BENEFITS GUIDE

Transcription

1 1 BENEFITS GUIDE 2018

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3 To Our Valued Faculty & Staff, There is no doubt that healthcare costs are on the rise. Western New England University is dedicated to making sure that the plans available to you offer the best benefits possible while keeping costs reasonable. Open enrollment provides you and your eligible dependents with the opportunity to review the benefit package being offered to you and allows you to make clear and informed decisions about your plan. Navigating the choices available can be difficult this guide will help you to choose the plan design that makes the most sense for you. We offer the following employee benefits: Medical & Prescription Drug Insurance Voluntary Dental Insurance University Paid Life and AD&D Insurance University Paid Short Term Disability Insurance University Paid Long Term Disability Insurance Voluntary Individual Supplemental Insurance Flexible Spending Accounts, Dependent Care Accounts, Health Reimbursement Arrangements

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5 Table of Contents What s Offered...1 Eligibility...2 Qualifying Events...3 COBRA & Wellness...4 Health Services...5 Making the Most of Your Benefits.6 Flexible Spending Accounts/Dependent Care Accounts.8 Medical Benefits...9 Dental Benefits...10 Other Benefits...11 Employee Contributions...12 This document is intended to provide a brief summary of your benefit plans. For a complete description of plan features including eligibility and termination provisions, definitions, limitations and exclusions, please refer to your insurance booklet/certificate and Summary Plan Description. Western New England University reserves the right to change plan provisions in whole or in part as it deems necessary. This symbol will appear in messages throughout this guide. It designates bright ideas or key concepts that you should be aware of to make the most out of your benefit plan. Keep an eye out for them!

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7 WHAT S OFFERED? Please refer to the chart below for a summary of the employee benefit plans that are offered. Medical and Rx Coverage Blue Cross Blue Shield of MA Flexible Spending Accounts/ Health Care Reimbursement Accounts, Dependent Care Accounts, and Health Reimbursement Arrangement Health Equity Dental Coverage Blue Cross Blue Shield of MA WHAT S OFFERED? Blue NE HMO $3,000 Blue Care Elect PPO $3,000 We will continue to offer an FSA/Health Care Reimbursement Account, DRCA and HRA. The HRA is funded by the University; anyone who is enrolled into the medical plan automatically is enrolled into the HRA. The HRA pays the providers directly for the second portion of the deductible according to the income-based schedule. Dental Blue Program 2 FORMS TO FILL OUT You will need to complete a BCBS of MA enrollment/change form only if you are enrolling for the first time, terminating coverage, or making changes. You will need to complete the 2018 Benefit Election Guide to confirm your 2018 benefits for the new plan year. Please return to HR by 11/30/17 You will need to complete a BCBS of MA enrollment/change form only if you are enrolling for the first time, terminating coverage, or making changes. Basic Life, AD&D, and Long Term Disability Coverage Cigna Short Term Disability University Funded Life, AD& D. Long Term Disability Short Term Disability No forms are required, unless you would like to update your beneficiary. Please reach out to the Human Resource Department for any forms needed to file a claim. Please reach out to the Human Resource Department for any forms needed to file a claim. Voluntary Individual Supplemental Insurance Colonial Life Supplemental Voluntary Benefits Critical Illness / Hospital Confinement / Life Insurance Please reach out to the Human Resource Department to schedule a meeting with Colonial if you would like to enroll for the first time. 1

8 Benefits Website: Don t forget about the university s internet website that houses information regarding our Medical, Dental, Life, Long Term Disability, Short Term Disability and 403b retirement plans. You can find enrollment forms, plan summaries, claim forms, contact information and direct links to carrier s websites at the web address below: How the Health Reimbursement Arrangement (HRA) Works: Health Reimbursement Arrangement (integrated with the Health Plan administered by Health Equity) Based upon Employee s Annual Salary as of 1/1/2018 Salary Salary Salary $30,000 or Less $30,001 to $40,000 $40,001 or Greater Employee pays first $500 of Deductible expenses, then: WNE funded HRA pays from $501 up to the full $3,000 Deductible Employee pays first $750 of Deductible expenses, then: WNE funded HRA pays from $751 up to the full $3,000 Deductible Employee pays first $1,000 of Deductible expenses, then: WNE funded HRA pays from $1,001 up to the full $3,000 Deductible 2

9 ELIGIBILITY & ENROLLMENT PROVISIONS Employees who meet the plan s eligibility requirements may be eligible for coverage under our benefit plans. Each plan s requirements are summarized below: WHO MAY PARTICIPATE WHEN YOU BECOME ELIGIBLE WHEN COVERAGE ENDS Medical and Prescription Benefits Full Time employees (employees regularly scheduled to work 30 hours a week) your spouse, domestic partner, and your eligible dependent children. Part Time employees (regularly scheduled to work at least 17 hours per week) must pay full premium. You are eligible on the first day of employment. On the day your employment terminates. Dependents are eligible until age 26 regardless of student status, which state they live in or if they are married. Coverage will end of the month in which they turn 26. Dental Benefits Full Time and Part Time employees (employees regularly scheduled to work at least 17 hours per week) your spouse, your domestic partner, and your eligible dependent children - must pay full premium. You are eligible on the first day of employment. On the day your employment terminates. Dependents covered until age 26 regardless of financial, student or employment status. Basic Life/AD&D, Short Term Disability, Long Term Disability Full Time employees (employees regularly scheduled to work 35 hours a week) For the Short and Long Term Disability, you are eligible after a consecutive 6 months of employment. For the Life Insurance, you are eligible on the first of the month after you complete 3 months of continuous employment. On the day your employment terminates. 3

10 QUALIFYING EVENTS HIPAA Special Enrollment and Section 125 Rules Generally, the coverage you elect for yourself and your dependents may only be changed during the next annual enrollment period, unless you experience a qualifying event as defined under HIPAA (the Health Insurance Portability & Accountability Act of 1996) and the Internal Revenue Code 125. These are defined below: Employees and/or dependents may enroll in your Plan as a Special Enrollee under the following circumstances: Marital Status Change Marriage Divorce or legal separation Number of Dependents Change Birth or adoption Death of dependent child or spouse Newly eligible dependents due to plan design change Judgment or decree requiring coverage Loss of Coverage If the employee loses other coverage (e.g. spouse s health plan coverage terminates, or Medicare/Medicaid eligibility ends) Enrollment in an Exchange - IRS NOTICE On September 18, 2014 the IRS expanded the situations in which individuals can change their health coverage elections under a Section 125 Cafeteria Pan. There are two specific situations in which an individual may revoke their election under his or her employer s plan in order to purchase coverage through an Exchange IF: The employee s hours of service are reduced so that the employee is expected to average less than 30 hours of service per week, but the reduction does not affect eligibility for coverage under the employer s group health plan and the employee intends to enroll in another plan that provides minimum essential coverage; or The employee would like to cease coverage under the employer s group health plan and is eligible for special enrollment in an Exchange plan or the employee wants to enroll in an Exchange plan during the Exchange s annual open enrollment period and the employee intends to purchase coverage through an Exchange, without having a period of either duplicate coverage or no coverage. This does not apply to health FSA plans. An election to revoke coverage on a retroactive basis is not allowed. If you wish to request a change in your coverage due to a qualifying event, while actively at work, you must submit a written request within thirty (30) days of the date of the event. 4

11 COBRA If you or your covered dependents lose health coverage under our group plan, you may be eligible for continuation coverage under Federal and/or State COBRA regulations. In certain circumstances death of a dependent, divorce, or a dependent child ceasing to be eligible for coverage it is your responsibility to notify the Human Resources Department of the qualifying event within sixty (60) days. You are also responsible to keep the Human Resources Department informed of changes in your address, as well as address changes for your dependent(s), if different from your own. If you want more information about your rights and responsibilities under COBRA, please contact Human Resources. WorkWell Western New England Employee Program WorkWell, which began in 1995, is a program that has been developed for all university employee encouraging them to take an active part in their own health. There are 2 main components to the program; health education and physical activity. Participation in the program is voluntary. Incentives are available to people who participate in the physical activity for 4 months consecutively. Release time from work is provided to attend educational programs and for exercise time. The following is an outline of how the exercise/physical activity component works: 1. Go to Health Services and sign up; during the specified period. 2. If you complete the 4 months exercise program you will return to Health Services and provide your signature attesting the completion of the program, be given your incentive and be able to sign up for the next exercise session minutes of release time, up to 3 times per week, may be used for exercise (with supervisor permission) More resources including FAQ s can be found on the Universities website at under WorkWell program. Health Services- On Campus Faculty and staff are able to access Health Services on campus. Health Services is structured much like a doctor s office or urgent care center. All providers are board certified and licensed to prescribe all medications, order and interpret diagnostic tests like labs or x- rays, CT scans and MRIs. Health Services performs a variety of surgical procedures including suturing, abscess draining, toenail removal, phlebotomy services, biopsies as well as IVs and casting or splinting. Location: The Center for the Sciences and Pharmacy, Suite 235 Phone:

12 THE ALUMNI HEALTHFUL LIVING CENTER- On Campus The Alumni Healthful Living Center rivals the area s best health clubs. It offers Nautilus and weight training equipment, wellness and recreation programs, an indoor track, and an eight-lane swimming pool. Faculty and staff are welcome at all hours the Center is open. There is no charge for faculty and staff, or their family members to use the facility. Family members are defined as the spouse, domestic partner, children and parents of the employee. All other relatives would be considered guests. Guest passes for family and friends may be purchased for $2 each from the Student Administrative Services (SAS) Office by calling Faculty/ Staff ID Cards are required for admission. Good diet, exercise, and weight control, can help keep your blood sugar levels at an acceptable range and are the most important things you can do to prevent long-term health complications. 6

13 MAKE THE MOST OUT OF YOUR BENEFITS! Here are some tips for you and your family members so that you can get the care you need quickly and conveniently, while saving money at the same time. Use Urgent Care Centers Urgent Care Centers offer an easy and inexpensive alternative to conventional care in the ER or doctor s office and no appointment is required. Most visits take less than one hour and are a great choice for people looking to avoid long and costly visits to the ER for minor illnesses or injuries. The average wait time in the ER is about 4 hours! The urgent care copay is only $30, compared to the ER, which is $150 copay. It is important that you have a relationship with a primary care doctor, but when your doctor isn t available or your needs are minor, an Urgent Care Center can offer an easy alternative for professional care. Please see the listing of centers near you. See Your Primary Care Physician Having a primary care provider (PCP) and establishing a working relationship is critical. If you do not have a PCP, consider getting one. Preventive visits and screenings as well as scheduled immunizations are important to have done regularly. If your PCP has prescribed medication for you, it is very important that you follow your medication protocol and discuss any issues that arise with your PCP. Use Health Insurance Carrier Nurse Lines Most health insurance carriers offer a free service to all members that allow them to call a Registered Nurse 24 hour a day, 7 days a week to ask for health advice. Most people call for self-care advice such as treating a cold or flu, but it could be more serious such as you may be unsure whether you should go to the Emergency Room. These trained professionals will help make the right decision for you and your family. BCBS of MA s Blue Care Line: Use Blue Cross Blue Shield of MA Telehealth Telehealth covers both medical and behavioral health care for conditions that can be treated through video visits. With Telehealth, you can see a doctor or therapist anywhere you have online access, including your home, workplace, or wherever else you may be by using a smartphone, computer or tablet. Use Generics By law, generic drugs must have the same active ingredients as the brand name drug and both are regulated by the federal government. Generic drugs are not only less expensive, they are safe. Talk to your doctor about switching to a less expensive generic drug. Use the Mail Order Program for Prescription Drugs A mail service option is available for maintenance medications if you want to get your prescriptions delivered to your home. Mail service is limited to those items for which a 90-day supply is appropriate. Your copays for mail service prescription may be different from your standard prescription copays. Each copay covers up to a 90 day supply of a prescription or refill: $30/$60/$150. The 30-day supply copays are as follows: $15/$30/$50/$75/$100. 7

14 Get Your Preventive Care Going for your annual preventive care visit to your PCP is key to staying on top of your health. It allows you to manage and treat symptoms of chronic disease before they have a drastic effect on your well-being. Under the Affordable Care Act, insurers are required to cover certain preventive services at no cost to you. For a complete list, visit An abbreviated list is below: Preventive exam for adults Well child visits Routine immunizations Well-women visits including pap smears Mammograms for women 40+ PSA testing for men 40+ Routine Hearing and Vision Screenings performed in your primary care physicians office Be sure to check with your doctor to determine that the tests requested are 100% covered and no cost to you. Tips to prepare for your annual preventive care visit: Prepare a list of questions. Ask questions in order of importance. Bring paper and pencil to write down the doctor's answers. Bring a list of all drugs, vitamins, minerals, other nutritional supplements, over-the-counter medicines, and alternative treatments you are taking. Bring copies of any resources you have found, including medical literature or information found online. Establishing a relationship with a primary care physician (PCP) is a great way to stay on top of your lifestyle so that you can live the healthiest life possible. If you don t have a PCP, think about getting one today! 8

15 WHAT IS A SECTION 125 PLAN (FSA)? A Section 125 plan or Flexible Spending Account (FSA) is a plan that allows you to set aside pre-tax dollars to pay for certain eligible healthcare expenses. By using an FSA to pay for these expenses you can save anywhere from 25 to 40 percent on these purchases. There are two types of FSA s. The healthcare FSA is for healthcare expenses not paid by insurance, including exams, copayments, deductibles, eyeglasses, contact lenses and dental expenses. The dependent care FSA is used for dependent care expenses you incur, like daycare, after school care, or summer camp. ACCOUNT MAXIMUM FOR 2018 Flexible Spending Account $2,650 Dependent Care Account $5,000 (or $2,500 if married and filing separately). What happens to my FSA dollars if I don t use them? At the end of the plan year, if you do not spend all of your FSA dollars, you will lose them. It is very important to budget accordingly. Can I take my FSA with me if I change jobs? Under the federal act known as COBRA, you have the option to continue participating in the University s health care FSA. If you choose to continue a health care FSA under COBRA, your contributions must be paid with after-tax dollars. You cannot continue in a dependent care FSA under COBRA. You can use your FSA to pay for Healthcare, Dental, Vision, and some over the counter expenses with a doctor s prescription. 9

16 MEDICAL BENEFITS Blue New England $3,000 Blue Care Elect $3,000 IN-NETWORK SERVICES HMO PPO Plan Deductible $3,000 Single / $6,000 Family $3,000 Single / $6,000 Family Out of Pocket Maximum $4,000 Single/ $8,000 Family $4,000 Single/ $8,000 Family Preventive Services No Charge No Charge Office Visits $30 Co-pay $30 Co-pay Outpatient Hospital $0 After Deductible $0 After Deductible Urgent Care $30 Co-pay $30 Co-pay Emergency Room $150 Co-pay $150 Co-pay Prescription Drugs $15/$30/$50/$75/$100 Retail $30/$60/$150 Mail Order $15/$30/$50/$75/$100 Retail $30/$60/$150 Mail Order *Please consult the BCBS of MA benefits summary for complete details of the covered benefits. 10

17 DENTAL BENEFITS Dental Blue Program 2 PPO / In Network Out of Network* Office Visit Co-pay Calendar Year Deductible N/A $50 Per Member / $150 Person per Family Waived For Preventive & Diagnostic Maximum Benefit / Person / Calendar Year $1,000 per person Preventive & Diagnostic 100% Basic Services 80% Major Services 50% *In MA benefits are usually only provided when covered services are furnished by a participating dentist. For covered services received by OON dentists, BCBS of MA calculates your benefit payment based on the 90 th percentile of the prevailing dental charges in the zip code region where the services are received, but no more than the dentist s actual charge. This amount is sometimes less than the dentist s actual charge. In this case, you must pay the amount of the actual charge that is in excess of the allowed charge. Rollover Feature: This dental plan includes an Accumulated Maximum Rollover Benefit. This rollover benefit allows members to roll over a certain portion of their unused annual dental benefits so that they can use them in a future year. There are limits and restrictions on this benefit. *Please refer to the BCBS of MA plan summary for a complete listing of services covered under the plan. 11

18 OTHER BENEFITS BASIC LIFE INSURANCE CIGNA Paid for by The University Benefit Amount 1 X Annual Salary rounded to the nearest $1,000 Maximum Amount $150,000 ACCIDENTAL DEATH AND DISMEMBERMENT CIGNA Paid for by The University Benefit Amount 1 X Annual Salary rounded to the nearest $1,000 Maximum Amount $150,000 SHORT TERM DISABILITY University Funded Paid for by Benefit Amount The University University Funded Plan, see Human Resources for details. LONG TERM DISABILITY CIGNA Paid for by Waiting Period Benefit Amount Maximum Benefit Duration The University 90 days 50% to a max of $7,000/month Later of employee s Social Security Normal Retirement Age or the Maximum Benefit Period listed in the policy plan document. 12

19 PAYROLL DEDUCTIONS 2017 vs Comparison of Employee Bi-Weekly (Based on 26 Pay Periods) Deductions as of 1/1/2018 Employee Family Medical and RX HMO $68.76 $81.40 $ $ Employee Family Medical and RX PPO $81.01 $97.92 $ $ Employee Family Dental Semi-Monthly (24 weeks) $20.15 $22.25 $53.02 $

20 BENEFIT RESOURCES/CUSTOMER SERVICE NUMBERS Medical and Rx BCBS of MA BLUE Dental BCBS of MA FSA and HRA Accounts Health Equity The Gaudreau Group Inc. All Lines of Coverage NOTES: If you experience claims issues with the health insurance or HRA plans that you need help to resolve, please feel free to contact the Gaudreau Group for assistance at Melissa Cuzzone and Joe Lawler, along with the entire Gaudreau Group staff, will do whatever is possible to resolve your issues! 14