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HISD Benefits Office

Bringing Benefits To Life

2017 Plan and Legal Documents

Accident

Aflac Accident High Certificate

HISD_2016_Acc_Cert_High.pdf 196.21 KB (Last Modified on August 13, 2018)

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Aflac Accident High Dependent Rider

HISD_2014_AFLAC_Accident_High_Plan_Dependent_Rider.pdf 138.15 KB (Last Modified on August 13, 2018)

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Aflac Accident Low Certificate

HISD_2016_Acc_Cert_Low.pdf 196.12 KB (Last Modified on August 13, 2018)

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Aflac Accident Low Dependent Rider

HISD_2014_AFLAC_Accident_Low_Plan_Dependent_Rider.pdf 265.88 KB (Last Modified on August 13, 2018)

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Cancer & Specified Diseases

Aflac Cancer High Certificate

HISD_2017_CA_Cert_High_101216.pdf 884.32 KB (Last Modified on August 13, 2018)

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Aflac Cancer Low Certificate

HISD_2017_CA_Cert_Low_101216.pdf 885.35 KB (Last Modified on August 13, 2018)

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Critical Illness

Aflac Critical Illness Certificate

HISD_2017_CI_Cert_101216.pdf 922.44 KB (Last Modified on August 13, 2018)

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Dental

Cigna Dental HMO Brochure

HISD_2016_Dental_DHMO_Product_Brochure_Generic.pdf 626.78 KB (Last Modified on August 13, 2018)

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Cigna Dental HMO Patient Charge Schedule

HISD_2016_DHMOBenefitCopaySchedule_FINAL.PDF 233.74 KB (Last Modified on August 13, 2018)

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Cigna Dental PPO Brochure

HISD_2016_DPPO_Plan_Brochure-English.pdf 1.99 MB (Last Modified on August 13, 2018)

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Cigna Dental PPO Summary

HISD_2017_Cigna_Dental_PPO_Benefit_Summary_101216.pdf 119.75 KB (Last Modified on August 13, 2018)

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QCD Discount Dental Schedule

HISD_QCD_Schedule_of_Program_Fees.pdf 7.55 MB (Last Modified on August 13, 2018)

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General

Creditable Coverage - Medicare Part D

HISD-2017_Notice_CreditableCoverage_Medicare_Part_D.pdf 93.19 KB (Last Modified on August 14, 2018)

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Non-creditable Coverage - Medicare Part D

HISD-2017_Notice_NonCreditableCoverage_Medicare_Part_D.pdf 94.34 KB (Last Modified on August 14, 2018)

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Hospital Indemnity

Aflac Hospital Indemnity High Certificate

HISD_2017_SHI_Cert_High_101216.pdf 865 KB (Last Modified on August 13, 2018)

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Aflac Hospital Indemnity Low Certificate

HISD_2017_SHI_Cert_Low_101216.pdf 865.8 KB (Last Modified on August 13, 2018)

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Personal Legal

Hyatt Legal Benefit Definitions and Reimbursements

HISD_2016_Hyatt_Legal_Plans.pdf 145.49 KB (Last Modified on August 13, 2018)

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Hyatt Legal Plan Fee Reimbursement Schedule

HISD_2017_FeeReimbursementSchedule.pdf 161.66 KB (Last Modified on August 13, 2018)

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Hyatt Legal Plan Summary

HISD_2017_Hyatt_legal_Summary_Plan_Description.pdf 176.71 KB (Last Modified on August 13, 2018)

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Disability

UNUM Certificate of Coverage

UNUM Certificte of Coverage.pdf 202.55 KB (Last Modified on December 10, 2020)

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Prescription Drugs

2017 Express Scripts National Preferred Drug List

2017_National_Preferred_Alpha_with_contraceptives_Limited_Choice_Open_plans.pdf 50.2 KB (Last Modified on August 13, 2018)

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2017 Express ScriptsI High Performance Alpha Select Plans

2017_Express_ScriptsI_High_Performance_Alpha_without_Step_Therapy_Select_Plans.pdf 53.59 KB (Last Modified on August 13, 2018)

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Express Scripts Free Generic Drugs List

HISD-2017_ESI_FreeGenericsList.pdf 80.6 KB (Last Modified on August 13, 2018)

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Express Scripts Mobile App Highlights

Express Scripts Mobile App Highlights

2017_Express_ScriptsI_High_Performance_Alpha_without_Step_Therapy_Select_Plans.pdf 53.59 KB (Last Modified on August 18, 2021)

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Express Scripts National Preferred Drug List - Alphabetized

HISD-2017_ESI_NationalPreferredDrugListAlpha.pdf 58.61 KB (Last Modified on August 13, 2018)

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Vision

EyeMed Vision Mobile App Infographic

ISD-2017_EyeMed_Members_App_Infographic.pdf 928.37 KB (Last Modified on August 14, 2018)

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Vision High Plan Certificate

HISD_2017_High_Plan_Vision_Certificate_101216.pdf 612.08 KB (Last Modified on August 13, 2018)

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Vision High Plan Summary

HISD_2017_High_Plan_Vision_Summary_101216.pdf 293.23 KB (Last Modified on August 13, 2018)

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Vision Low Plan Certificate

HISD_2017_Low_Plan_Vision_Certificate_101216.pdf 612.15 KB (Last Modified on August 14, 2018)

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Vision Low Plan Summary

HISD_2017_Low_Plan_Vision_Summary_101216.pdf 293.15 KB (Last Modified on August 14, 2018)

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Life & AD&D/travel assistance

2017 Minnesota Life Certificate

HISD_2017_Grp_Term_Life_Certificate.pdf 499.58 KB (Last Modified on August 13, 2018)

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Minnesota Life Certificate

HISD_2018_Grp_Term_Life_Certificate.pdf 499.58 KB (Last Modified on August 13, 2018)

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RedPoint Travel Assistance

HISD_2017_Travel_Assistance_Services_Handout.pdf 428.91 KB (Last Modified on August 13, 2018)

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Medical

Consumer Choice (Basic/Plus) Benefit Plan

2017_SPD_Consumer_Choice_Basic_and_Plus.pdf 789.37 KB (Last Modified on August 13, 2018)

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Consumer Limited (Basic/Plus) Benefit Plan

2017_SPD_Consumer_Limited_Basic_and_Plus.pdf 791.08 KB (Last Modified on August 13, 2018)

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Open Access Benefit Plan

2017_SPD_Open_Access_Plan.pdf 872.23 KB (Last Modified on August 13, 2018)

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Schedule of Benefits - Consumer Choice Basic

2017_SDP_Consumer_Choice_Basic_Plan_Schedule_of_Benefits.pdf 306.03 KB (Last Modified on August 13, 2018)

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Schedule of Benefits - Consumer Choice Plus

2017_SPD_Consumer_Choice_Plus_Plan_Schedule_of_Benefits.pdf 306.51 KB (Last Modified on August 13, 2018)

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Schedule of Benefits - Consumer Limited Basic

2017_SDP_Consumer_Limited_Basic_plan_Schedule_of_Benefits.pdf 272.34 KB (Last Modified on August 13, 2018)

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Schedule of Benefits - Consumer Limited Plus

2017_SPD_Consumer_Limited_Plus_Plan_Schedule_of_Benefits.pdf 271.93 KB (Last Modified on August 13, 2018)

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Schedule of Benefits - Consumer Limited Plus

2017_SPD_Open_Access_Plan_Schedule_of_Benefits.pdf 282.6 KB (Last Modified on August 13, 2018)

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Schedule of Benefits - Open Access

2017_SPD_Open_Access_Plan_Schedule_of_Benefits.pdf 282.6 KB (Last Modified on August 13, 2018)

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Select Benefit Plan

2017_SPD_Select_Plan.pdf 787.2 KB (Last Modified on August 13, 2018)

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