Your CHEIBA Trust Benefits

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1 2019 Faculty & Exempt Staff Benefit Summary Explore your Benefits

2 Your CHEIBA Trust Benefits We re committed to you and your health An annual open enrollment period is announced each November, in which eligible employees can make certain coverage changes. The information in this booklet provides an overview of your 2019 benefits package to help you in making the choices that best meet your individual and family s needs but it is up to you to take action. In the end, it s your coverage. You have the power take your health into your own hands through the selections available to you. We encourage you to read the selections carefully and go online to the BeneCenter to protect what s important to you. Ensure you elect the best coverage for you and your family: Carefully read the benefit summaries and utilize resources before completing your election forms. Review the additions and changes to your benefits for the 2019 plan year. Add or delete dependents from coverage under the plan. If you have questions, phone numbers and website addresses are included throughout this guide for your convenience. We know your health is important to you, and it is important to us, too. That s why the CHEIBA Trust is committed to providing you and your family a strong benefits package. Who is CHEIBA? CHEIBA stands for Colorado Higher Education Insurance Benefits Alliance. Your employer has joined together with seven other educational institutions to create more purchasing power in the insurance market. What does this mean to you? Simply, lower premiums for richer benefits. By creating a purchasing group of over 9,000 lives, your employer is able to deliver better benefits at a lower cost. The Trust meets every other month to monitor your plans, and reevaluates them each year to determine the best benefit offerings. CHEIBA Trust Member Institutions: Adams State University, Auraria Higher Education Center, Colorado School of Mines, Colorado State University-Pueblo, Fort Lewis College, Metropolitan State University of Denver, University of Northern Colorado, and Western Colorado University.

3 2019 Rates Health Insurance Anthem Blue Cross and Blue Shield Total Cost per Pay Period Your Bi-Weekly Cost BlueAdvantage Point of Service Plan (HMO/POS), Prime Blue Priority PPO Plan, and Custom Plus Health Plan Employee Only $ $90.16 Employee + Spouse $ $ Employee + Child(ren) $ $ Employee + Family $ $ Blue Priority HMO Plan Employee Only $ $82.86 Employee + Spouse $ $ Employee + Child(ren) $ $ Employee + Family $ $ HDHP Plan Employee Only $ $69.19 Employee + Spouse $ $ Employee + Child(ren) $ $ Employee + Family $ $ Dental Insurance Anthem Blue Cross and Blue Shield Anthem Dental Essential Choice PPO Employee Only $19.48 $4.29 Employee + Spouse $44.04 $19.38 Employee + Child(ren) $42.20 $18.57 Employee + Family $50.54 $22.24 Vision Insurance Anthem Blue Cross and Blue Shield Blue View Voluntary Vision Plan Employee Only $4.34 $4.34 Employee + Spouse $8.13 $8.13 Employee + Child(ren) $8.13 $8.13 Employee + Family $11.81 $11.81

4 What are my options? This is a brief benefit outline, for more detail, including Out-of-Network benefits, please see the plan documents in the BeneCenter. BlueAdvantage HMO/POS PRIMEBlue Priority PPO Blue Priority HMO 2500 HDHP PPO Out-of-Network access? Emergency services only Deductible Individual/Family None $500/$1,000 $2,000/$6,000 $2,500/$5,000 Coinsurance 0% (Copay-based) 15% 0% (Copay-based) 15% Out-of-Pocket Max Individual/Family $2,000/$4,000 $3,000/$6,000 $4,000/$10,000 $3,500/$7,000 Preventive Care 100% covered 100% covered 100% covered 100% covered Telemedicine $20 copayment per visit $10 copayment per visit $20 copayment per visit $49 prior to deductible being met, then 15% after deductible Primary Office Copay $20 per visit $0 at a Paladina facility* $10 per visit (designated provider) 15% after deductible (participating provider) $0 at a Paladina facility* $20 per visit $0 at a Paladina facility* 15% after deductible Significantly lower cost at a Paladina facility* Specialist Office Copay $40 per visit $10 per visit (designated provider) 15% after deductible (participating provider) $60 per visit 15% after deductible Inpatient Hospital $600 per admission 15% after deductible $250 per admission + 20% after deductible 15% after deductible Outpatient Hospital $125 per visit 15% after deductible $250 per admission + 20% after deductible 15% after deductible Emergency Room $150 per visit 15% after deductible $250 per visit 15% after deductible Urgent Care $50 copayment per visit 15% after deductible $60 copayment per visit 15% after deductible * Must be enrolled in the Paladina program to visit a Paladina provider. See page 12 for more details.

5 Dental Insurance Smile, you re covered Anthem Blue Cross and Blue Shield Strong teeth and healthy gums are a big part of your overall health. We give you coverage when it comes to your teeth and gums for a reason. Aside from routine check-ups and cleanings, knowing that you re covered should you need to see a dentist or a specialist for a big-ticket procedure, such as fillings, root canals, and crowns, is added peace of mind. The CHEIBA Trust has made changes to the dental benefits for the 2019 plan year, to offer you and your family an upgraded single-option program. The new Anthem Dental Essential Choice PPO network is broader than before, and the benefits have been enhanced. To learn more about the upgraded dental plan, Out-of-Network coverage, and the costs associated, go online to the BeneCenter. mybensite.com/cheiba Moving to Anthem Dental Essential Choice PPO also allows access to powerful member tools, including Ask a Hygienist, risk assessments, cost estimators, as well as network information and on-the-go claims info via Anthem Anywhere. Look for an expanded provider listing in the Anthem Complete Network on anthem.com. Anthem Dental Essential Choice PPO Prices Benefit Description In-Network Out-of-Network Deductible Individual/Family $0/$0 $50/$150 Preventive/Diagnostic Oral Exam X-rays Cleanings (3x annual) 100% Deductible waived 80% Basic Prosthodontic Orthodontics General anesthesia Endodontics Periodontal Simple oral surgery Tooth extractions Root canals Specified space maintainers Crowns/onlays Removable/fixed partials or dentures Implants Realignment of teeth (adults and children) 80% 60% 50% 40% 50% 40% Orthodontics Maximum Per eligible person $1,500 $1,500 Annual Maximum per person Per insured person. Preventive/ diagnostic costs do not apply. $2,000 $2,000

6 Vision Insurance Your vision, our coverage Anthem Blue View Vision We understand how important vision is in everyday life, and how expensive it can be if you aren t insured. That s why we give you coverage that will help your eye health and your wallet at the same time. For 2019, employees can elect the voluntary full-service vision coverage, comprising of a yearly vision exam, eyewear materials, and lens treatments (LASIK discounts are also included in this plan). Plan Prices To learn more about your vision benefit, levels of coverage, Out-of-Network coverage, and the costs associated, go online to the BeneCenter. mybensite.com/cheiba Benefit Description Copay Frequency Vision Exam $15 copay, then 100% covered 12 months (from last day of service) Materials $15 copay 12 months (from last day of service) Frames $130 allowance, then 20% off remaining balance 12 months (from last day of service) Lenses Plastic Single Vision $15 copay, then 100% covered 12 months (from last day of service) Plastic lined Bifocals Plastic lined Trifocals Lens Enhancements materials copay applies Included as part of the Lenses Benefits Transitions Lenses (Adult) Polycarbonate (Adult) UV Coating Progressive Lenses Standard Premium Tier 1 Premium Tier 2 Premium Tier 3 Anti-Reflective Coating Standard Premium Tier 1 Premium Tier 2 Other Add-ons and Services Contacts Medical Necessary Elective Conventional Elective Disposable Exam & Fitting Low Vision Benefit Those with severe visual problems that are not correctable with regular lenses Additional Glasses Benefit $75 $40 $15 $65 $85 $95 $110 $45 $57 $68 20% off retail price Covered in full $130 allowance, 15% off balance $130 allowance Up to $55 Maximum $1, months Supplementary Testing Covered in full Supplementary Care Aids 25% copay Additional sets of glasses can be obtained on the same day as an exam by the same provider 40% discount 12 months (from last day of service) Lasik VisionCare Program Anthem BVV partners with TruVision & Premier Lasik to offer multiple discount options for Lasik surgery candidates. Log in at anthem.com, select discounts, then Vision, Hearing & Dental.

7 Eligibility Who is eligible to be a dependent? Legal spouse. Employee s married or unmarried child(ren) until the end of the month in which their 26th birthday occurs or medically certified disabled child(ren) of any age. Timeframes Documentation of dependency must be provided within the following timeframes: Within 31 days of benefits eligibility; During the annual Open Enrollment period; or Within 31 days of all changes related qualifying events. Documentation Legal Spouse A document dated within the last 60 days showing current relationship status (household bill or statement of account), listing your spouse s name, the date and your address, or the first page and signature page of your most recent federal tax return, AND Registered copy of marriage certificate, and common-law marriage affidavit, or registered copy of civil union certificate. Child(ren) The child s birth or adoption certificate, naming you or your spouse as the child s parent, or appropriate custody or allocation of parental responsibility documents naming you or your spouse as the responsible party to provide insurance for the child. Qualifying events Qualifying events are the only opportunities to make changes to your benefit elections outside of annual Open Enrollment, and include, but are not limited to: A marriage, common-law marriage, civil union, divorce, or legal separation. The death of a spouse or other dependent. The birth or adoption of a child. You or your spouse experiencing a change in work hours that affects benefits eligibility. Loss or gain of a spouse s coverage through their employer. Changing your benefit elections related to these events must be completed within 31 days of the event.

8 Waiving coverage If employees elect medical coverage, they will automatically be enrolled in dental coverage. However, if employees waive medical coverage, they are still able to enroll in dental and vision coverage. If medical and dental coverage is waived, dependent coverage must also be waived. If coverage is waived, eligible employees and their dependents may only enroll in coverage during the next open enrollment, or within 31 days of a qualifying event. Medical coverage may only be waived with proof of other group medical coverage. Section 125 pre-/post-tax elections Complete the Section 125 election form to elect whether or not your insurance premiums will be taxed. The Defined Contribution Pension Plan retirement benefits are based on the dollars contributed to the plan over your total years of employment. These contributions may be based on your taxable wages which are reduced by your participation in the Section 125 plan. However, you may be able to increase your voluntary retirement plan contributions to compensate for this reduction in contributions and reduction in future retirement benefits. Public Employee Retirement Association (PERA) contributions are not paid on any dollars re-directed through participation in the Section 125 plan. PERA retirement benefits are based on your highest average salary. If you are within your final three years of employment under PERA, you may want to elect after-tax payments for insurance premiums and decline participation in the spending accounts.

9 Basic Term Life Insurance (Life and AD&D) Anthem Life (premiums per $10,000 death ben t) Active Employees $1.40/$1,000 Group Long Term Disability The Standard Insurance Active Employees $3.30/$100 Paid to a maximum salary of $10,500 per month Voluntary Group Term Life Insurance (Employee and/ or Spouse) Anthem Life (premium per $1,000 death ben t) Attained Age Smoker Non-Smoker <25 $0.042 $ $0.042 $ $0.042 $ $0.060 $ $0.093 $ $0.171 $ $0.276 $ $0.492 $ $0.600 $ $0.966 $ $1.530 $ $2.832 $ $3.792 $ $6.042 $5.445 Voluntary Dependent Child Term Life (per $5,000 up to $25,000 per child) $0.75 per $5,000 per month Voluntary Accidental Death & Dismemberment Mutual of Omaha Employee Principal Sum Employee Only Employee and Family $ 10,000 $0.180 $0.260 $ 30,000 $0.540 $0.780 $ 50,000 $0.900 $1.300 $ 80,000 $1.440 $2.080 $100,000 $1.800 $2.600 $150,000 $2.700 $3.900 $200,000 $3.600 $5.200 $250,000 $4.500 $6.500 $300,000 $5.400 $7.800 $500,000 $9.000 $ The amount of insurance you select is called the Principal Sum. You may select a Principal Sum up to a maximum of $500,000, in increments of $10,000. Amounts over $250,000 are subject to ten (10) times your annual salary. Employee and Family includes coverage for you, your spouse, and eligible children. If you elect a Family Plan, your spouse s benefit will be 50% of your Principal Sum and the benefit for each child (no matter how many), will be 10% of your Principal Sum.

10 The BeneCenter is your online portal for all CHEIBA Trust benefits, forms, resources and information. Check it out at Login: cheiba Password: ftlewis First Impressions First Impressions is your helping hand for deciding which health, vision and dental options will work best for you and your family. Call Monday Friday, 7:30am 5:30pm to: 1. Explore the differences between your old health plan and your new one. 2. See if the doctor from your old plan is part of our network. 3. Find nonemergency health care services. Online Anthem Account Registration: Participant Advocate Link (P.A.L.) CHEIBA group participants have the wonderful benefit of a personal advocate to answer benefit questions. This personalized service helps employees to have quick answers to questions related to coverage, medical cards or any benefit related issue REQUIRED College Retirement Program Fort Lewis College DOES NOT PAY INTO THE SOCIAL SECURITY SYSTEM for retirement purposes (per legislation: Section 419(c) of Public Law , the Social Security Protection Act of 2004). No social security is withheld and no quarters are earned toward a social security benefit. However, the college does deduct and match 1.45% of employee s salary for Medicare premiums.employees are required to contribute 8% of their salary into a Defined Contribution Retirement Plan (DCRP). The college currently contributes 11.4% into the same plan. Employees have a choice of either enrolling in VALIC or TIAA for the DCRP contributions. There is no vesting period. The benefit upon retirement is dependent upon the investment return of the funds the employee has chosen. Only employees who have worked and contributed to a PERA retirement plan for 12 months prior to employment at Fort Lewis College and have not taken a distribution or closed the account, may have the choice to remain in PERA for their retirement plan instead of the DCRP. Employees are required to contribute 8%. Retirement benefits are defined by years of service and highest average salaries.

11 Voluntary Flexible Spending Accounts Employees have the option of establishing a Flexible Spending Account for out of pocket expenses for qualifying health care or dependent care. To take advantage of this pre tax benefit, employees establish an amount that will be deducted from each biweekly paycheck. Employees may have no more than $2,650 for medical and $5,000 for child care deductions each calendar year for one or combination of both plans. Throughout the plan year, employees submit receipts for qualifying health care and/or dependent care to the administrator of the plan for reimbursement. This is a use it or lose it account. If a balance remains in the account at the end of the plan year and cannot be reimbursed to the employee, the balance is forfeited. If employees take advantage of this tax break, they are not allowed to claim the expenses when filing that year s income tax returns. Voluntary Tax Sheltered Annuity Plans Employees may voluntarily enroll in an additional tax sheltered annuity program under section 403(b) of the Internal Revenue Service Tax code at any time. Contributions to these plans are voluntary and may help provide more income upon retirement. These contributions are subject to the IRS maximum limits and make up contribution limits. Current tax sheltered annuity vendors and plan options are: State of CO PERA Deferred Compensation Plan 457 TIAA 403(b) Public Employees Retirement Association (PERA) 401(k) Variable Life Insurance Company (VALIC) 403(b) AXA 403(b) Travel Accident Insurance Employees who are actively employed and have an accident while traveling for collegeapproved business are covered for a maximum benefit of up to $100,000 for loss of life or dismemberment. (Some exclusions and limitations apply.) There is no cost to employees for this benefit.

12 Annual and Sick Leave Full time, exempt and non-exempt staff accrue 7.39 hours of annual leave and 4.62 hours of sick leave each pay period worked. This equals 24 days of paid annual leave and 15 days of paid sick leave per year. In addition to the annual and sick leave, we also offer 10 paid holidays per year. [Accrued time is pro-rated for part time staff based on time off. This benefit is based on FTE. ] Holiday Schedule for 2019 New Year's Day Tuesday, January 1, 2019 Martin Luther King, Jr. Day Observe, Friday, November 29, 2019 President's Day Observe Thursday, December 26, 2019 Memorial Day Monday, May 27, 2019 Independence Day Thursday, July 4, 2019 Labor Day Observe Friday, December 27, 2019 Indigenous Peoples Day Observe Monday, December 30, 2019 Veteran's Day Observe Tuesday, December 31, 2019 Thanksgiving Day Thursday, November 28, 2019 Christmas Day Wednesday, December 25, 2019 SkyCard: Employees are encouraged to obtain a SkyCard as their employee ID card soon after starting employment. Advantages include a 10% discount at the FLC bookstore & your SkyCard allows you to attend athletic events for FREE. The card also has a magnetic strip that employees may put pre paid dollar amounts on the card for food purchases with Campus Dining tax free. The card will also grant door access to some departments. Parking: Parking passes are required between September through April for all vehicles on campus. Parking passes are $ and are good for the commuter lots only. If you meet the September deadline, you may have this amount taken out of your paycheck over 4 or 8 months. Otherwise, parking passes can be purchased at the Cashier s Office or at the Campus Police Department. If you will only be parking on campus one semester, cost is $60.00 per parking sticker. Work Life Discounts: The State of Colorado Human Resources department has worked with numerous companies across the state to bring special discounts to state employees. To sign up for discounts please visit: Campbell Child and Family Center: is an early care and education program with high quality staff. Employees who have children ages 1 year to 5 years of age can enroll their children in this oncampus childcare program. For pricing, please call the Center at (970) Employee Assistance Program (EAP): FLC offer two EAP programs. One is Profile EAP and the other is on campus C-SEAP. Services provide employees with free counseling sessions with a licensed professional for a variety of personal or work-related concerns. This benefit is for current employees and their spouses/dependents.

13 Tuition discounts: Provided for employees, spouses/dependents. Employees may take up to 8 hours of credits at FLC (per calendar year) tuition free based on full-time or part-time employment status. Employee s spouse AND children receive 25% discount on in-state tuition if enrolled in 6 credit hours or more. Please see our website for more information: Student Life Center: Provides employees a great place to exercise and maintain physical balance. Fort Lewis College also has an active Wellness Committee that provides opportunities for healthy lifestyle practices and education. For pricing, payroll deduction and membership information, please see their website: StudentLifeCenter.aspx Outdoor Pursuits: Outdoor Pursuits provides outdoor and social experiences emphasizing environmental awareness, outdoor education, challenge, personal development, managed risk, a sense of community, and fun. Membership fees are currently $100 valid Aug. 27, mid Aug, More information including membership benefits please visit StudentLifeCenter.aspx Community Concert Hall: Employees receive a 10% discount for performances and a 20% discount when purchasing 4 shows in advance. If 10 shows are purchased in advance, employees get 2 performances for free. For concert information, go to the website:

14 Notice to Prospective Employees: The Fort Lewis College is required by the Clery Act of 1990 to notify prospective employees, current employees, students and applicants where to access our Campus Security Report. The report is updated and published annually in accordance with the Higher Education Amendments of 1998, Federal Student Right to Know, the Federal Drug free Schools and Campuses Act of This report contains information about: Fort Lewis College s alcohol and other drug policy Sexual assault policy Campus security policies Campus/community resources The Colorado Riot Offense Statute restriction on enrollment Where to find registered sex offender information Crime statistics for the previous three calendar years Reporting crimes The Campus Security Report can be accessed in two ways: 1. By going to the internet website at: 2. Fort Lewis College Student Affairs Office will also provide a paper copy of the annual security report upon request. You can reach them at (970)