BENEFITS OVERVIEW FOR THE PLAN YEAR

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Lake Travis Independent School District | 2014 - 2015 Benefits Overview 1

Medical Plan

Blue Cross and Blue Shield will continue to offer a high and low plan PPO to the staff of Lake Travis ISD. Due to rising medical costs, there was an increase to the premium this year. This increase will be reflected in the payroll deductions depending upon the plan elected. (See page 8.)

Beginning in January of 2014, every person lawfully residing in the United States is required to carry health insurance. Failure to do so is punishable by a tax penalty assessed on Income Tax Statements filed

beginning with the 2014 tax year. The fine for failure to comply with this basic aspect of the law is the greater of 1% of the gross household earnings or $95 per adult and $47.50 per child. Your coverage may be obtained through the employer’s plan, an individual plan or the Federal Exchange Marketplace. Lake Travis Independent School District is not obligated to contribute toward any of these methods of obtaining coverage but has chosen to continue to participate in an employer sponsored plan. Lake Travis ISD’s coverage offered to its employees meets both Minimum Essential Value and Affordability as defined by ACA.

Lake Travis ISD Contribution

The Board has approved to continue their contribution level of $473.75 for employee medical coverage through Blue Cross and Blue Shield of Texas.

Dental Plan

The dental benefits continue to be provided through Assurant Employee Benefits with no change to the premiums. Employees will continue to have a choice between the low plan DMO, known as Heritage Pre- Paid, (must go to a selected dentist) and the high plan PPO, known as Freedom Advance PPO plan (can go to any dentist). The premium rates for the dental options remain the same.

Vision Plan

Vision coverage will remain with EyeMed with no change in the current premium structure.

Disability Plan

All employees who earn more than $1,000 per month may enroll in the disability program provided by Assurant Employee Benefits. New participants in the plan with a pre-existing condition will not be turned down for coverage, but may not be covered for the first 24 months.

WHAT’S STAYING THE SAME The Affordable Care Act and You What is Changing

BENEFITS OVERVIEW

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TO BE SURE YOU HAVE THE BENEFITS YOU WANT

Read through this benefits guide to learn about the different benefits options before you make

any enrollment decisions. After enrollment, keep this guide and your confirmation statement as

a reference throughout the November 1, 2014 to October 31, 2015 plan year.

Access the Benefits Overview on the Lake Travis ISD Staff website.

Login to the Staff website using your district computer login. Review the benefits overview for

specific information about benefits available, including premiums, contact information and

coverage.

Access PlanSource

Logon at https://benefits.plansource.com (also linked on the Staff website) Once you are in PlanSource, you will complete your benefits elections. The screens will help you flow through the enrollment process and you will be able to refer to the outlines and other materials in PlanSource to assist in answering your questions.

Print and Sign Benefits Confirmation

At the conclusion of your on-line enrollment, you must print your confirmation statement, sign it and return it to your campus/department administrative assistant by October 2, 2014.

NEED MORE INFORMATION?

All District Employees are encouraged to attend the Benefits Fair on Tuesday,

October 1, 2014 from 8:00 am to 5:00 pm at the Educational Development Center.

PLANSOURCE LOGIN INFORMATION:

Your login is your first initial, first six letters of your

last name and last four numbers of your social security number. Your initial password is your birth year, month and day. You will be required to change

your password to a new 8 character login. For example: If you were born on February 1, 1969, your password is 19690201.

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WHO IS ELIGIBLE

You can participate in the Lake Travis ISD Benefits if you are a regular employee (active or on a paid leave approved by the district) working a minimum of 25 hours per week for the District. Eligible dependents can participate in some benefits plans. Eligible dependents include:

 Legal spouse

 Dependent children:

o under the age of 26 for medical, dental and vision

o under the age of 25 for dependent life insurance, &

o under the age of 19 (or 25 if a full-time student) for the critical illness program.

 Child who qualifies as your dependent under the

terms of a qualified medical child support order (QMCSO)

COVERAGE LEVELS

The “levels of coverage” under each plan vary and the selections you make affect your per-pay-period cost. You can choose a different level of coverage for each benefit. For example, you may choose: employee + family coverage for medical, employee + spouse for dental and employee only for vision. However, you cannot select coverage for a dependent when you have not chosen coverage for yourself for that benefit selection.

WHEN COVERAGE BEGINS

For benefits elected during the open enrollment period, your coverage will become effective on November 1, 2014. If you decline coverage for yourself or your dependents, you cannot enroll until the next benefits enrollment period unless you have a qualifying life event or change in status.

For benefits you select when you are a new hire or newly eligible for benefits, coverage begins on the first day of the month following your date of hire. If your date of hire is the first day of the month, then your benefits start that day.

WHEN YOU CAN MAKE CHANGES

In general, you can only change benefits during the year if you have a life event or change in status. Any changes you make for yourself and your dependents must be consistent with and on account of your change in status. For example, you can enroll your newborn in medical coverage,

but you cannot drop coverage for your spouse or change medical options because of the birth of your child.

Choose your benefits coverage carefully!

In most cases, you cannot change your

selections until the next annual

enrollment period.

DEFINITION OF CHILD:

Your “child” can mean your natural or legally adopted child from the time he or she is placed for adoption.

Your child may also be a stepchild, foster child, and any other child for whom you are a legal guardian or

any grandchild whom you can claim on your federal income tax return in the year you first covered him or

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Most coverage changes due to a life event or change in status are effective the first of the month following the date they are submitted if the changes were submitted within 30 days of the event. One exception is a change due to birth or adoption, which is effective on the day of the birth or adoption if a change request is submitted within 30 days.

There are certain changes in family status that may qualify your dependent for COBRA coverage. For these events, it is necessary that you report the change in status to the LTISD Human Resources within 30 days from the event date; otherwise, the dependent will not be eligible for COBRA coverage.

Life events and changes in status that permit coverage changes are:

 Employee gains a tax dependent through birth, legal adoption or placement for adoption

 Marriage, Divorce or Annulment

 Enrollment in ACA approved Marketplace coverage

 Dependent reaches the limiting age noted in the policy and is no longer eligible for the plan

 Spouse/dependent gains or loses coverage due to gaining or losing employment/eligibility with current employer

 Death of spouse or dependent child

 Spouse/dependent or employee becomes Medicare/Medicaid eligible or ineligible

 Spouse adds or drops coverage during their own company’s benefits enrollment period that is not concurrent with the district’s benefits enrollment period

 Court order (QMCSO)

COST OF COVERAGE

The cost of the coverage is dependent upon the benefits you elect. As you complete the on-line enrollment process, the monthly cost of your deductions will be totaled for you. Please remember that once your enrollment in the benefits is confirmed, you may not change your mind unless there is a qualifying event resulting in a change in family status as defined by HIPAA regulations.

PREPARING TO ENROLL

CURRENT EMPLOYEES

In order to receive benefits beginning November 1, 2014, all employees must enroll in benefits on-line by the October 2, 2014 deadline. If you do not submit your selections before the October 2, 2014 enrollment deadline, you will not have any benefits coverage for the 2014-2015 plan year and you will not be able to

IMPORTANT NOTE ABOUT CHANGING YOUR BENEFITS

It is your responsibility to notify the LTISD Human Resources of a life event or family status

change within 30 days of the event or change. If you don’t make changes to your benefits

within 30 days of the life event, you can’t make changes to your district benefits until

enrollment for the next plan year.

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participate in the Health Care Reimbursement Account. Enrollment dates are September 24th, 2014 through October 2, 2014 for all current eligible employees.

NEW EMPLOYEES

You must enroll in the coverage within 30 days of your date of hire. Late enrollees forfeit their rights to all benefits and may not be able to enroll in all options at the annual open enrollment.

IMPORTANT NOTE BEFORE YOU START

Carefully check out each benefit option. Use the worksheets and information online, by phone and through all the other resources available to determine the most appropriate options for you

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STEP BY STEP INSTRUCTIONS

1. Access the Plansource Enrollment System at https://benefits.plansource.com OR through the Lake Travis web‐site (under Staff > Benefits Open Enrollment). The login screen,

as pictured to the right, will appear.

2. Username: Your user name is your first initial, first 6 characters of your last name (lowercase no spaces) followed by the last 4 digits of your SSN. For example: If your name is Joe Smithson and your SSN is 111‐11‐1234, your user name would be jsmiths1234. If your name is Joe Smith and your SSN is the same, your user name would be jsmith1234.

3. Password: Your password is your date of birth in YYYYMMDD format. For example: If your birth date is August 14, 1962, your password would be 19620814.

Once you log into the system with your initial password, you will be required to change your password. Your new password must be at least 8 characters long.

4. The Welcome Screen appears. Click on Enroll in Benefits ‐ Open found on the left hand side of your screen.

5. Flow through the enrollment screens.

6. After you have concluded your on-line enrollment, you must print your benefits confirmation form and click confirm for the 2014-2015 plan year, sign it and turn it into your campus/department’s administrative assistant no later than October 2, 2014.

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You will find a summary benefit description of each plan available on the enrollment site.

Benefits Plans Levels of Available Coverage

How You & Lake Travis ISD Share Coverage Costs LTISD Pays You Pay (Pre-Tax) You Pay (Post-Tax) MEDICAL PLANS

with Blue Cross and Blue Shield of Texas

 High Plan PPO

 Low Plan PPO

 Employee Only

 Eligible Dependents

X X

X

DENTAL PLAN

with Assurant Employee Benefits

 Heritage Pre-Paid Low Plan DMO

 Freedom Advance PPO High Plan

 Employee and Eligible Dependents

X

VISION PLAN

with Eye Med Vision Care

 Employee and Eligible

Dependents X

CRITICAL ILLNES

 Benefits of $5,000, $10,000 or $15,000 for the employee

 Spouse benefit 50% of the employee amount and children at $2500 or $5000 in benefit

X

SUPPLEMENTAL LIFE INSURANCE

 Beginning at $20,000 in $10,000 increments up to a maximum of $170,000

 Maximum benefits available are 5 times the annual salary or $170,000 whichever is less

 Employee Only

X

DEPENDENT LIFE INSURANCE

 Spouse up to 50% of the employee only coverage OR $60,000 whichever is less.

 Children under the 25 years - $10,000

 Eligible Dependents

X

ACCIDENTAL DEATH & DISMEMBERMENT

 Additional life insurance benefits are provided in the event of an accidental death or dismemberment

 Must be enrolled in the life insurance to obtain this coverage

X

DISABILITY PLAN

 Insuring 60% of the employee’s salary in the event of an illness or injury

 Eligibility limited to employees earning greater than $12,000 per year.

 Employee Only

X

HEALTH CARE REIMBURSEMENT ACCOUNT

 Allows employee to use pre-tax dollars to fund IRS-approved eligible medical expenses

 Employees and Eligible Dependents

X

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MEDICAL PLAN

Blue Cross Blue Shield of Texas

www.bcbstx.com

Customer Service: 1-800-521-2227

Representatives available: 8 am to 8 pm (CST) M-F, except holidays Claims Filing Address

Blue Cross Blue Shield of Texas P. O. Box 660044

Richardson, TX 75226-0044

Medical Plan – Payroll Deduction Costs – monthly

Option Employee Only Employee +Spouse Employee +Child(ren) Employee +Family

BCBS High Plan $ 152.84 $ 611.86 $ 527.57 $ 910.44

BCBS Low Plan $ 71.60 $ 446.33 $ 375.24 $ 689.05

Lake Travis ISD offers Blue Cross and Blue Shield of Texas as the medical carrier for the District’s group health plan. Two PPO plans are available to the employee: High Plan and Low Plan. The primary differences in the two plans can be found in the chart below. This is not a complete representation of the benefits offered. The government required Summary of Benefits and Coverage for each plan is provided on the enrollment site or can be obtained from Paola McIntyre in the Office of Human Resource Services. Please review the outline of benefits and your policy carefully for a complete understanding of the benefits available to you. Once enrolled, questions regarding your benefits should be directed to Blue Cross Customer Service at 800-521-2227.

MEDICAL OPTIONS COMPARISON CHART

Please refer to the Summary of Benefits and Coverage for complete details

High Plan Low Plan

FEATURES In-Network Out-of-Network In-Network Out-of-Network

You Pay

Annual Deductible None $300 / person

+$250 Hospital $500 /person $1,000 / person +$250 Hospital Annual Coinsurance 10% to $1,500 per person 30% to $3,000 per person 20% to $3,000 per person 30% to $6,000 per person

Office Visit Copayment $15 None $20 for PCP

$40 Specialist

None

Prescription drug copays for mail order scripts are 2 copays for a 90-day supply

Generic

(Retail, 30‐day supply)

$10 copay N/A $20 copay N/A

Preferred, Brand Name (Retail, 30‐day supply)

Non‐Preferred, Brand Name (Retail, 30‐day supply)

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Certain services may require precertification prior to receiving benefits. Please familiarize yourself with the outline of coverage and present your identification card each time you visit a medical provider. Questions regarding eligibility of specific services or treatments should be referred to Blue Cross and Blue Shield of Texas at the customer service number located on the back of your identification card. Under both the High and the Low plan that LTISD offers, you will receive better benefits if you seek treatments from providers who participate in the Blue Cross PPO network. To search for providers who participate in the network, visit the Blue Cross web-site at www.bcbstx.com and perform a provider search.

Lake Travis ISD believes that the plans provided for its employees through Blue Cross and Blue Shield of Texas are “grandfathered health plans” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that the LTISD Health Plan may not include certain preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.

Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the agent for the District’s health plan, Sue Gibson, at [email protected] . You may also visit the web site www.dol.gov/ebsa/healthreform. This site has a table summarizing which protections do and do not apply to grandfathered health plans.

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DENTAL PLAN

Assurant Employee Benefits

www.assurantemployeebenefits.com

Customer Service

High Plan Freedom Advance PPO: 1-800-442-7742 or 1-800-733-7879 Low Plan Heritage Pre-Paid Dental: 1-800-443-2995

Representatives available: 8 am to 5:30 pm (CST) M-F, except holidays Dental PPO High Plan Claims Filing Address

Assurant Employee Benefits P. O. Box 2940

Clinton, IA 52733

Dental Plan – Payroll Deduction Costs ‐ monthly

High Plan: Freedom PPO $36.58 $70.24 $91.06 $124.70

Low Plan: Heritage Pre‐Paid Dental DMO $12.07 $19.53 $26.40 $ 30.94

Dental Coverage is offered through Assurant Employee Benefits and you may pick from two options:

• High Plan – Freedom Advance PPO

Limited benefits are available for most dental services. Preventive care is typically covered in full with no deductible. You will pay a deductible for basic, major and orthodontic care. During the first 12 months of dental coverage, major care is covered at 25%. There is a 12-month waiting period for orthodontic care for new hires or employees newly eligible for benefits. You can use any licensed dental provider you wish and change dentists or seek care from a specialist at any time. You are responsible for costs that exceed the usual, customary and reasonable (UCR) guidelines or the plan’s share of covered services.

• Low Plan ‐ Heritage Pre‐Paid Dental DMO

You do not pay a deductible or have restrictions for pre-existing conditions. You must choose a Primary Care Dentist (PCD) who directs all your dental care. You must use in-network providers for coverage. Services outside the network are not covered. You pay only the specified copay when you receive care (schedule of copayments available through the LTISD on-line enrollment site).

If you enroll in the Assurant Employee Benefits Heritage Pre-Paid Dental DMO option, you must choose a Primary Care Dentist (PCD) for you and all covered family members. In most cases, you will need to have these PCD numbers handy when you connect to the

enrollment Web site. Consider writing your choices on your worksheet, so you have them right there with your selections.

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An overview of each program and a range of out-of-pocket costs appear below.

Features Freedom Advance

High Dental Plan PPO

Heritage Pre‐Paid Low Dental Plan DMO

Deductible $50 – Individual; $150 – Family $0

Annual Maximum $1,000 per Individual Unlimited

Covered Services Depending on the Service, You Pay:

Preventive and Diagnostic Care

Exam, teeth cleaning, fluoride and sealants

$0 with no annual deductible $0 - $5

Basic Care

Fillings, general anesthetics, space maintainers

20% of covered expenses after deductible $10 - $80

Major Care

Crowns, bridges, dentures, oral surgery, endodontic, periodontal

75% of covered expenses after deductible in

the first year of coverage – 50% thereafter $12 - $300

Orthodontia (12‐month waiting period)

24-month course of treatment: 50% of covered expenses after deductible (lifetime maximum benefit of $1,000/person)

Coverage for Children only

24-month course of treatment:

 Child - $2,100

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VISION PLAN

Vision Plan ‐ EyeMed Vision Care

www.eyemedvisioncare.com

Representatives available: 9 am to 11 pm (Monday – Saturday); 11 am to 8 pm (Sunday)

Vision Plan – Payroll Deduction Costs – monthly

EyeMed Vision Care $ 6.44 $ 12.24 $ 12.88 $ 18.96

EyeMed Vision Care offers in-network and out-of-network care. If you choose to receive treatment or services from providers outside the network, you are responsible for expenses that exceed the schedule of benefits.

In-Network Out-of-Network

FEATURES PLANS PAYS: PLAN PAYS (UP TO):

Eye Exam 100% after a $10 copayment $35

Frames $100 Allowance +

20% of balance over $100 $50

Lenses Varies based on lens selected. Most

lenses available for a $25 copayment. Please refer to summary benefits provided

by EyeMed.

$40 – Single $65 – Bifocal $40 – Trifocal or Ventricular

Contact Lenses

(in lieu of lenses & frames) Up to $115 Up to $92

LASIK Surgery & PRK Corrective Procedure

Member receives a discount of 15% off Retail Pricing or 5% off Promotional

pricing from provider

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CRITICAL ILLNESS

www.asibpi.com

Customer Service: 1-800-877-2701 or e-mail [email protected]

Representatives available: 8 am to 5 pm (CST) M-F, except holidays Claims Filing Address

Assurant Employee Benefits PO Box 419568

Kansas City, MO 64141-6568

Claims Assistance at 800-451-4531 or fax 816-881-8768

Critical Illness Insurance

Premium for initial or increased volume enrollments are based on the employee’s age as of November 1, 2014

Benefits may be purchased in increments of $5,000; $10,000 or $15,000 for the employee. (Benefits are subject to a 50% reduction when the employee reaches age 70.) A spouse is eligible for coverage at 50% of the employee amount

and children may be covered for either $2,500 (monthly cost of $.15) or $5,000 (monthly cost $.30)

Employee Age as of November 1

Employee Cost per $1,000 in coverage

Spouse Cost per $1,000 in coverage

<30 $0.87 $0.932 30 -39 $1.47 $1.50 40 -49 $2.41 $2.40 50 - 59 $4.68 $4.55 60-64 $6.58 $6.37 65+ $7.44 $7.18

Although the medical benefit program provides you with excellent coverage for these expenses, critical illness coverage will pay you a fixed benefit upon the initial diagnosis of a covered illness. Benefits may be elected for yourself at increments of $5,000, $10,000 or $15,000 in coverage. For your spouse, you may elect benefits at 50% of your election and children may be eligible for either $2,500 or $5,000. These benefits may be used for any purpose that you wish and – because your premium is paid with after tax dollars – the benefits will not be taxable to you. Critical illnesses that are considered eligible for 100% of your benefit election amount include: heart attack, heart failure, stroke, blindness, major organ failure, coma, end stage kidney disease and invasive cancer. 25% of your benefit election may be paid for coronary bypass surgery or cancer in situ.

You will not have to answer medical questions in order to obtain this coverage; however, your benefits may be subject to preexisting condition limitations.

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LIFE INSURANCE

Customer Service: 1-800-451-4531 or 1-800-733-7879

Representatives available: 8 am to 5:30 pm (CST) M-F, except holidays Claims Filing Address

Assurant Employee Benefits – Life Insurance Claims PO Box 419876

You (and your eligible dependents) are eligible to enroll in Supplemental Life Insurance at your initial date of hire and the first open enrollment following your date of hire. If you do not enroll during these times, you may not be eligible for this benefit.

If you are currently enrolled in the benefit, you may increase the coverage for yourself by $10,000 up to the limits specified below. You may not increase coverage for either your spouse or your dependent child(ren). You may decrease the amount of life insurance on you, your spouse and/or your child(ren) during any open enrollment period.

Supplemental Life Insurance

Rates for coverage are based on your (or your spouse’s) age each November 1st or the date you become benefit eligible, if later. The maximum benefit is 5 times your annual salary or $170,000 whichever is less.

Spouse Life Insurance is available at 50% of your election up to a maximum benefit of $60,000. Life insurance for your child(ren) is offered at $10,000.

Life insurance coverage for your dependent child under the age of 25 is available for a cost of $1.80 per month. This cost is constant whether you insure one or four children.

Age as of November 1 Employee Cost per $1,000 in coverage

Spouse Age as of November 1

Spouse Cost per $1,000 in coverage <20 $0.028 <20 $0.042 20‐24 $0.042 20-24 $0.064 25‐29 $0.052 25-29 $0.078 30‐34 $0.068 30-34 $0.094 35‐39 $0.090 35-39 $0.124 40‐44 $0.146 40-44 $0.184 45‐49 $0.208 45-49 $0.290 50‐54 $0.390 50-54 $0.522 55‐59 $0.742 55-59 $0.972 60‐64 $1.062 60-64 $1.458 65‐69 $1.854 65-69 $2.372 70‐74 $3.295 70-74 $4.420 75+ $12.283 75+ $14.672

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Life insurance benefits are paid to your beneficiary if you die while covered (subject to policy exclusions). If your spouse also works for LTISD, you may each have only employee coverage and only one of you may cover dependent children.

Your cost for supplemental coverage is based on your age and the amount of coverage you select. If you are a new hire and within your first 30 days of eligibility, you may elect up to 5 times your annual salary or $170,000 (whichever is the lesser amount) without medical questions. The minimum that you may elect is $20,000.

Your spouse may be covered for 50% of your coverage amount or $60,000 whichever is less. The premium for your spouse is based on your spouse’s age. Dependent children may be covered for $10,000 per child up to the age of 25. The cost for covering any number of children for this benefit is the same - $1.80 per month.

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE

This benefit is only available to those who have elected life insurance coverage. Both the life insurance and AD&D Insurance are provided through Assurant Employee Benefits. The accidental death and

dismemberment (AD&D) rider will pay additional benefits in the event that the death or dismemberment resulted from a covered accident. The cost for this enhancement is $.026 per thousand in coverage. The AD&D benefits will mirror the life insurance elected.

Supplemental Accident and Dismemberment Insurance

You may enroll in supplemental accident and dismemberment coverage. Enrollment in the life insurance is required. To add this coverage to the life insurance for yourself, your spouse and/or our children, the cost is $.026 per thousand

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DISABILITY INSURANCE

Customer Service: 1-800-451-4531 or 1-800-733-7879

Representatives available: 8 am to 5:30 pm (CST) M-F, except holidays Claims Filing Address

Assurant Employee Benefits – Disability Claims PO Box 419568

Disability Coverage

Rates for coverage are based on your age each November 1st or the date you become benefit eligible, if later. You must earn a minimum of $1,000 a month in salary to be eligible for this benefit. The costs cited below are per $100

in benefit.

To obtain your benefit amount, use the formula: annual salary divided by 12 times 60% divided by 100 times the premium rate cited for your age band below.

Age as of November 1 Employee Cost per $100 in benefit

<25 $0.424 25‐29 $0.450 30‐34 $0.503 35‐39 $0.583 40‐44 $0.769 45‐49 $1.087 50‐54 $1.644 55‐59 $2.386 60‐64 $5.967 65‐69 $5.967 70+ $5.967

Disability coverage is offered through Assurant Employee Benefits. You may elect the coverage at the open enrollment; however, as a new enrollee, your coverage may be subject to pre-existing condition limitations. The disability coverage is intended to pay a monthly benefit equal to 60% of your base monthly salary if you become disabled and unable to work due to an injury, illness or pregnancy. If you purchase this coverage and become disabled, you will need to file a claim with Assurant Employee Benefits who will determine if you are eligible for benefits under the policy.

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HEALTH CARE REIMBURSEMENT ACCOUNT (HCRA)

Benefit Systems, Inc.

Representatives available: 8 am to 5 pm, M-F Claims Filing

Fax: 1-512-458-4550

Mail: 8140 North MoPac, Bldg. 4, Suite 200, Austin, TX 78759

Health Care Spending Account ‐ Payroll Deduction Costs

Minimum and Maximum Contribution Pay Period Cost Debit Card

$480 to $2,400 per plan year Up to $200 per payroll Included

These accounts allow you to set aside tax-free dollars to pay yourself back for eligible health care and dependent care expenses. Here’s how they work:

 Choose a specific amount of money between the minimum of $480 to a maximum of $2,400 per year to contribute each pay period, tax free, to the account during the plan year.

 The amount is automatically deducted from your pay at the same level each pay period.

 As you have eligible expenses, you submit claims to be reimbursed with your tax-free contributions.  Over the counter drugs will NOT be eligible for reimbursement unless prescribed by a licensed medical

provider.

 Remember the plan year for the HCRA only is October 15th

, 2014 through October 14th, 2015

HCRA RULES

In return for the tax advantages, the IRS has strict rules that must be followed:

 You cannot change the amount that you contribute to either account until the next plan year, unless you have a qualified life event or change in status.

 Any money left in the account at the end of the plan year must be forfeited. RECEIVING REIMBURSEMENT

 You can be reimbursed at any time of the year up to the full amount that you have elected to contribute.

 Expenses must be incurred during the HCRA plan year to be eligible for reimbursement.

 There is an ‘extended grace period’ following the end of the plan year of 2.5 months in which you can continue to incur expenses for reimbursement.

 All expenses must be filed by February 15, 2016 to be eligible for consideration.

The plan year for the Health Care Reimbursement Account ONLY is October 15, 2014 through October 14, 2015.

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 You may elect to receive a Debit Card. The use of the debit card will allow you to immediately pay for your eligible medical expenses at the time the expense the made. The card automatically pulls the funds from your account.

HEALTH CARE REIMBURSEMENT ACCOUNT

When you participate in the Health Care Reimbursement Account, you choose to have a certain amount of money deducted from your paycheck each pay period before taxes are withheld, not to exceed $2,400 per calendar year. You can then use the money in your account to pay yourself back for eligible health care expenses for you and your family. Participation in the District’s medical, dental or vision plan is not required.

You cannot use the account to reimburse yourself for monthly health care coverage premiums because you already pay your contributions for those benefits with pre‐tax dollars.

All IRS allowed medical expenses are eligible. These may include:  Over the counter medications if prescribed by a licensed provider  Hearing aids

 Special medical equipment

 LASIK or other vision correction surgery  Acupuncture

 Deductibles, coinsurance and copays under your medical, dental and vision plans

 Other eligible health costs that are not covered by any health care plan in which you participate

Health Care Reimbursement Account – Do your homework!

Before making a decision to contribute to the Health Care Reimbursement Account, check with your tax advisor or see IRS Publication 502 on the IRS Web site for the full list of eligible expenses. In addition, there is a calculator on the Lake Travis ISD Plansource Benefits Site to assist you in calculating the amount to withhold and your potential tax savings.

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Refer to the Plansource system link at https://benefits.plansource.com.

Check out the District’s Benefits Open Enrollment web-site at www.ltisdschools.org (under Staff > Benefits Open Enrollment).

Contact the Office of Human Resources at 512-533-6024 or by email at [email protected] or come see us at the Benefits Fair at the EDC on October 1st!

Attend the Benefits Fair

October 1, 2014

at the Educational Development Center

Enrollment Support and Vendors On-site

from 8 am to 5 pm

- Computers will be available for you to complete your online enrollment - HR staff will be present to answer questions and provide assistance - Blue Cross, Assurant, Benefits System and Eyemed will be on-site to

address any of your coverage questions

Free Flu Shots for Employees

from 7 am to 5 pm

- Free flu shots to all employees

- Clinic available to LTISD employees only - Walk-ins welcome