2021-2022 Benefits Guide
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Welcome to your 2021-2022 Benefits Guide
The Edwards Aquifer Authority offers a comprehensive insurance benefits package to current eligible employees as well as COBRA members. Our health and welfare benefits provide both choice and value to meet the needs of our diverse workforce. This booklet offers a comprehensive overview of your health and welfare benefits options, including details about eligibility, enrollment, and the plans available to you to help you choose benefit plans that best suit your individual needs. It also explains how life changes and changes to your employment status can affect your benefits. The information in this booklet reflects the terms of the benefit plans in effect as of October 1, 2021. Please note that this is a summary of your benefits only, additional requirements, limitations and exclusions may apply. Refer to applicable plan summary documents and regulations located at the end of this booklet for details. The applicable policy issued by the carrier will take precedence if there is a difference between the provisions therein and those of this document.
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What’s Inside
ENROLLMENT ELIGIBILITY .................................................................................................... 4
BENEFIT CARRIER CONTACT INFORMATION ........................................................................ 8
MEDICAL PLANS ................................................................................................................. 11
MEDICAL PLAN SUMMARY COMPARISON CHART ............................................................. 12
DENTAL PLAN ..................................................................................................................... 19
HEALTH REIMBURSEMENT ACCOUNT (HRA)...................................................................... 22
FLEX SPENDING ACCOUNTS (FSA) ...................................................................................... 22
GROUP TERM LIFE INSURANCE .......................................................................................... 24
ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) COVERAGE .................................... 24
LIFE INSURANCE FEATURES................................................................................................ 25
LONG-TERM DISABILITY (LTD) ............................................................................................ 26
OPTIONAL TERM LIFE INSURANCE ..................................................................................... 26
WELLNESS .......................................................................................................................... 30
OPTIONAL BENEFITS........................................................................................................... 33
LEAVE ................................................................................................................................. 38
RETIREMENT ...................................................................................................................... 38
TRAINING ........................................................................................................................... 40
REQUIRED NOTICES............................................................................................................ 41
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ENROLLMENT ELIGIBILITY
Employee Eligibility
All active full-time employees are eligible for full benefits. Full-time is defined as employees who work more than 30 hours per week.
Dependent Eligibility
Dependents who meet the descriptions listed below are eligible for coverage. Full-time employees may elect medical, dental, and dependent life coverage for their dependents within 30 days of being hired. Current full-time employees may elect health care coverage for their dependents during the Open Enrollment period or within 30 days of experiencing a Qualifying Life Event. Your child – your biological child, child with a qualified medical support order, legally adopted child, or child placed in the home for the purpose of applicable state and federal laws through the end of the month in which the child turns age 26. • Your stepchild – the child of your spouse for as long as you remain legally married to the child’s parent through the end of the month in which the child turns age 26. • Legal guardianship – a child for whom you have legal guardianship in accordance with an Order of Guardianship pursuant to applicable state or federal laws or a child for whom you are grant court-ordered temporary or other custody through the end of the month in which the child turns age 26. • Your adopted child – a child through adoption through the end of the month in which the child turns age 26. • Other Medical Support Order – a child in accordance with a Court Order pursuant to applicable state or federal laws. • Children over the age of 26 with permanent intellectual or physical disabilities if: o They were enrolled before they turned 26 and remain covered or they were over the age of 26 at the time of the enrollee’s initial enrollmen t; and o They are incapable of self-sustaining employment because of the intellectual or physical disability; and o They are dependent on the enrollee for care and financial support. • Your spouse – the person to whom you are legally married. •
How to Enroll in Benefits
New hires will complete their benefit enrollment forms through the NEOGOV Onboarding portal and will also create an ADP account as first-time users to make benefit elections. Instructions will be emailed to new hires on how to register for ADP and make benefit elections. Current EAA employees will elect benefits via ADP during the annual Open Enrollment period. Instructions to make benefit elections will be emailed to employees prior to each annual Open Enrollment period.
Employees are automatically enrolled in the following EAA plans and the required payroll deductions for TCDRS:
• Basic Life & AD&D Insurance – no cost to the employee • Long Term Disability – no cost to the employee • Texas County District Retirement System (TCDRS) – 7% mandatory contribution
Benefit elections become effective on the first of the month following date of hire. TCDRS becomes effective on date of hire.
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Coverage Effective Dates
The following effective dates apply provided the appropriate enrollment transaction (electronic or paper form) has been completed within the applicable enrollment period. Your coverage is effective for you and your dependent as follows:
New Hire
If you enroll within 30 days from date of hire, coverage for you and any dependents you enroll will be effective on the first of the month following date of hire.
Annual Open Enrollment
If you enroll during annual Open Enrollment, coverage for you and any dependents you enroll will be effective on the beginning of the plan year, October 1st. If you do not submit the appropriate enrollment forms during the required eligibility period of 30 days, you will have to wait until the next open enrollment period or experience a qualifying life event to make enrollment changes to your medical health plans.
Coverage End Dates
Coverage for you and your dependents will end on the earliest of the following:
• The date the plan in question is terminated. • The last day of the month, in which you voluntarily terminate you or your dependents’ coverage. • The last day of the month in which you or your dependents no longer meet eligibility requirements. • The last day of the month your dependents no longer meet eligibility due to age.
Waiving Coverage
If you have medical coverage under another plan, you may choose to decline (waive) the EAA’s medical plans. When an employee makes this choice, a “Declination of Coverage” form must be completed and returned to Human Resources. If you decide later that you would like coverage, you will not be able to enroll until the next Open Enrollment period or within 30 days of a qualifying life event.
Some examples of other coverage could be:
Your spouse’s or parents’ plan A government insurance program
•
•
• An individual policy or other group coverage
Qualifying Life Events
A qualifying event is a life event that may allow an employee to add or drop coverage after being hired and outside of the Open Enrollment period. The change must be consistent with the event and documentation (i.e., marriage license, birth certificate, divorce decree, etc., ) must be provided to the HR Administrator within 30 days of the event. Please call or email the HR Administrator to schedule an appointment. You can add, drop or change coverage for yourself and your dependents when you experience a Qualifying Life Event such as:
Marriage Divorce
•
•
Birth or adoption of a child
•
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Death
•
Child reaching age 26
•
Child’s loss of eligibility on another plan Spouse’s gain or loss of other coverage
•
•
A child is terminated from medical and dental on the last day of the month he/she attains age 26.
When a child gains or loses Children’s Health Insurance Program also know n as CHIP, employees have 60 days to provide documentation of the gain or loss of coverage to make a corresponding change to their coverage (adding or dropping). If notification isn’t made to the HR Administrator within 30 days of the event , then employees must wait until the next Open Enrollment period. However, you must notify the HR Administrator to drop coverage for dependents who no longer meet eligibility requirements.
Coverage effective dates for Qualifying Life Events
Qualifying Event – Other than Birth/Adoption of Child
If you enroll within 30 days of the qualifying life event, coverage for you and any dependents you enroll will be effective on the first day of the month following the date you submit the enrollment form.
Qualifying Event – Birth/Placement/Adoption of Child
If you enroll within 30 days of the date of birth, coverage will be effective on the date of birth; even if you have family coverage, you must complete an enrollment form. Premium is due for any period of dependent coverage if the dependent is subsequently enrolled, unless, specifically not allowed by applicable law. Additional premium may not be required when dependent coverage is already in force. If you enroll within 30 days of the court-ordered adoption, placement for adoption, guardianship or conservatorship of a child, coverage will be effective on the date of the adoption, placement for adoption, guardianship or conservatorship; even if you have family coverage, you must complete a Benefits Enrollment Form. • Have Social Security numbers, birth dates and required documentation to enroll your eligible dependents. • Choose your options carefully. Once you make an election as a new hire, during open enrollment or within the 30-day qualifying event window, you cannot cancel or change to another plan (i.e., switch your health insurance plan). Group insurance plan premiums are deducted from your paycheck before calculating payroll taxes. Because of these pretax tax savings, the IRS determines when you may make changes — either annually during open enrollment or during the plan year if you experience a qualifying life event. • If you are a new hire, complete your enrollment forms via NeoGov Onboard. • Enroll online in ADP during open enrollment or within 30 days from your date of hire if you are a new employee. If you miss either of these enrollment deadlines, then you must wait until the next open enrollment period unless you experience another qualifying event during the year that allows you to make a change. • If you are hired during open enrollment and your benefits become effective prior to the new plan year, you will have to make new hire elections for the current year first, and then make open enrollment elections/changes for the next plan year. • Medical benefit plans run from October 1st through September 30th.
Enrollment Tips
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• Medical deductibles run from January 1st through December 31st.
Enrollment Form Errors
It is your responsibility to ensure that information on your Benefits Enrollment Form is correct. If an error occurs, notify the Human Resources Administrator immediately.
Premium Deduction Errors
It is your responsibility to verify that the premium deductions taken from your paycheck are correct. Any deduction errors must be reported immediately to the HR Administrator. If an underpayment occurs, the EAA has the right to collect any additional premiums owed.
Human Resources Contact Information
Human Resources Representative Contact Information
Hilda Campos, HR Administrator
(210) 477-8508
hcampos@edwardsaquifer.org
Raquel Garza, Director of HR
(210) 477-5137
rgarza@edwardsaquifer.org
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BENEFIT CARRIER CONTACT INFORMATION
Contact the HR Administrator for questions regarding insurance plans, premiums, eligibility or enrollment. For claims information, please contact the provider below for assistance.
Provider/Plan
Contact Information
Website
MEDICAL Blue Cross Blue Shield
(800) 521-2227 Claims Mailing Address: P.O Box 660044 Dallas, TX 75266-0044
www.bxcbstx.com
DENTAL Guardian Group #00024715
(800) 275-4638 Claims Mailing Address: PO Box 981282 El Paso, TX 79998 (800) 351-7500 Claims Mailing Address: P.O. Box 7818 Philadelphia, PA 19101-7818
www.guardianlife.com
LIFE INSURANCE Reliance Standard Life Insurance Company Life, AD&D, Vol Life Policy #GL161012 LTD Policy #LTD131287 HRA/FSA Proficient Benefit Solutions
www.rsli.com
(210) 659-8100 (888) 659-8151 ask@proficientbenefits.com
www.proficientbenefits.com
RETIREMENT TCDRS Group# 448
Member Services (800) 823-7782
www.TCDRS.org
ICMA-RC 457 Group #304645 IRA Group #701784 IRA Group #705239 RHS Group #801871
(800) 669-7400 Mailing Address: PO Box 96220 Washington, DC 20090
www.icmarc.org
401a Group #100069(MP) 401a Group #1000105 (PS)
Voluntary Benefits
Legal Shield
(800) 654-7757 memberservices@legalshield.com (800) 992-3522 admin@canalichiogroup.com (319) 355-8511 admin@canalichiogroup.com (210) 489- 6239 or call any Gold’s Gym location directly (210)-246-9600 or call any YMCA location directly 800-891-2565 customercare@petbenefits.com
www.legalshield.com
AFLAC
www.aflac.com
TransAmerica
www.transamerica.com
Gold’s Gym
www.goldsgym.com
YMCA
www.ymcasatx.org
Pet Benefit Solutions
https://www.petbenefits.com/lan d/edwardsaquifer https://www.texastuitionpromise fund.com/
Texas Tuition Promise Fund
1-800-445-4723
Goodly Student Loan Program
support@goodlyapp.com
www.goodlyapp.com
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PLAN CHOICES
Medical Dental Life Insurance FSA HRA
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MEDICAL PLANS Medical coverage for full-time employees is provided through Blue Cross Blue Shield and have two medical plan options to choose from, the Preferred Provider Organization (PPO) plan or the High Deductible Health Plan (HDHP). Each plan provides comprehensive major medical and prescription drug coverage as well as preventative care benefits and wellness programs. The premium rates for the medical plans being offered by the EAA are effective for the current plan year and run from October 1, 2021 through September 30, 2022. The EAA will pay 100% of the premium for the employee only cost on both plans. Employees may elect to add dependent coverage to their plan however the cost associated with adding dependent coverage is to be paid for by the employee. The PPO plan is a Preferred Provider Organization plan that provides in and out of network coverage and has pre-set copays and deductibles. Once you meet your calendar year deductible, the plan will pay 70% coinsurance for in-network covered services while you pay 30%. For additional information regarding the various services, deductibles and copays, please refer to the Summary of Benefits located at the end of this booklet. The HDHP is a high deductible health plan that provides in and out of network coverage. Services under this plan are paid 100% by the employee until the calendar year deductible has been met. Once the calendar year deductible has been met, the plan covers benefits at 100%. For additional information regarding the various services, deductibles and copays, please refer to the Summary of Benefits located at the end of this booklet. To compare the premium between the two plans and determine what your biweekly cost will be, see Tables I and II. These tables reflect what the biweekly and monthly costs are. Premiums for benefits are based on 24 pay periods annually. Employees who enroll in a medical plan will be automatically enrolled in a Health Reimbursement Arrangement (HRA) account. An HRA account is an employer-funded plan that reimburses employees for qualified medical expenses at no cost to employees. Depending on the plan that is selected, the EAA will contribute a set dollar PPO Plan Table I Biweekly Employee Cost Monthly Employee Cost Employee Only $0.00 $0.00 Employee + Spouse $277.56 $555.12 Employee + Child(ren) $214.43 $428.85 Employee + Family $492.00 $983.99 HDHP Plan Table II Biweekly Employee Cost Monthly Employee Cost Employee Only $0.00 $0.00 Employee + Spouse $192.49 $384.97 Employee + Child(ren) $148.71 $297.41 Employee + Family $341.19 $682.38
amount towards the employee’s Health Reimbursement Arrangement (HRA) account. For new hires, this contribution amount is prorated. The prorated amount is determined by the number of full months from an employee’s hire date to the remainder of the plan year. For example, if you are hired on July 5th and elect the PPO plan, then the HRA amount
HRA ANNUAL CONTRIBUTION
PPO
$1,000.00 $3,499.99 $1,000.00
HDHP Medical
HDHP Dental & Vision
HDHP FSA
$500.00
will be 5/12th of the annual contribution ($1000/12 X 5 = 416.67). Employees enrolled in the PPO Plan will be enrolled in an HRA that can be applied to medical, dental and vision expenses. Employees enrolled in the HDHP plan will be enrolled in two separate HRA accounts. One account is exclusive to medical expenses and the other is only for dental and vision expenses. If enrolled in the HDHP plan, you will also receive an employer FSA contribution. For more info on FSA accounts, refer to page 17.
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For a brief overview of the two plans, please see the following comparison chart. This chart will allow you to compare the two plans side by side.
MEDICAL PLAN SUMMARY COMPARISON CHART
The table below reflects an overview of some of the more common services used.
BCBS PPO
BCBS HDHP
OUT-OF- NETWORK
Services you may need
IN-NETWORK
IN-NETWORK
OUT-OF-NETWORK
Deductible Credit from Prior Credit Coinsurance Stop-loss Credit from Prior Carrier Calendar Year Deductible Individual
Yes
Yes
Yes
Yes
Yes
No
Yes
No
$5,000 $10,000
$14,700 $29,400
$6,000 $12,000
$12,000 $24,0000
Family
Coinsurance Stop-loss Maximum per cal. year Individual $5,600
Unlimited Unlimited
$6,000 $12.000
Unlimited Unlimited
Family
$14,700
Office Visits
Primary Care Physician
$45 copay $90 copay
100% after cal yr deductible
50% coinsurance
30% coinsurance
Specialist
Virtual Visit (MD Live)
$0 copay
$44 copay
Preventative care
Preventive Care/Screening (Routine Physicals)
No charge; deductible does not apply
No charge; deductible does not apply
50% coinsurance
30% coinsurance
Diagnostic Testing
No charge; deductible does not apply
100% after cal yr deductible
X-Ray / Blood work
50% coinsurance
30% coinsurance
Other Diagnostic Procedures
Imaging (CT/PET scans, MRIs)
100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible
30% coinsurance
50% coinsurance
30% coinsurance
Durable Medical Equipment
30% coinsurance
50% coinsurance
30% coinsurance
Physician/Surgeon Fees
30% coinsurance
50% coinsurance
30% coinsurance
Urgent Care
$75 copay
50% coinsurance
30% coinsurance
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$500 copay plus 30% coinsurance
$500 copay plus 30% coinsurance
100% after cal yr deductible
100% after cal yr deductible
Emergency Room Care
Non-Emergency Situations (Preauthorization required) Facility Charges (Hospital room) 30% coinsurance
100% after cal yr deductible
50% coinsurance
30% coinsurance
Physician/Surgeon Charges
Emergency Medical Transportation
100% after cal yr deductible
100% after cal yr deductible
30% coinsurance
30% coinsurance
Facility Fee
Out-Patient Ambulatory Surgery Center In-Patient Hospital Room Extended Care Services Home Health Care
100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible 100% after cal yr deductible
30% coinsurance
50% coinsurance
30% coinsurance
30% coinsurance
50% coinsurance
30% coinsurance
30% coinsurance
50% coinsurance
30% coinsurance
Skilled Nursing Facility
No Charge; deductible does not apply
Hospice Care
50% coinsurance
30% coinsurance
Mental Health/Behavior Health/ Substance Abuse Services
Inpatient Services
30% coinsurance
50% coinsurance
30% coinsurance
Outpatient Services (Office Visits) All other outpatient services
$45 copay
50% coinsurance
30% coinsurance
30% coinsurance
50% coinsurance
30% coinsurance
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Prescription Drug Coverage
Retail Prescription (copays per 30-day supply)
Preferred $0 Non-Preferred $10 Preferred $10 Non-Preferred $20 Preferred $50 Non-Preferred $70
$10 plus 50% additional charge $20 plus 50% additional charge $70 plus 50% additional charge $120 plus 50% additional charge $150 plus 50% additional charge $250 plus 50% additional charge
Preferred Generic Drugs
Non-Preferred Generic Drugs
Preferred Brand Drugs
No charge after deductible plus 50% additional charge
100% after cal yr deductible
Preferred $100 Non-Preferred $120
Non-Preferred Brand Drugs
Preferred Specialty Drugs
$150 per Rx
Non-Preferred Specialty Drugs
$250 per Rx
Mail Service Prescription (copays per 90-day supply) Deductible does not apply
Preferred Generic Drugs
No Charge
Non-Preferred Generic Drugs
$30 per Rx
100% after cal yr deductible
Not Applicable
Not Applicable
Preferred Brand Drugs
$150 per Rx
Non-Preferred Brand Drugs
$300 per Rx
More information about prescription drug coverage is available at https://www.bcbstx.com/rx-drugs/drug- lists/drug-lists
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MEDICAL PLAN FEATURES
Preferred Pharmacy Network
A Preferred Pharmacy Network is included in your prescription drug benefit plan. When you fill a prescription for up to a 30-day supply of a covered prescription drug from a retail pharmacy that contracts to participate in the Preferred Pharmacy Network, you may pay the lowest copay/coinsurance amount. If you fill a prescription at a non- preferred, in-network pharmacy, you may pay a higher copay or coinsurance. You can also fill a prescription for up to a 90-day supply of a covered prescription drug at a retail pharmacy that participates in the Preferred Pharmacy Network.
To find a preferred pharmacy, sign in to myprime.com. Please note that changes may be made to the participating pharmacies in the future
BCBS Top Preferred Pharmacies are: HEB, Walmart, Walgreens and Sam’s Club.
IMPORTANT: CVS is out of the BCBS network . If you currently fill your prescriptions at CVS, you’ll still have access to more than 55,000 in-network pharmacies nationwide (without CVS). To find a new in-network pharmacy visit myprime.com and select “Find a Pharmacy” or call the Pharmacy Program number on the back o f your member ID card. Once you find a new in-network pharmacy, you can easily transfer your prescriptions by doing one of the following: 1. Take your prescription bottle/bag to your new pharmacy. They can contact your current pharmacy to transfer your prescription. 2. Call your new pharmacy and ask them to contact your current pharmacy for your prescription information. 3. Ask your doctor to contact your new pharmacy with your prescription information.
Moving to Home Delivery
If you take any long-term medicine(s), consider using the PrimeMail home delivery service to help you save time and money. Up to a 90-day supply of your covered prescriptions can be shipped to you anywhere in the U.S., with free standard shipping. To choose home delivery:
1. Register and/or sign i n to myprime.com. Click on “Fill with PrimeMail”. 2. Go to “Transfer to PrimeMail” and click on “Fill with PrimeMail”.
You can also call PrimeMail at 800-423-1973 to transfer your prescription.
Provider Finder
Provider Finder from Blue Cross and Blue Shield of Texas (BCBSTX) is an innovative tool for helping you choose a provider, plus estimate, and manage health care costs. By logging in to Blue Access for MembersSM (BAM) you can use Provider Finder to:
• Find a network primary care physician, specialist or hospital. • Filter search results by doctor, specialty, ZIP code, language and gender – even get directions. • Estimate the cost of hundreds of procedures, treatments and tests and your out-of-pocket expenses. • Determine if Blue Distinction Center® (BDC), BDC+ or Blue Distinction Total Care is an option for treatment.
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• View patient feedback or add your review for a provider.
It’s easy to get started with Provider Finder by registering for Blue Access for Members (BAM):
1. Go to bcbstx.com. 2. Click the Log In tab, and then click the Register Now link. 3. Use the information on your BCBSTX ID card to complete the process. 4. Then, log in to BAM. Provider Finder is located under the Doctors & Hospitals tab.
You can also call a BCBSTX Customer Service Advocate at the toll-free telephone number on the back of your member ID card for help in locating a provider. Get assistance while you are away from home. Text BCBSTXAPP to 33633 to get the BCBSTX App. The app lets you use BAM while you are on the go. You can stay connected to your claim’s activity, member ID card and coverage details – you can also receive prescription reminders and health tips via text messages.
Blue365 Discount Program
Blue365 is just one more advantage you have by being a Blue Cross and Blue Shield of Texas (BCBSTX) member. With this program, you may save money on health and wellness products and services from top retailers not covered by
insurance. There are no claims to file and no referrals or preauthorization’s. Once you sign up for Blue365 at blue365deals.com/bcbstx, weekly “Featured Deals” will be emailed to you. These deals offer special savings for a short period of time.
Below are some of the ongoing deals offered to Blue365 members.
TruHearing® | Beltone™ | Amer ican Hearing Benefits - Members (and possibly their immediate family members) could get savings on hearing tests, evaluations and hearing aids. Jenny Craig® | Sun Basket | Nutrisystem® - Members can work toward reaching their weight loss goals with savings from leading programs. You may save on healthy meals, membership fees (where applicable), nutritional products and services. Fitbit® - You can customize your workout routines with Fitbit’s family of trackers and smartwatches that can be employed seamlessly with your lifestyle, your budget and your goals. Members receive a 20% discount on Fitbit devices plus free shipping. Reebok | SKECHERS® - Reebok, a trusted brand for more than 100 years, makes top athletic equipment for all people, from professional athletes to kids playing soccer. You can get 20% off select models. SKECHERS, an award- winning leader in the footwear industry, offers exclusive pricing on select men’s and women’s styles. You can get 30% off plus free shipping on their online orders. Livekick - Livekick is the future of private fitness. You can choose from training or yoga over live video with a private coach. You can get fit and feel healthier with action-packed 30-minute sessions that you can do from home, gym or hotel while traveling. You’ll also get a free two-week trial and 20% off a monthly plan on any Live Online Personal Training.
The Fitness Program
The Fitness Program gives you flexible options to help you live a healthy lifestyle. As a Blue Cross and Blue Shield
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of Texas member, the Fitness Program is available exclusively to you and your covered dependents (age 16 and older). The program gives you access to a nationwide network of fitness locations. Choose one location close to home and one near work or visit locations while traveling.
Other program perks include:
• Flexible Gym Network: A choice of gym networks to fit your budget and preferences. • Studio Class Network: Boutique-style classes and specialty gyms with pay-as-you-go option and 30% off every 10th class. • Family Friendly: Expands gym network access to your covered dependents at a bundled price discount. • Convenient Payment: Monthly fees are paid via automatic credit card or bank account withdrawals.
The Fitness Program Features
Mobile App: Allows you to access location search, studio class registration, location check-in and activity history. • Real-time Data: Provided to the mobile app and Well onTarget portals. • Complementary and Alternative Medicine (CAM) Discounts Through the Whole Health Living Choices Program: Save money through a nationwide network of 40,000 health and well-being providers, such as acupuncturists, massage therapists and personal trainers. To take advantage of these discounts, register at whlchoices.com. • Blue PointsSM: Get 2,500 points for joining the Fitness Program. Earn additional points for weekly visits. You can redeem points for apparel, books, electronics, health and personal care items, music and sporting goods. • Web Resources: You can go online to find fitness locations and track your visits The EyeMed Vision Discount through Blue365 offers savings on eyeglasses, contact lenses, eye exams, accessories and laser vision correction. The EyeMed network consists of major national and regional retail locations, such as LENSCRAFTERS®, PEARLE VISION®, Target Optical®, Sears Optical® and JCPenney Optical, as well as independent ophthalmologists and optometrists. Additionally, you may go online to in-network providers at contactsdirect.com Visit eyemedexchange.com/blue365, click Find a Provider and begin your search. Be sure the Advantage network is selected. For more information about Blue365, log in to Blue Access for MembersSM (BAMSM) at bcbstx.com. Click the My Coverage tab at the top, and then click the Discounts link on the left. Blue365: EyeMed Vision Discount Program
You do not need a referral. Simply visit any EyeMed provider and show your BCBSTX medical ID card.
Note : This is not insurance. When contacting EyeMed or any retailer or provider in the EyeMed Advantage network, be sure to refer to the discount program.
Virtual Visits
Getting sick after hours or on weekends used to mean a lengthy, costly trip to the emergency room or urgent care center. But with your virtual visits benefit, provided by Blue Cross and Blue Shield of Texas (BCBSTX) and powered by MDLIVE, the doctor is in 24/7/365. And you don’t have to leave the comfort of your own home.
Virtual visits allow you to consult a doctor for non-emergency situations by phone, mobile app or online video anytime, anywhere. Speak to a doctor or schedule an appointment at a time that works best for you.
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With virtual visits, you get:
• 24/7 access to an independently contracted, board-certified doctor • Access via online video, mobile app or telephone • If necessary, e-prescription sent to your local pharmacy
Virtual visits doctors can treat a variety of health conditions, including allergies, ear problems (age 12+), pink eye, asthma, fever (age 3+), rash, cold/flu, nausea, sinus infections and more. Also available is talk therapy which allows you to speak with a licensed counselor, therapist or psychiatrist for support with virtual visits, available by appointment. You can choose who you want to work with for issues such as anxiety, depression, trauma and loss or relationship problems.
Activate your account or schedule a virtual visit
• Go to Blue Access for MembersSM or MDLIVE.com/bcbstx. • Download the MDLIVE app from Apple’s App Store, StoreSM or Google PlayTM. • Call MDLIVE at (888) 680-8646. • Text BCBSTX to 635- 483. (MDLIVE’s online assistant Sophie will help you activate your account.
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DENTAL PLAN
The EAA offers 2 dental insurance plans through Guardian Life. Both plans are PPO plans that can meet your needs; the difference is how out-of-network benefits are reimbursed. If you visit a dentist in the Guardian network, you will receive the most savings through either plan. To verify that your dentist is in network, visit the Guardian website. Make sure PPO is selected under Plan Type and search by location, dentist last name, or office name. If your dentist is in-network, you may consider enrolling in the Value Plan as the coinsurance amounts are higher resulting in increased coverage. If you currently have a dentist that is NOT in the Guardian network, and you do NOT want to change your dentist, you may consider enrolling in the NAP plan as it pays up 90% of the usual and customary rate within the service area for an out-of-network provider. Both plans have an individual deductible of $50. The types of services that you receive at the dentist’s office are categorized by type. The table below will show what percentage the plan covers after you meet your deductible based on the type of services you receive. IMPORTANT: After selecting a plan, you cannot change your selection until the next Open Enrollment period.
PREVENTATIVE SERVICES include oral exams, cleanings, X-Rays, fluoride treatment, sealants.
BASIC SERVICES include fillings, periodontal maintenance procedures, periodontal services, periodontal surgery, simple extractions, complex extractions, Endodontic Services, root canals. MAJOR SERVICES include bridges & dentures, implants, single crowns, repair and maintenance of crowns, general anesthesia, inlays, onlays, veneers, TMJ.
Guardian Dental Plans
PPO Value Plan
PPO Network Access Plan (NAP)
In-Network
Out-of-Network
In-Network
Out-of-Network
Deductible
$50
$50
Period
Calendar Year 3 per family Preventative
Calendar Year 3 per family Preventative
Family Limit Waived For
Annual Maximum Maximum Rollover
$1500 plus Maximum Rollover
$1500 plus Maximum Rollover
Threshold
$700 $350 $1,250
$700 $350 $1,250
Rollover Amount Account Limit Claim Payment Basis
Negotiated Fee Schedule
Negotiated Fee Schedule
Negotiated Fee Schedule
90 th % UCR
Coinsurance
Preventative
100% 100%
100% 100%
100%
100%
Basic Major
80% 50%
80% 50%
60%
60%
Orthodontia
50% for children (Orthodontia in Progress – covered)
50% for children (Orthodontia in Progress – covered)
Orthodontia Lifetime Maximum
$1500
$1500
Dependent Age Limits
To Age 26
To Age 26
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Pick the plan that best suits your needs
Value Plan
Network Access Plan (NAP)
In-network and out-of-network benefits are paid at the same coinsurance percentages. Both plans allow you to retain the freedom of choice to see any dentist, in-network or out of network.
Description
Preventive services covered at 100%. Coinsurance for other services is higher than the Network Access Plan (increased coverage).
Preventive services covered at 100%. Coinsurance for other services is lower than the Value Plan (decreased coverage).
Coinsurance
Member benefits are based on discounted (negotiated) rates.
In-Network
Member pays the difference over network negotiated rates.
Member costs are based on usual and customary (UCR) rates.
Out-of-Network
For additional information regarding the various services and how often you may receive services, please refer to the Summary of Benefits for more information.
Employee Bi-Weekly Cost
Premiums are the same for either plan. Employee only dental coverage is offered at no cost to employees. If dependents were to be added, then employees will be responsible for the difference of their premium amounts. Refer to the table on the left to view monthly and bi-weekly costs.
Employee Monthly Cost
Dental Rates
Employee Only
$0.00
$0.00
Employee + Spouse Employee + Child(ren) Employee + Family
$25.52 $41.67 $73.59
$12.76 $20.85 $36.79
Guardian’s Dental Maximum Rollover
With Maximum Rollover, Guardian will roll over a portion of the unused annual dental maximum into a personal
Maximum Rollover Account (MRA), which can be used in future years if the plan’s annual maximum is reached. As an added advantage, additional money is rolled over if in- network dentists are used exclusively during the benefit year.
ANNUAL MAXIMUM:
$1,500.00
THRESHOLD
$700.00 $350.00
MAX ROLLOVER AMOUNT
IN-NETWORK ONLY ROLLOVER AMOUNT
$500.00
To qualify, a member must have a paid claim (not just a visit) and must not have exceeded the paid claims threshold during the benefit year. Each member's MRA may not exceed the MRA limit. The employee and each enrolled dependent maintain separate MRAs based on their own claim activity. You may view your annual MRA statements online at wvw.GuardianAnytime.com MAX ROLLOVER ACCOUNT LIMIT $1,250.00
How Maximum Rollover Works
If you use $700.00 or less of the $1,500.00 annual maximum and submit at least one claim, then you will be eligible to rollover up to $350.00 of the annual maximum not used. You can accumulate up to $1250 over an extended period of time.
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International Dental Travel Assistance
While traveling internationally. Guardian members can get a referral to a local dentist for immediate dental care through the International Dental Travel Assistance Program. This service is available 24/7, in over 200 countries. Coverage will be considered under the out-of-network benefits.
Guardian Davis Vision Access Discount Plan
If you are enrolled in dental coverage you can receive discounts on vision care services or supplies from your vision provider if they are under contract with the Davis Vision network. The Guardian Davis Vision Access plan is a
AVERAGE DISCOUNTS
discount program that helps you save and stay on top of your eye care. This discount program does not serve as traditional vision insurance. You must pay the entire discounted fee directly to your Davis Vision network doctor. Discounts are not available from providers outside the Davis Vision network. Find a participating doctor near you by visiting Guardian website or call 1-800-877-7195.
Eye Exams
15% off usual charge
Frames, Standard Lenses and Lens Options
20%-80% off usual charge
Contact Lens
10%-20% off usual charge 15%-25% off usual charge
Contact Lens Professional Services
Laser Surgery
Up to 25% off usual charge
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Manage Your Benefits
Go to http://www.Guardianlife.com to access secure information about your Guardian benefits including access to an image of your ID Card and the ability to find a provider.
HEALTH REIMBURSEMENT ACCOUNT (HRA) The Health Reimbursement Arrangement (HRA) is administered through Proficient Benefits Solutions. An HRA is an employer sponsored benefit contributed 100% by the EAA and is designed to help offset medical expenses incurred by you. The HRA functions the same as an FSA plan. Even if you do not elect medical and dental coverage for your dependents, you can still utilize your HRA funds to cover their eligible expenses. The HRA contribution provided by the EAA is tied to the medical plan elected. Employees who elect the HDHP plan, are eligible to enroll in the medical HRA and a dental/vision HRA. Employees who elect the PPO plan, are only eligible to enroll in the Medical HRA.
Please refer to the table on the right for annual maximum contribution. As mentioned, for new hires, this contribution amount is prorated. The prorated amount is determined by the number of full months from an employee’s hire date. For example, if you ar e hired on July 5th and elect the PPO plan, then the HRA amount will be 5/12th of the annual contribution ($1000/12 X 5 = 416.67). Amounts are also prorated for the dental/vision HRA.
HRA ANNUAL CONTRIBUTION January 1 PPO $1,000.00 HDHP Medical $3,499.99 HDHP Dental & Vision $1,000.00
You can receive reimbursement from your HRA for eligible medical, dental and vision expenses incurred by you or an eligible dependent during the current plan year, January 1 – December 31. HRA funds must be reimbursed during the plan year in which the expense was incurred. For example, expenses incurred in plan year 2021, must be reimbursed from funds during the same year (2021). Claims are processed by Proficient Benefit Solutions. You CANNOT cash the HRA annual contribution out and the funds must be spent on eligible expenses. Any money that is not used during the plan year will be rolled over for use in future years for medical expenses up to a maximum of $2,500. At the end of the plan year and allotted run-off period, any funds over $2,500 are rolled over to a Retirement Health Savings Account (RHS) in April of each year. For more information regarding an RHS, please see the RHS section of this booklet. For those enrolled in the PPO Plan, $2500.00 will be rolled into the HRA account for the following year. For those enrolled in the HDHP Plan, $1500.00 of the $2500.00 will be rolled into their Medical HRA account for the following year. The remaining $1000.00 will be rolled over into their Dental and Vision HRA account.
Eligible Expenses
HRA eligible expenses are the same as FSA eligible expenses. A list of HRA eligible expenses can be found here.
HRA Run Off Period
December 31st is the last day to incur claims for the 2021 plan year, and you must submit all claims by March 31, 2022.
FLEX SPENDING ACCOUNTS (FSA) A Flexible Spending Account (FSA) is a tax advantaged benefit plan administered by Proficient Benefit Solutions that allows employees to set aside portions of their salary to pay for their family’s hea lth and/or daycare expenses. The amount set aside is not subject to payroll taxes. Flexible spending accounts contributions are based on the plan year (October 1, 2021 to September 30, 2022) election. IMPORTANT : You are not eligible to contribute towards a Medical FSA or be enrolled in the employer FSA, if you or your spouse have a Health Savings Account (HSA).
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Medical FSA
You can receive reimbursement from your Health Care FSA for eligible medical and dental expenses
incurred by you or an eligible dependent using your pre-tax dollars. Claims will be processed through Proficient Benefits Solution. The maximum amount you may contribute to your Health Care FSA for plan year 2021-2022 is $2,750. Employees who enroll in the HDHP medical plan will receive FSA funds from the EAA and the amount is
pro-rated if you are a new hire. Please refer to the table on the right for the plan year amount. If you have funds remaining at the end of the plan year, a maximum of $550 will carry over to the next plan year while any funds in excess of $550 will be forfeited.
EAA FSA CONTRIBUTION
PPO
HDHP
October 1
N/A
$500.00
The entire annual amount is prefunded at the beginning of the plan year for immediate use on eligible expenses for current employees. You must enroll as a new hire for the FSA or enroll for the FSA every year during open enrollment or after a qualifying life event. The IRS publishes information on FSAs and eligible expenses on their website. If you have questions about an expense, please contact Proficient at (210) 659-8100, option 1. You may also view a list of eligible expenses on the Proficient Benefits Solution website. A Dependent Care FSA offers an opportunity to save money on daycare expenses for eligible dependents. The maximum amount you may contribute to your Dependent Care FSA is $5,000 for individuals or married couples filing jointly or $2,500 for a married person filing separately. Also, the person whose daycare expenses you are claiming must satisfy the definition of a Tax Dependent, per IRS regulations. If you are a new hire and enrolling mid-year, you may want to choose a lower annual amount now and then increase it during open enrollment for the next year. For example, if you are hired in June and you choose a $4,000 annual contribution amount, that amount is divided by the number of payrolls left in the plan year (October – September) and that amount will be deducted from each paycheck (i.e. you elect $5,000, there are 7 pay periods remaining in the plan year, $714.28 will be deducted from each paycheck). You can receive reimbursement from your Dependent Care FSA for expenses that have already been incurred and only up to the dollar amount that has already been deposited into your account. If you have funds remaining at the end of plan year these funds will be forfeited. Dependent Care FSA
FSA Run Off Period
September 30th is the last day to incur claims for the 2021-2022 plan year, and you must submit all claims by December 31, 2022.
Reimbursement Process for FSA and HRA
When you incur an eligible expense for you or your dependents, you may upload the Explanation of Benefits and/or receipts to the Proficient Portal or the Proficient Connect app. Claims are processed on a weekly basis and reimbursements are issued up to the available balance of your FSA and/or your Health Reimbursement Account. Monies will be reimbursed first from an employee’s FSA account then from the HRA account. To receive reimbursements for a covered expense under your health or dental coverage you must submit an itemized receipt or Explanation of Benefits (EOB) issued from the health and/or dental insurance plan. For all eligible expenses, you must submit documentation showing the following information:
Provider Name and Address
•
Patient Name
•
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Date of Service
•
Description of service or supply Amount of service or supply
•
•
NOTE - A “paid receipt” is not proper documentation.
While Proficient attempts to verify expenses automatically, there are times they cannot. The IRS requires proof that the paid amount is for a qualified expense, therefore you will be asked to verify the qualified expense(s) by submitting an explanation of benefits (EOB) or receipt of payment with service details and date of service. A reimbursement claim form can also be submitted. Since Proficient does not process checks, you will be required to submit your direct deposit information when you create your Proficient Connect account. Claims received by Proficient will be processed and any expenses eligible for reimbursement will be direct deposited into your personal banking account.
Proficient MasterCard
Employees will receive a MasterCard from Proficient to use when paying for eligible expenses (FSA Medical, FSA Dependent Care) and co-pays at the time of service.
Register for Proficient Connect
Through this online system, you can submit claims, add receipts, view your account details, access forms, and get answers to frequently asked questions anytime from anywhere. To register for Proficient Connect online go to www.proficientbenefits. Select Register. When creating your account, your Employee ID number is your SSN.
Download the Proficient Connect App
You can also download the Proficient Connect App from the App Store or Google Play. The app makes it convenient to keep track of your reimbursements and makes it easy to submit EOB’s. Simply take a photo or a screenshot and upload it directly to the app!
GROUP TERM LIFE INSURANCE
Basic Life Insurance
One of the most important things about life insurance is the financial peace of mind it gives your loved ones. This benefit is provided at no cost for all full-time employees and employees are automatically enrolled. This benefit is offered through Reliance Standard Life Insurance (RSLI). Your beneficiaries will receive two times your annual salary rounded to next $1,000.00 with no maximum limit. Please refer to the Summary of Benefits for more details.
ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) COVERAGE AD&D coverage for full-time employees is provided through RSLI and is paid 100% by the EAA. The AD&D plan provides additional protection for insured employees in the event of an accidental bodily injury resulting in death or dismemberment. In the event of an employee’s accidental death or dismemberment, the AD&D plan coverage is equal to the basic life insurance coverage.
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