123456789) or employer ID number

• The Default Password – Your Password is the last four digits of your social security number.

Once you have logged in pleaseVerify your personal information is correctVerify your beneficiary information is correct

including social security numbersFollow instructions to complete enrollment.

DisclaimerIt is your responsibility to:• Ensure you have enrolled timely• Review your paycheck stub in

September to make sure the benefits and amount for each benefit is being deducted.

Please contact the Benefits Office promptly in the event of an error or discrepancy with these deductions.

Where to go for more Information

To find more information about benefits and benefit rates offered by Galena Park ISD please visit:

www.galenaparkisd.com/benefits/

For detailed information about TRS ActiveCare go to:

www.trsactivecareaetna.com

Contacts in the Benefit Office

• Gina Martinezo Benefits Specialisto gmartinez@galenaparkisd.com o Ext. 1276

• Stephanie Soto Benefits Specialist ssoto@galenaparkisd.como Ext. 1245

• Colleen Martino Director of Employee Benefitso comartin@galenaparkisd.como Ext. 1507