2019 Employee Benefits Guide

Transcription

1 BENEFIT ELIGIBLE NON-STATUTORY EMPLOYEES Benefit Effective Date January 1, Employee Benefits Guide All Employees must complete an Election Form Changes, no changes and coverage waivers. Annual Notices regarding Medical Coverage, Premium Assistance Under Medicaid & Children s Health Insurance Program (CHIP), and Medicare Part D Creditable Coverage Benefits provided in association with Questions Help

2 Table of Contents Benefits at a Glance... 1 Eligibility... 2 Medical Plan Comparison... 5 Optum Rx Prescription Coverage... 6 Dental Plan MetLife... 7 Vision Plan EyeMed... 8 Flexible Spending Arrangements (FSA - Health Care & Dependent Care)... 9 Term Life/AD&D Insurances (Basic & Voluntary Plans) Disability Insurances (Long & Short-Term Plans) NY Paid Family Leave (NYPFL) Appendix Compliance Annual Notices Important Notice About Your Prescription Drugs & Medicare (Part D) Legal Disclaimer: Relph Benefit Advisors has attempted to ensure that the information in this Benefits Guide is clear and accurate. However, this Benefits Guide is not a legal document; the terms and provisions of each benefit are governed by the Plan Document or Summary Plan Description.

3 Benefits at a Glance 2019 Benefit Plans Coverage Rates / 26-Pay Periods HEALTH BENEFITS Medical Univera PPO Signature Plans Dependents to age 26 Dental PPO Plan MetLife Dependents to age 26 Vision EyeMed Dependents to age 26 REIMBURSEMENT ACCOUNTS COPAY PLAN - GOLD Employee $91.53 $59.64 Employee+Spouse/Dom Prtnr $ $ Employee+Child(ren) $ $ Family $ $ Employee $14.44 Employee + 1 $29.59 Family $49.06 Employee $2.71 Employee + 1 $5.15 Family $7.56 DEDUCTIBLE & COINSURANCE PLAN - SILVER Flexible Spending Arrangements (FSAs) EMPLOYER PAID BENEFITS Long Term Disability Insurance Cigna Basic Term Life/AD&D Insurance Cigna New York State Disability Insurance Health Care FSA Dependent Care FSA Employee Employee, Spouse & Child(ren) Employee $2,700 (annual maximum) $250 minimum $5,000 (annual maximum) $250 minimum 60% of Base Monthly Earnings & 7% Pension Benefit (Max: $8K monthly Benefit and $1,000 Monthly Pension Benefit) Life=Employee: $10K / Spouse: $5,000 / Child(ren): $2,000 AD&D= Employee Only: $10K 50% of Average Wages to a max of $170 weekly VOLUNTARY BENEFITS Term Life Insurance Cigna Accidental Death & Dismemberment (AD&D) Insurance Cigna Short Term Disability Insurance Cigna Employee, Employee+ Spouse/Dom Prtnr and/or Child(ren) Employee, Employee+ Spouse/Dom Prtnr and/or Child(ren) Employee Rates based on age and benefit elected Employee: up to 1-5x annual earnings to a max of $550K Spouse: 50% of employee s election to a max of $275K Child(ren): $1K increments to a max of $5K Rates based on benefit elected Employee: Increments of $25,000, $300K Maximum Spouse: If no child(ren) insured: 50% of employee s benefit If child(ren) insured: 100% of employee s benefit $250K, Maximum Child(ren): If no spouse insured: 10% of employee s benefit If spouse insured: 15% of employee s benefit $25K Maximum Monthly Rate per $10 of weekly benefit to a max of $1,500 or 50% of earnings. <Age 54: $0.254 Age 60-64: $0.367 Age 55-59: $0.311 Age 65+: $0.403

4 Eligibility Requirements You are eligible for medical, dental, vision, long-term disability, FSA, and group life benefits coverage if you are an active eligible employee. If you enroll, you also may enroll your eligible dependents including: - Your lawful spouse (including same-sex spouse in a state that recognizes such unions) - Your same or opposite sex domestic partner (per Alfred policy guidelines) - Your dependent child(ren) - Medical Plan: Up to Age 26 - Does not need to be a full-time student - Does not need to be an eligible dependent on the parent s tax return - Is not required to live with you - May be unmarried or married (your child s spouse and children are not eligible) - Dental Plan: Up to age 26 - Vision Plan: Up to age 26 - Your unmarried children of any age who are permanently and totally disabled physically or mentally for whom you provide financial support. You must periodically provide medical documentation of such disability If you are adding dependents to your medical, dental, and/or vision benefits, proof of dependent eligibility may be required, such as a birth, adoption, or marriage certificate, or domestic partner certification. Changes to Your Benefit Elections Generally, employees may only make changes to your benefit elections during Open Enrollment; however, midyear changes can be made, should you experience an IRS qualifying change in status listed below: Marriage; Birth or adoption of a child; Divorce / Dissolution of Domestic Partnership; Death of your spouse/domestic partner or child; Change in employment status that affects benefit eligibility for you or your spouse/domestic partner; or Change of eligibility status of a dependent (i.e., your child reaches the age limit of a benefit plan). For full details, reference the Plan Documents or contact Human Resources. If a request for a change does not meet at least one of the criteria above, you will not be able to change your election until the next open enrollment period.

5 Eligibility Who is entitled to Benefits under COBRA? COBRA Qualified Beneficiaries are individuals covered by a group health plan on the day before a COBRA qualifying event who is an employee, the employee's spouse, or an employee's dependent child. The COBRA Qualifying Events noted below are certain events that would cause an employee, their covered spouse and dependent children to lose health coverage: The death of the employee/parent; The employee/parent s hours of employment are reduced; The employee/parent s employment ends for any reason other than gross misconduct; The employee/parent becomes entitled to Medicare benefits (under Part A, Part B, or both); The employee/parent divorces or is legally separated; or The child is no longer eligible for coverage under the Plan as a dependent child (usually due to overage status). State and Federal Regulations Regarding Enrollment in Benefits and Dependent Status Employees should consider that the choices made regarding their benefits and the decision to cover their dependents (i.e. spouse, domestic partner, children, etc.) could affect their State and Federal taxable income. The reimbursement plans offered by your employer are subject to State and Federal regulations; therefore, please be advised that claims for reimbursement may be affected by your marital status. Please consult with your financial advisor, accountant or tax attorney for specific implications. Flexible Spending Arrangements are governed by Federal IRS Code 152.

6 Eligibility Domestic Partner Coverage Rules Employees may cover their domestic partner provided each are over 18 years old and each other s sole domestic partner and are not married to anyone. Employees must provide documentation verifying the existence of the domestic partnership to qualify a domestic partner for coverage. Acceptable forms of documentation are listed below. 1. Registration as a domestic partnership or an affidavit of domestic partnership; 2. Proof of cohabitation for 6 months (for example, a driver s license or tax return); and 3. Proof of financial interdependence, as evidenced by two or more of the following: a. A joint bank account b. A joint credit or charge card c. Joint obligation on a loan d. Status as authorized signatory on the partner s bank account, credit or charge card e. Joint ownership of holding of investments f. Joint ownership of a residence g. Joint ownership of real estate other than residence h. Listing of both partners as tenants on the lease of the shared residence i. Shared rental payments of residence (need not be shared 50/50) j. Listing of both partners as tenants on a lease, or shared rental payments, for property other than residence k. A common household and shared household expenses (for example, shared grocery, utility, telephone bills (need not be shared 50/50) l. Shared household budget for purposes of receiving government benefits m. Status of one as representative payee for the other s government benefits n. Joint ownership of major items of personal property (for example, appliances, furniture) o. Joint ownership of a motor vehicle p. Joint responsibility for child care (for example, school documents, guardianship) q. Shared child care expenses (for example, baby-sitting, day care, school bills (need not be shared 50/50) r. Execution of wills naming each other as executor and/or beneficiary s. Designation as beneficiary under the other s life insurance policy t. Designation as beneficiary under the other s retirement benefits account u. Mutual grant of durable power of attorney v. Mutual grant of authority to make health care decisions (for example, health care power of attorney) w. Affidavit by creditor or other individual able to testify to partners financial interdependence x. Other item(s) of proof sufficient to establish economic interdependency under the circumstances of the particular case. Coverage of the subscriber s domestic partner under the medical contract will terminate on the date the domestic partnership ends. You are responsible for notifying Human Resources. A six (6) month waiting period will be imposed from the date a covered domestic partner is no longer eligible, until the date a new domestic partner is deemed eligible for coverage. The value of your Domestic Partner s coverage will be added as taxable income to your pay.

7 Medical Plan Comparison UNIVERA PPO PLANS COPAY PLAN GOLD DEDUCTIBLE/COINSURANCE PLAN SILVER Medical Services In Network Out-of-Network* In Network Out-of-Network* Deductible (Calendar Yr) Single/Family $0/$0 $1,000/$2,000 $250/$750 $1,000/$2,000 Coinsurance 0% 25% 15% 25% Medical Out-of-Pocket Maximum** (Calendar Yr; includes deductible) (Single/Family) Pharmacy Out-of-Pocket Maximum** (Calendar Yr) (Single/Family) $4,350/$8,700 $5,000/$10,000 $2,000/$5,000 $5,000/$10,000 $2,000/$4,000 NA $2,000/$4,000 NA Preventive Services Covered in Full 25% Coinsurance* Covered in Full 25% Coinsurance* Office Visits PCP/SCP $25/$25 25% Coinsurance* 15% Coinsurance* 25% Coinsurance* Lab Covered in Full 25% Coinsurance* 15% Coinsurance* 25% Coinsurance* Maternity Care Inpatient Outpatient $250 Copay $25 Copay 25% Coinsurance* 25% Coinsurance* 15% Coinsurance* 15% Coinsurance* 25% Coinsurance* 25% Coinsurance* Chiropractic Care $25 Copay 25% Coinsurance* 15% Coinsurance* 25% Coinsurance Telemedicine Rehabilitation (Physical/Occupational/Speech) $10 Copay $0 Copay for members to age 19 Not Covered 15% Coinsurance* Not Covered $25 Copay 25% Coinsurance* 15% Coinsurance* 25% Coinsurance* Urgent Care Center $25 Copay $25 Copay 15% Coinsurance* 25% Coinsurance* Emergency Room $150 Copay $150 Copay 15% Coinsurance* 15% Coinsurance* Hospital Inpatient Outpatient Vision Rider Exam (Routine 1x / year) Eyewear (Routine) $250 Copay $75 Copay Covered in Full $100 per year 25% Coinsurance* 25% Coinsurance* 25% Coinsurance* $100 per year Prescription Drug Benefits Optum Rx Tier 1 / Tier 2 / Tier 3 15% Coinsurance* 15% Coinsurance* Covered in Full $100 per year 25% Coinsurance* 25% Coinsurance* 25% Coinsurance* $100 per year Retail (up to 30 days) $10/$35/$55 $10/$35/$55 Not Covered Mail Order (up to 90 days) $20/$70/$110 $20/$70/$110 *Subject to Deductible Not Covered Please refer to Medical Plan Benefit Summaries for further details

8 OptumRx Prescription Coverage January 1, 2019, Alfred University s prescription benefit will be managed by OptumRx. With OptumRx, you ll have access to: Convenient Home Delivery services. You ll be able to have up to a 90-day supply of most maintenance medications delivered directly to you at a savings of up to 33%. A large network of participating retail pharmacies including independent and chain pharmacies located nationwide. Helpful resources on the OptumRx website and Mobile App. Online resources at will allow you to: Order prescription refills, renewals and check your order status Transfer retail prescriptions to Home Delivery for convenience and potential savings Enroll in Worry-Free Fills to conveniently receive Home Delivery medication automatically Discover possible ways to save money on medications, such as using generics and Home Delivery Receive time-sensitive medication-related alerts on your personalized pharmacy care profile Look up information about your medications and your prescription drug benefit Ask a pharmacist questions anytime, day or night View a financial summary of your prescription expenses, especially valuable at tax time Review your prescription history to share with your doctor Specialist pharmacists, who each have expertise in the medications that treat a single condition, such as high blood pressure, asthma, diabetes or cancer. Specialist pharmacists at OptumRx can answer your questions about how your medications work with each other and to make them work best for you. Optum Rx Customer Service is available 24 hours per day, 7 days per week, and can be reached at beginning January 1, Important Prescription Coverage Information Participants in the medical plan will receive separate OptumRx member ID cards and a welcome kit. Participants should present their OptumRx ID card each time you fill a prescription through a retail outlet. The formulary is the list of medications covered by the plan and is updated twice per year based on the latest research & clinical evidence. The member s cost share or copays are determined by the prescription s tier; Tier 1 Generics Safe, effective & have the same active ingredients as a brand name medication, but cost much less Tier 2 Preferred Lower cost or more clinically effective than non-preferred or excluded medications Tier 3 Non-Preferred Highest cost or medications with clinical alternatives Specialty Generally tier 3, high complexity medications, must be purchased through BriovaRx specialty pharmacy Excluded Medications with clinical alternatives or generics that are not covered by the plan. Members must choose an alternative therapy. The formulary also determines which medications require treatment protocols including; Quantity Limits for safety & cost reasons, the plan limits the amount of drugs they cover over a certain period of time. Prior Authorization to be sure that medications are prescribed and used correctly, before the plan will cover a particular drug, your prescriber must first show that you have a medically necessary need for that particular drug and/or have met the requirements for the drug. Step Therapy you must first try a less expensive drug on the formulary that has been proven effective for most people with your condition before you can move up a step to a more expensive drug. However, if you have already tried the more affordable drug and it didn t work or if your prescriber believes that it is medically necessary for you to be on a more expensive drug, they can contact the plan to request an exception.

9 Dental Plan MetLife The dental plan, insured by MetLife, encourages preventive care and provides coverage for basic and major services. The DPPO Plan The PPO Plan offers the flexibility to visit any dentist, with lower out-of-pocket costs to you when you visit a network dentist. When you use out-of-network providers, your cost is based on the Usual, Customary and Reasonable (UCR) charge, instead of a discounted fee. You are responsible for any amounts that exceed the UCR, in addition to the deductible and coinsurance. Maximize Your Benefits Use network dentists. Your share of the cost is based on the discounted fee. Use the Health Care Flexible Spending Account to pay for your out-of-pocket costs with pre-tax dollars. Use the Health Savings Account to pay for your out-ofpocket costs with pre-tax dollars. Get a Pre-Treatment Review if you are in the PPO Plan and your costs are expected to exceed $300. Late Entrant Penalties It s important to enroll when you are first eligible. If you waive coverage when you are first eligible, and want to enroll at a later date, your dental benefits will be reduced due to late entrant penalties. : Basic Services (Fillings) 6 month waiting period Basic Services (All other services) 12 month waiting period Major Services 24 month waiting period Orthodontic Services 24 month waiting period MetLife PPO Plan In-Network Out-of-Network* Annual Deductible (Calendar Year) (Single/Family) $50/ $150 $50/ $150 Annual Maximum Benefit $1,000 $1,000 Reimbursement Levels Based on Negotiated Fee Based on Usual & Customary Rate Preventive Care (Cleanings, X- rays) (Deductible Waived) 100% 100% Basic Services (Fillings) 80% 80% Major Services (Crowns, Dentures) 50% 50% Orthodontia (Child(ren) to age 19) 50% 50% Lifetime Orthodontia Maximum $1,000 $1,000 Network PPO N/A Primary Care Dentist No No Coverage Tier Bi-Weekly Contributions Employee Employee + 1 Family $14.44 $29.59 $49.06 To find a network dentist, visit

10 Vision Plan EyeMed The vision plan, through EyeMed, covers eye exams and materials, such as glasses, frames, and contacts. To receive maximum coverage, visit a provider in the Select network. When you visit an out-of-network provider, you receive reimbursement up to a scheduled amount for each covered service or supply after you file a claim for reimbursement. The plan helps you pay for a range of vision-related services and products as shown below. Vision Plan EyeMed In-Network Member Cost Out-of-Network Reimbursement Network Select Not Applicable Vision Exam (Once Per 12 Months) $10 Up to $30 Frames (Once Per 24 Months) $0; $130 Allowance; 20% off balance above $130 Up to $65 Lenses (Once Per 12 Months) Single $25 Up to $25 Bifocal $25 Up to $40 Trifocal $25 Up to $60 Progressive $25 Up to $40 Contact Lenses (Once Per 12 Months) Fit & Follow up Up to $40 Not Covered Conventional $0; $130 Allowance; 15% off balance above $130 Up to $104 Disposable $0; $130 Allowance Up to $104 Medically Necessary $0; Paid in full Up to $200 Coverage Tier Bi-Weekly Contributions Employee Employee +1 Family $2.71 $5.15 $7.56 To find a network provider, visit

11 Flexible Spending Accounts (FSAs) When you participate in the Health Care and/or Dependent Care Flexible Spending Accounts (FSAs), administered by Benefit Resource, you can pay for eligible expenses with pre-tax dollars. Since your contributions are deducted before federal income taxes and Social Security taxes are calculated, your taxable income is lowered. This means you pay less tax in each paycheck and you reimburse yourself with tax-free money from your account, as shown in the chart below. Savings Example With FSA Without FSA Annual Pay $30,000 $30,000 Health Care FSA Contributions Federal, State and Social Security Taxes* After-Tax Dollars Spent on Health Care Expenses Net Available Income Tax Savings with the FSA Plan $1,000 $0 $8,019 $8,295 $0 $1,000 $20,981 $20,705 $276 $0 *Assumes 15% federal tax, 5% state tax and 7.65% Social Security tax. FSA Facts In exchange for tax advantages, the IRS sets certain requirements for FSAs: Use it or lose it. Any balance left in your FSA(s) after all of your incurred expenses are submitted and paid timely (see next page) will be forfeited. You cannot roll the balance over to the next year. You must enroll each year. Your 2018 enrollment will not carry over to The two Accounts are separate. You cannot use the money in your Health Care FSA to pay for Dependent Care expenses, nor vice versa. You may not be eligible for both the Dependent Care FSA and the dependent care tax credit on your federal income tax return. Check with your tax advisor for details. If you contribute to a Health Savings Account, you cannot contribute to a Full Health Care FSA for reimbursement for medical expenses. Paying for Eligible Expenses Debit Card It works like a credit card and you can use it to pay for your health care and/or dependent care, expenses. Just one Debit Card is needed for all accounts. Keep your receipts. You may need to provide documentation to substantiate your purchase. Submit a Claim for Reimbursement You will receive payment by check or Direct Deposit.

12 Flexible Spending Accounts (FSAs) Actions to Follow Full Health Care FSA Dependent Care FSA Eligible Expenses Annual Contributions Payroll deductions are taken: Amount Available for Reimbursement Deductibles, copays and coinsurance for medical, prescription drug, dental and vision care that are not paid under any health plan. Expenses exceeding plan limits or UCR cost. Over-the-counter medications not eligible unless insulin or with a prescription. Refer to Publication 502 for more information. Up to $2,700 Per Year, $150 minimum January 1, 2019 December 31, 2019 Annual Elected Amount Expenses that enable you and your spouse to work, look for work or attend school full-time. Child care centers, private providers, nursery schools, summer day camps and after-school care provided for your eligible dependent (children up to age 13). Care provided for your eligible elderly or disabled, tax-qualified dependent. Refer to Publication 503 for more information. Up to $5,000 Per Year, $150 minimum ($2,500 if Married and Filing Separately) Account Balance Enrollment Deadline Enroll during Open Enrollment OR when you have a qualifying life event You must re-enroll every year. Your election will NOT carry over. Important Deadlines Incur expenses: March 15, 2020 Submit expenses: March 31, 2020 Incur expenses: March 15, 2020 Submit expenses: March 31, 2020 For more information, including a list of eligible expenses, visit or call

13 Term Life/AD&D Insurances (Basic & Voluntary Plans) Basic Term Life/AD&D Insurance (Employer Paid) Your employer provides eligible employees with this basic coverage at no cost to you. LIFE/AD&D INSURANCE FEATURES Life Insurance Benefit Employee: $10,000 Spouse: $5,000; Child(ren): $2,000 Accidental Death Benefit Employee: $10,000 According to Federal law, the first $50,000 of employer provided Life Insurance is not taxable. See the carrier plan booklet for limitations, exclusions, and full benefit details including continuation of coverage options. Reductions due to age All amounts reduce to 50% at age 70 Voluntary Term Life Insurance (Employee Paid) EMPLOYEE LIFE INSURANCE FEATURES Life Insurance Benefit Purchased in increments of 1, 2, 3, 4 or 5x basic annual earnings. Maximum Benefit The lesser of 5x-earnings or $550,000. Guaranteed Issue Amount $350,000 at initial eligibility. Reductions Due to Age Reduces to 50% at age 70 SPOUSE LIFE INSURANCE FEATURES Life Insurance Benefit Maximum Benefit Guaranteed Issue Amount $20,000 Reductions Due to Age 50% of the employee election CHILD LIFE INSURANCE FEATURES Eligible Dependents The lesser of 50% of the employee s benefit or $275,000 Same as the employee and based on the employee s age. Unmarried dependent children, to age 20; or to 25 if full-time student. Life Insurance Benefit Purchased in increments of $1,000. Maximum Benefit $5,000 Guaranteed Issue Amount $5,000 Requirement: Employee coverage required to purchase spouse and/or dependent coverage. Evidence of Insurability (Proof of Good Health) is required if: 1-enrollment is waived at initial date of eligibility; 2- applying for an amount greater than the Guaranteed Issue Amount; and 3- increases in coverage. Employee paid with after tax payroll deductions. Coverage ends at the employee s retirement or if leaving employment. Monthly Rates for Employees & Spouse Plans Age Per $1,000 Age Per $1,000 <20 $ $ $ $ $ $ $ $ $ $ $.245 Dependent Children $.271 See the carrier plan booklet for limitations, exclusions, and full benefit details including continuation of coverage options.

14 Term Life/AD&D Insurances (Voluntary Plan) Voluntary Term AD&D Insurance (Employee Paid) EMPLOYEE AD&D INSURANCE FEATURES AD&D Benefit Purchased in increments of $25,000 Maximum Benefit Age Reductions Lesser of 10 x annual earnings or $300,000 From age reduces by 32%, at age reduces by 53%, at age reduces by 68%, and at age 85+ reduces by 84% SPOUSE AD&D INSURANCE FEATURES AD&D INSURANCE Monthly Rates / $1,000 Employee $0.029 Spouse $0.029 Child(ren) $0.062 Benefit If no child(ren) insured: 50% of employee s benefit If child(ren) insured: 100% of employee s benefit Maximum Benefit $250,000 CHILD AD&D INSURANCE FEATURES Eligible Dependents Unmarried dependent children, to age 20; or to 25 if full-time student. See the carrier plan booklet for limitations, exclusions, and full benefit details including continuation of coverage options. Benefit Maximum Benefit If no insured spouse: 10% of employee s benefit If insured spouse: 15% of employee s benefit $25,000

15 Disability Insurances (Long and Short Term Plans) Employer Paid Long Term Disability (LTD) Insurance Alfred University provides a level of income protection should you become disabled and cannot work. Since Alfred University pays for your LTD coverage, any benefits you receive would be taxed as ordinary income. LTD coverage is provided to you automatically. FEATURES OF THE PLAN Maximum Benefit Period* (see contract for full details) Monthly Benefit To normal Social Security Retirement Age 60% of Base Monthly Earnings. May be reduced by other incomes eligible to receive. Maximum Benefit / Monthly $8,000 Maximum Benefit / Monthly Pension Benefit Start Date Own Occuptation Period Any Occupation Period 7% of Base Monthly Earnings or $1,000 Max. 180-days (Elimination Period) 24-months 60-months For more information about benefits and limitations, contact your HR department Voluntary Short Term Disability (STD) Insurance Employees are automatically enrolled in this employee paid short term disability program. Employees may opt-out of coverage but must elect that change. The Short Term Disability benefits are offset by your NYS DBL benefit, as well as any other income you receive as a result of your disability. FEATURES OF THE PLAN Contributions Employee Paid Monthly Rate / $10 Of Monthly Covered Payroll Example Annual Income 52 and x 50%= Weekly Benefit 10= Multiplier See Rate Above/ (Age) Multiplier x Rate= Monthly Rate $28,000 $ $.254 / (32) $6.83 Monthly Rate x 12= Annual Premium and 26 = Per Pay Premium Benefit Start Date Maximum Benefit Period Benefit Amount After 7-days (injury or illness) 26-weeks (25-payments) 50% of Base Weekly Earnings Insert Your Income and Compute Your Monthly Rate Maximum Benefit / week $1,500 Payments Pays in addition to any other benefits, including New York State Disability. NOTE: This benefit is in addition to the mandatory New York State Disability (NYS DBL) that provides a benefit of 50% of your weekly earnings up to $170 per week. For more information about benefits and limitations, contact your HR department

16 NY Paid Family Leave (PFL) Eligibility Employees eligible for Paid Family Leave (PFL) for Non-Faculty Staff - Employees working 20 or more hours per week, must have been employed at least 26 consecutive weeks at their current employer - Employees working less than 20 hours per week, must have completed at least 175 work days at their current employer If an employee changes employers, time worked at the previous employer does not count. In other words, employees with the new employer begin a new qualification period. Time out on NYS Disability (DBL) does not count toward the qualification period. NOTE: Faculty are excluded from this benefit per the PFL regulations that relate to employees who are in a teaching capacity who work for a non-profit incorporated 501(c)(3) What is the Paid Family Leave (PFL) Benefit? Effective Date January 1, 2019 Benefit Amount 55% of an Employee s Average Weekly Wage* Maxiumum Benefit Amount 55% of NY State Average Weekly Wage up to $746 Duration of Benefits Up to 10 weeks Percent of Gross Wages 0.153% Increases to Benefit Amount and Duration will be implemented incrementally through Benefit paid on wages up to the 2019 Statewide Average Weekly Wage of $1, * Leaves taken in daily increments are based on the average number of days worked per week during the last 8 weeks before the leave and capped at 60 days. Who pays the Paid Family Leave (PFL) Premium? - PFL premiums are paid through employee payroll deductions on a post tax basis. Alfred University will commence payroll deductions for PFL with the first payroll of January 2019 at the State-mandated rate of 0.153% of your annual wages for the calendar year. PFL deductions will be processed according to our normal payroll schedule on a post tax basis, not to exceed 0.153% of the annualized statewide average weekly wage. For the calendar year 2019, the annualized statewide average weekly wage is $70,570. For more information about benefits and limitations, contact your HR department

17 Annual Compliance Notices Plan Administrator: Alfred University, 1 Saxon Drive, Alfred, NY PH: Effective Date: January 1, 2019 As a plan participant, you are entitled to a comprehensive description of your rights and obligations under the Alfred University Welfare Benefits Plan and the Alfred University Flexible Spending Plan. We ve recently posted a copy of the following documents to the Alfred University HR website at You and your obligations as a plan participant, it is imperative that you familiarize yourself with the information contained within these documents. Alfred University Welfare Benefits Plan Summary Plan Description Alfred University Flexible Benefit Plan Summary Plan Description 2019 OptumRx Formulary Drug & Exclusion Lists 2019 Medical Summary of Benefit Coverage Medicare Part D Creditable Coverage Notice Children s Health Insurance Program (CHIP) Notice HIPAA Notice of Privacy Practices Summary Annual Reports If you would like to receive a paper copy of any or all of these documents, you may guinan@alfred.edu or call and one will be provided to you free of charge. Health Insurance Portability & Accountability Act (HIPAA) Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents other coverage). However, you must request enrollment within 30 days after your or your dependents other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information contact your Plan Administrator, noted above. Women s Health & Cancer Rights Act Enrollment Notice If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: all stages of reconstruction of the breast on which the mastectomy was performed; surgery and reconstruction of the other breast to produce a symmetrical appearance; prostheses; and treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, contact your Plan Administrator, noted above.

18 Annual Compliance Notices Patient Protection Disclosure The Plan generally allows the designation of a primary care provider. You have the right to designate any participating primary care provider who is available to accept you or your family members. For information on how to select a primary care provider and for a list of participating primary care providers, visit the Plan on-line at For more information, contact the Plan Administrator at the phone number listed on the cover page of this Employee Benefit Guide. For children, you may designate a pediatrician as the primary care provider. You do not need prior authorization from the Plan or from any other person, including your primary care provider, in order to obtain access to obstetrical or gynecological care from a health care professional; however, you may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, visit the Plan on-line at the web address or contact your Plan Administrator, noted above, for more information. Summary of Benefit and Coverage As required under the Affordable Care Act (ACA), the following items are available on the website: Summary of Benefit and Coverage Glossary of Terms Printed copies of these documents are available at no charge through your plan Administrator, noted previously. Individual Disclosure Relph Benefit Advisors role is to provide the most appropriate and cost-effective solutions in the area of health, life and disability insurance for employees of our client organizations. Our firm receives compensation in the form of commissions from New York State insurance carriers based on their state approved commission schedules. Our licensed insurance counselors that meet with employees to select and apply for coverage are compensated on a per diem basis and do not receive direct commission payments. Sometimes in the course of our work, certain insurance carriers will provide bonus or override compensation based on volume of coverage sold or other factors. These amounts are not normally known in advance and we do not make insurance recommendations based on this or other forms of compensation. You may receive information about the compensation expected to be received by Relph Benefit Advisors based in whole or in part on the sale, and the compensation expected to be received in whole or part on any alternative quotes presented by Relph Benefit Advisors by contacting our Director of Compliance at the address below. Relph Benefit Advisors 400 WillowBrook Office Park, Suite 400 Fairport, NY 14450

19 Annual Compliance Notices Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP)

20 Annual Compliance Notices Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP)

21 Annual Compliance Notices Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP)

22 Important Notice from Alfred University About Your Prescription Drug Coverage & Medicare Effective: January 1, 2019 If you and/or your dependent(s) have Medicare or will become eligible for Medicare in the next 12-months, please take special care in reviewing this notice. You should keep this notice where you can find it! This notice has information about your current prescription drug coverage and prescription drug coverage available for people with Medicare. It also explains the options you have under Medicare prescription drug coverage and can help you decide whether or not you want to enroll. At the end of this notice is information about where you can get help to make decisions about your prescription drug coverage. 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Alfred University has determined that the prescription drug coverage offered in the following plan(s) is, on average for all plan participants, expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Creditable Coverage: Univera GOLD Plan Univera SILVER Plan Because the coverage in the above CREDITABLE plan(s) is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide to enroll in Medicare prescription drug coverage. 3. Alfred University has determined that the following Health Plan(s) has(have) prescription drug coverage that is on average for all plan participants, NOT expected to pay out as much as the standard Medicare prescription drug coverage will pay and is considered Non-Creditable Coverage: Not Applicable This is important because for most people enrolled in the above NON-CREDITABLE plans, enrolling in Medicare prescription drug coverage means you will get more assistance with drug costs than if you had prescription drug coverage exclusively through the above NON-CREDITABLE plans. Consider enrolling in Medicare prescription drug coverage. You can keep your Non-Creditable coverage from Alfred University. You can keep the coverage regardless of whether it is as good as a Medicare drug plan. However, because Non-Creditable Coverage is, on average, NOT at least as good as standard Medicare drug coverage, you may pay a higher premium (a penalty) if you decide later to join a Medicare drug plan. 4. You have decisions to make about Medicare prescription drug coverage that may affect how much you pay for that coverage, depending on if and when you enroll. Read this notice carefully it explains your options.

23 Important Notice from Alfred University About Your Prescription Drug Coverage & Medicare Why is your decision so important? You should also know that if you drop or lose your coverage with Alfred University and don t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later. If you go 63 continuous days or longer without prescription drug coverage that s at least as good as Medicare s prescription drug coverage, your monthly premium may go up by at least 1% of the base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without coverage, your premium may consistently be at least 19% higher than the base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join. When to enroll? You can join a Medicare prescription drug plan when they first become eligible for Medicare and each year from October 15 through December 7. This may mean that you have to wait to join a Medicare drug plan and that you may pay a higher premium (a penalty) if you join later. However, if you lose creditable prescription drug coverage, through no fault of your own, you will be eligible for a sixty (60) day Special Enrollment Period (SEP) because you lost creditable coverage to join a Part D plan. Additionally, if you decide to leave your employer sponsored plan, you will be eligible to join a Part D plan at that time using an employer group Special Enrollment Period. You need to make a decision! When you make your decision, you should also compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. For more information about this notice or your current prescription drug coverage Contact our office for further information at NOTE: You will receive this notice annually and at other times in the future such before the next period you can enroll in Medicare prescription drug coverage, and if this coverage through Alfred University changes. You also may request a copy. For more information about your options under Medicare prescription drug coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook from Medicare. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare-approved prescription drug plans. For more information about Medicare prescription drug plans: Visit Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help, Call MEDICARE ( ). TTY users should call For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this extra help is available from the Social Security Administration (SSA) online at or you call them at (TTY ) Remember! Keep this Creditable/Non-Creditable Coverage Notice. If you decide to join one of the Medicare drug Plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).

24 Relph Benefit Advisors Insurance Carrier Contact Information Many websites require registration to login using information from your ID card and SSN. Benefit Insurance Provider Website Phone Medical Univera Dental MetLife Vision EyeMed FSAs Benefit Resource, Inc Short Term Disability Insurance Cigna Long Term Disability Insurance Cigna Term Life & AD&D Insurance (Employer Paid) Cigna Term Life Insurance (Voluntary) Cigna Term AD&D Insurance (Voluntary) Cigna