Open Enrollment. November 1 to November 22, This guide provides general details about your health, dental and vision benefits.

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1 Open Enrollment November 1 to November 22, 2017 Table of Contents General Information What s New for Wellness Rewards Program Employee Premiums... 6 Health Plan Information... 7 Prescription Drug Plan Information... 8 Vision Coverage Information... 8 Dental Plan Information...9 Health Reimbursement Account Flexible Spending Account Plans.. 11 This guide provides general details about your health, dental and vision benefits.

2 ; 2 General Information Franklin & Marshall College is pleased to offer eligible employees a comprehensive and valuable benefits program. Open Enrollment is the period when eligible employees have the opportunity to enroll or change their options for health and welfare benefits. The changes you make during Open Enrollment will be effective January 1, The elections you make during Open Enrollment will remain in effect for the entire year (January 1, 2018 through December 31, 2018) unless you have a qualified life event. Qualified life events include: Marriage Divorce Legal Separation Status change Birth or adoption of a child Change in child s dependent status Death of a spouse, child or other qualifying dependent Change in spouse s benefits or employment status A complete list of qualifying life events may be found in the Summary Plan Description found on the Open Enrollment website. Between the dates of November 1 through November 22, you may do the following: Enroll in or change coverage Add and/or remove an eligible dependent from your coverage, including dependent children up to age 26 Opt out of coverage* Elect your annual contribution to the Medical and/or Dependent Care Flexible Spending Account. Your current election DOES NOT roll over from year to year. * You may decline health insurance offered by Franklin & Marshall College - this is called a Waiver of Coverage. If you waive coverage for yourself, you may not cover dependents under the F&M health plan. Note that if you decline coverage considered affordable and adequate under the Patient Protection and Affordable Care Act, you will not qualify for government subsidies to purchase individual health insurance. Electing to Opt Out of coverage through open enrollment, or allowing your opt out status to continue constitutes a Waiver of Coverage. The decision to waive coverage has consequences. If you refuse employer coverage and don t obtain coverage on your own (through another plan such as a spouse s plan, Medicaid, or Medicare), you will be subject to a tax penalty. Page 2

3 ; 3 General Information November 1-22, 2017 Plan Booklets Health & Dental Cards Open Enrollment is available on Inside F&M from Wednesday, November 1, through Wednesday, November 22. You must enroll online before the deadline, so we encourage you to submit your choices as soon as possible. If you do not want to make changes to your coverage, you do not need to do anything during Open Enrollment. The only exception is you MUST re-enroll in Flexible Spending Accounts each year. Plan booklets are available electronically. We recommend reviewing plan booklets for details of each plan by visiting and clicking on Open Enrollment. If you lose your cards, please contact Highmark, Delta Dental or NVA Vision directly for a replacement. Questions about Your Benefit Options? Highmark (800) Delta Dental (800) Contact Fill (866) NVA Vision (800) TIAA (800) Who do I contact at F&M for help? Dependent Changes Human Resources is available Monday through Friday from 8:30 a.m.-5:00 p.m. to assist with questions about Open Enrollment. Please call or humanresources@fandm.edu with questions. If you will be making dependent changes to your plan during Open Enrollment, you must complete the online Dependent Change Form and submit supporting documentation to Human Resources by Friday, December 1. The Dependent Change Form can be found at the top of the benefit election page via the online Open Enrollment process on Inside F&M. It is also available on the Human Resources website Open Enrollment. Examples of dependent changes are: Going from Employee Only coverage to Employee + 1 or Employee + Family coverage Going from Employee + 1 or Employee + Family to Employee Only coverage Page 3

4 ; 4 What s New for 2018 The cost of health care in America continues to rise, driven by the inflation in the cost of medical services & products and an aging population. F&M is no exception to these rising costs, as we are trending at a 12.8% increase in In response to this, the College health plans are continuously revised to offer high-quality, comprehensive coverage. The following changes to our health plans were recommended by the Franklin & Marshall Fringe Benefits Committee and approved by the Administration for 2018: Employee premiums, the dollar amount deducted from your pay, will remain the same for Medical, Dental and Vision in 2018 Office visit copays will remain the same in 2018 Annual deductibles will increase: o Low Deductible Plan: In-Network: $450 Individual / $900 Family Out-of-Network: $1,125 Individual / $2,250 Family o High Deductible Plan: In-Network: $1,500 Individual / $3,000 Family Out-of-Network: $3,000 Individual / $6,000 Family Introducing a 5% In-Network Coinsurance provision that will apply to most services except Preventive Care, which will remain covered at 100% o The Coinsurance Annual Out-of-Pocket Maximum for In-Network Services for both the Low Deductible and High Deductible Plan will be: In-Network: $1,000 Individual / $2,000 Family Out-of-Network: $5,000 Individual / $10,000 Family A streamlined Wellness Rewards Program that offers you the opportunity to earn $300! Take advantage of convenient on-campus preventive health services. What does a Coinsurance and an Annual Out-of-Pocket Maximum mean? A Coinsurance is the percentage of cost that you pay for a covered health care service after you ve met your deductible. For example, a physical therapy session is $100 and your coinsurance is 5%. If you ve already met your annual deductible, you pay 5% of $100, or $5. An Annual Coinsurance Out-of-Pocket Maximum is the most you have to pay for covered services in a plan year. Once you ve spent this amount on deductibles and coinsurance, the health plan pays 100% of the cost of covered benefits. Page 4

5 ; 5 Wellness Rewards Program $ Earn up to $300 in wellness rewards! Increase your strides to a healthier you and earn money for each tier completion. About The Program Take advantage of a simple wellness rewards program offered by Highmark and Franklin & Marshall College. As you complete these requirements, you will make strides towards a healthier you. This is a cumulative program. Participants must complete the first tier of activities to move to the second tier and complete the second tier to move to the third tier. There is a total rewards potential of $300. You may participate in any activity at any time, but only receive rewards once the requirement for the tier is fulfilled. Program Dates: You have until April 30, 2018 to earn your reward. Eligibility: All Franklin & Marshall College fulltime employees Log In And Get Started! Go to highmarkblueshield.com and log into your account. Click on Rewards Program under Wellness Program. Contact wellnessask@fandm.edu with any questions. Tier 1 (Required): $75 Complete the Wellness Profile Register for Telemedicine Complete Preventive Check Up Join F&M Wellness Google group Tier 2 (Choose 3): $200 Dental exam Mammogram/Pap test Vision exam Prostate exam Colorectal screening Osteoporosis screening Flu Shot Skin Health assessment Tier 3 (Choose 3): $300 Enroll in How to Be Tobacco Free program Stress assessment Cigna or F&M Wellness seminar Set a goal with a health coach Set any goal in My Health Assistant Enroll in Baby BluePrints Completion of an organized community walk/run Utilize Connect Care 3 Nurse Navigator Completion of a financial consultation with a TIAA advisor or Cigna financial specialist. Stay alert of wellness rewards opportunities! Join the F&M Employee & Family Google Group. Type go.fandm.edu/wellness-instructions into your browser to sign-up. Page 5

6 ; Health Employee Plan Information Premiums Low Deductible Plan: Employee premiums will remain the same in Medical/Prescription Plan Monthly Cost Bi-Weekly Cost Employee Only $ $51.39 Employee + One $ $83.94 Employee + Family $ $ High Deductible Plan: Monthly Cost Bi-Weekly Cost Employee Only $74.56 $34.41 Employee + One $ $56.30 Employee + Family $ $91.58 Dental Plan Monthly Cost Bi-Weekly Cost Employee Only $27.35 $12.62 Employee + One $47.82 $22.07 Employee + Family $71.47 $32.99 Vision Plan Monthly Cost Bi-Weekly Cost Employee Only $3.33 $1.53 Employee + One $4.88 $2.52 Employee + Family $9.13 $4.21 Page 6

7 ; 7 Health Plan Information Preventive Care Preventive care coverage is an important part of the Franklin & Marshall College Health Plan. You do not pay deductibles, coinsurance, or copays for eligible preventive healthcare services such as annual checkups, well-child visits, routine screenings, and covered immunizations performed by a participating Highmark provider. Office Visit Copays Primary Care Physician Telemedicine Services Urgent Care Center Specialist Emergency Room Visit In-Patient Hospital Stay $20 per visit $15 per visit $30 per visit $40 per visit $100 per visit $100 per stay The College is pleased to continue to offer two Health Plan options so that you may choose the one that best meets your needs. A complete 2018 Benefit Summary Grid can be found on the Open Enrollment website. Low Deductible Health Plan: Annual Deductible Individual: Family: Coinsurance Coins Out-of-Pocket Max Individual: Family: High Deductible Health Plan: Annual Deductible Individual: Family: Coinsurance Coins Out-of-Pocket Max Individual: Family: In-Network $450 $900 Plan pays 95% after deductible $1,000 $2,000 In-Network $1,500 $3,000 Plan pays 95% after deductible $1,000 $2,000 Out-of-Network $1,125 $2,250 Plan pays 70% after deductible $5,000 $10,000 Out-of-Network $3,000 $6,000 Plan pays 70% after deductible $5,000 $10,000 Page 7

8 ; 8 Prescription Drug Plan Prescription Drug The listed copays will apply when purchasing prescription drugs through a participating pharmacy or the Express Scripts mail order program. Retail Pharmacy (31 day supply) Mail Order (90 day supply) Tier 1 Generic Drugs Tier 2 Brand Name Drugs Tier 3 Non-Formulary and Specialty Drugs You pay 15% of the drug cost, with a $5 minimum and $15 maximum copay per prescription You pay 25% of the drug cost, with a $20 minimum and $50 maximum copay per prescription You pay 35% of the drug cost, with a $50 minimum and $80 maximum copay per prescription You pay 15% of the drug cost, with a $12 minimum and $37 maximum copay per prescription You pay 25% of the drug cost, with a $40 minimum and $100 maximum copay per prescription You pay 35% of the drug cost, with a $100 minimum and $160 maximum copay per prescription Annual Maximum You will continue to pay a maximum of $1,500 per person, per calendar year and up to $3,000 per family per calendar year for prescription medications. Vision Coverage What is Covered? Eligible members and dependents are entitled to receive the following from a participating NVA provider: An examination once every calendar year covered at 100% Lenses once every calendar year (covered at 100%) Frames once every two calendar years (up to $60) Contact Lenses in lieu of Lenses once every calendar year (up to $75 retail) Laser Eye Surgery discounts including a free initial consultation with all in-network providers Mail order is available for contact lenses through Contact Fill by calling or visiting Page 8

9 ; 9 Dental Plan Information What does the Plan cover? When visiting a participating Delta Dental provider: 100% coverage is provided for diagnostic and preventive services, including up to two cleanings and routine exams per calendar year, X-rays, fluoride treatments through age 18, and sealants up to age 14 (no deductible is required). 80% coverage is provided for basic restorative services such as fillings, extractions, treatment of gum disorders, and root canal therapy (participants will pay 10% of a contracted rate when visiting a participating dentist, plus the annual deductible). 50% coverage is provided for major restorative services such as crowns, dentures and bridgework (participants will pay 50% of a contracted rate when visiting a participating dentist, plus the annual deductible). 50% coverage is provided for orthodontia services for children through age 18, including braces, up to a maximum lifetime orthodontia benefit of $1,500 per child (no deductible). Annual Maximum Benefit Annual Deductible A maximum benefit of $1,500 per person per calendar year is provided through this plan. Coverage is not provided for some services, including cosmetic procedures, implants and preventive plaque control procedures. Dental Plan deductibles will remain $50 per person per calendar year, and up to $150 per year for a family. You will pay the deductible each year toward covered services before the dental insurer will begin making payments. Delta Dental maintains an extensive network of providers. You will typically pay the lowest costs for dental services when visiting a participating provider. Visiting a Non- Participating Provider Participants who visit a non-participating dentist will still receive coverage, but will likely pay higher out-of-pocket costs. If seeing a non-participating provider, you will be responsible for normal coinsurance as listed above, plus all fees charged by your provider in excess of Delta Dental s normal reimbursement rates to participating dentists. Page 9

10 ; 10 Health Reimbursement Account (High Deductible Only) Health Reimbursement Account (HRA) HRA Annual Contributions Carryover of Balances How to Get Reimbursed How Does the HRA Work If I Also Have a Flexible Spending Account for Medical Expenses? Do I Keep the HRA Funds Forever? To help those who elect the High Deductible Health Plan pay the deductible, copays, and coinsurance, the College contributes money into a Health Reimbursement Account (HRA). Once you have incurred eligible health care expenses, you may receive reimbursement through the HRA up to your available balance. Franklin & Marshall College contributes the following amounts to each HRA every January: Employee Only $420 Employee + One $840 Employee + Family $1,260 Any funds remaining in an employee s HRA as of December 31 will carry over to the next year, providing the individual remains employed and enrolled in the High Deductible Health Plan. These funds will be added to the contribution the College makes on behalf of each participant that year. An HRA participant may receive reimbursement from his/her HRA by either charging eligible expenses using an HRA debit card, or by paying for the health care expense and uploading, faxing, or mailing a claim form to Highmark (the Administrator of the plan). HRA claim forms are available online. For employees participating in both the HRA and the Flexible Spending Account (FSA) for Medical Expenses, eligible expenses will be reimbursed first from your Flexible Spending Account. An employee who moves to a different Health Plan Option, discontinues his/her health coverage through the College, or terminates employment will permanently forfeit the balance in his/her HRA. Upon employment termination, a former employee may request reimbursement from the HRA for eligible health care expenses that were incurred through the termination date. Retirees have a four-year period after their retirement date to spend the balance of their HRA. Page 10

11 ; 11 Flexible Spending Accounts (FSA) Medical FSA Dependent Care FSA What is a Flexible Spending Account? Flexible Spending Accounts provide a convenient way to contribute pre-tax dollars for qualified medical and dependent care expenses. The FSA is commonly known as the use it or lose it account as funds not used by the deadlines below are forfeited. For this reason, please plan your FSA contributions carefully. You do not have to participate in a Health Plan to participate in a Flexible Spending Account Plan. Do elections carry over? Your 2017 FSA elections will NOT carry over from year to year. You must elect a contribution via the online Open Enrollment process if you would like to participate in Annual Maximums Medical $2,650 Dependent Care $5,000 ($2,500 if married but filing separately) Deadlines Eligible Expenses- Medical Medical Expenses incurred from January 1, 2018 to March 15, 2019 must be submitted for reimbursement by March 31, Dependent Care Expenses from January 1, 2018 to December 31, 2018 must be submitted for reimbursement by March 31, The Medical FSA can be used for expenses such as copays, deductible expenses, coinsurance, dental, and prescription drugs which are not reimbursed through any insurance plan. For a full list of eligible expenses, visit Eligible Expenses- Dependent Care The Dependent Care FSA can be used for expenses such as the cost of childcare services for children through age 12. What if I have an HRA and a Medical FSA? For those who elect to participate in both the High Deductible Health Plan and the Medical FSA, eligible expenses will be reimbursed first from your Medical FSA. Since both the HRA and FSA can reimburse for the same types of eligible expenses, this decreases the risk of forfeiting unused FSA contributions. You may not be reimbursed for the same expense from both the FSA and the HRA, essentially being reimbursed twice for the same expense. How do I get Reimbursed? You may pay for eligible medical expenses (not dependent care expenses) with the debit card issued by Highmark. You may also submit a claim for reimbursement to Highmark online, fax, or by mail. You may elect to be reimbursed by check or by direct deposit, or you may choose to have Highmark send payment directly to the provider. Page 11