Skip to Main Content

Search Our Site

HISD Benefits Office

Bringing Benefits To Life

2020 Plan and Legal Documents

Benefits Dept. Guides

2020 Benefits Guide

2020_BENEFITSGUIDE_2.5.20.pdf 853.89 KB (Last Modified on February 10, 2020)

Comments (-1)

Covid-19

Families First Coronavirus Response Act (FFCRA) Notice 2020

FFCRA_Poster_WH1422_Non-Federal.pdf 177.72 KB (Last Modified on April 15, 2020)

Comments (-1)

Aflac Group Insurance Plans Overview

HISD Aflac Insurance Plan

HISD Bklt FINAL 3-4-19.pdf 690.48 KB (Last Modified on July 17, 2019)

Comments (-1)
HISD Aflac Insurance Plan Spanish

HISD Bklt ESP FINAL 3-4-19.pdf 239.8 KB (Last Modified on July 17, 2019)

Comments (-1)
Aflac Booklet

Aflac Booklet.pdf 690.48 KB (Last Modified on October 19, 2020)

Comments (-1)

Life Insurance

HISD Life Certificate of Insurance

Houston ISD Certificate - Eff 1-1-2020.pdf 563.35 KB (Last Modified on November 21, 2019)

Comments (-1)
Houston ISD Term life Policy

Houston ISD Term Life Policy 34018 Amd 10.pdf 1.74 MB (Last Modified on November 14, 2019)

Comments (-1)

Accident

Accident Claim Form

HISD_2016_Accident_Claim_Form.pdf 611.22 KB (Last Modified on November 6, 2020)

Comments (-1)
2020 AFLAC Accident Low Plan Dependent Rider

HISD_2019_AFLAC_Accident_Low_Plan_Dependent_Rider.pdf 265.88 KB (Last Modified on January 18, 2019)

Comments (-1)
2020 HISD AFLAC Accident High Plan Dependent Rider

HISD_2019_AFLAC_Accident_High_Plan_Dependent_Rider.pdf 138.15 KB (Last Modified on January 18, 2019)

Comments (-1)
2020 AFLAC Accident Certificate Low

HISD_2019_Acc_Cert_Low_101216.pdf 196.12 KB (Last Modified on January 18, 2019)

Comments (-1)
2020 AFLAC Accident Certificate High

HISD_2019_Acc_Cert_High_101216.pdf 196.21 KB (Last Modified on January 18, 2019)

Comments (-1)

Cancer & Specified Diseases

Cancer Claim Form

HISD_2012_Cancer_Claim_Form.pdf 223.39 KB (Last Modified on November 6, 2020)

Comments (-1)
2020 AFLAC Cancer Certificate Low

HISD_2019_CA_Cert_Low_101216.pdf 885.35 KB (Last Modified on January 18, 2019)

Comments (-1)
2020 AFLAC Cancer Certificate High

HISD_2019_CA_Cert_High_101216.pdf 884.32 KB (Last Modified on January 18, 2019)

Comments (-1)

Critical Illness

Critical Illness Claim Form

HISD_2016_Critical_Illness_ClaimForm.pdf 121.34 KB (Last Modified on November 6, 2020)

Comments (-1)
2020 AFLAC Critical Illness Certificate

HISD_2019_CI_Cert_101216.pdf 922.44 KB (Last Modified on January 18, 2019)

Comments (-1)

Hospital Indemnity

Hospital Indemnity Claim Form

HISD_2016_Hospital_Indemnity_ClaimForm.pdf 714.32 KB (Last Modified on November 6, 2020)

Comments (-1)
2020 AFLAC Hospital Indemnity Certificate Low

HISD_2019_SHI_Cert_Low_101216.pdf 865.8 KB (Last Modified on January 18, 2019)

Comments (-1)
2020 AFLAC Hospital Indemnity Certificate High

HISD_2019_SHI_Cert_High_101216.pdf 865 KB (Last Modified on January 18, 2019)

Comments (-1)

Personal Legal

2020 Hyatt Legal Fee Reimbursement Schedule

HISD_2019_FeeReimbursementSchedule.pdf 161.66 KB (Last Modified on January 18, 2019)

Comments (-1)
2020 Hyatt legal Plan

HISD_2019_Hyatt_Legal_Plans.pdf 116.62 KB (Last Modified on January 18, 2019)

Comments (-1)
2020 Hyatt Legal Summary Plan

HISD_2019_Hyatt_legal_Summary_Plan_Description.pdf 176.71 KB (Last Modified on January 18, 2019)

Comments (-1)

Legal Documents

2020 Legal Notices

2019 Legal Notices - Revisedv2.pdf 1,004.33 KB (Last Modified on June 24, 2019)

Comments (-1)
Dept. of Labor National Healthcare Exchange

department of labor national heath care exchange.pdf 163.18 KB (Last Modified on October 26, 2018)

Comments (-1)
Notice for Employers Offering Health Plans

model-notice-for-employers-who-offer-a-health-plan-to-some-or-all-employees FULL.pdf 162.55 KB (Last Modified on October 26, 2018)

Comments (-1)

Medical Plan Summary

Memorial Hermann SPD

Memorial Hermann Final SPD 12-01-2020.pdf 1.02 MB (Last Modified on December 15, 2020)

Comments (-1)
Texas Medical Neighborhood SPD

TMN Final SPD 12-01-2020.pdf 1.03 MB (Last Modified on December 15, 2020)

Comments (-1)
Kelsey Select ACO Coverage

Kelsey Select ACO Summary of Benefits and Coverage FINAL APPROVED 12-11-2019.pdf 1.5 MB (Last Modified on December 11, 2019)

Comments (-1)
Kelsey Basic ACO Coverage

Kelsey Basic ACO Summary of Benefits and Coverage FINAL APPROVED 12-11-2019.pdf 1.54 MB (Last Modified on December 11, 2019)

Comments (-1)
Kelsey Plus ACO Coverage

Kelsey Plus ACO Summary of Benefits and Coverage FINAL APPROVED 12-11-2019.pdf 1.54 MB (Last Modified on December 11, 2019)

Comments (-1)
Memorial Herman Basic ACO Coverage

Memorial Hermann Basic ACO Summary of Benefits and Coverage FINAL APPROVED 12-11-2019.pdf 1.5 MB (Last Modified on December 11, 2019)

Comments (-1)
Memorial Herman Plus ACO Coverage

Memorial Hermann Plus ACO Summary of Benefits and Coverage FINAL APPROVED 12-11-2019.pdf 1.5 MB (Last Modified on December 11, 2019)

Comments (-1)
TX Medical Neighborhood Basic Coverage

TX Medical Neighborhood Basic Summary of Benefits and Coverage FINAL APPROVED 12-11-2019.pdf 1.5 MB (Last Modified on December 11, 2019)

Comments (-1)
TX Medical Neighborhood Plus Coverage

TX Medical Neighborhood Plus Summary of Benefits and Coverage FINAL APPROVED 12-11-2019.pdf 1.5 MB (Last Modified on December 11, 2019)

Comments (-1)

Disability

UNUM Certificate of Coverage

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

Comments (-1)

Dental

Resumen de beneficios de Cigna Dental HISD

Houston ISD DPPO 2020_SP.PDF 284.48 KB (Last Modified on December 20, 2019)

Comments (-1)
Cigna Dental Benefit Summary HISD

Houston ISD 2020.pdf 123.3 KB (Last Modified on December 20, 2019)

Comments (-1)
Cigna Dental Care - DHMO Patient Charge Schedule

HIXV9_10198737.pdf 156.71 KB (Last Modified on December 20, 2019)

Comments (-1)
Cigna Dental Care - DHMO

887430_HIXV9_DFO_Final.pdf 79.24 KB (Last Modified on December 20, 2019)

Comments (-1)

Prescription Drugs

2020 ESI High Performance Alpha

ESI High Performance Alpha PRMT1703A-20.200401.pdf 54.47 KB (Last Modified on April 6, 2020)

Comments (-1)
2020 National Preferred Alpha with Exclusion List

National Preferred Alpha with Exclusions List 10-15-2020.pdf 113.59 KB (Last Modified on November 4, 2020)

Comments (-1)
2020 High Performance Alpha Formulary

High Performance Formulary List Updated 10-15-2020.pdf 52.2 KB (Last Modified on November 4, 2020)

Comments (-1)
2020 Natl. Preferred Formulary Exclusions

DL44109Q-SD-20-204612-ExclusionList191215.pdf 72.54 KB (Last Modified on January 6, 2020)

Comments (-1)
2020 Natl. Preferred Alpha Formulary

NationalPreferredAlphaPRMT22157-20-191215.pdf 57.97 KB (Last Modified on January 6, 2020)

Comments (-1)
2020 Rx SPD - Select Plan

2020 Rx SPD_Select FINAL 12-17-2019.pdf 820.43 KB (Last Modified on December 17, 2019)

Comments (-1)
2020 Rx SPD Consumer Plan - Open Access

2020 Rx SPD ConsumerPlan-OpenAccess FINAL 12-17-2019.pdf 587.1 KB (Last Modified on December 17, 2019)

Comments (-1)
Express Scripts Mail Order Form

Mail Order Form.pdf 734.37 KB (Last Modified on September 29, 2020)

Comments (-1)
Express Scripts Fax Order Form

Mail Order Fax Order Form.pdf 47 KB (Last Modified on September 29, 2020)

Comments (-1)

Sumario de Plan Médico

Cobertura HISD Basic Limited 2020

SBC Houston ISD_Basic Limited 01.01.2019_SP.pdf 1.16 MB (Last Modified on October 26, 2018)

Comments (-1)
Cobertura HISD Choice Plan 2020

SBC Houston ISD_Basic Choice 01.01.2019_SP.pdf 1.19 MB (Last Modified on October 26, 2018)

Comments (-1)
Cobertura HISD Open Access 2020

SBC Houston ISD_Open Access 01.01.2019_SP.pdf 1.15 MB (Last Modified on October 26, 2018)

Comments (-1)
Cobertura HISD Plus Choice 2020

SBC Houston ISD_Plus Choice 01.01.2019_SP.pdf 1.16 MB (Last Modified on October 26, 2018)

Comments (-1)
Cobertura HISD Plus Limited 2020

SBC Houston ISD_Plus Limited 01.01.2019_SP.pdf 1.16 MB (Last Modified on October 26, 2018)

Comments (-1)
Cobertura HISD Select Plan 2020

SBC Houston ISD_Select 01.01.2019_SP.pdf 1.13 MB (Last Modified on October 26, 2018)

Comments (-1)

Vision

2020 EyeMed Members App Infographic

HISD-2019_EyeMed_Members_App_Infographic.pdf 928.37 KB (Last Modified on January 18, 2019)

Comments (-1)
2020 Vision Plan Certificate High

HISD_2019_High_Plan_Vision_Certificate_101216.pdf 612.08 KB (Last Modified on January 18, 2019)

Comments (-1)
2020 Vision Plan Certificate Low

HISD_2019_Low_Plan_Vision_Certificate_101216.pdf 612.15 KB (Last Modified on January 18, 2019)

Comments (-1)
2020 Vision Plan Summary High

HISD_2019_High_Plan_Vision_Summary_101216.pdf 293.23 KB (Last Modified on January 18, 2019)

Comments (-1)
2020 Vision Plan Summary Low

HISD_2019_Low_Plan_Vision_Summary_101216.pdf 293.15 KB (Last Modified on January 18, 2019)

Comments (-1)

Health Insurance Marketplace Coverage Options

New Health Insurance Marketplace Coverage Options

model-notice-for-employers-who-offer-a-health-plan-to-some-or-all-employees.pdf 162.55 KB (Last Modified on July 22, 2019)

Comments (-1)
Nuevas opciones de cobertura en el mercado de seguros medicos

model-notice-for-employers-who-offer-a-health-plan-to-some-or-all-employees-spanish.pdf 161.09 KB (Last Modified on July 22, 2019)

Comments (-1)

CLOSE

CLOSE