Employee Benefits Guide

Transcription

1 Employee Benefits Guide Plans effective January 1, 2016 Full-Time Public Safety Employees

2 Welcome to Montgomery County Community College! Montgomery County Community College (the College) strives to offer you and your dependents a competitive and comprehensive benefits package. We encourage you to take the time to review the benefits available to you, presented in this Guide, and choose the ones that best suit your needs. Once you have made your elections, you will not be able to change them until the next Open Enrollment period, unless you experience a qualified change in status. If you have any questions please contact Brett Schorle in Human Resources. Who is eligible to elect benefits? Full-time public safety employees, are eligible to enroll in the benefits described in this Guide, on the first of the month, following three (3) months of continuous employment counting the month in which the employee is hired (or is otherwise eligible) as a full month of service, unless the effective date of benefits would exceed 90 days, in which case benefits will start on the 90th day. Please remember that only eligible dependents can be enrolled. Eligible dependents include all of the following: Spouse Unmarried dependent child(ren) who meet age requirements of the plan How often can I change plan elections? Unless you experience a qualified change in status, you cannot make changes to the benefits you elect until the next Open Enrollment period. Qualified status changes include: marriage, divorce, birth or adoption of a child, change in child s dependent status, death of spouse, child or other qualified dependent, or change in your spouse s or domestic partner s benefits or employment status. If you are enrolling a dependent(s) for the first time, you will need to provide proof of your dependents eligibility (e.g. birth certificate, marriage certificate, proof of full-time student status, etc.). You must notify Human Resources within 30 days of experiencing a qualified change in status. 1 1

3 Medical Plans: Independence Blue Cross Below is a summary of the medical plans effective January 1, provider, please visit To find a participating Keystone Health Plan Personal Choice 10/20/70 PPO Plan East HMO Services In-Network Out-of-Network In-Network Deductible Single Family Out-of-Pocket Max Single Family $500 $1,000 $1,000* $2,000* $1,000 $2,000 $2,000 $4,000 $500 $1,000 $650/person* Up to a max of $1950* Primary Care Physician (PCP) Office Visit $10 copay Plan pays 70% $5 copay Specialist Office Visit $20 copay Plan pays 70% $5 copay Preventive Care NO deductible Plan pays 70% NO deductible NO deductible Outpatient Laboratory Plan pays 70% Outpatient Radiology $20 copay Plan pays 70% Inpatient Hospital $75 copay per day Maximum 5 copays per admission Plan pays 70% Outpatient Surgery $75 copay Plan pays 70% Emergency Room $40 copay waived if admitted $35 copay waived if admitted Durable Medical Equipment $20 copay Plan pays 70% after deductible Vision N/A $5 copay every 24 months 2 *Includes copays, deductible and coinsurance. 2

4 Prescription Drug Plan: Express Scripts Below are the prescription drug benefits for the 2016 Plan Year. If you elect to participate in either medical plan, you are automatically enrolled in the prescription drug plan. You will receive a separate ID card for the prescription drug plan. Retail (up to a 30-day supply) Generic Preferred Brand Non-preferred Brand Mail Order (up to a 90-day supply) Generic Preferred Brand Non-preferred Brand In-Network Prescription Drug Plan Out-of-Network (Personal Choice Plan ONLY) $10 copay $20 copay $30 copay Plan pays 50% of retail cost $20 copay $40 copay $60 copay Why should I use mail order instead of the retail pharmacy? Using the mail order program for your maintenance medications will save you money. You will receive a 90-day (3-month) supply for the equivalent of two (2) retail copays. In addition to the savings, your prescriptions will be delivered right to your home. To begin using mail order, simply complete a mail order form and send along with your prescription(s) written for a 90-day supply of medication. Forms can be obtained online at 3 3

5 Dental Plan: Delta Dental The Delta Dental of PA plan is available to College employees at no cost the College pays 100% of the premium. Your dependent child(ren) are covered for dental until the end of the month in which they turn 26. Proof of full-time student status is not required. Below is a summary of the dental plan effective January 1, You can visit any dentist you wish. However, if you visit a dentist from Delta Dental s Premier preferred provider network, you can reduce your out-of-pocket expenses. To find an in-network provider, please visit If you utilize an out-of-network provider, you may be subject to balance billing the provider can bill you for the difference in what they charge and what Delta Dental pays for the service. In-Network Dental Plan Out-of-Network Annual Maximum (per patient) $1,500 $1,500 Orthodontia Benefits (child age 19 and under) Preventive Care Visits, X-rays and Teeth cleaning Plan pays 50% up to a lifetime maximum amount of $1,500 Plan pays 50% of UCR* charges up to a lifetime maximum amount of $1,500 of UCR* charges Basic Care (excluding periodontal services) Inlays & Crowns, Oral exams, Full mouth X-rays, Fluoride treatments, Lab work & tests, Fillings, Oral surgery, Endodontics & General Anesthesia, Vizilite Basic Care Periodontics Plan pays 80% of UCR* charges Plan pays 80% of UCR* charges Major Care Pontics (artificial teeth), Removable bridge, Denture, Repair to crown & bridges Plan pays 50% Plan pays 50% of UCR* charges *UCR refers to the usual, customary and reasonable charges for the service as per Delta Dental s guidelines. 4

6 Vision Plans: Davis Vision/Superior Vision Davis Vision The Keystone HMO Plan has a $100 vision rider included in the medical plan at no cost to you. This allows reimbursement to a member for covered eyewear purchases up to $100 every 24 months. Find a participating provider at Superior Vision Employees enrolled in the Personal Choice PPO Plan are offered a different vision plan through Superior Vision. The premium is 100% paid by the employee. Please refer to the chart below for a list of benefits. Your dependent child(ren) are covered for vision until the end of the year in which they turn 26. Proof of full-time student status is not required. To find a participating provider, visit Superior Vision Plan Gold Preferred Plan (Must be enrolled in the Personal Choice medical plan to elect) In-Network Benefits Out-of-Network Reimbursements Comprehensive Eye Exam By an Ophthalmologist By an Optometrist $10 copay $10 copay Up to $52 Up to $44 Frames Up to $100 Up to $54 Lenses Single Vision Bifocal Trifocal Lenticular Contact Lenses Medically Necessary Cosmetic (Elective) Standard Contact Lens Fitting Exam Fee Specialty Contact Lens Fitting Exam Fee $25 copay $25 copay $25 copay $25 copay Covered in full Up to $100 $25 copay $25 copay Up to $40 Up to $56 Up to $72 Up to $100 Up to $210 Up to $100 Not covered Not covered Frequency Comprehensive Exam Lenses Frames Contact Lenses Once every 12 months Once every 12 months Once every 24 months Once every 12 months 5

7 Sick Leave and Disability Insurance Sick Leave For the first thirty (30) calendar days of an illness, an employee shall be paid to the extent of his/her accumulated sick leave. Additional time off is charged against accumulated vacation or personal leave. An employee who has not exhausted his/her sick leave during the first thirty (30) calendar days shall have the option of collecting his/her full pay up to the end of his/her accumulated sick leave, but not to exceed one hundred and eighty (180) calendar days. If the employee does not have thirty (30) days of earned leave, then he/she must go on an unpaid leave. Short-Term Disability Short-term disability (STD) is a period of extended sick leave during which the employee is eligible to be paid. Upon presentation of acceptable medical certification, the STD plan is available to College employees after one year of service. The STD period begins when the illness continues more than 30 consecutive days from the date of the original illness or medical certification until the start of the long-term disability (LTD) benefits. Benefit Percent Short-Term Disability (STD) Plan 66% of weekly earnings Elimination Period 30 days Extended Sick Leave After thirty (30) calendar days, an eligible employee shall receive 66% of his/her pay until the employee is no longer disabled or they have met the 180-day elimination period under the College s Long-Term Disability coverage. Long-Term Disability: Reliance Standard All active, full-time public safety employees are eligible for the Long-Term Disability (LTD) Plan on the first day following 365 days of service. The College pays 100% of the LTD premium. Long-Term Disability (LTD) Plan Elimination Period Benefit Amount 180 consecutive days of total disability 60% of your monthly earnings but not more than the maximum monthly amount of $7,500 6

8 Vacation & Personal Leave and Basic Life and AD&D Vacation & Personal Leave Full-time public safety employees shall be entitled to three (3) days of personal/emergency leave with pay, per fiscal year. Maximum Accumulation allowed on October 1. Vacation Schedule Monthly Rate of Accumulation Maximum Accumulation Allowed During the first 5 years (60 months) of regular employment 1 work day 28 work days Beginning of 6 th year & including the 10 th year (61 to 120 months) From the beginning of the 11 th year to and including the 15 th year (121 to 180 months) From the beginning of the 16 th year (181 months) 1 ¼ work days 28 work days 1 ½ work days 28 work days 1 ¾ work days 35 work days Basic Life and AD&D: Reliance Standard All active, full-time public safety employees are eligible for the Basic Life and Accidental Death and Dismemberment (AD&D). This plan is available to College employees, at no cost the College pays 100% of the Basic Life and AD&D premium. Benefit Amount Basic Term Life and AD&D Plan 2 times your salary up to a maximum of $600,000 7

9 Healthcare & Dependent Care Flexible Spending Accounts (FSAs) The College provides you with the opportunity to pay for out-of-pocket medical, dental, vision and dependent care expenses with pre-tax dollars through the Flexible Spending Account administered by Benefit Express. You can save approximately 25% of each dollar spent on these expenses when you participate in an 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 tax, Social Security taxes and state and local income taxes on the portion of your paycheck you contribute to your FSA. The Flexible Spending Account plan year runs from January 1 st through December 31 st. You should contribute the amount of money you expect to pay out-of-pocket for eligible expenses for the plan period. However, the plan allows for up to $500 of unused balances in the Healthcare FSA to be rolled over for qualified medical expenses incurred during the following plan year. As per IRS regulations, you must choose to participate in an FSA every year this election will never carry over. You can choose to participate in either or both FSAs as described below: A Healthcare Flexible Spending Account is used to reimburse out-of-pocket medical expenses incurred by you and your dependents. The maximum that you can contribute to the Healthcare FSA is $2,550, in accordance with the new IRS regulations. Eligible expenses include, but are not limited to, amounts paid to satisfy a deductible, copays, coinsurance and out-of-pocket dental, vision and hearing expenses. Over-the-counter medications are not eligible for FSA reimbursement unlessyou have a prescription from a doctor. A Dependent Care Flexible Spending Account is used to reimburse expenses related to care of eligible dependents while you and your spouse work. The maximum that you can contribute to the Dependent Care FSA is $5,000 if you are a single employee or married filing jointly, or $2,500 if you are married and filing separately. For more information on FSAs, contact Benefit Express at or visit You can also contact Brett Schorle in Human Resources. 8

10 Per Pay Additional Benefits Tuition Waiver Full-time public safety employees are eligible to participate in the tuition waiver program for courses at Montgomery County Community College. Qualified dependent children (age 25 or younger) and the legally married spouse of a full-time public safety employee are eligible to participate in the tuition waiver for courses at Montgomery County Community College as well. Tuition Reimbursement Eligible to all full-time regular employees of the College who have completed a minimum of six months of continuous satisfactory employment with the College at the time of their application for educational assistance. Courses are required to be taken through an accredited educational institution. The rate per credit is based on Temple s annual credit rate for each new academic year. Expenses for tuition, fees and books are eligible for reimbursement as per noted in the procedures. The program is administered by the Human Resources Department. Retirement Plan TIAA/CREF 403(b) retirement plan is offered by the College. Employees contribute 5% of their annual salary and the College contributes 11% into the plan. If you are a current member of PSERS or SERS, you may elect to continue that retirement plan. If you are not a current member, these plans are not available. Participation in a retirement plan is mandatory. 9

11 Per Pay Employee Contributions The contributions below will be deducted each pay period effective January 1, Tiers Personal Choice 10/20/70 PPO Plan / Express Scripts Rx Employee Contributions <=$40,000 > $40,000 - $60,000 > $60,000 - $80,000 > $80,000 - $100,000 > $100,000 Single $7.88 $15.75 $23.63 $31.50 $39.39 Parent/Child $15.07 $30.13 $45.05 $56.22 $67.39 Parent/Children $16.59 $33.17 $48.40 $60.69 $ Adults $19.08 $38.16 $52.97 $66.78 $80.59 Family $21.66 $41.39 $56.32 $71.25 $86.19 Tiers Superior Vision Plan Employee Contributions Single $2.68 Parent/Child $6.72 Parent/Children $ Adults $6.72 Family $6.72 Tiers Keystone Health Plan East HMO / Express Scripts Rx Employee Contributions <=$40,000 > $40,000 - $60,000 > $60,000 - $80,000 > $80,000 - $100,000 > $100,000 Single $7.56 $15.11 $22.67 $30.22 $37.78 Parent/Child $13.29 $26.57 $39.69 $49.08 $58.47 Parent/Children $13.69 $27.37 $39.69 $49.08 $ Adults $17.38 $34.77 $47.87 $59.99 $72.10 Family $22.18 $42.42 $57.87 $73.32 $

12 Questions & Answers When is the completion date for all enrollments? All enrollments and/or waivers must be completed within 30 days of becoming eligible. Please return your completed forms to Brett Schorle in Human Resources. Whom should I contact with questions? Contact Brett Schorle in Human Resources. At what age does a Dependent Child become no longer eligible for coverage under my plan? Medical plans: coverage for the dependent(s) will terminate at the end of the month they turn age 26. No proof of full-time status will be required. Dental plan: coverage will terminate at the end of the month they turn age 26. No proof of full-time status will be required. Vision plan: coverage for dependent child(ren) will terminate at the end of the year in which they turn age 26. No proof of full-time status will be required. I need to change my beneficiaries. What do I do? Beneficiary information may be updated at any time of the year. You can change your beneficiaries for Life and Disability by contacting your Human Resources Department for the appropriate forms. To change your beneficiary information with TIAA-CREF, contact them directly at or 11

13 Questions & Answers (continued) Will I receive a separate Prescription Card? Yes, you will receive a separate prescription ID card from our carrier, Express Scripts. Please present this card to the pharmacy when presenting your prescription to be filled. For a card or assistance, call If I sign up for the Keystone HMO plan with vision will I receive a separate Vision Card? No, the Keystone HMO card that you receive for your medical benefits also includes your vision benefits. Please present this card at the time of service. How do I check the balance remaining in my Flexible Spending Account? You can check your balances by calling or log on to What is the deadline for incurring or submitting Flexible Spending Account claims? The Flexible Spending Account plan year runs from January 1 st through December 31 st. You have until April 15 th, 2017 to file for reimbursement for claims incurred from January 1 st, 2016 through December 31 st, Additionally, the plan allows for up to $500 of unused balances in the Healthcare FSA to be rolled over for qualified medical expenses incurred during the following plan year. Montgomery County Community College reserves the right to modify, amend, suspend or terminate any plan, in whole or in part, at any time. The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by the employer. 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. 12

14 Legal Notices HIPAA/CHIP Special Enrollment Notice Loss of other Coverage (excluding Medicaid or a State Children s Health Insurance Program). If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, 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 Company 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). Loss of coverage for Medicaid or a State Children s Health Insurance Program. If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children s health insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after your or your dependents coverage ends under Medicaid or a state children s health insurance program (CHIP). New dependent by marriage, birth, adoption, or placement for adoption. 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 new dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. If you request a change due to a special enrollment event within the applicable timeframe, coverage will be effective the date of birth, adoption or placement for adoption. For all other events, coverage will be effective the first of the month following your request for enrollment. Eligibility for Medicaid or a State Children s Health Insurance Program. If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a state children s health insurance program (CHIP) with respect to coverage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60 days after your or your dependents determination of eligibility for such assistance. To request special enrollment or obtain more information, contact Brett Schorle in Human Resources. 13

15 Newborns and Mothers Notice Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Women's Health and Cancer Rights Act 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 benefits. If you have any questions, please speak with Human Resources. Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for these programs, but also have access to health insurance through their employer. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs. If you aren t eligible for these programs, you may be able to buy individual insurance coverage through the Health Insurance Marketplace. Visit If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, 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 14

16 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, as well as eligible under your employer plan, your employer must permit you to enroll in your employer plan if you are not already enrolled. This is called a special enrollment opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, you can contact the Department of Labor electronically at or by calling toll-free EBSA (3272). 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 July 31, You should contact your State for further information on eligibility ALABAMA Medicaid Website: Phone: ALASKA Medicaid Website: Phone (Outside of Anchorage): Phone (Anchorage): FLORIDA Medicaid Website: Phone: GEORGIA Medicaid Website: Click on Programs, then Medicaid, thenhealth Insurance Premium Payment (HIPP) Phone: MONTANA Medicaid Website: clientindex.shtml Phone: COLORADO Medicaid Medicaid Website: Medicaid Customer Contact Center:

17 INDIANA Medicaid Website: Phone: IOWA Medicaid Website: Phone: KANSAS Medicaid Website: Phone: KENTUCKY Medicaid Website: Phone: LOUISIANA Medicaid Website: Phone: MAINE Medicaid Website: Phone: TTY MASSACHUSETTS Medicaid and CHIP Website: Phone: MINNESOTA Medicaid Website: Clickon Health Care, then MedicalAssistance Phone: MISSOURI Medicaid Website: Phone: NEBRASKA Medicaid Website: Phone: NEVADA Medicaid Medicaid Website: Medicaid Phone: NEW HAMPSHIRE Medicaid Website: Phone: NEW JERSEY Medicaid and CHIP Medicaid Website: dmahs/clients/medicaid/ Medicaid Phone: CHIP Website: CHIP Phone: NEW YORK Medicaid Website: Phone: NORTH CAROLINA Medicaid Website: Phone: NORTH DAKOTA Medicaid Website: Phone:

18 OKLAHOMA Medicaid and CHIP Website: Phone: OREGON Medicaid and CHIP Website: Phone: PENNSYLVANIA Medicaid Website: Phone: RHODE ISLAND Medicaid Website: Phone: SOUTH CAROLINA Medicaid Website: Phone: SOUTH DAKOTA - Medicaid Website: Phone: TEXAS Medicaid Website: Phone: UTAH Medicaid and CHIP Website: Phone: VERMONT Medicaid Website: Phone: VIRGINIA Medicaid and CHIP Medicaid Website: HIPP.htm Medicaid Phone: CHIP Website: CHIP Phone: WASHINGTON Medicaid Website: Phone: ext WEST VIRGINIA Medicaid Website: Phone: , HMS Third Party Liability WISCONSIN Medicaid Website: htm Phone: WYOMING Medicaid Website: Phone: To see if any more States have added a premium assistance program since July 31, 2015, 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