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2014 Frenship ISD. Group Health Insurance Plan. CAMPUS REPRESENTATIVES : FHS Tate Casey Reese Lynn Mills FMS Katrina Smith Terra Vista David Speer HMS Emily Wagner Bennett Sanae Allison Crestview Cindy York/Kathy Dawson Oak Ridge Shane Langen

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2014 frenship isd

2014 Frenship ISD

Group Health Insurance Plan

2013 2014 fisd health insurance committee


FHS Tate Casey

Reese Lynn Mills

FMS Katrina Smith

Terra Vista David Speer

HMS Emily Wagner

Bennett Sanae Allison

Crestview Cindy York/Kathy Dawson Oak Ridge Shane Langen

North Ridge Betsy Bucy

Westwind Bobbie Jo Williams

Willow Bend Stacey Price

Custodians Balt Padilla

Maintenance Alex Diaz, Derek Cobb, Allen Tanner

Central Office Rhonda Dillard, Pat Valdez, Greg Cartwright, Dr. Vroonland, Michelle McCord, Tim Williams, Courtney Reeves

2013-2014 FISD Health Insurance Committee

Remember our plan year

January 1, 2014 through

December 31, 2014

Remember, Our Plan year…

Plan options in network includes umc covenant

HMO (free plan for employees)

 PPO 1

PPO 2

 High Deductable/HSA (Health Savings Acct.)

Plan Options:(In Network Includes UMC & Covenant )

Premiums comparison all plans side by side


Employee Only $ 0 $313 $ 42 $ 21

Emp. & Spouse $399 $1112 $504 $417

Emp. & Child $234 $655 $313 $191

Emp. & Family $456 $1170 $570 $446

**Increases in premiums reflects a portion of the 4.3% tax as required by the Affordable Care Act**

Note: All premiums INCLUDE $266/month that is paid by FISD and reflect YOUR monthly cost:

Premiums ComparisonAll Plans Side by Side

Hmo plan free plan for employees

  • Deductible - $4000 per member

  • Co-Insurance – 100% (plan pays after deductible)

  • $40 Dr. Visit Co-pay ($80 specialist)

  • RX - $10/generic - 50%/preferred after $250 deductible

    • Tier 4 drugs 50%($4000 addl. out of pocket maximum)

  • Out-of-Pocket Maximum = $4000 individual/ $8000 family

  • Hospital/Emergency/Maternity – 100%after $4000 Deductible is met

HMO Plan (free plan for employees)

Ppo 1 plan

  • Deductible $1500 per member ( $3000/family) - In Network

  • Co-Insurance – 80% in network/ 60% out of network (plan pays after deductible)

  • $30 Dr. visit Co-pay ( $60 / specialist)

  • RX - $10-$35-$60 after $100 deductible

    • Tier 4 drugs @ 20% ($4000 addl. out of pocket)

  • Out-of-Pocket Maximum = $4000 per member

    ($8000/family) – In Network

  • Hospital/Maternity – 80%/60%(Emergency room/ 80% after deductible)

  • Maternity –Pediatrician, delivery, and nursery are covered at 80% after the $1500 deductible

PPO 1 Plan

Ppo 2 plan

  • Deductible $2500 per member ( $5000 /family) – In Network

  • Co-Insurance – 70% in network / 50% out of network (plan pays after deductible)

  • $35 Dr. visit Copay ( $70 /specialist)

  • RX - $10 generic / 30% preferred after $250 deductible

    • Tier 4 drugs / 30% ($4000 max. out of pocket)

  • Out-of-Pocket Maximum - $4,000 per member

    ( $8000 / family) - In Network

  • Hospital/Maternity – 70%/50%

    (Emergency room/ 70% after deductible)

  • Maternity – Pediatrician, delivery, and nursery charges are covered at 70% after the $2500 deductible.

PPO 2 Plan

In network out of network

In Network / Out of Network

In-network - Any provider that accepts First Care.

Outside Lubbock area –

PHCS / Multiplan

When seeking services with these networks, you will need preauthorization. This information is on the back of your insurance card.

In Network / Out of Network

Hsa plan health savings account

  • Deductible - $2,500 per member ($5000/family)

  • No Copay…Discounted Dr. office visits and 80% after deductible is met

  • RX – 80% after deductible is met

  • Out-of-Pocket Maximum - $5,200 per member ($10,400/family)

  • Maternity - $5000 max. out of pocket for mom

    (Routine Facility charges covered under mom/ Professional service provider applies to baby’s deductible)

  • All coverage starts after member has met deductible or max. out of pocket. Money placed in HSA account is above and beyond premium.

  • HSA account must be set up prior to incurring claims in order to have tax advantage.

HSA PlanHealth Savings Account

2014 frenship isd

  • Individual and/or family deductible must be met before you are eligible for any insurance benefits.

  • You have the option to open a Health Savings account. This money must be used on medical expenses and is your money as long as the account is open.

  • HSA account must be opened prior to accessing any funds.

    Maximum - $3300.00/Individual



Options to cover family or children

Options to cover Family or Children…

Affordable care act aca

  • Public Marketplace Care Act

  • Guaranteed issue / No Pre-existing limitations

  • Sold through healthcare.gov, Ashmore & Associates, Aycock and Fowler, independent agents and other entities

  • Policies and rates are identical on both public and private marketplaces.

  • Only licensed agents can assist consumers with actual purchase decisions.

  • Navigators are licensed to assist with the completion of the application.

Affordable Care Act (ACA)

2014 frenship isd

  • Subsidies Care Act and Tax credits are available through the public marketplace – ONLY if your employer does NOT offer you a compliant plan as an option.

  • FISD plans comply with all the minimum benefit and affordability standards.

Ways to manage your insurance

  • If at all possible, go to a provider that takes First Care so that claims are paid in network.

  • Prescriptions – Always ask for generic, check at least three pharmacies for best price, check United to see if the meds are FREE, Google prescription for coupons and discounts, and ask Doctor for samples.

  • Lab work and x-rays done in conjunction with the office visit are included in your office visit copay.

  • Other class of diagnostic tests are subject to your deductible. (Ex. MRI)

Ways to manage your insurance…

Healthiest you

  • Telehealth so that claims are paid in network. & Wellness solution plan - $9.00 per month covers the entire family

  • Compliments the medical plans and saves on medical claims

  • 3 easy steps to speak to a physician anytime anywhere online or by phone

  • Prescriptions are called in to the pharmacy of your choice – (Must accept First Care)

  • Online tool provided to shop for the best price on prescriptions in your area

  • You must complete medical history on line

  • Covers most common conditions including but not limited to: allergies, bronchitis, earache, sore throat, sinusitis, pink eye, strep throat, upper respiratory infection, urinary tract infection….

Healthiest You

Preventative care

All Insurance plans cover Preventative Care at 100%!! so that claims are paid in network.

This could include: annual routine physicals, routine immunizations, well baby and well child care, routine eye/speech/hearing screenings for children when performed in the office, examination and testing for the detection of prostate cancer…

First Care list of Preventative Care is posted on the HR website

Preventative Care

Additional contributions

FISD so that claims are paid in network.provides $20,000 of Life Insurance on all employees

  • The group life coverage was offered on a guarantee issue basis to all employees during the first year.

  • If you want to increase your group live coverage, you now have to apply for the additional coverage.

  • You will have the opportunity to talk to an FBS representative during enrollment about supplemental benefits.

Additional Contributions

Fisd cafeteria plan section 125 why should i participate
FISD Cafeteria Plan (Section 125) so that claims are paid in network.“Why should I participate?”

The only entity to benefit from your participation is YOU.

The district does not profit from #125

No insurance agent or company benefits

Individual enrollments @ your campus

Section 125 is the tax code which allows participating employees to place certain financial expenses into an account PRIOR to taxes being withheld.

Fisd cafeteria plan options

  • Child Care Reimbursement Plan so that claims are paid in network.

  • Medical Reimbursement Plan

  • Cancer/Intensive Care Insurance

  • Vision

  • Accident Insurance

  • Dental Reimbursement Plan – Must file paper copy

  • Medical Insurance

FISD Cafeteria Plan OPTIONS

Medical reimbursement account nbs flex card

  • Money can be taken from your check before taxes each month and placed in a medical reimbursement account.

  • You will use an NBS Flex Visa credit card preloaded with the amount of money that you will put in for the year. (Ex. $50 x 12 = $600) This money can only be used for medical expenses. Additional cards are $5.00 each.

  • The NBS Flex card cannot be used for dental expenses. You must submit a claim form with receipt for reimbursement.

  • Maximum - $2500 per year (you must use it or lose it at the end of each year)

  • FISD – 2 ½ month grace period to spend funds in flexible account.

  • 90 day run out period – can file claims up to 90 days after plan year ends.

Medical Reimbursement Account NBS Flex card

Understanding your insurance plan

You can learn more about the advantages of the PPO1, PPO2, HMO and High Deductible/HSA by:

  • Contacting The Ashmore Agency or Aycock & Fowler Insurance Agency for a consultation.

  • Visiting with an Insurance representative on the day of enrollment from 8:30 – 10:00 to discuss your insurance options.

“UNDERSTANDING” Your Insurance plan

Consultations available

HMO and High Deductible/HSA by:NOTE: If you are going to meet your deductible for any reasonplease call:

Ashmore and Associates - 806-745-8358 Aycock & Fowler - 806-798-2700

You will get one-on-one assistance to help you know what is ahead of you (i.e. – know what your plan is paying and what you should pay.

Consultations Available

Frenship isd brokers

Beth Ashmore HMO and High Deductible/HSA by:


Ashmore & Associates

Brent Aycock


Aycock& FowlerInsurance Agency

Frenship ISD Brokers