2024 Liberty County School System Employee Benefit Guide
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2024
Liberty County School System
Employee Benefit Guide
Liberty County School System
Dear Liberty County Employee,
As an eligible employee, you are entitled to enroll in the Section 125 plan, an IRS approved program designed to
help you save money on taxes. Certain insurance products are available for purchase on a pre-tax basis, under
Section 125. You have the option of deducting your premiums before tax, resulting in increased take-home pay and
reduced income taxes.
Flexible Spending Accounts are also available under Section 125. Each year, you can elect a portion of your paycheck
into an account (on a pre-tax basis) to gain reimbursement for out-of-pocket medical and dependent day care
expenses.
For 2024, American Fidelity will also be offering the following voluntary benefits:
• Disability Income Insurance
• Accident Insurance
• Cancer Insurance
• Life Insurance
• Dental/Vision/Group Life/AD&D
Enrollment counselors will be available throughout the open enrollment process to assist you in enrolling in all
of your benefits and to answer any questions you may have. To see this years enrollment dates please see page 5.
Liberty County Schools has developed the following benefit guide to provide you with information about your
benefit options for the new plan year, explain the enrollment process, and serve as a valuable resource for
information about all the benefits available to you. It’s a good idea to take some time to read this guide before
attending open enrollment and/or completing your enrollment forms.
Thank you in advance for taking the time to review this benefit guide and we look forward to seeing you during
this year’s open enrollment.
Sincerely,
�µ�
Michele Dasher Teresa White
Human Resource Director HR Benefits
Table of Contents
2024 Benefits Enrollment
Annual Enrollment........................................................................................................5
Section 125 Cafeteria Plan .........................................................................................5
How to Enroll ..................................................................................................................6
Insurance Plans
BCBS Contact Information..........................................................................................8
Employee Assistance Program (EAP)......................................................................9
Dental Plan.....................................................................................................................10
Vision Plan......................................................................................................................13
Group Life Insurance/AD&D....................................................................................16
Disability Income Insurance ....................................................................................23
Term Life Insurance.....................................................................................................24
Accident Only Insurance ..........................................................................................25
Cancer Insurance ........................................................................................................26
GAP PLAN Insurance ....................................................................................................2
Whole Life Insurance..................................................................................................28
Permanent Universal Life Insurance.....................................................................29
Flexible Spending Accounts (FSA)
Healthcare Flexible Spending Account (Healthcare FSA).............................31
Benefits Debit Card.....................................................................................................32
Dependent Care Account (DCA)............................................................................33
Managing Your Account............................................................................................34
Other Information
Retirement Information.............................................................................................35
YMCA ...............................................................................................................................36
Other Information.......................................................................................................37
Benefits Resource Directory ............................................................................... Back
About this Guide
This benefit guide is a compilation guide of Liberty County Schools-sponsored Human Resources. It is intended for informational
purposes only. The actual benefits available and the full descriptions of these benefits are governed in all cases by the relevant
plan document, insurance contracts, and Ordinances and Resolutions of Liberty County Schools, and where applicable, collective
bargaining agreements. If there are discrepancies between the benefit guide and the actual plan documents, insurance contracts,
and Ordinances and Resolutions, the documents, contracts, and Ordinances and Resolutions will govern.
2024 BENEFITS ENROLLMENT Annual Enrollment How to Enroll Section 125 Cafeteria Plan Enrollment Schedule
Your Annual Enrollment
NOTE: If eligibility changes during the year you must notify Human
Important Dates to Remember Resources within 31 days of the qualifying event.
Before you meet with your American Fidelity Representative, take time
Spring Open Enrollment for all other benefits to evaluate your current coverage and decide how well it serves the
April 8, 2024 - April 26, 2024 needs of you and your family.
Important Points To Consider
Note: Changes to insurance plans will go into effect January 1st, for
• Figure an estimate of out-of-pocket medical expenses. Remember
Health only.
that over-the-counter drugs and medicines now require a
Annual Open Enrollment prescription to be reimbursed. A worksheet can be found online at
Each year Open Enrollment provides you an opportunity to change http://liberty.k12.ga.us/Personnel under the “Employee Benefits”
plans and modify dependent coverage. Spring Open Enrollment dates tab to help you calculate these costs.
for Voluntary Benefits and Flexible Spending Accounts are April 8, 2024 • Figure an estimate of child care expenses.
- April 26, 2024 (See Liberty Co Schedule 2024 on your benefit website)
• Review your beneficiaries.
below. Health insurance open enrollment is October - November dates
and times will be announced in the fall. • Review American Fidelity’s options of portable insurance plans
that you can keep if your employment changes.
www.libertyschools.org/apps/pages/index.jsp?uREC_ID=285117&type=d
• Evaluate your need for life insurance.
American Fidelity Enrollment Site:
www.enroll.americanfidelity.com/9D24C8A0 • Consider increasing your Disability Income Insurance policy
amount to match your current salary.
Your Section 125 Plan
Save Money With Section 125 How Can This Plan Help Me?
If there was a program available that could dramatically save money The sample paycheck below shows the benefits under the Section
on your taxes, would you take advantage of it? That’s exactly what 125 Plan compared to benefits outside of the Plan. In this example,
the Section 125 Plan does—reduces your taxes and increases your the employee gained $55 more spendable income per month!
spendable income! Plus, the Plan is available to you at no cost* and
you’re already eligible, all you have to do is enroll. Pre-Tax Example After-Tax
Example
The Plan works like this: You are allowed to deduct needed benefits $1,500.00 Monthly Gross Salary $1,500.00
from gross earnings before taxes are computed. This means that
- $150.00 Pre-Tax Medical Insurance $0.00
current after-tax expenses, such as insurance products and benefits,
can be paid for with pre-tax dollars. - $25.00 Pre-Tax Disability Insurance $0.00
- $25.00 Pre-Tax Accident Insurance $0.00
The advantage of this Plan is simple: The eligible premiums you pay $1,300.00 Adjusted Monthly Gross Salary $1,500.00
under the Plan are paid on a pre-tax basis. You could be on your way to
- $260.00 Estimated Federal Tax (20%) - $300.00
increased savings, just by signing up and taking advantage of this Plan!
- $99.45 Estimated FICA (7.65%) - $114.75
Benefits Eligible For The Section 125 Cafeteria $0.00 After-Tax Medical Insurance - $150.00
Plan $0.00 After-Tax Disability Insurance - $25.00
• Group Medical, Dental and Vision Insurance $0.00 After-Tax Accident Insurance - $25.00
$940.55 Take-Home Pay $885.25
• Accident Insurance
* Taxes are a sample average of State, Federal and FICA taxes. Your own
• Cancer Insurance
average tax rate may vary.
• Flexible Spending Accounts
5
How to Enroll
Liberty County makes it easy for you to enroll in your 2023 benefits. Don’t Miss It!
Employees can enroll on-site with your American Fidelity representative.
• Have you recently received a pay increase?
Enroll On-site during Open Enrollment • Have you or are you planning on getting married, having children,
• All new hires must meet with an American Fidelity Assurance or buying a home?
Company Representative. During Spring Open Enrollment all • What would happen if you were suddenly ill or disabled?
employees must see an American Fidelity Representative to sign
a new election form for next year. These questions and others will be addressed during your benefit
• For Health Insurance, you must enroll online: www.myshbpga. consultation to make sure you are properly covered. It takes just a few
adp.com. moments to review your coverage and protect the welfare of you and
your family.
What To Bring To Your Appointment
• Driver’s license. By enrolling on-site you can enroll in:
• Bank account information (to sign up for direct deposit) • Dental Insurance • Accident Only Insurance
• Vision Insurance • Life Insurance
• Spouse and children’s DOB and Social Security number if
considering coverage for them. • Group Life Insurance/AD&D • Health Flex Spending Account
• Disability Income Insurance • Dependent Care FSA
• Beneficiary information, including (if a trust) full name and date
of trust. • Cancer Insurance • GAP Insurance
6
INSURANCE
PLANS
Contact Directory AFA Term Life
Employee Assistance Program Accident Insurance
Dental Plan Cancer Insurance
Vision Plan Critical Illness Insurance
Group Life Insurance/AD&D GAP PLAN Insurance
Disability Income Insurance Texas Life InsuranceHealth Plan Benefits
State Health Benefit Plan (SHBP)
Contact Directory
Vendor Member Services Website
Anthem Blue Cross Blue Shield of Georgia 855-641-4862 www.bcbsga.com/shbp
(BCBSGa)
Member Services: Mon - Fri 8:00 a.m. to 8:00 p.m. ET
UnitedHealthcare 888-364-6352 www.welcometouhc.com/shbp
Member Services: Mon - Fri 8:00 a.m. to 8:00 p.m. ET
TTY 711
SHBP Eligibility 800-610-1863 www.dch.georgia.gov/shbp
Member Services: Mon - Fri 8:30 a.m. to 5:00 p.m. ET
SHBP 1-800-610-1863 www.dch.georgia.gov/shbp
Call Center
Healthways 888-646-6411 www.bewellshbp.com
Member Services: Mon - Fri 8:00 a.m. to 8:00 p.m. ET
Additional Information Member Services Website
CVS Caremark 1-844-345-3241 www.caremark.com
Member Services: 24 hours a day/7 days a week
TRICARE Supplemental Plan 866-637-9911 www.asicorporation.com/ga_shbp
Member Services 8:30 a.m. to 5 p.m. ET
Monday – Friday
PeachCare for Kids 877-427-3224 www.peachcare.org
Health benefits enrollment will be in the Fall. Information will be communicated and included in this benefits guide when it is available.
To learn more about our Health Plan options, please review the following guides:
2024 SHBP Active Rates Jan 1 - Dec 31
2024 SHBP Frequently Asked Questions
2024 SHBP Enrollment Portal
2024 SHBP Active Employee Decision Guide
2024 SHBP Retiree Decision Guide
2024 SHBP Plan Documents
2024 SHBP Telemedicine
2024 SHBP Wellness
PeachCare for Kids Georgia Department of Community Health
2024 Employee Assistance Program EAP
8Employee Assistance
Program (EAP)
American Fidelity
Employee Assistance
Program (EAP)
Support for Everyday Issues,
Every Day
American Fidelity EAP provides emotional wellness and
work/life balance resources for you and your immediate
family members.
Everyone faces problems or situations that are difficult
to resolve. When these instances arise, American Fidelity
EAP will be there to help. American Fidelity EAP provides
confidential resources to help you navigate life’s ups and
downs. This includes professional referrals for a wide
variety of concerns, such as:
Anxiety
Depression Easy Digital Access
Marriage and Relationship Problems Mobile
Grief and Loss • eConnect® mobile app for on-the-go access to the EAP
Substance Abuse • Call or live chat with a licensed counselor
• Review a summary of the program
Anger Management
Work Related Pressures Web
Stress • Discounted fitness center memberships
• Library of online seminars and eLearning modules
Expert Referrals and Consultation • Bilingual content (English and Spanish)
Whether you are a new parent, a caregiver, selling your • Thousands of helpful articles and tip sheets for personal
home, or looking for legal advice, you’re likely to need and work related topics
guidance and referrals to expert resources. • Search engines and directories for child care, elder care,
• Legal Assist Free telephonic or face-to-face legal education, legal, financial, and convenience services
consultation
• Financial Assist Expert financial planning and
consultation
• Family Assist Consultation and referrals for everyday Access eConnect® Mobile App
issues, such as: dependent care, auto repair, pet care,
Username: americanfidelity
and home improvement
Confidentiality: American Fidelity EAP upholds strict confidentiality standards. Nobody, including your employer, will know you have accessed the program unless you
specifically grant permission or express a concern that presents us with a legal obligation to release information.
Some products and services may be provided by third party contractors and affiliated companies.
800-295-8323
americanfidelity.mysupportportal.com
American Fidelity Assurance Company
SB-32903-0120
9Dental Plan
Delta Dental PPOTM
We’re pleased to be your partner in maintaining great oral health. The Delta Dental PPO* plan makes it easy for you to find a dentist, and easy to control
your costs when you visit a network dentist. Here are some of the great things you’ll need to know about enrolling with Delta Dental:
Save Money with a Delta Dental PPO Dentist. Many Network Dentists to Choose From.
Our PPO network dentists accept reduced fees for covered services Since Delta Dental offers access to some of the largest dentist
they provide you, so you’ll usually pay the least when you visit a networks in the U.S., chances are there’s a wide choice of network
PPO network dentist. This also ensures Delta Dental dentists won’t dentists near your home or office. Four out of five dentists nationwide
balance bill you the difference between the contracted amount and are contracted Delta Dental dentists, giving more enrollees
their usual fee. convenient access to more dentists. Visit us at www.deltadentalins.
com to search our dentist directory by location or specialty.
The PPO plus Premier “safety-net”. Easy to Use Your Benefits.
If you don’t choose to visit a Delta Dental PPO dentist, you also have When you visit a Delta Dental dentist, pay only your portion for
access to the Delta Dental Premier® network. You’ll usually pay more services. Delta Dental dentists will file claim forms for you and
than if you visit a PPO dentist, but you’ll still have cost protections receive payment directly from us. Many non-Delta Dental dentists
that you don’t get when you visit a non-Delta Dental dentist. ask that you pay the entire cost up front and wait for reimbursement.
Visit the Dentist of your Choice. Delta Dental’s Online Services Make Getting
Want to visit a non-Delta Dental dentist? No problem. You can visit information Quick and Easy.
any licensed dentist, but your costs are usually lowest when you see Access your benefits and eligibility, print ID cards and get information
a PPO dentist. about your claims. And check out Delta Dental’s oral health resources
for tips and information that can help keep your smile healthy.
Monthly Premiums
Emp. Only $34.92
Emp. + spouse $67.42
Emp. + child(ren) $77.70
Family $109.58
10Dental Plan
Delta Dental PPOTM
Plan Benefit Highlights for: Liberty County School District
Group No: 15847 Effective Date: 7/1/2021
Eligibility For eligibility details, refer to the plan's Evidence/Certificate of Coverage
(on file with your benefits administrator, plan sponsor or employer).
Deductibles* $50 per person / $150 per family each plan year
Deductibles waived for
Diagnostic & Preventive (D & P) Yes
and Orthodontics, if applicable?
Maximums* Low Plan: $1,000 per person per each plan year
High Plan: $1,200 per person per each plan year
D & P counts toward maximum?
No
Waiting Period(s) Orthodontics
Basic Services Major Services Prosthodontics
12 Months
None None None
(Plus Plan)
Low Plan Plus Plan
Benefits and Delta Dental Non-Delta Dental Delta Dental Non-Delta Dental
Covered Services** PPO dentists† PPO dentists† PPO dentists† PPO dentists†
Diagnostic & Preventive
Services (D & P) 100 % 100 % 100 % 100 %
Exams, (4) cleanings and x-rays
Basic Services 50 % 50 % 80 % 80 %
Fillings and sealants
Endodontics (root canals) 50 % 50 % 80 % 80 %
Covered Under Basic Services
Periodontics (gum treatment) 50 % 50 % 80 % 80 %
Covered Under Basic Services
Oral Surgery 50 % 50 % 80 % 80 %
Covered Under Basic Services
Major Services
Crowns, inlays, onlays and cast 50 % 50 % 50 % 50 %
restorations
Prosthodontics 50 % 50 % 50 % 50 %
Bridges and dentures
Orthodontic Benefits 0% 0% 50 % 50 %
Dependent children to age 19
Orthodontic Maximums N/A N/A $1,000 Lifetime $1,000 Lifetime
* If you switch plans during the calendar year your Deductible and Annual Maximum may be adjusted accordingly.
** Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement
is based on Delta Dental contract allowances and not necessarily each dentist’s actual fees.
† Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and
program allowance for non-Delta Dental dentists.
Delta Dental Insurance Company Customer Service Claims Address
1130 Sanctuary Parkway, Suite 600 800-521-2651 P.O. Box 1809
Alpharetta, GA 30009 Alpharetta, GA 30023-1809
deltadentalins.com
This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or Summary Plan
Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your
company’s benefits representative. HLT_PPO_2COL_HILO_DDIC (Rev. 3/1/2021)
11Dental Plan
Delta Dental PPOTM
Keep Smiling
Delta Dental PPO™
Save with PPO Coordinate dual coverage
Visit a dentist in the PPO1 network to maximize If you’re covered under two plans, ask your dental
your savings.2 These dentists have agreed to office to include information about both plans
reduced fees, and you won’t get charged more with your claim — we’ll handle the rest.
than your expected share of the bill.3 Find a PPO
dentist at deltadentalins.com. Understand transition of care
Generally, multi-stage procedures are covered
Set up an online account under your current plan only if treatment began
Get information about your plan, check benefits after your plan’s effective date of coverage.4
and eligibility information, find a network dentist Log in to your online account to find this date.
and more. Sign up for an online account at
deltadentalins.com. Get LASIK and hearing aid discounts
With access to QualSight and Amplifon Hearing
Check in without an ID card Health Care5, you can save as much as 50% on
You don’t need a Delta Dental ID card when you LASIK procedures and more than 60% on hearing
visit the dentist. Just provide your name, birth aids. To take advantage of these discounts, call
date and enrollee ID or Social Security number. QualSight at 855-248-2020 and Amplifon at
If your family members are covered under your 888-779-1429.
plan, they’ll need your information. Prefer to have
an ID card? Simply log in to your account to view
or print your card.
Save with a
PPO dentist
PPO NON–PPO
1 In Texas, Delta Dental Insurance Company provides a dental provider organization (DPO) plan.
2 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-PPO dentist. Network dentists are paid contracted fees.
3 You are responsible for any applicable deductibles, coinsurance, amounts over annual or lifetime maximums and charges for non-covered services. Out-of-network
dentists may bill the difference between their usual fee and Delta Dental’s maximum contract allowance.
4 Applies only to procedures covered under your plan. If you began treatment prior to your effective date of coverage, you or your prior carrier is responsible for
any costs. Group- and state-specific exceptions may apply. If you are currently undergoing active orthodontic treatment, you may be eligible to continue treatment
under Delta Dental PPO. Review your Evidence of Coverage, Summary Plan Description or Group Dental Service Contract for specific details about your plan.
5 Vision corrective services and Amplifon’s hearing health care services are not insured benefits. Delta Dental makes the vision corrective services program and
hearing health care services program available to you to provide access to the preferred pricing for LASIK surgery and for hearing aids and other hearing health
services.
Copyright © 2020 Delta Dental. All rights reserved.
HL_PPO #129455W (rev. 10/20)
12Vision Plan
Superior Vision
superiorvision.com | 1 (800) 507-3800
Vision Care Plan for
Liberty County School District
Benefits through Superior National network
Frequency
Exam 12 months
Frame 24 months
Contact lens fitting 12 months
Eyeglass lenses 12 months
Contact Lenses 12 months
(based on date of service)
Need help? Contact 1 (800) 507-3800 or visit superiorvision.com for assistance.
Exams Materials1
Eye exam copay: Materials copay:
$10 $25 Monthly Premiums
Contact lens fitting2 copay
(standard and specialty): Employee only: $8.80
$10 Employee + spouse: $17.42
Specialty In-network allowance:
$50 Employee + child(ren): $17.04
Frames
Contacts4 Employee + family: $25.94
in lieu of glasses
In-network allowance: In-network allowance:
$140 $120
Lenses (per pair) In-Network Coverage Out-of-Network Reimbursement
Single vision Covered-in-full Up to $32
Bifocal Covered-in-full Up to $46
Trifocal Covered-in-full Up to $61
Progressives See description3 Up to $61
Shop with convenience while using your benefits
through these in-network online retailers.
13Vision Plan
Superior Vision
Lens Add-Ons Your Cost
Anti-scratch coating $15
Ultraviolet coating $12
Tints - solid / gradient $15 / $18 LASIK Discounts5
Polycarbonate lenses $40 Multiple discounts on laser vision
correction procedures may be
Blue light filtering $15
available to you. To learn more,
Digital single vision $30 visit superiorvision.com or
Progressive lenses contact your benefits coordinator.
$55 / $110 / $150 / $225
(standard / premium / ultra / ultimate)
Anti-reflective coating
$50 / $70 / $85 / $120
(standard / premium / ultra / ultimate)
Polarized lenses $75
Plastic photochromic lenses $80
Hi-index (1.67 / 1.75) $80 / $120 Hearing Aid Discounts5
Through Your Hearing Network,
Overage Discounts5 Amount you have access to discounts on
hearing services, devices, and
Frames 20% off amount over allowance
accessories. To learn more, visit
Conventional contacts 20% off amount over allowance superiorvision.com or contact
your benefits coordinator.
Disposable contacts 10% off amount over allowance
Non-Covered Services Discounts5 Amount
Exams, frames, prescription lenses 30% off retail
Contacts, miscellaneous options 20% off retail
Disposable contact lenses 10% off retail
Retinal imaging $39 cost Free Mobile App
With the free Superior Vision app
Additional Out-of-Network (available for Android and Apple
Amount
Reimbursements5 devices), you can create an
Eye exam (MD) Up to $42 account, check your eligibility and
benefits, find providers, and view
Eye exam (OD) Up to $37
your member ID card.
Frame Up to $48
Contact lens fitting (standard / specialty)2 Not covered
Contact lenses Up to $100
MetLife Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY. Certain claims and network administration services are provided through Superior Vision Services, Inc.
(“Superior Vision”), a Delaware corporation. Superior Vision is part of the MetLife family of companies. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain
exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details.
Co-pays apply to in-network benefits; co-pays for out-of-network visits are deducted from reimbursements 1. Materials co-pay applies to lenses and frames only, not contact lenses. 2. Standard contact lens
fitting applies to a current contact lens user who wears disposable, daily wear, or extended wear lenses only. Specialty contact lens fitting applies to new contact wearers and/or a member who wear toric, gas
permeable, or multi-focal lenses. 3. Covered to provider’s in-office standard retail lined trifocal amount; member pays difference between progressive and standard retail lined trifocal, plus applicable co-pay 4.
Contact lenses are in lieu of eyeglass lenses and frames benefit. 5. Not all providers support these discounts, including the member out-of-pocket features. Call your provider prior to scheduling an
appointment to confirm if they offer the discount and member out-of-pocket features. The discount and member out-of-pocket features are not insurance. Discounts and member out-of-pocket are subject
to change without notice and do not apply if prohibited by the manufacturer. Lens options may not be available from all providers / all locations.
14Vision Plan
Superior Vision
Details
All allowances are retail; member is responsible for any amount over the allowance, minus available discounts.
Discounts are subject to change without notice. Disclaimer: All final determinations of benefits, administrative duties, and definitions are
governed by the Certificate of Insurance for your vision plan. Please check with your Human Resources department if you have any questions.
The Superior Vision Plan is underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not
affiliated with The Guardian Life Insurance Company of America, AKA The Guardian or Guardian Life
Contact Information
Superior Vision Services, Inc.
P.O. Box 967
Rancho Cordova, CA 95741
Customer Service: 800-507-3800
www.superiorvision.com
NVIGRP 5-07 0312-BSv1/GA
Co-Pays and Rates
2024 Rates
Copays
Exam $10
Materials1
$25
Contact Lens Fitting (standard & speciality) $10
Monthly Premiums
Emp. Only $8.80
Emp. + spouse $17.41
Emp. + child(ren) $17.04
Emp. + family $25.94
Services / Frequency
Exam 12 months
Frames 24 months
Contact Lens Fitting 12 months
Lenses 12 months
Contact Lenses 12 months
(Based on date of service)
15Group Life/AD&D Insurance
Standard
16Group Life/AD&D Insurance
Standard
17Group Life/AD&D Insurance
Standard
18Group Life/AD&D Insurance
Standard
Employee Life with AD&D Monthly Premiums
Coverage Employees Age as of July 1
AmountGroup Life/AD&D Insurance
Standard
Spouse Life Monthly Premiums
Coverage Employees Age as of July 1
AmountGroup Life/AD&D Insurance
Standard
21Group Life/AD&D Insurance
Group Life and AD&D Insurance Standard
percentage of the amount payable for the benefit on the • The date the last period ends for which a premium was
date of the accident. No more than 100 percent of the paid
AD&D benefit will be paid for all losses resulting from one • The last day of the calendar month in which your
accident. employment terminates
Any loss must be caused solely and directly by a n • The date you cease to meet the eligibility requirements
accident within 365 days of the accident. A certified copy (insurance may continue for limited periods under
of the death certificate is needed to prove loss of life. certain circumstances)
All other losses must be certified by a physician in the • The date the group policy, or your employer's coverage
appropriate specialty determined by The Standard. under the group policy, terminates
Covered loss: Percentage of AD&D • For each elective insurance coverage, the date that
benefit payable: coverage terminates under the group policy
Life 1 100% • The date your Life coverage ends, your AD&D coverage
One hand or one foot 2 50% will end as well
Sight in one eye, speech or hearing in both ears 50% In addition to the above requirements, your Dependents
Life coverage ends automatically on the date your
Two or more of the losses listed above 100%
dependent ceases to meet the eligibility requirements for a
Thumb and index finger of the same hand 3 25% dependent.
Quadriplegia 100% For more details on when your insurance ends, contact
Hemiplegia 50% your human resources representative or plan
administrator.
Paraplegia 50%
1 Includes loss of life caused by accidental exposure to adverse weather Group Insurance Certificate
conditions or disappearance if disappearance is caused by an
accident that reasonably could have resulted in your death. If coverage becomes effective and you become insured,
2 Even if the severed part is surgically re-attached. This benefit is not you will receive a group insurance certificate containing a
payable if an AD&D benefit is payable for quadriplegia, detailed description of the insurance coverage, including
hemiplegia, paraplegia, involving the same hand or foot.
the definitions, exclusions, limitations, reductions and
3 This benefit is not payable if an AD&D benefit is payable for the loss of terminating events. The controlling provisions will be in
the entire hand.
the group policy. The information present in this summary
AD&D Insurance Exclusions does not modify the group policy, certificate or the
You are not covered for death or dismemberment caused insurance coverage in any way.
or contributed to by any of the following:
About Standard Insurance Company
• Committing or attempting to commit an assault or
felony, or actively participating in a violent disorder or For more than 100 years, we have been dedicated to our
riot core purpose: to help people achieve financial well-being
and peace of mind. Headquartered in Portland, Oregon,
• Suicide or other intentionally self-inflicted injury, while
The Standard is a nationally recognized provider of group
sane or insane
employee benefits. To learn more about products from
• War or any act of war (declared or undeclared), and any The Standard, visit us at www.standard.com.
substantial armed conflict between organized forces of The Standard is a marketing name for StanCorp Financial
a military nature Group, Inc. and subsidiaries. Insurance products are
• Voluntary consumption of any poison, chemical offered by Standard Insurance Company of Portland,
compound, alcohol or drug, unless used or consumed Oregon, in all states except New York. Product features
according to the directions of a physician and availability vary by state and are solely the
• Sickness or pregnancy existing at the time of the responsibility of Standard Insurance Company.
accident GP190-LIFE/S399, GP399-LIFE/TRUST, GP899-LIFE,
• Heart attack or stroke GP190-LIFE/A997/S399, GP411-LIFE
Standard Insurance Company
• Medical or surgical treatment for any of the above 1100 SW Sixth Avenue
Portland OR 97204
When Your Insurance Ends www.standard.com
Your insurance ends automatically when any of the SI 12505-D-VLVA-GA-Liberty County Board of Education (3/20)
following occur: 6408081-526585
Standard Insurance Company 8
22Long-Term Disability Income Insurance
American Fidelity Assurance Company
How do you pay for your mortgage, bills, food and other monthly
Coverage Feature What It Means To You
expenses? If your paycheck stopped today, could you maintain your
current lifestyle? Accidental Injury and You are covered in the case of a
Sickness Coverage covered accident that occurs away
from work or a covered sickness that
American Fidelity Assurance Company’s Long-Term Disability Income causes you to be disabled.
Insurance is designed to help protect you if you become disabled and
Benefit Paid Directly to Use the money however best fits your
cannot work due to a covered Accidental Injury or Sickness. You, Regardless of Other financial needs, regardless of other
Coverage insurance.
How the Plan Works
If you become disabled due to a covered accident or sickness, Long- Waiver of Premium Premiums are not required while you
Term Disability Income Insurance will pay the disability benefit once are disabled based on the length of
your disability.
you have satisfied the elimination period. Your benefit amount is
dependent on your salary and the amount you select at the time of Age at Entry Your premiums will be based on the
application. Disability benefits will be payable up to the benefit period date your policy becomes effective.
stated in your policy. Accidental Death Benefit Receive a benefit if you die as the
direct result of an Accidental Injury
and death occurs within 90 days after
Optional Riders the date of the Accidental Injury.
Enhance your base plan with the following riders: Competitive Premiums Your monthly premiums could be
• Critical Illness Rider paid with only one hour of a week’s
paycheck.
• Accident Only Spousal Rider
Payroll Deducted Enjoy the convenience of having your
• Hospital Indemnity Benefit Rider premiums deducted straight from
your paycheck.
• COBRA Premium Rider
• Survivor Benefit Rider Limitations, exclusions, and waiting periods apply. Refer to your policy
for complete details.
Learn more at americanfidelity.com/info/disability
AF-1767-0123
23Individual Term Life Insurance
American Fidelity Assurance Company
Life insurance is an important factor to any family. It serves as a
Coverage Feature What It Means To You
foundation to help in the case of a loved one’s premature death. Plan
today to make the right move for your loved ones. Three Plan Options: 10, Choose the coverage period to meet
20 and 30-Year Level your financial needs.
Term Coverage
American Fidelity Assurance Company offers a Term Life Insurance
policy to help with your financial needs for your short-term and long- Guaranteed Death Your death benefit is guaranteed as long
Benefit as the policy is active.
term goals.
Accelerated Death Receive a portion of the chosen death
Benefit for Terminal benefit if you are diagnosed with a
How the Plan Works Condition covered Terminal Condition. Limitations
Individual Term Life Insurance has a death benefit with no cash and exclusions may apply.
accumulation feature. The policy is initially written for a 10, 20 or 30- Conversion Benefit Turn your policy into a permanent plan
year term period, but may be renewed at the insured’s option for the any time up to age 70. The rate for your
same level renewal period depending upon the term chosen. new plan will be based on your attained
age.
The last level renewal period is no later than age 70 for the 10-year term Guaranteed Renewable Renew your policy up to age 90
policy and age 60 for the 20-year term policy. Thereafter, premiums are regardless of your health.1
renewable annually up to age 90. The 30-year term policy is renewable Interim Coverage for Death benefit coverage starts when
annually after the initial 30-year term period up to age 90. Renewal Death the life insurance application has been
rates will be based on the insured’s age at the time of renewal.1 signed and underwriting guidelines have
been met.
Optional Riders Express Issue Application Only 3 express issue health questions are
required to issue coverage.2
Enhance your base plan with the following riders:
Portable You own the policy. Take the coverage
• Spouse Term with you if you choose to leave your
• Children’s Term current job.
Payroll Deducted Enjoy the convenience of having your
• Waiver of Premium
premiums deducted straight from your
• Accidental Death & Dismemberment paycheck.
• Accelerated Benefit for Long Term Illness (30 Year Term Only)
1
Premiums are subject to increase upon renewal. 2Issuance of the policy may
depend on the answer to these questions.
Limitations, exclusions and waiting periods apply. Please refer to your
Learn more at americanfidelity.com/info/life policy for complete details, Policy Form Series ICC14 RCTL14. Not
generally qualified benefits under Section 125 Plans.
AF-1769-0123
24Accident Only Insurance
Limited Benefit Accident Only Insurance
American Fidelity Assurance Company
From weekend warriors to active families and those of us just living
Coverage Feature What It Means For You
everyday life, accidents can happen without warning anytime,
anywhere. As healthcare expenses continue to rise, are you financially Plan Options: Choose the plan to meet your financial
Levels 1, 2, 3, 4 needs.
prepared for the unexpected costs resulting from an injury?
Four Choices of Coverage: Choose the coverage that fits your
Individual, Individual lifestyle.
Limited Benefit Accident Only Insurance may help manage and Spouse, Individual
out-of-pocket expenses to treat injuries resulting from a covered and Child, or Family
accident. This plan pays benefits directly to you, and may help you
Wide-Ranging Benefits for many types of covered
with unplanned accident medical expenses. And, for some policies, the Schedule of Benefits injuries.
Accident Screening Benefit pays annually for routine physical exams,
Accident Screening The plan pays an annual Accident
preventive testing and more. Benefit Screening Benefit for one Covered
Person to receive a covered screening
How the Plan Works including routine physical exams,
preventive testing, and more.
Our Accident Only Insurance policy pays according to a wide-ranging
schedule of benefits. In addition, the policy provides 24-hour coverage Initial Treatment Benefit Receive a benefit when treatment is
for accidents that occur both on and off the job. received by a Physician or Medical
Professional within 30 days of a
covered accident.
All benefits are only paid as a result of Injuries received in an Accident
Benefit Paid Directly to Use the benefit however best fits your
that occurs while coverage is in force. All treatment, procedures, and You, to use as you see fit financial needs.
medical equipment must be diagnosed, recommended and treated by
Guaranteed Renewable Keep your coverage as long as
a Physician. All benefits are paid once per Covered Person per Covered
premiums are paid as required.
Accident unless otherwise specified in the Limitations and Exclusions
24-Hour Coverage You are covered on or off the job.
section. Twenty-four-hour (24-hour) coverage not applicable on Non-
Twenty-four-hour (24-hour) coverage
Occupational policies. Refer to your brochure and/or policy for details. not applicable on Non-Occupational
policies. Refer to your brochure and/or
policy for details.
Features
Portable You own the policy. Take the coverage
• Benefits paid directly to you with you if you choose to leave your
• A policy you own—take the policy with you if you leave your current job. Your premiums will remain
employer or retire the same.
• Coverage for you, your spouse and children under age 26 Payroll Deducted Enjoy the convenience of having your
premiums deducted straight from
your paycheck.
Learn more at americanfidelity.com/info/accident
Limitations, exclusions and waiting periods apply. Refer to your policy
for complete details, AO22. This product is inappropriate for people
who are eligible for Medicaid coverage. The premium and amount
of benefits provided vary dependent upon the plan selected. The
company has the right to change premiums by class. The Accident
Screening Benefit is not available in all states.
AF-1196-0722
25Cancer Insurance
Limited Benefit Cancer Insurance Policy
American Fidelity Assurance Company
A cancer diagnosis may be overwhelming. Even with a good major
Coverage Feature What It Means For You
medical plan, the out-of-pocket costs of cancer treatment, such as
travel, childcare, and loss of income, are considerable and may not be Plan Options: Basic, Choose the plan option to meet your
Enhanced and financial needs.
covered. Enhanced Plus
Three Choices of Choose the coverage that fits your
American Fidelity Assurance Company’s Limited Benefit Individual Coverage: Individual, lifestyle.
Cancer Insurance offers a solution to help you focus your attention Single Parent Family, or
on fighting cancer. We offer plans that can help assist with out-of- Family
pocket costs often associated with a cancer diagnosis. Wide-Ranging Covers a wide range of treatments.
Schedule of Benefits
How the Plans Work Benefit Paid Use the money however best fits your
Our plans are designed to help cover expenses if you are diagnosed Directly to You financial needs.
with a covered Cancer. With over 20 benefits available to you, these Guaranteed Renewable Policy is guaranteed renewable as
plans can provide benefits for the treatment of cancer, transportation, long as premiums are paid as required.
hospitalization and more. We provide the benefit directly to you, to be Diagnostic and Receive a benefit for visiting your
used however you see fit. Prevention Benefit doctor for a cancer screening test,
which helps with early detection.
Transportation Receive benefits if you travel more
Optional Riders and Lodging than 50 miles from your home using
Enhance your base plan with the following riders: the most direct route for covered
• Critical Illness Rider treatment.
May include option to choose lump sum benefit for diagnosis of Portable You own the policy. Take the coverage
internal cancer only, heart attack/stroke (first to occur) only or with you if you choose to leave your
both. current job. Your premiums will remain
the same.
• Hospital Intensive Care Unit Rider Additional Coverage Enhance the base plan by choosing
Options from a selection of optional riders.
Payroll Deducted Enjoy the convenience of having your
Learn more at americanfidelity.com/info/cancer
premiums deducted straight from
your paycheck.
Limitations, exclusions and waiting periods apply. Please refer to your
policy for complete details. This product is inappropriate for people
who are eligible for Medicaid coverage. The company has the right
to change premiums by class. The premium and amount of benefits
provided vary dependent upon the plan selected. Availability of riders
may vary by state. Diagnostic and Prevention Benefit is not available
in all states.
AF-1768-0123
26Hospital GAP PLAN® Insurance
Hospital Limited Benefit Medical Expense Insurance Policy American Fidelity Assurance Company
Limited Benefit Hospital GAP PLAN® Insurance from American Fidelity
What It Means for the
Assurance Company can help policyholders pay for their out-of-
pocket expenses. Supplementing their major medical insurance with
Coverage Feature Policyholder
gap insurance can help cover their expenses so they can focus on In-Hospital Benefit This is payable for covered for out-of-
pocket expenses up to the maximum
getting well.
benefit selected per confinement.
Outpatient Benefit This is payable for the difference
Three Primary Benefits between the actual outpatient
• In-Hospital** expenses incurred and the amount
paid by the primary medical plan for
• Outpatient out-of-pocket Covered Charges up
to a maximum outpatient benefit of
• Physician Outpatient Treatment
$200.00 for outpatient treatment in a
Hospital emergency room, outpatient
**
”Hospital” shall not include any institution used as a place for rehabilitation, a place surgery in a Hospital outpatient
for rest or for the aged, a nursing or convalescent home, a long term nursing unit or facility or free-standing outpatient
geriatrics ward, or an extended care facility for the care of convalescent, rehabilitative surgery center, and diagnostic testing
or ambulatory patients.
in a Hospital outpatient facility or
MRI facility. All benefits for the same
You must have SHBP or other health insurance to have this policy. or related conditions will be subject
to the maximum outpatient benefit,
unless such conditions are separated
by 90 consecutive days, then a new
maximum outpatient benefit will
apply.
Physician Outpatient This is payable for Physician visits. This
Treatment Benefit benefit pays up to $25.00 per visit, for
up to five visits ($125.00) per family per
calendar year, for outpatient treatment
due to Sickness, or outpatient
emergency care for an injury due to
an Accident, provided the Covered
Person is covered by Another Medical
Plan when such charges are incurred,
at a Hospital outpatient clinic, free-
standing emergency care clinic, or
Physician office for out-of-pocket
Covered Charges.
THIS IS A LIMITED POLICY. This highlights the important features of the
policy. Limitations, exclusions, and waiting periods apply. Refer to the
policy for complete details. This product is inappropriate for people
who are eligible for Medicaid coverage. If the policyholder resides in
a state other than their employer’s state of domicile, where required by
law, policy provisions and benefits may vary.
AF-1771-0123
27Individual Whole Life Insurance
American Fidelity Assurance Company
It’s important to prepare for the unexpected and help ensure your Flexbility when you need it
loved ones will be financially protected in the event of a tragedy. Your By choosing a Whole Life Policy, you have flexibility to adjust your
life insurance benefit can help replace your income and help your benefits when needed. Cash value flexibility features include:
family meet important financial needs like funeral expenses, everyday
living costs, and college. What It Means To You
Cash Surrender If you choose to terminate your policy,
American Fidelity Assurance Company’s Whole Life Insurance provides you will receive a check equal to your
protection for your entire life. It’s an individual policy, which means plan’s current available cash value. In
you own it and can take it with you when you leave employment or many situations, cash surrenders may
be paid tax free.1
when you retire to age 121. The premium and amount of protection
stay the same as long as the policy is in force, provided premiums are Partial Surrender You can withdraw a small portion of
the policy’s cash value in the form of
paid as required. cash, in exchange for a proportional
reduction to the policy’s available cash
Discontinue Your Premium While Keeping Your value and the face amount.
Coverage Active Loans You can borrow against your
cash value at a competitive
• Same Amount of Coverage - Shorter Length of Time: Under the 8% loan interest rate.
Extended Term Insurance Provision, your policy’s original
face amount (minus outstanding loans or accelerated benefit
payments) will be guaranteed for a specific term of time. In
addition, your premium is “paid in full” until your new extended 1
As long as the cash surrender does not exceed the total premiums received under
term period expires, terminating your policy. the policy since inception. Please consult your tax consultant for your specific
situation.
• Coverage to Age 121 - Smaller Guaranteed Benefit Amount.
You can rest easy knowing you are covered for your entire life
Limitations, exclusions and waiting periods apply. Please refer to your
by utilizing the Reduced Paid-Up Provision and reducing
your original death benefit to a smaller amount. Enjoy being policy for complete details, ICC14 WL14 series. Individual life plans do
premium-free while having the security of guaranteed lifetime not qualify under Section 125.
coverage, just at a reduced benefit amount. Plus your cash value
will continue to accumulate.
Optional Riders
Enhance your base plan with the following riders:
• Waiver of Premium Rider
• Accidental Death and Dismemberment Rider
• Children’s Term Rider
• Accelerated Benefit Rider for Long Term Illness
• Accelerated Benefit Rider for Critical Illness
Learn more at americanfidelity.com/info/life
AF-1773-0123
28Universal Life Insurance
Texas Life Insurance Company
It is impossible for life insurance to emotionally compensate for a loss,
Coverage Feature What It Means To You
but it may help ease the financial obligations placed on your loved
ones. Individual life insurance products can help. Several Product Options Choose the coverage to meet your
financial needs.
Guaranteed Premium3 Your premiums are guaranteed for
Universal Life Insurance each applicable period.
(PureLife-Plus)
Guaranteed Death Benefit5 Your death benefit is guaranteed
A voluntary permanent1 life insurance product that guarantees life for the life of the contract provided
insurance to age 121. (Underwritten by Texas Life Insurance Company) premiums are paid when due.
Interim Coverage6 Coverage normally begins when you
Did You Know? complete the application and the
More than 100 million individuals in the United States don't have authorization for your employer to
sufficient coverage to provide their families with financial security in deduct premiums from your paycheck.
Two year suicide and contestability
case of a tragedy.2
provisions apply. (one year in ND).
Enhance Your Coverage Additional riders may be available
Voluntary permanent life insurance can be an ideal complement
on certain products to expand your
to the Group Life Insurance coverage provided by your employer. policy.
Ask your AFES or AWD representative about the benefits of owning
Easy Application No medical exams and minimal health
voluntary permanent life, the coverage you can keep after your questions.7
employment ends.
Portable You own the policy. Take the coverage
with you if you choose to leave your
Consider a PureLife-Plus Contract! current job.
Ask your Employer or American Fidelity Representative how you can Payroll Deducted Enjoy the convenience of having your
secure your permanent7 life insurance with a product that provides: premiums deducted straight from
• Guaranteed death benefit to age 121.1 your paycheck.
• Minimal cash value – premiums dedicated primarily to the
purchase of life insurance. This product is not available in NY and is not generally qualified under
Section 125 Plans. Underwritten by Texas Life Insurance Company. Not
• Long premium guarantees.3
affiliated with American Fidelity Assurance Company.
• Limited right to partial refund of premium if future premium
required to continue coverage increases.3
(Conditions apply)
• Take it with you when you leave employment.
• Coverage available for employee, spouse, children and
grandchildren.4
1
Provided required premiums are paid timely.
2
Insurance Barometer Study, 2021. Life Happens & LIMRA, p8.
3
After the guaranteed period, premiums may go down, stay the same or go up.
4
Coverage not available in WA on children or on grandchildren in WA or MD. In
MD, child must reside with the applicant to be eligible for coverage.
5
Some limitations apply. See brochure for details.
6
Conditions apply. In Kansas, Temporary Insurance applies. Form 16M050.
7
Issuance of this policy may depend on the answer to these questions.
As with most life insurance products, Texas Life contracts and riders contain certain exclusions, limitations, exceptions, reductions
of benefits, waiting periods and terms for keeping them in force. Please see product summaries for costs and complete details.
Flexible Premium Adjustable Life Insurance to age 121. PureLife-plus is underwritten and issued by Texas Life Insurance Company,
900 Washington Avenue, Waco, Texas 76701. Texas Life is licensed to do business in the District of Columbia and every state but
NY. See the PureLife-plus brochure for details. Form ICC18-PRFNG-NI-18, Form Series PRFNG-NI-18 or PRFNG-NI-20-OHIO.
23M001-C 1000 (exp0125)
AF-1766-0123 29FLEXIBLE
SPENDING
ACCOUNTS
Healthcare Flexible Spending Account
(Healthcare) FSA
Benefits Debit Card
Dependent Care Account (DCA)
Managing Your Account
30Flexible Spending Accounts
American Fidelity Assurance Company
Flexible Spending Accounts are great cost savings tools to help Healthcare Flexible Spending Account
with common medical expenses not covered by your major medical (Healthcare FSA)
insurance and/or dependent care expenses. You can elect a portion of A Healthcare FSA allows you to allocate money on a pre-tax basis
your pay to be deducted, on a pre-tax basis, from each paycheck to use to reimburse yourself for qualified medical expenses for you and
for reimbursement of qualified out-of-pocket expenses throughout your family. Qualified expenses include anything from co-payments,
the plan year. medical deductibles, prescriptions and much more.
Flexible Spending Account Savings Example Minimum Annual Election: Determined by your employer.
With FSA Without FSA Maximum Annual Election: Internal Revenue Code allows up to
$30,000 Annual Gross Income $30,000 $3,050 per plan year, the employer may set the maximum equal to or
lower than this amount.
- $2,400 Healthcare FSA Election $0
- $2,500 Dependent Care Account Election $0
Examples of Eligible Expenses for Healthcare FSA
$25,100 Taxable Gross Income $30,000 Copays/coinsurance
- $5,020 Estimated Tax (20%)* - 6,000
Deductibles
- $1,920.15 Estimated FICA (7.65%) - 2,295
$18,159.85 Annual Net Income $21,705 Dental treatments
$0 Cost of Medical Expenses - $2,400
Diabetic supplies
$0 Cost of Dependent Care Expenses - $2,500
$18,159.85 Spendable Income $16,805 Prescription drugs and medicines
With an FSA, potential annual savings in this example is: $1,354.85 Eye exams, eyeglasses, contact lenses, contact lens solution and enzyme
By using an FSA to pay for eligible expenses, you can reduce your taxable
Flu shots
income.
Immunizations
* Estimated state 5% and federal 15%.
Lab fees
Laser/Lasik/RK surgery
Medical exams
Orthodontia
Psychiatric care
Wheelchair
X-rays
For a complete list of eligible expenses,
please visit:
https://americanfidelity.com/claims/fsa-hsa-eligibility-list/
SB-23290-1022
31Flexible Spending Accounts
Benefits Debit Card
Benefits Debit Card Snap. Submit. And Go!
American Fidelity will provide a Benefits Debit Card to all employees When using your Benefits Debit Card to pay for an eligible expense,
who elect to participate in a Healthcare FSA (where offered by your you may need to retain documentation to verify the expense. The
employer). The debit card gives immediate, convenient access to AFmobile® app makes this easy.
Healthcare FSA funds at the point of sale for prescriptions, copays, and
other common qualified medical expenses. The card can only be used • Snap a photo of the itemized receipt* with your phone.
for the Healthcare FSA and is not available for the DCA. • Submit the photo of the itemized receipts within the app when
you receive notification that a receipt is needed to verify your
expense.
• Go! After submitting your verification and its review, you will be
able to view the status of your reimbursement within the app.
*The Internal Revenue Code (IRC) requires proof of the eligible expenses
using itemized receipts or other documentation showing the date of
service, person for whom service was provided and description of the
expense. Depending on the type of expense, documentation may
come in the form of third party itemized statements or Explanation
of Benefits.
Activating Your Card
You will receive your card at your home address and may begin
using your card on the first day of your plan year. Your card will be
Using Your Benefits Debit Card automatically activated when you use it for the first time for an eligible
Simply swipe your card like you would with any other credit card. expense.
Whether at the doctor’s office or the dentist, the amount of your
eligible expenses will be automatically deducted from your Healthcare
FSA. Save ALL receipts!
Cards for Healthcare FSAs can be used at:
• Health care related facilities which include: hospitals, physician
offices, dental offices, vision offices; and,
• Merchants participating in the Inventory Information Approval
System (IIAS).
• The card is for medical expenses only; dependent day care
expenses are not eligible.
SB-23290-1022
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