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HISD Benefits Office

Bringing Benefits To Life

2023 Plan and Legal Documents

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Benefits Dept. Guides

2023 Benefits Guide

2023_Benefits_Guide_Final_optimized.pdf 5.54 MB (Last Modified on May 24, 2023)

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2022 Benefits Guide

2022_Benefits guide _FINAL.pdf 15.77 MB (Last Modified on November 11, 2021)

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2021 New Hire Guide

NEW_HIRE_GUIDE_21.pdf 4.04 MB (Last Modified on March 11, 2021)

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Aflac

2022 Wellness Claim Form

wellness_claim_form.pdf 252.01 KB (Last Modified on November 11, 2021)

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2022 Hospitalization Claim Form

hospitalization_claim_form.pdf 1 MB (Last Modified on November 11, 2021)

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2022 Group Critical Illness

group_critical_illness.pdf 1.09 MB (Last Modified on November 11, 2021)

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2022 Cancer Claim Form

CancerClaimform.pdf 1.02 MB (Last Modified on November 11, 2021)

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2022 Accidental Claim Form

accidentclaimform.pdf 1,020.89 KB (Last Modified on November 11, 2021)

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Aflac Booklet 2022

HISD Bklt FINAL 9-2-21.pdf 704.54 KB (Last Modified on September 15, 2021)

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Accident

Aflac Accident Certificate Low

HISD_2019_Acc_Cert_Low_101216.pdf 196.12 KB (Last Modified on November 4, 2020)

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Aflac Accident Certificate High

HISD_2019_Acc_Cert_High_101216.pdf 196.21 KB (Last Modified on November 4, 2020)

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Aflac Accident High Plan Dependent Rider

HISD_2019_AFLAC_Accident_High_Plan_Dependent_Rider.pdf 138.15 KB (Last Modified on November 4, 2020)

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Aflac Accident Low Plan Dependent Rider

HISD_2019_AFLAC_Accident_Low_Plan_Dependent_Rider.pdf 265.88 KB (Last Modified on November 4, 2020)

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Critical Illness

Aflac Critical Illness Certificate

HISD_2019_CI_Cert_101216.pdf 922.44 KB (Last Modified on November 4, 2020)

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Cancer & Specified Diseases

Aflac Cancer Certificate Low

HISD_2019_CA_Cert_Low_101216.pdf 885.35 KB (Last Modified on November 4, 2020)

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Aflac Cancer Certificate High

HISD_2019_CA_Cert_High_101216.pdf 884.32 KB (Last Modified on November 4, 2020)

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Life Insurance

Houston ISD Life Policy

Houston ISD Term Life Policy 34018 Amd 12.pdf 1.97 MB (Last Modified on February 9, 2021)

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Houston ISD Certificate

Houston ISD Certificate - Eff 1-1-2021.pdf 564.35 KB (Last Modified on February 9, 2021)

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Policy Plan Documents

HISD Cancer Master Policy

Houston ISD Cancer Master Policy.pdf 1.49 MB (Last Modified on February 9, 2021)

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HISD AC 7700 Master Policy High and Low

Houston ISD AC7700 Master Policy - High and Low.pdf 1.79 MB (Last Modified on February 9, 2021)

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Houston ISD 8500 Master Policy

Houston ISD 8500 Master Policy - High and Low.pdf 1.82 MB (Last Modified on February 9, 2021)

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Houston ISD 2800 Master Policy

Houston ISD 2800 Master Policy.pdf 2.1 MB (Last Modified on February 9, 2021)

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Legal Documents

HISD TRS Medical Comparability

TRS Compatability 09012022 Plan Year.pdf 131.73 KB (Last Modified on June 6, 2022)

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HISD 2022 Legal Notices Disclosures

HISD 2022 Legal Notices Disclosure - w Non Creditable Coverage Lang.pdf 757.9 KB (Last Modified on November 11, 2021)

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Medical Plans

2023 Kelsey Basic ACO Plan

Kelsey Basic ACO Summary

2023 Kelsey Basic ACO Plan SPD 09-13-2023.pdf 333.71 KB (Last Modified on September 18, 2023)

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2023 Kelsey Seybold ACO Plan

Kelsey Seybold Plus ACO Summary

2023 Kelsey Plus ACO Plan SPD 09-13-2023.pdf 332.7 KB (Last Modified on September 18, 2023)

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2023 Kelsey Select ACO Plan

2023 Kelsey Select ACO Summary

2023 Kelsey Select ACO Plan 09-13-2023.pdf 336.75 KB (Last Modified on September 18, 2023)

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Medical Plan Summaries

2023 Kelsey Seybold ACO Summary Benefits and Coverage

2023KelseyBasicACOSummaryBenefits-Coverage_SBC_091823.pdf 867.6 KB (Last Modified on September 18, 2023)

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2023 Kelsey Seybold Plus ACO Summary Benefits and Coverage

2023KelseyPlusACOSummaryBenefits-Coverage_SBC_091823.pdf 867.69 KB (Last Modified on September 18, 2023)

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2023 Kelsey Select ACO Summary of Benefits and Coverage

2023KelseySelectACOSummaryBenefits-Coverage_SBC_091823.pdf 847.75 KB (Last Modified on September 18, 2023)

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2023 Memorial Hermann Basic ACO Summary and Benefits

2023MemorialHermannBasicACOSummary-Benefits-Coverage_SBC_091823.pdf 845.2 KB (Last Modified on September 18, 2023)

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2023 Memorial Hermann Plus Summary and Benefits

2023Memorial-Hermann-PlusACOSummary-Benefits-Coverage_SBC_091823.pdf 846.52 KB (Last Modified on September 18, 2023)

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2023 TX Medical Neighborhood Basic Summary Benefits and Coverage

2023TXMedicalNeighborhood-BasicSummary-Benefits-Coverage_SBC_091823.pdf 848.29 KB (Last Modified on September 18, 2023)

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2023 TX Medical Neighborhood Plus Summary Benefits and Coverage

2023TXMedicalNeighborhoodPlus-Summary-Benefits-Coverage_SBC_091823.pdf 847.93 KB (Last Modified on September 18, 2023)

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Prescription Drugs

2023 Express Scripts National Preferred Formulary with Exclusion List

2023 National Preferred Formulary Alpha with Exclusion List.220902.pdf 222.67 KB (Last Modified on July 26, 2023)

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2023 Express Scripts High Performance Formulary Alpha

2023 High Performance Formulary Alpha PRMT1703A-23.CRP2205_0016034.1.220902.pdf 83.64 KB (Last Modified on July 26, 2023)

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Dental

Cigna Dental DHMO or DPPO

Take this quiz to find the right dental plan.

DHMO DPPO Dual Option Decision Guide Access Plus Network.pdf 192.02 KB (Last Modified on September 4, 2020)

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Cigna Dental DHMO plan

View this flyer for savings and coverage.

DHMO Product Customer Brochure - Access Plus Network.pdf 545.15 KB (Last Modified on September 4, 2020)

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Cigna Dental DHMO Access Plus

Dental DHMO Plus

DHMO Access Plus Promotional Customer Flyer.pdf 457.57 KB (Last Modified on September 4, 2020)

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Cigna Dental DHMO Access Plus Network

How to find a dentist

DHMO Access Plus Network Dentist How to Find a Dentist Customer Flyer.pdf 47.56 KB (Last Modified on September 4, 2020)

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Cigna Dental DHMO Access Plus Network Español

DHMO Product Customer Brochure - Access Plus Network - Spanish.pdf 383.58 KB (Last Modified on October 23, 2020)

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Cigna Dental DPPO Calendar Year Maximums

Houston ISD - Current Wellness Plus DPPO.pdf 61.3 KB (Last Modified on October 23, 2020)

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Cigna Dental DPPO Wellness Plus Calendar Year Maximums

Houston ISD SOB - 2000 CYM.PDF 59.25 KB (Last Modified on October 23, 2020)

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Hospital Indemnity

Aflac Hospital Indemnity Certificate Low

HISD_2019_SHI_Cert_Low_101216.pdf 865.8 KB (Last Modified on November 4, 2020)

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Aflac Hospital Indemnity Certificate High

HISD_2019_SHI_Cert_High_101216.pdf 865 KB (Last Modified on November 4, 2020)

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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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