EMPLOYEE BENEFITS

Transcription

1 EMPLOYEE BENEFITS

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3 NEW HIRE BENEFITS OVERVIEW The University of St. Thomas offers a comprehensive benefits package to all of our full time employees. You are eligible to participate in benefits on the 1st of the month following your date of hire. You have 31 days from your date of hire to make your elections. Once enrolled, you will be locked into your selected plans until Annual Enrollment, which occurs each year in May, unless you experience a life status change. Examples of life status changes are: marriage, divorce, birth or adoption of a child, change in employment status or loss of dependent eligibility. If you experience a life status change you will be eligible to make a change to your benefits based on the life event. You must inform Human Resources of the life event within 30 days of the date of the event, and complete the necessary paperwork in order to make the change to your benefits. To enroll in benefits you must complete the UST enrollment form and submit it to Human Resources. The enrollment form is available online at mystthom or in the Human Resources Office. The following pages of this booklet will outline the benefit offerings for the benefits plan year. UST provides a dedicated Benefit Advocate Service to assist employess with questions and issues related to their benefits. They can assist you with questions relating to your new hire enrollment and also assist you throughout the year should you have any ongoing benefits questions or claim issues. The service is available to both employees and their dependents. UST Benefit Advocates: Dora Mahan and Neil Smith Phone: ustbenefits@alliantinsurance.com Office Hours: Monday- Friday 10:30am-7:30pm 1

4 MEDICAL Group Pension Administrators (GPA) ' Customer Service ' ELAP UST offers three comprehensive benefit plans through Group Pension Administrators with the PHCS Physician Network. There is not a network for hospital or outpatient facility services, and you will have the option of going to a facility of your choice. When utilizing hospital or outpatient facility care, you should never pay an amount greater than your deductible and coinsurance initially. Once the facility has filed a claim you will receive a letter from ERISA Liability Assurance Program (ELAP) along with your Explanation of Benefits (EOB) from GPA that will state the amount you should owe the facility. If the facility bills an amount that exceeds what has been provided in the EOB employees should contact ELAP immediately and they will handle the claim. The contact information is provided above. Please refer to the GPA documents and benefit summaries for more details. The major features of the plan are shown below. Calendar Year Deductible Individual Family Out of Pocket Maximum Individual Family 70/50 Choice Plan 80/60 Risk/Reward Plan 90/70 Premium Plan In Network In Network In Network $500 $1,500 $5,000 $15,000 $250 $750 $4,000 $12,000 N/A N/A $3,000 $9,000 Coinsurance Levels 70% / 30% 80% / 20% 90% / 10% Office Visit Copay $15 $15 $15 Preventive Care including preventive diagnostic Hospital Inpatient Hospital Emergency Room copay waived if admitted within 24 hours 100% after office visit copay 70% after $250 per admission copay + deductible 70% after $100 copay/deductible 100% after office visit copay 80% after $250 per admission copay + deductible 80% after $100 copay/deductible 100% after office visit copay 90% after $250 per admission copay 90% after $100 copay Outpatient Surgical/Diagnostic Services 70% after deductible 80% after deductible 90% Retail Prescription Drugs Generic Formulary Non-Formulary $10 $25 $35 Lifetime Maximum Unlimited Unlimited Unlimited $10 $25 $35 $10 $25 $35 Tier Level SEMI MONTHLY RATES Employee Only $51.82 $ $ Employee and Spouse $ $ $ Employee and Child(ren) $ $ $ Employee and Family $ $ $

5 IMPORTANT MEDICAL PLAN INFORMATION! Physician Coverage (Use Network Providers) PPO through - PHCS/Multiplan Physician Only Network Hospital- Inpatient/Outpatient/ Surgery and Dialysis Coverage (No PPO Network) You will have access to the hospital, outpatient/surgical care, emergency room care and/or Dialysis Clinics of your choice. There is no PPO Network for these types of providers. You will be responsible for your plan s deductible/coinsurance levels when receiving services at any of the above providers. After you are released from the hospital or facility, Group & Pension Administrators, Inc. (GPA) will process your claims and you will receive a letter from ERISA Liability Assurance Program (ELAP) (the legal entity representing you). This letter advises you to call the ELAP toll free number if a provider bills you for any amount above your deductible/ coinsurance level ELAP will arrange for one of its retained attorneys to represent you at no cost. Thereafter, the medical provider will deal directly with the attorney and not contact you anymore. This service helps you determine which obligations must be paid to the provider under your plan benefits vs. any additional amounts billed by the provider. If You Have Additional Questions Please call GPA at (972) or (800) and ask for customer service. 3

6 DENTAL MetLife 8 ' Customer Service 800.ASK.4MET University of St. Thomas offers two comprehensive and reliable dental plans through MetLife. You will be locked into your selected plan for the entire plan year. The table below gives details on the benefits offered through each plan. Please note that anyone enrolling in the DHMO plan must designate a dentist at the time of enrollment. Visit the MetLife website listed above to find providers near you. Calendar Year Deductible Individual Family DPPO $50 $150 DHMO Orthodontia Deductible N/A N/A Preventive Service 80% 100% after $5 office copay Basic Service 80% Fixed Fee Schedule Major Service 50% Fixed Fee Schedule Calendar Year Max $2,000 N/A Orthodontia Max $2,000 Available - Fixed Fee Schedule DHMO Group Code: SGX185 Tier Level N/A N/A SEMI MONTHLY PREMIUMS Employee Only No Cost No Cost Employee and Spouse $15.86 $6.27 Employee and Child(ren) $20.30 $6.96 Employee and Family $36.79 $14.62 VISION VSP 8 ' Customer Service Vision insurance is offered to you and your family through VSP. If coverage is waived, you will be required to provide proof of credible vision coverage to enroll into the plan in the future. Details of the plan are shown in the table below. For more information please visit Exam - Once every 12 months $15 Lenses - Once every 12 months Single 100% after office copay Bifocal 100% after office copay Trifocal 100% after office copay Frame - Once every 24 months $120 allowance plus 20% discount Contact Lenses - Once every 12 months, in lieu of glasses Elective Medically Necessary Tier Level $120 allowance Up to $210 SEMI MONTHLY PREMIUMS Employee Only $3.67 Employee Plus One $5.72 Employee Plus Family $9.13 4

7 LIFE AND AD&D ING Employee Basic Life/AD&D UST provides and pays for Basic Life and AD&D insurance for all full time employees through ING. Details of the benefits provided are in the table below: Employee Benefit Amount 1.5 times annual earnings Employee Maximum $50,000 Supplemental Employee Life UST offers you the opportunity to purchase life insurance coverage for yourself through ING in addition to what is provided by the company. Benefit details and rates are included in the table below. Please refer to the ING plan documents for further information. Note: Employee s electing coverage above the Guaranteed Issue (GI) will be required to submit an Evidence of Insurability Form which can be found on the UST benefits website. Employee Benefit Amount Employee Maximum Employee Guaranteed Issue $10,000 increments up to $420,000 Lesser of 4 times annual salary or $420,000 SUPPLEMENTAL MONTHLY EMPLOYEE LIFE RATES Supplemental Dependent Life You have the option of purchasing life insurance for your spouse and dependent children through ING. Benefit details and rates are included in the table below. Please refer to ING plan documents for further information. Note: Spouse s electing above the Guaranteed Issue (GI) Amount will be required to submit an Evidence of Insurability Form which can be found on the UST benefits website. Spouse Benefit Amount Spouse Maximum Increments of $5,000 up to $100,000 not to exceed 50% of employee amount Lesser of $100,000 ro 50% of employee amount $150,000 Spouse Guaranteed Issue $30,000 Child Benefit $5,000 or $10,000 per child SUPPLEMENTAL MONTHLY DEPENDENT LIFE RATES Age Band Employee Rate / $1,000 Age Band Spouse Rate / $1, $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $4.728 Average Rate $0.999 Age Band Child Rate/$1000 n/a $0.12 5

8 SHORT TERM AND LONG TERM DISABILITY ING UST provides and pays for short and long term disability coverage for all full time, benefit eligible employees through ING. You are not eligible for short term disability coverage during your first year of continuous employment. However, you do have the option of electing an individual short term disability benefit through UNUM, which will provide coverage during this one year waiting period. See UNUM section below for details. Long Term Disability coverage is effective the 1st of the month following date of hire. Details of the plan are listed below. Please refer to the ING plan documents for further information. Short Term Disability Weekly Benefit Amount Benefit Duration Benefits Commence 100% of annual base earnings (reduced by any other income benefits) 11 weeks for injury / accident 15th day for injury / accident Long Term Disability Benefit Percentage 60% of base annual earnings (reduced by any other income benefits) Maximum Monthly Benefit $5,000 Minimum Monthly Benefit Elimination Period Benefit Duration Lesser of $100 or 10% of the benefit based on monthly income loss 90 days Benefits payable to age 63 or normal retirement age or 48 months if greater FLEXIBLE SPENDING ACCOUNTS Medical Flexible Spending Account You are eligible to participate in the Medical Flexible Spending Accounts through GPA. The flexible spending account allows you to set aside tax free dollars to help pay for qualifying medical and dependent care expenses. The FSA is a use it or lose it benefit, which means that you will lose any remaining balance at the end of the year; plan accordingly when designating your contributions for the year. You will receive a debit card that will be tied to your Flexible Spending Account. You and your family members can use the debit card for qualifying healthcare expenses. These expenses include prescriptions, copays, deductibles and other qualified medical expenses. **The FSA benefit will be changed to a calendar year basis on 01/01/2012. Therefore, you will be required to enroll again for this benefit by the end of the calendar year. Only contribute amount for the period of 07/01/11 12/31/2011.** Due to the partial plan year, the maximum you will be able to contribute to the medical FSA for 2011 is $2,500. This will be increased to a maximum of $5,000 beginning on January 1, Dependent Care Flexible Spending Account The Dependent Care Flexible Spending Account is administered directly through the University. The Dependent Care account allows to use pre-tax dollars to pay for child care or elderly care services. You are eligible to contribute a maximum of $5000 per year. Unlike the Medical FSA you must have the money in your account before you can start claiming reimbursement. Any unused dollars will be forfeited at the end of the plan year so it is important to plan accordingly. To claim reimbursement on your dependent care, fill out a Dependent Care Reimbursement Claim Form which is available on the HR website, attach receipts of payment and forward to the Payroll office. You will receive reimbursement via check within 7 business days. 6

9 VOLUNTARY PRODUCTS UNUM University of St. Thomas offers voluntary products which are issued on an individual basis through UNUM. The below coverages are fully portable and are paid for 100% by employees. You are required to complete a separate application for each of these products. Please contact the Benefit Advocate or Human Resources for more information regarding these products and the application process. Accident & Sickness Hospital Confinement Coverage Optional Sickness Hospital Benefit ER Treatment Benefit Catastrophic Accident Benefit ($100,000) Hospital/ICU Benefits $25-$100,000 for specific injuries Max Age is 80 Critical Illness & Cancer Benefit Lump sum benefit ($5,000- $50,000) For initial cancer diagnosis Additional Lump Sum Benefit For Critical Illness Wellness Benefit Included for Health Screenings Max Age is 69 Individual Short Term Disability $500 base amount; can elect additional $100 increments up to 60% of annual base salary Max Age is 69 Long Term Care Provides benefits to pay for your stay in a longer term care facility or for someone to care for you in your home in the event that you become disabled Benefits available in increments of $1000 per month to a maximum of $8000 per month Policies available for benefit duration of 3 years, 6 years or unlimited Premiums based on duration, type of benefits and your age at time of enrollment 403(B) MATCHING RETIREMENT PLAN UST believes that saving for retirement is one of the most important things you can do for your future. You are eligible to participate in a 403(b) retirement plan that allows you to save for retirement by automatically transferring pre-tax dollars from your paycheck directly into a financial account in your name. Participation is completely voluntary and you can increase, decrease or stop your contributions at anytime up to 4 changes per year. You are able to contribute as little as $1 per paycheck and as much as $16,500 per year. ($22,000 if your are over the age of 50). You can also decide how you want to invest your funds. You will receive a quarterly report on the progress of your investment and you have online access to your account. The money you contribute is always yours even if you leave the University. You can withdraw the cash, transfer it to an IRA or another employer plan, or draw from the account to pay for retirement expenses. After completion of one year of employment with the University, we will match dollar for dollar up to 6% of your pay. You are eligible to enroll at any time during the year and can invest your contributions with one of the below three companies of your choice; TIAA-CREF Raymond James Valic 7

10 MEDICAID AND THE CHILDREN S HEALTH INSURANCE PROGRAM (CHIP) Offer Free Or Low-Cost Health Coverage To Children And Families If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed on the following page, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial KIDS NOW or to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer s health plan is required to permit you and your dependents to enroll in the plan as long as you and your dependents are eligible, but not already enrolled in the employer s plan. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of January 31, You should contact your State for further information on eligibility. To see if any more States have added a premium assistance program since January 31, 2011, or for more information on special enrollment rights, you can contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services EBSA (3272) , Ext

11 ALABAMA Medicaid Website: Phone: ALASKA Medicaid Website: Phone (Outside of Anchorage): Phone (Anchorage): ARIZONA CHIP Website: Phone (Outside of Maricopa County): Phone (Maricopa County): ARKANSAS CHIP Website: Phone: CALIFORNIA Medicaid Website: TPLRD_CAU_cont.aspx Phone: COLORADO Medicaid and CHIP Medicaid Website: Medicaid Phone: In-state: ; Out-of-state: CHIP Website: CHIP Phone: FLORIDA Medicaid Website: Phone: GEORGIA Medicaid Website: Click on Programs, then Medicaid Phone: IDAHO Medicaid and CHIP Medicaid Website: Medicaid Phone: CHIP Website: CHIP Phone: INDIANA Medicaid Website: Phone: IOWA Medicaid Website: Phone: KANSAS Medicaid Website: Phone: KENTUCKY Medicaid Website: Phone: LOUISIANA Medicaid Website: Phone: MAINE Medicaid Website: index.html Phone: MASSACHUSETTS Medicaid and CHIP Medicaid & CHIP Website: Medicaid & CHIP Phone: MINNESOTA Medicaid Website: Click on Health Care, then Medical Assistance Phone (Outside of Twin City area): Phone (Twin City area): MISSOURI Medicaid Website: Phone: MONTANA Medicaid Website: clientindex.shtml Phone: NEBRASKA Medicaid Website: Phone: NEVADA Medicaid and CHIP Medicaid Website: Medicaid Phone: CHIP Website: CHIP Phone: NEW HAMPSHIRE Medicaid Website: Phone: NEW JERSEY Medicaid and CHIP Medicaid Website: medicaid Medicaid Phone: CHIP Website: CHIP Phone: NEW MEXICO Medicaid and CHIP Medicaid Website: Medicaid Phone: CHIP Website: Click on Insure New Mexico CHIP Phone: NEW YORK Medicaid Website: Phone: NORTH CAROLINA Medicaid Website: Phone: NORTH DAKOTA Medicaid Website: Phone: OKLAHOMA Medicaid Website: Phone: OREGON Medicaid and CHIP Medicaid and CHIP Website: Medicaid and CHIP Phone: PENNSYLVANIA Medicaid Website: doingbusiness/ htm Phone: RHODE ISLAND Medicaid Website: Phone: SOUTH CAROLINA Medicaid Website: Phone: TEXAS Medicaid Website: Phone: UTAH Medicaid Website: Phone: VERMONT Medicaid Website: Telephone: VIRGINIA Medicaid and CHIP Medicaid Website: Medicaid Phone: CHIP Website: CHIP Phone: WASHINGTON Medicaid Website: Phone: ext WEST VIRGINIA Medicaid Website: Phone: WISCONSIN Medicaid Website: Phone: WYOMING Medicaid Website: Telephone:

12 Women s Health Act The Women s Health and Cancer Rights Act of 1998 requires that all health insurance plans that cover mastectomy also cover the following medical care: 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 at all stages of the mastectomy, including lymphedemas, and mastectomy bras and external prostheses limited to the lowest cost alternative available that meets the patient s physical needs. Continuation Required by Federal Law for You and Your Dependents The Continuation Required by Federal Law does not apply to any benefits for loss of life, dismemberment or loss of income. Federal law enables you or your dependent to continue health insurance if coverage would cease due to a reduction of your work hours or your termination of employment (other than for gross misconduct). Federal law also enables your dependents to continue health insurance if their coverage ceases due to your death, divorce or legal separation, or with respect to a dependent child, failure to continue to qualify as a dependent. Continuation must be elected in accordance with the rules of your employer s group health plan(s) and is subject to federal law, regulations and interpretations. Newborns and Mothers Health Protection Act Federal law (Newborns and Mothers Health Protection Act of 1996) prohibits the plan from limiting a mother s or newborn s length of hospital stay to less than 48 hours for a normal delivery or 96 hours for a Cesarean delivery or from requiring the provider to obtain preauthorization for a stay of 48 or 96 hours, as appropriate. However, federal law generally does not prohibit the attending provider, after consultation with the mother, from discharging the mother or her newborn earlier than 48 hours for normal delivery or 96 hours for Cesarean delivery. Health Insurance Portability and Accountability Act (HIPAA) University of St. Thomas, in accordance with HIPAA, protects your Protected Health Information (PHI). University of St. Thomas will only discuss your PHI with medical providers and third party administrators when necessary to administer the plan that provides you your medical, dental, and vision benefits or as mandated by law. A copy of the Notice of Privacy Practices is available upon request in the Human Resources department. Lifetime Limits The lifetime limit on the dollar value of benefits under the University of St. Thomas plan no longer applies. Individuals whose coverage ended by reason of reaching a lifetime limit under the plan are eligible to enroll in the plan. Individuals have 30 days from the date of this notice to request enrollment. For more information contact Human Resources Benefits department. Disclosure of Grandfathered Status University of St. Thomas believes this plan is a grandfathered health plan under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your [plan or policy] may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator the Human Resources department. This brochure summarizes the health care and income protection benefits that are available to University of St. Thomas teammates and their eligible dependents. Official plan documents, policies, and certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any conflict, the official documents prevail. These documents are available upon request through the Human Resources Department. Information provided in this brochure is not a guarantee of benefits. 10 Rev Alliant Insurance Services