Benefit G uide

Transcription

1 Benefit Guide

2 Table of Contents Introduction 1 Introduction to Benefits Contacts 2 Who to Contact with Questions What s New 3 Changes for the Upcoming Year Medical 4 Benefits & Costs Teladoc 14 24/7 Virtual Office Visits Dental 15 Benefits & Costs Vision 20 Benefits & Costs Health Savings Account 22 Understanding HSAs Flexible Spending Accounts 25 Understanding FSAs Life Insurance 27 Benefits & Costs Disability 30 Benefits & Costs Allstate Benefits 31 Benefits & Costs Eligibility & Enrollment 35 Who s Eligible, How & When to Enroll

3 Introduction Ave Maria University is pleased to offer our employees an exceptional benefits program. Through Ave Maria University, you are eligible to elect Medical, Dental, Vision, HSA, FSA, Voluntary Life, and/or Allstate Benefits. Ave Maria University provides employees with Life and AD&D, Short Term Disability, Long Term Disability, Adoption Assistance, and Teladoc benefits. These benefits are designed to help protect you and your family while you re employed with Ave Maria University. It is very important to think about the needs of your family when making decisions about your benefits. We encourage you to read the following materials about the benefits, your contributions, and the coverages carefully; please share this information with your dependents. Notice to all Plan Enrollees The organization that sponsors or arranges your health plan has certified that it qualifies for an injunction with respect to the Federal requirement to cover contraceptive services without cost sharing. During this period, coverage under your health plan will not include coverage of contraceptive medications, devices, appliances, or other Health Care Services when provided for contraception. Please Note: All of the benefit descriptions in this booklet are a summary; you should refer to the Summary Plan Description or full Benefit Summaries for complete details of coverage. 1

4 CONTACTS First Florida Integrity Bank HSA FirstFloridaIntegrityBank.com Ave Maria University HR Kathy Phelps, Director of Human Resources Ave Maria University HR Debbie Lennox Brown & Brown Insurance Britney Wojcechowskyj UMR Medical umr.com WageWorks FSA takecarewageworks.com Mutual of Omaha Life & Disability Life Disability EAP Travel Assist Travel Assist mutualofomaha.com Teladoc (800) teladoc.com Allstate Benefits (800) allstateatwork.com/mybenefits Delta Dental PPO: DHMO: deltadentalins.com/enrollees VSP Vision vsp.com 2

5 WHAT S NEW Effective November 1, 2017: Moving Medical to UMR (United Medical Resource) New Network is UnitedHealthcare Choice Plus Plan options remain the same Rates have increased slightly Review the Medication Guide and discuss any changes in covered medications with your Physician prior to November 1 If you ve satisfied any portion of your 2017 Deductible and/or Maximum, UMR will give you credit for the remainder of the year Health Smart will provide a report, in early November If any claims are processed after 10/31, you will need to provide us with a Health Smart EOB to receive any additional credit All Other Benefits & Costs Will Remain the Same 3

6 Locate a Participating Provider: MEDICAL Go to umr.com Click on Find a Provider Select UnitedHealthcare Choice Plus as the Provider network Click on the Search for a medical provider link Costs Per Pay Effective November 1, 2017 Coverage Buy-Up 500 Core 1000 HDHP Employee $70.00 $35.00 $24.00 Employee + Spouse $ $91.00 $65.00 Employee + Child/ren $ $69.00 $47.00 Employee + Spouse + Child/ren $ $ $

7 MEDICAL Buy-Up 500 Core 1000 HDHP Services You Pay In-Network 1 You Pay In-Network 1 You Pay In-Network 1 Calendar Year Deductible - Individual - Family $500 $1,500 $1,000 $3,000 $1,300 $2,600 Coinsurance 20% 20% 20% Calendar Year Maximum - Individual - Family $2,500 $5,000 Deductible, Coinsurance & Copays $3,500 $7,000 Deductible, Coinsurance & Copays $5,000 $5,000 Deductible, Coinsurance & Copays Preventive Care Covered at 100% Covered at 100% Covered at 100% Teladoc Consultations Covered at 100% Covered at 100% $45 Consultation Fee Office Visits - Primary Care - Specialists $20 Copay $40 Copay $25 Copay $45 Copay Deductible + 20% Deductible + 20% Urgent Care Facility $45 Copay $50 Copay Deductible + 20% Emergency Room - Facility - Physician $100 Copay Deductible + 20% $200 Copay $100 Copay Deductible + 20% Deductible + 20% Ambulatory Surgical Center - Facility - Physician $100 Copay Deductible + 20% $150 Copay $45 Copay Deductible + 20% Deductible + 20% Independent Lab Services Covered at 100% Covered at 100% Deductible + 20% Diagnostic Testing Facility - X-ray - Advanced Imaging Services $50 Copay $150 Copay $50 Copay $200 Copay Deductible + 20% 1 Non-Network benefits are subject to a separate and higher Deductible, Coinsurance and Maximum. 2 HDHP 1300 has a Family Deductible that applies to anyone covering dependents. The Family Deductible applies to the entire family; whether one member of the family meets the Family Deductible or a combination of family members contribute to the Deductible. The 80/20% Coinsurance does not apply to any family member until the Family Deductible has been met. 5

8 MEDICAL Buy-Up 500 Core 1000 HDHP Services You Pay In-Network 1 You Pay In-Network 1 You Pay In-Network 1 Outpatient Hospital Facility - Facility - Physician $200 Copay Deductible + 20% Deductible + 20% $100 Copay Deductible + 20% Deductible + 20% Inpatient Hospital Facility - Facility - Physician $600 Copay Deductible + 20% Deductible + 20% $100 Copay Deductible + 20% Deductible + 20% Prescription Drugs Retail 30 days - Generic - Preferred - Non-Preferred $10 Copay $50 Copay $80 Copay $10 Copay $50 Copay $80 Copay Deductible, then: $10 Copay $50 Copay $80 Copay Prescription Drugs Mail Order 90 days - Generic - Preferred - Non-Preferred $25 Copay $125 Copay $200 Copay $25 Copay $125 Copay $200 Copay Deductible, then: $25 Copay $125 Copay $200 Copay 1 Non-Network benefits are subject to a separate and higher Deductible, Coinsurance and Maximum. 2 HDHP 1300 has a Family Deductible that applies to anyone covering dependents. The Family Deductible applies to the entire family; whether one member of the family meets the Family Deductible or a combination of family members contribute to the Deductible. The 80/20% Coinsurance does not apply to any family member until the Family Deductible has been met. 6

9 MEDICAL 1. Stay In-Network! Prior to every service, verify the provider that is treating you is In-Network. Your Medical network is UnitedHealthcare Choice Plus. It is your responsibility to verify your providers participate in your network even when your physician refers you to a specialist or lab. Ask the provider if they participate in your network; do not ask if they accept your insurance. You can search for participating providers online at umr.com. 2. Coverage Outside of Florida! Your coverage works outside of Florida. As long as the out-of-state provider participates in their state s UnitedHealthcare Choice Plus network, your In-Network benefits apply. Search for National Providers at umr.com. 3. Urgent Care vs Emergency Room (ER) Emergency Room Visits are more expensive and take more time than an Urgent Care Center. Save the ER visits for a true medical emergency. Plan ahead and verify the hours of operation of the participating Urgent Care Center near your home or office. 4. Prior Authorization! UMR requires prior authorization on Advanced Imaging Services (AIS): MRI, CAT, PET. Your physician is responsible for obtaining the authorization. If the AIS is denied, the radiology group will provide an alternate method of treatment. If your physician feels strongly that you need the AIS, have your physician call and request a peer-to-peer review. If your physician feels strongly that you need the AIS, have your physician call and request a peer-to-peer review. The number your physician should call is Disease Management! Once you are identified as having a chronic condition, you are automatically enrolled into the Disease Management Program. You will receive an introduction letter and a follow-up telephone call from a registered nurse. For more information on the Disease Management Program, call Pricing Tool! Use the Health cost estimator to look up a treatment or procedure in your area. 7

10 MEDICAL 7. Preventive Care! Wellness services are covered at 100% In-Network. Mammograms are covered at 100% whether routine or diagnostic, In-Network or Out-of-Network. A routine colonoscopy is covered at 100% for individuals age 50 and older once every 10 years, In-Network or Out-of-Network. 8. Monthly EOBs! Don t pay a provider bill without first matching it to your UMR Explanation of Benefits (EOB). You can view your EOBs online at umr.com. 9. Customer Service! If you have a claim or benefit question, contact UMR at If you are not satisfied with the results after speaking with UMR, please contact your Brown & Brown Insurance Agent, Britney Wojcechowskyj, at , or at bw@bbswfla.com. 10. Fill Generic! When prescribed a new medication, ask your provider for samples. If the new medication works, ask for the Generic. When a prescription is filled with a Brand name medications when a Generic is available, you will pay the Brand copay, plus the difference in cost between the Brand and Generic. If you haven t met your deductible, you will pay the Brand cost and receive credit for the Generic cost toward the deductible. If you cannot take Generic, have your physician write Medically Necessary on your Brand prescription to avoid unnecessary costs. 11. Prescription Savings! Publix provides several medications for free, including antibiotics, Amlodipine, Lisinopril, Montelukast and Metformin. Many Generic medications are available for $4 at Walmart and Winn Dixie. Walgreens has a prescription savings club where members can get a 90-day supply of many Generics for $10. Prescription savings are also available with your AAA membership. For brand names drugs you may find manufacturer assistance at needymeds.org, blinkhealth.com, and goodrx.com. Visit fsastore.com or hsastore.com to learn which over the counter items are eligible for purchase with your FSA or HSA funds; learn which products require a prescription for purchase with FSA or HSA funds. 12. Pharmacy Programs! UMR has programs in place to help control costs. When filling a prescription with UMR for the first time, refer to the Prescription Drug List (PDL) to see if your medication requires prior authorization, has a quantity limitation, requires you try an alternate medication first (steptherapy), or is a specialty pharmacy medicine that is only covered when filled through Optum s Specialty Pharmacy. You can view the PDL online at umr.com. If you have questions regarding your Rx coverage, you can call Optum, the Pharmacy Benefit Manager for UMR, 24/7 at

11 MEDICAL Sample ID Card: Each member will receive a set of 2 ID cards. You may request additional ID cards by logging into umr.com as a registered member. You can also access a digital ID from your mobile phone; simply use your mobile web browser to go to umr.com. 9

12 Get all your answers quick and umr.com Access your health benefits in two clicks You don t have time to dig through paperwork or be left wondering where to go for care when you need it. And your health and financial resources are too valuable for second guesses. At umr.com, there are no hassles and no waiting just the answers you re looking for, anytime, night or day. ions Log in now to: Check your benefits and see what s covered Look up what you owe and how much you ve paid Find a doctor in your network Learn about medical conditions and your treatment options Access tools and trusted resources to help you live a healthier life Want a quick tour? Use the QR code reader on your smart phone to watch a short video. Fictionalized data Note: The images shown reflect available features within our desktop site. These features may or may not be available to all users, depending on your individual and/or company benefits. 10

13 You don t need a Ph.D. to understand your benefits We ve made it easy to find the top things people want to know. Choose Benefits & coverage from mymenu to find out: What health care services are covered? What s the cost difference between an in-network and out-of-network service? What s your deductible, and are you close to reaching it? Is there a copayment for your office visit? If so, how much? Get your answers at a glance on umr.com Fictionalized data Glossary Still confused about what a deductible is? Just click the glossary tile shortcut on the member home page to find common health care terms (including benefit terms) defined in plain, clear language. Did your dog eat your ID card? Fictionalized data No worries. It s easy to get a replacement online. Just click ID card in the mymenu to see a copy of your card. With a couple more clicks you can have a new card mailed to your home. Can t wait for the mailman? Print a temporary copy from our desktop site. Or, use your smart phone to view your ID card or fax a copy to your doctor s office. 11

14 Don t be surprised by unexpected costs Health cost estimator Claim cost summary Find a provider Know the price you ll pay ahead of time Use the Health cost estimator to look up a treatment or procedure in your area. Quickly see what you spent on health care this year Get a breakdown by the types of services, so you can see where all your money went. Make sure you get your in-network discount Do a quick search for participating doctors and facilities near you. Buried in paperwork? A single click lets you track all your claims Saves time - no waiting! Keep up-to-date- 24/7 Clearly organized and easy to sort Get all the details in one place Safe and secure Find out what you owe No lost paperwork Hassle-free access when you need it Fictionalized data Check in at your convenience to see if a claim has been processed and what you might owe. Get more details by selecting the explanation of benefits (EOB) link. This will tell you the type of services provided, the amount billed and the amount paid, if any. You can choose to receive a secure any time you have a new EOB. And if you re not ready to give up paper completely, you can print out copies from our claims center. 12

15 Helpful apps, calculators, videos and health information all in one place Online health information: up-to-date and ad-free Search your health symptoms Understand your treatment options Learn about drug interactions Find first aid information Our top picks for healthy eating and exercise Get the essentials on men s, women s & kids health Watch step-by-step recipe videos Log your exercise and activity Free tools, apps and calculators Calculate your body-mass index (BMI) Download apps to help you stay healthy Track your nutrition and fitness goals First aid Sympton navigator The healthy plate Fitness tools Health education library Healthy U presentations Chronic condit Health apps Start your personalized search in the umr.com Health center Choose Health center from the mymenu and select the tile shortcuts that interest you. You can be confident knowing the information we ve gathered draws upon our clinical expertise and guidelines from trusted health organizations. Logging in is easy Ready to pop in and take our site for a spin? Visit umr.com on your desktop or tablet device. If you already have an account, simply enter your username and password in the upper-right corner. If it s your first time visiting us, click New user? Register here to open an account. Make sure you have your ID card handy and follow the steps to get started United HealthCare Services, Inc. UM0106-CPS 0515 No part of this document may be reproduced without permission. This content is provided for information only and is not to be considered medical advice. All decisions about medical care should be made by the doctor and patient. Always refer to the plan document for specific benefit coverage or call the toll-free member phone number on the back of your health plan ID card. UMR operates in accordance with medical privacy standards established by applicable federal and state laws. The screen shots shown are for illustrative purposes and use fictional data only. 13

16 Getting started with Teladoc Teladoc gives you access 24 hours, 7 days a week to a U.S. board-certified doctor through the convenience of phone, video or mobile app visits. Set up your account today so when you need care now, a Teladoc doctor is just a call or click away. 1 SET UP YOUR ACCOUNT Set up your account by phone (toll-free) web, mobile app or by texting "Get Started" to Online: Go to Teladoc.com and click "set up account". 3 2 Mobile app: Download the app and click "Activate account". Visit teladoc.com/mobile to download the app. Call Teladoc: Teladoc can help you register your account over the phone. PROVIDE MEDICAL HISTORY REQUEST A CONSULT Your medical history provides Teladoc doctors with the information they need to make an accurate diagnosis. Once your account is set up, request a consult anytime you need care. And talk to a doctor by phone, web or mobile app. Talk to a doctor anytime! Teladoc.com Teladoc Teladoc, Inc. All rights reserved. Complete disclaimer at Teladoc.com. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc E-103B

17 DENTAL Locate a Participating Provider: Go to deltadentalins.com/enrollees Under Find a Dentist, select Delta Dental PPO for the High Plan; DeltaCare USA for the Low Plan Enter your search criteria NOTE: If electing coverage in the Low Plan, you must indicate the Office/Facility Number of your designated DeltaCare USA Network physician at the time of enrollment Dr. Raiger is not participating in the DeltaCare USA Network (Low Plan) Costs Per Pay Effective November 1, 2017 Coverage High Plan Delta Dental PPO Low Plan DeltaCare USA Employee $9.55 $0.00 Employee + Spouse $28.60 $1.29 Employee + Child/ren $29.88 $1.32 Employee + Spouse + Child/ren $51.11 $

18 DENTAL High Plan Delta Dental PPO Low Plan* DeltaCare USA You Pay You Pay In-Network or Out-of-Network 1 In-Network Only 2 Preventive Services: Exams, cleanings and x-rays Covered at 100% Covered at 100% Basic Services: Fillings, sealants, root canals $50 Deductible % Silver Fillings: :$8 to $22 Copay White Fillings: $22 to $95 Copay Sealants: $15 Copay Root Canals: $125 to $395 Copay Major Services: Crowns, dentures $50 Deductible % Crown: $185 to $395 Copay Dentures: $365 to $445 Copay Orthodontia Services: for children under age 19 50% $70 to $2,100 Copay Plan Pays Calendar Year Maximum: Preventive, Basic and Major Services (combined) $1,500 per person per calendar year N/A Orthodontic Lifetime Maximum $1,000 per child per lifetime N/A *A sample of the Low Plan benefits is listed. Please refer to the schedule of benefits for a detailed list of covered services and the applicable Copays. 1 The High Plan Out-of-Network services are subject to balance-billing. 2 The Low Plan only provides coverage for services rendered by your designated In-Network Office/Facility. You must indicate the Office/Facility Number of your designated physician at the time of enrollment, and you must visit that designated Office/Facility to receive covered services. If you are not happy with your designated Office/Facility, you may change your designation by calling Delta Dental; if you request your change by the 21st of the month, the change will be effective on the first of the following month. 3 The High Plan Deductible applies once per person per calendar year. A family is capped at $150, so a family of three or more will not pay more than $150 in Deductibles. 16

19 17

20 * 5&'D%&'D)3,+ *,.- 74%)/8/-4 $%&'&(&%&)* +,- *,. /01 *,.- +/2&%* JD/) &+ F D/A4 K.43)&,03 /(,.) 2* 74%)/8/-4 $% &'( )**+ &'(, -,'(./0 * &,*4(2,*)*5+0 %', 6*5+71 8'9*,7-*; &'( 875 *5,' =* D'( )7& 710' *5,'11 *12-231* 6*.*56*5+0C?'5+78+ &'(, 3*5*%2+0 76)2520+,7+', 2% &'( =79* 75& 4(*0+2'50C $/3* 40-,%%240) A2).1& 8').1*+* +=* *5,'11)*5+.,'8* ,*8+*6 3& &'(, 3*5*%2+0 76)2520+,7+',C E* 0(,* +' * 7 6*5+20+ F%,') +=* 120+ '% 8'5+,78+ 6*5+71 % *0G %', 3'+= &'(,0*1% 756 &'(, *12-231* 6*.*56*5+0C $581(6* +=* 57)* '% &'(, -,'(.C 5,6 *,.- 74%)/8/-4 9;= >-,'-/2 6,-?3 D'(, 0*1*8+*6 8'5+,78+ 6*5+20+ H211 +7I* 87,* '% &'(, 6* ,* 5**60C $% &'(,*4(2,* +,*7+)*5+ %,') 7 0.* ; &'(, 8'5+,78+ 6*5+20+ H211 =7561* +=*,*%*,,71 %', &'(C B%+*, &'( =79* *5,'11*6; &'( H211,*8*29* 7 )*)3*,0=2..78I*+ += (6* *5+2%287+2'5 87, ?*,+2%287+* '%?'9*,7-* +=7+ %(11& 6*08,23*0 +=* 3*5*%2+0 '% &'(, 6*5+71.,'-,7)C B10' 2581(6*6 25 +=20.78I*+ 7,* +=* 57)*; 766,* ='5* 5()3*, '% &'(, 8'5+,78+ 6*5+20+C A2).1& =* 6*5+71 %78212+& +' )7I* 75 +=* )75& 0*,928*0 7,* 8'9*,*6 7+ 5' 8'0+; H=21* '+=*,0 =79* 8'.7&)*5+0 F7)'(5+ &'(.7& &'(, 8'5+,78+ 6*5+20+G %', 8*,+725 3*5*%2+0C A** +=* J>*08,2.+2'5 '% E*5*% ?'.7&)*5+0J %', '% &'(, 3*5*%2+0C K1*70* 5'+*L >*5+71 0*,928*0 +=7+ 7,* 5'+.*,%',)*6 3& &'(, 0*1*8+*6 8'5+,78+ 6*5+20+; ', 7,* 5'+ 8'9*,*6 (56*,.,'9202'50 %', *)*,-*58& 87,* 3*1'H; )(0+ 3*.,*7(+=',2M*6 3& (0 +' 3* 8'9*,*6 3& +,- 424-'40B* &'(, &'( 756 &'(, *12-231* 6*.*56*5+0 7,* 8'9*,*6 %', '(+#'%#7,*7 6*5+71 *)*,-*582*0 FNO ', )',* )21*0 %,') &'(, 8'5+,78+ 6*5+20+GC D'(,.,'-,7).7&0 (. +' PQRR %', '(+#'%#7,*7 *)*,-*58& 6*5+71 *S.*50*0.*, *)*,-*58& %', *78= *5,'11**C C* 140)&3) &3 / 74%)/ 740)/% 140)&3) (.) &3 0,),0 )D4 %&3),+ 74%)/8/-4 9;= 140)&3)3E 8/0 F 3)&%% -4B4&A4 )-4/)240) +-,2 )D&3 140)&3)G D'( )(0+,*8*29* +,*7+)*5+ %,') &'(, 0*1*8+*6 8'5+,78+ 6*5+20+C K1*70* 5'+* +=7+ >*1+7 >*5+71 6* ,* 5'+ 5*8*007,21& 6*5+20+0C 7, 2* +/2&%* 242(4-3 -4B4&A4 )-4/)240) +-,2 )D4 3/24 74%)/8/-4 9;= B,0)-/B) 140)&3)G D'( 756 &'(, *12-231* 6*.*56*5+0 )7&,*8*29* 87,* %,') +=* 07)* 8'5+,78+ 6*5+20+; ', 2% &'(.,*%*,; &'( )7& 8'11*8+29*1& 0*1*8+ (. +' 7 )7S2)() '% +=,** 8'5+,78+ 6*5+71 % *0C 8/0 F BD/0'4 2* B,0)-/B) 140)&3)G D'( )7& 8=75-* 8'5+,78+ 6* & 5'+2%&25- (0 *2+=*, 3&.='5* ', 25 H,2+25-; ', 3& '(, H*302+* F6*1+76* C8')GC $% &'( 8'5+78+ (0 3& +=* TQ0+ '% +=* )'5+=; +=* 8=75-* H211 3*8')* *%%*8+29* +=* %2,0+ '% +=* %'11'H25- )'5+=C 8/0 F D/A4 2* )44)D 6D&) )D4 74%)/8/-4 9;= >-,'-/2G US+*,571 31*78= *5*%2+ (56*, &'(,.,'-,7)C A** +=* J>*08,2.+2'5 '% E*5*% ?'.7&)*5+0J I +' &'(, 8'5+,78+ 6* '(+ &'(, '.+2'50C 7,43 2* 74%)/8/-4 9;= >-,'-/2 B,A4- ),,)D#B,%,-41 +&%%&0'3 /01 B-,603G K',8* '+=*, +''+=#8'1',*6 )7+*,2710 7,* 2581(6* *5*%2+ (56*, &'(,.,'-,7)C V=* 8'.7&)*5+ 0='H0 &'( H=7+ &'(, '(+ '%.'8I*+ 8'0+ H211 3*C # 18

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`,267&C Z(,?(0+')*, A*,928*,*.,*0*5+7+29* H*, 3*5*%2+0 4(*0+2'50; 70 H* ,,75-* %78212+& +,750%*,0 756 (,-*5+ 87,*,*%*,,710C L.- 8.3),24- ;4-A&B4-4>-4340)/)&A43 D/A4 6,-?41 &0 140)/% +/B&%&)&43 /01 B/0 /0364- (404+&)3 K.43)&,03M /3 64%% /3 /--/0'4 +/B&%&)* )-/ /01.-'40) B/ /%3E $ 19

22 VISION Locate a Participating Provider: Go to vsp.com Enter your zip code to search the VSP Choice network Costs Per Pay Effective November 1, 2017 Coverage You Pay Employee $1.45 Employee + One $2.90 Employee + Child/ren $2.90 Employee + Spouse + Child/ren $

23 VISION You Pay In-Network 1 Eye Exam every 12 months $10 Copay Materials $25 Copay Frames every 24 months Lenses every 12 months Single, Bifocal, Trifocal, Lenticular Progressives $130 allowance, then 20% off the remaining balance Covered 20-25% Discount Scratch Resistant Coating, Anti-Reflective Coating, Tints, and Photochromics 20-25% Discount Contacts every 12 months in lieu of glasses $130 allowance Contact Lens Fitting & Evaluation 15% discount Capped at $60 Extra $20 toward featured frame brands Mail-in rebate savings for contacts 20% off additional Rx glasses and non-rx sunglasses 15-20% off LASIK No ID cards 1 Reimbursements available for services rendered Out-of-Network. 21

24 HEALTH SAVINGS ACCOUNT Employees who participate in the HDHP 1300 Plan may be eligible to set aside money in a Health Savings Account (HSA). The money you contribute to an HSA is exempt from taxes; you save on FICA and Federal taxes when contributing through payroll, and you spend the money tax-free when you spend it on qualified expenses. Qualified expenses include unreimbursed medical, dental and vision expenses incurred by you and your eligible dependents - even if you don t cover your dependents. An HSA is similar to a Flexible Spending Account (FSA); however, the HSA is a personal bank account, not a plan, so there s no use-it or lose-it rule. The money in your HSA remains in your HSA until you re ready to spend it; there s no time limit. If you change jobs or retire, you take the HSA with you. HSA funds can also be spent on Medicare, Cobra and Long Term Care insurance premiums. The HSA is not an automatic feature of enrolling in the HDHP 1300; it is a separate application that you must make with First Florida Integrity Bank. If you would like to have funds deducted from your paycheck, on a pre-tax basis, and directly deposited into your HSA, you must provide payroll with your HSA account and routing numbers. Similar to other direct deposits you may have set-up through payroll, you can increase, decrease, start or stop your HSA contributions throughout the year. Who is eligible to open and fund an HSA? Anyone who is: covered by a qualified high deductible health plan - HDHP 1300, and not covered under another medical plan that is not an HDHP - including Medicare, Medicaid, TriCare, VA and/or a general purpose Health Care Flexible Spending Account (FSA) What happens if I am currently participating in an FSA; when can I open the HSA? If you are only participating in the Dependent Care FSA, you can open the HSA as of your effective date in the HDHP If you are participating in the Health Care FSA, you cannot open the HSA until the FSA plan year ends and your FSA balance is $0 The Ave Maria University FSA plan year ends 12/31/2017; however, there is a 2.5 month run-out; if you have funds in your FSA on 1/1/2018, you cannot open the HSA until April 1 - the first of the month following the run-out 22

25 HEALTH SAVINGS ACCOUNT How much can I contribute to a HSA? The IRS sets a contribution limit every calendar year. For 2017, the contribution limits are: $3,400 for Individual Coverage - just you on the plan (2018 limit will be $3,450) $6,750 for Family Coverage - you and any number of dependents (2018 limit will be $6,900) If you re age 55 or older, you can contribute up to $1,000 more than the limits listed here. What if I establish a HSA mid-year? Your HSA contributions are generally determined on a monthly basis. If you establish an HSA mid-year, you re allowed to make the full year s contribution, provided you are eligible on December 1 of that year and you remain eligible to make HSA contributions throughout the next calendar year. How do I make contributions to my HSA? You can contribute to your HSA through payroll deductions. Where can I find a list of qualified expenses? Refer to the list found at irs.gov - search Publication 502. When can I start using the funds in my HSA? You can use the funds in your HSA once they are available. If you incur expenses under the qualified HDHP prior to having enough funds in your HSA, you can reimburse yourself months or years later, once you do have the funds available - so long as you were enrolled in the qualified HDHP at the time of service and the HSA was established at the time of service. Can I use my HSA to pay for non-qualified expenses? Money withdrawn from an HSA for non-qualified expenses is taxable and subject to a 20% penalty. Although the 20% penalty goes away at age 65, the non-qualified expenses are always subject to income tax. 23

26 HEALTH SAVINGS ACCOUNT What happens to my HSA if I leave my employer? The HSA is yours to keep. If you continue to meet the eligibility criteria for funding the account, you can continue making contributions to your HSA. If you are no longer eligible to fund the account, you re still eligible to spend the money (tax-free) on qualified expenses. Can I use the money in my HSA to pay for my dependents health care expenses? You can use the money in your HSA to pay for the health care expenses belonging to your eligible spouse and/or dependent children - even if they are not covered as your dependents. Refer to Internal Revenue Code Section 152 to determine if your spouse and/or child is an eligible dependent. Can couples establish a joint HSA and both make contributions, including catch-up contributions? Joint HSAs are not permitted. Each spouse should consider establishing an HSA in his or her own name. This allows you to both make catch-up contributions when you are age 55 or older. For more information on HSAs, visit: irs.gov - search Publication 502 and Publication 969 hsacenter.com - view videos, presentations, and frequently asked questions 24

27 FLEX SPENDING ACCOUNTS You may have the opportunity to pay for out-of-pocket Medical, Dental, Vision, and/or Dependent Care expenses with pre-tax dollars through the Flexible Spending Account (FSA). Note: If you will be funding an HSA, you cannot participate in the Health Care FSA. Plan Year: January 1, 2018 to October 31, **SHORT PLAN YEAR THIS YEAR** Health Care Contribution Limit: $2,600 Dependent Care Contribution Limit: $5,000 A Health Care FSA is used to reimburse out-of-pocket health care expenses incurred by you, your spouse and/or your children; whether you cover them or not. Eligible expenses include deductibles, coinsurance, copays, etc Your Health Care pledge is pre-loaded to a debit card; you have immediate access to the funds and will pay them back throughout the year via payroll deduction. A Dependent Care FSA is used to reimburse work related expenses; while you or your spouse work, look for work or attend school full-time or are physically unable to care for your dependent. Eligible children are under age 13, or a dependent who is physically or mentally not able to care for himself. Eligible expenses include nanny, nursery school, before care/after care, late pick-up fees, day camp, or day care. Your Dependent Care pledge is not pre-loaded to a debit card; you can only access what has been payroll deducted and is in your FSA. Contributions to your FSA come out of your paycheck before any taxes are taken out. This means that you don t pay federal income or FICA taxes on the portion of your paycheck you contribute to your FSA. You should contribute the amount of money you expect to pay out-of-pocket for eligible expenses incurred during the Plan Year: January 1, 2018 to October 31, If you still have money in the account at the end of the Plan Year (on October 31, 2018), you will have a 2.5 month extension period to incur additional eligible expenses. Any money remaining in the account when the extension period ends on January 15, 2019 is forfeited; this is the use-it or lose-it rule. Do your homework and consider known expenses. Make an informed decision when you elect your pledge for the year. FSA elections can only be changed during Open Enrollment or due to a Qualifying Event. 25

28 HSA VS. FSA Health Savings Account HSA Flexible Spending Account FSA Plan Requirements HDHP N/A Other Requirements Cannot be enrolled in any other health insurance - including an FSA N/A Account Owner You Employer Qualified Expenses Unreimbursed Medical, Dental and Vision As well as some insurance premiums: Medicare, Long Term Care and Cobra Unreimbursed Medical, Dental and Vision OTC Medicines Only with a Prescription Only with a Prescription 2017/2018 Annual Contribution Limits 2017: $3,400 Individual $6,750 Family Plus $1,000 Catch-Up at age : $3,450 Individual $6,900 Family Plus $1,000 Catch-Up at age 55 $2,600 Access to Funds Available balance only Up front availability Ability to Use Funds for Non-Qualified Expenses Ability to Change Pledge Yes, but taxable and subject to a 20% penalty (no penalty after age 65) Same as All Direct Deposit Banking No Open Enrollment only, or due to a qualified event Rollover of Funds Yes No Recordkeeping Eligible Dependents Retain receipts in case of IRS audit Legal Spouse and Dependent Children (IRC Section 152) Submit receipts when requested by Plan Administrator Legal Spouse and Dependent Children (IRC Section 152) 26

29 BASIC LIFE INSURANCE Ave Maria University provides employees with group life and accidental death and dismemberment (AD&D) coverage. The benefit is one times your annual salary to a maximum of $500,000. Benefit amounts in excess of $400,000 are subject to Evidence of Insurability (EOI). Your benefit amount will reduce to 65% at age 70, and to 50% at age 75. If you leave the company, you may be eligible to convert this benefit to an individual policy and take it with you. You have 30 days, following your termination date, to contact Mutual of Omaha regarding your conversion rights. 27

30 VOLUNTARY TERM LIFE You may purchase additional life insurance. As long as you elect coverage, you can also elect coverage for your legal spouse and/or dependent children. Rates are based on your age. You do not lock in your rate at your purchase age; as you get older, and enter a new age bracket, your premiums increase. Employee Minimum: $10,000 Employee Maximum: $500,000 - not to exceed 5 times your salary Employee Guarantee Issue: $150,000 - not to exceed 5 times your salary The Guarantee-Issue benefit is only available for new hires. Your benefit amount will reduce to 65% at age 70, and to 50% at age 75. For a cost of $1.11 per pay, you can elect a $10,000 benefit for your spouse and a $5,000 benefit for each of your children. Guarantee Issue amounts are only available during your initial eligibility. If you are a new hire and are applying for a benefit in excess of the Guarantee Issue amount, the additional amount will be subject to approval. You must provide Evidence of Insurability (EOI). If the additional amount is denied, you are still eligible to receive the Guarantee Issue amount. Once approved, the additional benefit takes effect on the first of the following month. If you apply for coverage outside of your initial eligibility, or if you increase your benefit at a later date, your application will be subject to approval of your EOI. Once approved, coverage takes effect on the first of the following month. When determining the amount of coverage you need, consider your personal circumstances: Do you have a medical condition that may cause you to be uninsurable if it wasn t for the Guarantee Issue benefit? Is your income the sole income in your household? Are there other expenses, such as college tuition, that may arise in the future? Don t forget to include potential medical and funeral costs. Above everything, you want to be sure your family does not get stuck with bills, 28

31 VOLUNTARY TERM LIFE 29

32 SHORT TERM DISABILITY Benefits Begin Benefits Payable Maximum Benefit Benefit Duration On the 1st day for an off-the-job injury; on the 8th day for an illness 66.67% of weekly earnings $750 per week 26 weeks Ave Maria University provides this benefit to all eligible employees, at no cost to the employee. LONG TERM DISABILITY Benefits Begin Benefits Payable Maximum Benefit After 180 days for an off-the-job injury or an illness 60% of monthly income $10,000 per month Benefit Duration Social Security Normal Retirement Age Ave Maria University provides this benefit to all eligible employees, at no cost to the employee. The disability benefits will be taxable. A Certification of Health Care Provider Form, completed by you and your provider, must be returned to HR prior to your disability leave. A release to work note from your physician is required before you can return to work. 30

33 ALLSTATE BENEFITS Initial Hospital Confinement $2,000 Accident Hospital Confinement ICU Confinement Dislocations & Fractures Medical Expenses Ambulance Follow-up Accident Treatment Common Carrier Accidental Death Accidental Death Accidental Dismemberment Outpatient Physician s Treatment - any type of office visit $800 per day - 90 days max $1,600 per day - 90 days max Up to $8,000 EE / $4,000 SP / $2,000 CH Up to $600 per accident per calendar year $800 Ground / $2,400 Air $200 per visit - 2 visit max per incident $500,000 EE / $250,000 SP / $125,000 CH $100,000 EE / $50,000 SP / $25,000 CH Up to $200,000 EE / $100,000 SP / $50,000 CH $50 per visit: 2 visit max per individual / 4 visit max per family - per calendar year Coverage Costs Per Pay Employee $6.70 Employee + Spouse $12.42 Employee + Child/ren $11.36 Employee + Spouse + Child/ren $

34 ALLSTATE BENEFITS Critical Illness The benefit is $10,000. If diagnosed with a covered condition, you are eligible for the benefit. Benefits are payable for each covered condition as long as the diagnosis is separated by 90 days. If you cover your spouse and/or child/ren, they are eligible for half of your benefit amount: $5,000. There s no additional cost to cover your child/ren. Each covered person is eligible to receive a $50 wellness benefit, every calendar year, when one of 23 specific preventive services is performed. A second event benefit is payable, once per condition, if the second event is more than 12 months after the first diagnosis. Covered Conditions Benefit Percentage Advanced Alzheimer s Disease, Advanced Parkinson s Disease, Coronary Artery By-Pass Surgery, Carcinoma in Situ 1 25% Invasive Cancer 1, Heart Attack, Benign Brain Tumor, Coma, Complete Blindness, Complete Loss of Hearing, Paralysis, Stroke, Major Organ Transplant, End Stage Renal Failure 100% 1 The Cancer Critical Illness benefits are payable for a diagnosis of a new or a recurrence of cancer, as long as you are diagnosed after the effective date of coverage, and have been free of any symptoms and treatment of cancer for 12 consecutive months immediately preceding the effective date of coverage, or any 12 consecutive months. Rates are based on age and tobacco use. Rates are locked in at your purchase age. See next page for rate table. Guarantee-issue benefits are only available during your initial eligibility. If you apply for coverage outside of your initial eligibility, you will need to provide Evidence of Insurability (EOI). 32

35 ALLSTATE BENEFITS Critical Illness Issue Age Non-Tobacco Costs per Pay Tobacco Costs per Pay EE & EE/CH EE/SP & ESC EE & EE/CH EE/SP & ESC $2.16 $3.14 $2.90 $ $2.24 $3.30 $2.98 $ $2.82 $4.18 $3.86 $ $3.70 $5.52 $5.52 $ $4.88 $7.32 $7.50 $ $6.82 $10.22 $10.88 $ $9.38 $13.98 $14.70 $ $12.42 $18.56 $20.26 $ $16.60 $24.74 $24.42 $ $24.86 $37.12 $35.94 $54.00 EE = Employee, EE/CH = Employee + Child/ren EE/SP = Employee + Spouse, ESC = Employee + Spouse + Child/ren Rates are locked in at your purchase age. 33

36 ALLSTATE BENEFITS Group Indemnity Medical Low Policy Initial Hospital Confinement Daily Hospital Confinement Daily ICU Confinement Benefits $1,100 - once per person per year $100 - limited to 10 days per year $100 - limited to 10 days per year High Policy Initial Hospital Confinement Daily Hospital Confinement Daily ICU Confinement Benefits $2,200 - once per person per year $200 - limited to 10 days per year $200 - limited to 10 days per year No pre-existing condition limitations. No underwriting required. Coverage Low Policy Costs per Pay High Policy Costs per Pay Employee Only $7.68 $15.36 Employee +Spouse $21.42 $42.84 Employee +Child/ren $13.26 $26.52 Employee + Spouse + Child/ren $22.98 $

37 Eligibility & Enrollment Who is Eligible? Regular full time employees, working 30 hours or more per week are eligible for the medical, dental, vision, life, HSA, FSA, Teladoc and Allstate Benefits; disability benefits are provided to employees working 35 hours or more per week. Benefits take effect on the first of the month following your hire date. Your spouse and children are eligible to be covered as your dependents. Children are eligible for coverage through the end of the year in which they turn age 26 for Medical and Vision, and through their 26th birthday for dental. How and When to Enroll You must elect or waive all eligible plans via paper form no later than Friday, October 6th, The coverage you elect during Open Enrollment will take effect November 1, 2017, and will remain in effect through October 31, unless you experience a qualifying event. *FSA elections take effect January 1, 2018, and will remain in effect through October 31, unless you experience a qualifying event. Waiving Coverage If you furnish evidence of other coverage, you are eligible to receive $15 per pay period for Medical and $2.50 per pay period for Dental. Qualifying Events You cannot make changes to the benefits you elect during your initial eligibility or open enrollment until the next open enrollment period - unless you experience a qualifying event. You must request a change due to a qualifying event within 30 days of the event. Qualifying events include getting married, divorced, having a baby, losing insurance, as well as gaining insurance. If you think you re experiencing a qualifying event, contact HR immediately to request your change before it s too late. 35

38 The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by Brown & Brown. The text contained in this Guide was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between the Guide and the actual plan documents the actual plan documents will prevail. All information is confidential, pursuant to the Health Insurance Portability and Accountability Act of If you have any questions about your Guide, contact the Benefits Department. Notes:

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40 Commercial * Employee benefits * Personal Insurance bbswfla.com