2016 Open Enrollment Benefit Guide Special Lecturers

Transcription

1 2016 Open Enrollment Benefit Guide Special Lecturers It is me for our annual open enrollment. This is when you have an opportunity to reevaluate your benefit choices and make changes for the upcoming plan year. Any changes you make will be effec ve January 1, 2016 and will remain in effect through December 31, 2016 unless you experience a qualifying event. Any changes or enrollment decisions must be completed online by midnight on Friday, November 20, 2015 for benefit changes to take effect January 1, Deduc ons for your 2016 benefit elec ons will begin with your first January paycheck, with benefits effec ve on January 1, Oakland University will kick off Open Enrollment with a Benefit and Wellness Fair in the Oakland University Rec Center on Wednesday, November 4, 2015, 9:00 am to 3:00 pm. What s Inside... Ac on Steps Open Enrollment 3 Benefit Contacts 4 Eligibility 5 Annual Elec ons & Life Status Changes 6 7 Medical/Rx Plan Overview 8 13 Dental Overview 14 Vision Overview 15 MetLaw Pre Paid Legal Overview 16 InfoArmor Iden ty & Credit Protec on Overview Flexible Spending Account Overview Legal No ces Appendix 29 Important information about Medicare If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your prescription drug coverage. Please see pages for more details

2 Action Steps This Benefit Guide provides an overview of each plan. We encourage you to review the packet in its en rety. Addi onal documents can be found by clicking Open Enrollment Materials at UHR s benefit website. Elec on Form Online All Employees must go online and confirm their benefits and covered dependents for Medical Please carefully review the 2016 Medical plan op ons and HMO qualifica on requirements found on pages 8 13 of the benefit guide. If you are moving to, or switching between HMOs, you will need to be aware of requirements to qualify for the Enhanced (or Choice) plan. Please note that HAP did not renew their contract with Oakland University and will not be a plan op on as of 1/1/16. If you are currently in the HAP HMO you will need to choose another Medical plan for If you re enrolling for the first me in an HMO plan, a default Primary Care Physician (PCP) will be selected for you. You can change your PCP by either calling the carrier (using the number listed on the back of your ID card) or by logging in to the carrier website. Flexible Spending Accounts If you want to par cipate in the Health Care Reimbursement and/or the Dependent Care Reimbursement Accounts in 2016, you must go online and enroll. The maximum amount you can contribute to your Health Care FSA in 2016 is $2,550. MetLaw If you wish to enroll or con nue your par cipa on in the Prepaid Legal plan, you must go online and enroll. InfoArmor If you wish to enroll or con nue your par cipa on in the credit and iden ty protec on benefit, you must go online and enroll. HIPAA Privacy No ce The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires employer health plans to maintain the privacy of your health informa on and to provide you with a no ce of the Plan s legal du es and privacy prac ces with respect to your health informa on. If you would like a copy of the Plan s No ce of Privacy Prac ces, please contact Human Resources. Page 2

3 Dear Oakland University Special Lecturers, 2016 Open Enrollment It is that me of year again when you have the opportunity to make decisions about your benefits. Open Enrollment runs from November 4, 2015 through November 20, This is the one me per year Oakland University members can make changes on their benefit elec ons without experiencing a life status event. The decisions made at this me remain in effect from January 1, 2016 through December 31, What s changing in 2016? In 2016, your medical op ons consist of the HealthByChoice Achievements HMO offered by Priority Health, the Healthy Blue Living HMO offered by BCN and two BCBSM PPO plans PPO A and PPO B. Please note that HAP will not be offered as of 1/1/16. All employees currently enrolled in the HAP plan must choose a new Medical plan during this Open Enrollment. There are no benefit design changes to the BCN and Priority Health HMOs, BCBSM PPO A, BCBSM PPO B, or Vision plans. Special Lecturers may enroll in the Dental plan star ng in The true out of pocket maximums for all Medical plans will be the amount allowed under Health Care Reform and by each carrier. What are True Out of Pocket Maximums (TrOOPs)? TrOOPs are the absolute most you will pay during the benefit year (January 1 through December 31) in out of pocket expenses. They include the cost of your deduc ble, coinsurance and any medical or prescrip on drug copays. Prior to Health Care Reform there was no overall limit on your out of pocket expenses. Health Care Reform added this benefit to all Medical plans. There is s ll a limit to how much you ll pay in deduc ble and coinsurance, but with the TrOOP there is now a limit on how much you ll pay in copays. This is an added benefit to the plan! If you are a full me, benefits eligible Special Lecturer you will receive a new IRS Tax Form (Form 1095 C) from Oakland University in January 2016 that will be used to complete your 2015 personal tax return, much like a Form W 2. You should also receive a similar Form (Form 1095 B) from your 2015 medical insurance carrier. These Forms provide informa on about the medical coverage that is offered to you by Oakland University. They also provide informa on about who is enrolled for coverage under our plan. More detailed informa on will be provided to you in early Please note that online enrollment closes at midnight on Friday, November 20, If you have not completed your enrollment by that me, you will remain in your current benefits at the new 2016 rates, with the excep on of the flexible spending accounts, group legal, and credit and iden ty protec on which will be discon nued. Feel free to contact the Benefit & Compensa on Services office at (248) or at benefits@oakland.edu with ques ons. Sincerely, University Human Resources Page 3

4 Blue Cross Blue Shield Medical/Rx, Vision (800) Blue Care Network Medical/Rx (800) Priority Health Medical/Rx (800) Delta Dental Dental (800) Davis Vision Vision (800) Meritain Flexible Spending Accounts (800) MetLaw Prepaid Legal (800) InfoArmor University Human Resources (UHR) 401 Wilson Hall Benefit Contacts Iden ty and Credit Protec on (800) (248) Page 4

5 Coverage for you All special lecturers are eligible for benefits on the first day of the month following date of hire. Coverage for your Dependents You can cover yourself and your eligible dependents under the benefits offered by Oakland University. Your eligible dependents are: Eligibility Your legal spouse; Your eligible children by birth, adop on or legal guardianship, un l the end of the calendar year in which they turn 26 for medical, dental and vision coverage; You may cover Other Eligible Adults if the other adult sa sfies all of the following: Resides with the employee and has done so for 18 con nuous months prior to the individual s enrollment; Is 26 years of age or older; Is not a dependent of the employee as defined by the Internal Revenue Service; Is not married to any other party; Is not related by blood (child, grandchild, parent, grandparent, sibling, niece, nephew, aunt, uncle, cousin) or marriage; Is not the employee s landlord, tenant, or boarder; Is not an undocumented immigrant; The employee and the Other Eligible Adult are financially interdependent. Financial interdependence may be established by submission of proof of joint bank account, joint home ownership, or some other specified documented proof. The employee is required to submit a signed Affidavit of Other Eligible Adult. The dependent child(ren) of the Other Eligible Adult is (are) eligible for membership providing all of the eligibility requirements for dependent children are met. Coverage for Other Eligible Adults is available through BCN, Priority Health, Delta Dental and Davis Vision. If you have any ques ons concerning the eligibility of your dependents, contact UHR. Page 5

6 Annual Elections and Life Status Changes Pre Tax Contribu ons We sponsor a program that allows you to pay for certain benefits using pre tax dollars. With this program, contribu ons are deducted from your paycheck before federal, state and Social Security taxes are withheld. As a result, you reduce your taxable income and take home more money. How much you save in taxes will vary depending on where you live and on your own personal tax situa on. These programs are regulated by the Internal Revenue Service (IRS). The IRS requires you to make your pre tax elec ons before the start of the plan year (January 1 December 31). Making Midyear Life Status Changes The IRS permits you to change your pre tax contribu on amount mid year only if you experience a change in status, which includes the following: Birth, placement for adop on, or adop on of a child, or being subject to a Qualified Medical Child Support Order which orders you to provide medical coverage for a child. Marriage, legal separa on, annulment or divorce. Death of a dependent. A change in employment status that affects eligibility under the plan. A change in elec on that is on account of, and corresponds with, a change made under another employer plan. A dependent sa sfying, or ceasing to sa sfy, eligibility requirements under the health care plan. Ordinarily, employees may not change their cafeteria plan elec ons un l open enrollment unless there are qualifying events. But in No ce , which took effect Sept. 18, 2014, the Internal Revenue Service (IRS) created two new circumstances when employees may revoke their elec on for employer sponsored health coverage under the cafeteria plan. First, an employee whose hours of service are reduced to an average of less than 30 hours per week, but who s ll is eligible for group health coverage, may revoke the elec on for employer sponsored health coverage to purchase a qualified health plan on one of the health care reform s public exchanges. Secondly, an employee may cease coverage under the group health plan when he or she has purchased coverage on a public exchange (or marketplace), thus avoiding a period of duplicate coverage under the employer s group health plan and the marketplace coverage or a period of no coverage. The change you make must be consistent with the change in status. For example, if you get married, you may add your new spouse to your coverage. If your spouse s employment terminates and he/she loses employersponsored coverage, you may elect coverage for yourself and your spouse under our program. However, the change must be requested within 30 days of the change in status. If you do not no fy UHR within 30 days, you must wait un l the next annual enrollment period to make a change. These rules relate to the program allowing you to pay for certain benefits using pre tax dollars. Please review the medical booklet and other vendor documents for informa on about when those programs allow you to elect or cancel coverage, add or drop dependents, and make other changes to your benefit coverage, as the rules for those programs may differ from the pre tax program. Page 6

7 Annual Elections and Life Status Changes (continued) HIPAA No ce of Special Enrollment Rights If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, 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 employer stops contribu ng towards your or your dependents other coverage). However, you must request enrollment within 30 days a er your or your dependents other coverage ends (or a er the employer stops contribu ng toward the other coverage). In addi on, if you have a new dependent as a result of marriage, birth, adop on or placement for adop on, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days a er the marriage, birth, adop on or placement for adop on. To request special enrollment or obtain more informa on, contact UHR. The Children s Health Insurance Program Reauthoriza on Act of 2009 added the following two special enrollment opportuni es: The employee s or dependent's Medicaid or CHIP (Children's Health Insurance Program) coverage is terminated as a result of loss of eligibility; or The employee or dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP. It is your responsibility to no fy UHR within 60 days of the loss of Medicaid or CHIP coverage, or within 60 days of when eligibility for premium assistance under Medicaid or CHIP is determined. More informa on on CHIP is provided later in this document. Page 7

8 Medical/Rx Plan Overview Medical coverage gives you financial protec on against the high cost of trea ng a serious illness or medical condi on. The Oakland University Medical/Rx Plans also provide coverage for preven ve services, including annual physicals and well child care at no cost to you. Your medical op ons are: Blue Cross Blue Shield of Michigan (BCBSM) Community Blue PPO A Blue Cross Blue Shield of Michigan (BCBSM) Community Blue PPO B Priority Health HealthbyChoice Achievement (HbCA) HMO Blue Care Network (BCN) Healthy Blue Living HMO PPO Op on Blue Cross Blue Shield of Michigan (BCBSM) You have a choice between two plans through Blue Cross Blue Shield of Michigan (BCBSM). Each plan covers the same services and uses the same BCBSM PPO network of providers. The difference is in your per pay premium and your out of pocket costs. You don t need to choose a Primary Care Physician with a PPO you can see any provider you want to see, even a specialist. You may go to any provider, whether they are in the BCBSM network or not. You can see non PPO providers, but your benefits will be reduced and you ll pay more out of pocket. A par cipa ng provider must accept BCBSM s approved amount they can t balance bill you for more than your deduc ble and coinsurance. A non par cipa ng provider can balance bill you whatever amount s/he thinks is fair there s no limit to what you can be charged. Care at Non Par cipa ng Providers Coverage at non par cipa ng hospitals (those who do not par cipate with BCBSM) is limited to care needed to treat an accidental injury or medical emergency. There is no coverage for non emergency hospital care or care received at non par cipa ng mental health or substance abuse facili es, ambulatory surgery facili es, end stage renal dialysis facili es, home infusion therapy providers, hospices, outpa ent physical therapy facili es, skilled nursing facili es or home health care agencies. Page 8

9 Medical/Rx Plan Overview (continued) Priority Health and BCN HMO Plans The HMO plans provide incen ves for our members to prac ce healthy behaviors. When you enroll in an HMO, you select a primary care physician who coordinates all aspects of your medical care, including specialist referrals (when required). If you enroll in an HMO plan, you must receive all medical care from HMO doctors and hospitals; out of network care is not covered except in extreme emergency situa ons. Each of the plans include two different levels of benefits with different cost sharing requirements. Enhanced (Choice) benefits have no deduc ble and the lowest copay requirements. You must qualify for Enhanced benefits. The qualifica on requirements differ by carrier so please review the carrier qualifica on forms carefully. Each carrier allows members to qualify for Enhanced benefits by either mee ng the specified qualifica ons or an alterna ve standard. Please note that Priority Health refers to their Enhanced benefit level as Choice. Standard benefits cover the same types of expenses as the Enhanced (Choice) plan, but include deduc bles and higher copay requirements. Visit the following websites for more informa on on their provider networks: Priority Health: BCN: ( ( You ll also need to access these websites in order to fulfill the online qualifica on procedures for each plan. Prescrip on Drug Coverage Prescrip on drug coverage is included with all the Medical plans. The amount you pay for each prescrip on depends on which plan you choose, and on whether the drug is a brand or generic medica on. Generics Save You Money Generic u liza on is mandatory for the BCN and BCBSM plans. If you choose to fill your prescrip on with a brand name medica on when a generic is available, you must pay the difference in cost between the approved amount for the brand name drug dispensed and the maximum allowable cost for the generic drug, plus your applicable copay. (except on the BCBSM plan if your prescriber writes Dispense as Wri en (DAW) ). Step Therapy Step Therapy is mandatory for the BCN and BCBSM plans. This applies only to prescrip ons being filled for the first me of certain targeted medica ons. Before filling your ini al prescrip on for select, high cost, brandname drugs, the pharmacy will contact your physician to suggest a generic alterna ve. If you have already tried the preferred medica ons, BCN/BCBSM will authorize the brand name prescrip on. If you have no record of trying the preferred medica on, you may be liable for the en re cost of the brand name drug unless you first try the preferred medica on or your physician obtains prior authoriza on from BCN/BCBSM. A list of select brand name drugs targeted for step therapy is available at along with the preferred medica ons. 90 Day Supply To save money, you may have prescrip ons filled for 90 day supply and you will only pay 1 2 mes your applicable copay (depending on which plan you choose). Your doctor must write the prescrip on to be filled as a 90 day supply. You may receive a 90 day supply either at retail stores (through the HMO plans only) or through mail order. The mail order program allows you to obtain a 90 day supply of your prescrip on delivered right to your door. Page 9

10 PPO Benefit Comparison Below is a summary of the PPO A and PPO B plans. This is a benefits highlight sheet, so not all benefits and limita on are shown. For complete detail on the plan design, please review the carrier materials found on UHR s benefit website. Calendar Year Deduc ble (Single/Family) BCBSM PPO A BCBSM PPO B In Network Out of Network In Network Out of Network $0/$0 $250/$500 $250/$500 $500/$1,000 Coinsurance 100%/0% 80%/20% 80%/20% 60%/40% Calendar Year Coinsurance Max (Single/Family) Calendar Year Out of Pocket Max (Single/Family) None $1,000/$2,000 $1,000/$2,000 $3,000/$6,000 $6,350/$12,700 $6,350/$12,700 $6,350/$12,700 $6,350/$12,700 Preven ve Care Covered 100% Not covered Covered 100% Not covered Office Visits (Med Necessary) $15 copay Covered 80% a er deduc ble $20 copay Covered 60% a er deduc ble Urgent Care $15 copay Covered 80% a er deduc ble $20 copay Covered 60% a er deduc ble Emergency Room $50 copay $50 copay $50 copay $50 copay Hospital Services Covered 100% Covered 80% a er deduc ble Physical, Speech and Occ Therapy Covered 100%, visit limits apply Chiroprac c Care Covered 100%, visit limits apply Mental/Substance Abuse Treatment Covered 80% a er deduc ble, visit limits apply Covered 80% a er deduc ble, visit limits apply Inpa ent Covered 100% Covered 80% a er deduc ble Outpa ent Covered 100% Covered 80% a er deduc ble Prescrip on Drugs (30 day supply) Reimbursed 75% a er Covered 80% a er deduc ble Covered 80% a er deduc ble, visit limits apply $20 copay, visit limits apply Covered 80% a er deduc ble Covered 80% a er deduc ble Covered 60% a er deduc ble Covered 60% a er deduc ble, visit limits apply Covered 60% a er deduc ble, visit limits apply Covered 60% a er deduc ble Covered 60% a er deduc ble Reimbursed 75% a er Generic $10 copay $10 copay $10 copay $10 copay Preferred Brand $20 copay $20 copay $20 copay $20 copay Non Preferred Brand $20 copay $20 copay $20 copay $20 copay 90 day supply mailorder 1x applicable copay Not covered 2x applicable copay Not covered Page 10

11 HMO Benefit Comparison Below is a summary comparison of the two outcomes based HMO plans. This is a benefits highlight sheet, so not all benefits and limita on are shown. For complete detail on each plan design, please review the carrier materials found on UHR s benefit website. Calendar Year Deduc ble (Single/Family) Priority Health BCN Choice Standard Enhanced Standard $0/$0 $200/$400 $0/$0 $200/$400 Coinsurance 100%/0% 80%/20% 100%/0% 80%/20% Calendar Year Coinsurance Max (Single/Family) None $2,000/$4,000 None $2,000/$4,000 Calendar Year True Out of Pocket Max (Single/Family) $6,850/$13,700 $6,850/$13,700 $6,600/$13,200 $6,600/$13,200 Preven ve Care Covered 100% Covered 100% Covered 100% Covered 100% Office Visits (Med Necessary) $20 copay $30 copay $20 copay $30 copay Urgent Care $20 copay $30 copay $20 copay $30 copay Emergency Room $100 copay $150 copay $100 copay $150 copay Hospital Services Covered 100% Covered 80% a er deduc ble Covered 100% Covered 80% a er deduc ble Physical, Speech and Occ Therapy $20 copay, visit limits apply $30 copay, visit limits apply $20 copay, visit limits apply $30 copay, visit limits apply Chiroprac c Care $20 copay, visit limits apply $30 copay, visit limits apply $20 copay, referral required $30 copay, referral required Inpa ent Mental/Substance Abuse Treatment Outpa ent Prescrip on Drugs (30 day supply) Covered 100%, when authorized $20 copay, when authorized Covered 80% a er deduc ble, when authorized $30 copay, when authorized Covered 100%, when authorized Covered 100% Covered 80% a er deduc ble, when authorized $30 copay Generic $7 copay $7 copay $7 copay $10 copay Preferred Brand $15 copay $15 copay $15 copay $20 copay Non Preferred Brand $30 copay $30 copay $30 copay $50 copay 90 day supply retail or mail order 2x applicable copay 2x applicable copay 2x applicable copay 2x applicable copay Page 11

12 Priority Health - HealthByChoice Achievements HMO You and your enrolled spouse/oea must qualify for the Choice level benefits each year. This table is a summary of the qualifica on requirements. Exact qualifica on requirements can be found on the Priority Health Qualifica on Form available on the UHR s benefit website. What plan do you start in? Priority Health HealthbyChoice Achievements HMO From January 1 March 31, new enrollees will start in the Choice plan. Members already enrolled will stay in the plan they were in at the end of the previous year (Choice or Standard). What is the qualifica on period? When will you move plans? What are the qualifica on requirements? Are reasonable alterna ves available if you do not pass one of the wellness targets? The qualifica on period for January 1, 2016 open enrollment is 1/1/16 through 3/31/16. If you fail a requirement and need extra me to meet your alternate goal, you will move to Choice effec ve on the latest date that all goals are met. If you complete and pass the requirements within the open enrollment qualifica on period of 1/1/16 through 3/31/16, you will be on the Choice plan on 4/1/16. If you do not complete and/or pass the requirements within the open enrollment qualifica on period of 1/1/16 through 3/31/16, you will move to the Standard plan on 4/1/16. Whether you begin in the Choice or Standard plan you must complete the following requirements within the qualifica on period in order to be on the Choice plan a er the qualifica on period has concluded: You must have your doctor complete the HealthbyChoice Achievements Qualifica on Form and return to Priority Health. You must be tobacco free. 3. Your body mass index (BMI) must be under Your blood pressure must be under 140/90 or 140/80 based on risk factors. 5. Your LDL cholesterol must be under 160 or under 100 based on risk factors. 6. Your blood sugar metrics are only required for members with diabetes or heart disease. HbA1c must be lower than 8% if you have diabetes or fas ng blood sugar lower than 126 if you have heart disease. 7. You must complete a confiden al, online health assessment. The above summarizes the qualifica on requirements. See the Qualifica on Form for complete detail. Yes, depending on the target you miss below are Priority Health s suggested alterna ve standards: Quit tobacco or complete a Priority Health tobacco cessa on program. Body Mass Index (BMI) reduce your weight by 5%. Blood Pressure reduce systolic by 10mm or diastolic by 5mm. Cholesterol reduce LDL by 20 mg/dl. Blood Sugar improve by reaching normal level, reduce HbA1c by 1%. Note that your physician can set their own alterna ve standard for you. If they are not using Priority Health s suggested altera ve standards, be sure your doctor enters your specific alterna ve standard into Priority Health s online system otherwise it will default to Priority Health s suggested alterna ve standard. Once you achieve the alterna ve wellness target you must visit your doctor and have them resubmit the HealthbyChoice Achievements Qualifica on Form showing the alterna ve target has been met. You will move to the Choice plan effec ve on the latest date that all goals and qualifica on requirements are met. Page 12

13 BCN - Healthy Blue Living HMO You and your enrolled spouse/oea must qualify for the Enhanced level benefits each year. This table is a summary of the qualifica on requirements. Exact qualifica on requirements can be found on the BCN Qualifica on Form available on the UHR s benefit website. What plan do you start in? What is the qualifica on period? When will you move plans? What are the qualifica on requirements? Are reasonable alterna ves available if you do not pass one of the wellness targets? BCN Healthy Blue Living HMO From January 1 March 31, new enrollees will start in the Enhanced plan. Members already enrolled will stay in the plan they were in at the end of the previous year (Enhanced or Standard). You have 90 days from your effec ve date for the ini al requirements and 120 days for addi onal requirements (i.e. Smoking Cessa on or Weight management). If you meet the ini al qualifica on requirements within the first 90 days of the plan year, then on the date BCN determines you qualify you will be moved to the Enhanced plan retroac ve to 1/1/16. You must have your doctor complete the Qualifica on Form and return to BCN. 2. You must be tobacco free. 3. Your body mass index (BMI) must be under Your blood pressure must be under 140/ Your LDL cholesterol must be under 160 or under 100 based on risk factors. 6. Your fas ng blood sugar or A1C for on diabe cs FBS must be <126mg/dL. 7. If you have symptoms of depression you must be seeking treatment. 8. You must complete a confiden al, online health assessment. You must complete these ini al qualifica ons in the first 90 days of the plan year and receive an A or B. If you use tobacco or have a body mass index of 30 or more, you will be required to enroll in tobacco cessa on programs or a weight management program within 120 days from the plan year s start. You must ac vely par cipate through the end of the year, in order to remain in Enhanced benefits. If you receive a C or do not pass any of the health measures you will be on the Standard benefits for the remainder of the year. The above summarizes the qualifica on requirements. See the Qualifica on Form for addi onal detail. If you use tobacco or have a body mass index of 30 or more, you will be required to enroll in tobacco cessa on programs or a weight management program within 120 days from the plan year s start. You must ac vely par cipate through the end of the year, in order to remain in Enhanced benefits. In the event the informa on provided in this benefit guide deviates from the informa on provided in the carrier materials, the carrier materials will always rule. Please review the carrier materials carefully before making your benefit elec on. Page 13

14 Dental Overview Dental coverage helps with the cost of rou ne dental care and major services for you and your eligible family members. Coverage is provided through Delta Dental s PPO Point of Service Plan. Through Delta Dental there are three types of den st you can choose to see: a PPO Member den st, a Premier den st and a Non Par cipa ng den st. Delta Dental PPO Member den sts and Premier den sts agree to accept Delta s fee determina on as full payment for covered services. This guaranteed acceptance protects employees from providers who want to bill in excess of what Delta deems reasonable and customary. If you choose to visit a Non Par cipa ng den st you will s ll have coverage but the den st may bill you directly for any charges in excess of what Delta deems reasonable and customary. An online provider directory is available at that will enable enrollees to obtain informa on on PPO Member and Premier den sts. Click on Consumer Toolkit to access the online provider directory. Deduc ble Annual Maximum (applies to Class I, II and III) Benefit Year: January 1 December 31 Life me Maximums (applies to Class IV) Covered Services Class I Benefits PPO Member Den st (accept Delta s fee determina on as full payment) PPO Member Den st Plan Pays: Delta Premier (accept Delta s fee determina on as full payment) None $1,000 per person $1,500 per person Delta Premier Plan Pays: Non Par cipa ng Den st (do not accept Delta s fee determina on as full payment) or Non Par cipa ng Den st Plan Pays: Exams, Cleanings, X rays, etc. (preven ve and diagnos c services do not count toward the annual maximum) Class II Benefits Extrac ons, Fillings, Root Canals, Relines/Repairs to Bridges and Dentures, etc. 100% 100% 100% 100% 50% 50% Class III Benefits Crowns, Bridges, Implants, Dentures, etc. 50% 50% 50% Class IV Benefits Orthodon cs (no age limit) 50% 50% 50% Did you know visi ng your den st for regular exams is just as important as visi ng your medical doctor? We encourage you to take advantage of the two exams covered each year! This Summary of Dental Plan Benefits should be read in conjunc on with your Dental Care Cer ficate. Your Dental Care Cer ficate will provide you with addi onal informa on about your Delta Dental plan, including informa on about plan exclusions and limita ons. In the event that you seek treatment from a den st that does not par cipate in any of Delta Dental s programs, you may be responsible for more than the percentage indicated above. Page 14

15 Oakland University offer two vision plans: Davis Vision Blue Cross Blue Shield of Michigan (BCBSM) Vision Both the Davis Vision and BCBSM Vision plans include ophthalmologists and optometrists in their network. Below is a summary of the two vision plan op ons: Eye Exams If you receive services outside of a rou ne eye exam you may be required to pay addi onal costs. Vision Overview Davis Vision Page 15 BCBSM Vision Par cipa ng Non Par cipa ng Par cipa ng Non Par cipa ng $0 copay Reimbursed up to $30 $5 copay Reimbursed 75% a er $5 copay 1 exam every 12 months 1 exam every 24 months Standard Lenses $0 copay Reimbursed up to predetermined amount based on lens type Contact Lenses $7.50 copay Reimbursed up to predetermined amount based on lens type 1 pair of lenses every 24 months 1 pair of lenses every 24 months Medical Necessary $0 copay 1 Reimbursed up to $225 Frames Elec ve Reimbursed up to $105 1 Reimbursed up to $75 $7.50 copay Reimbursed up to predetermined amount Reimbursed up to $35 Reimbursed up to predetermined amount 1 pair of contacts every 24 months 1 pair of contacts every 24 months $0 copay for Davis Vision Fashion level frames from Davis Vision s collec on Reimbursed up to $75 for noncollec on frames 1 Reimbursed up to $30 $7.50 copay (combined with lens copay) Reimbursed up to predetermined amount 1 frame every 24 months 1 frame every 24 months 1 For par cipa ng providers, there is a 20% discount on overage for frames and 15% discount on overage for contact lenses. Sign in at to find par cipa ng providers online. If you choose extra op ons beyond the standards that are covered, you are responsible for the addi onal cost, paid directly to the providers. If you choose the BCBSM Vision plan, you must select a provider who par cipates with the Blues vision network (Tradi onal A80). All other providers are considered non par cipa ng providers. A list of par cipa ng providers can be found using the instruc ons found here: h p:// a doctor/find a vision doctor.html.

16 MetLaw Pre-Paid Legal Overview This program offers you assistance in IRS Audits, Preven ve Legal Services (including legal document review, will prepara on and updates), and Motor Vehicle Legal Service. MetLaw requires a one year par cipant commitment. Included in the appendix is a brochure for your review. The cost for this service is $25.50 (a er tax) per month; premiums are paid on a calendar year basis. You must re enroll during Open Enrollment each year to con nue this benefit. InfoArmor Identity and Credit Protection Overview This program provides iden ty and credit monitoring that quickly alerts you of suspicious ac vity before major damages have been done. Services include: Iden ty monitoring to uncover fraud quickly. CreditArmor to make it easy to monitor your credit. Social Media Reputa on Monitoring to protect your en re family against reputa onal damage including racist, violent, derogatory, vulgar, or inappropriate comments on Facebook, LinkedIn, Twi er, and Instagram profiles. WalletArmor is an online vault for securely storing documents, credit cards and online accounts, plus a lost wallet replacement service. Digital Iden ty offers an easy to read report that summarizes what a real me deep Internet search discovers about you. Personalized customer care when you need it most. The cost for this service is $7.95 per individual or $13.95 per family per month (a er tax) and is completely paid by you. You must re enroll during Open Enrollment each year to con nue this benefit. Addi onal informa on on InfoArmor Iden ty and Credit Protec on can be found at or by calling (800) Page 16

17 Flexible Spending Account Overview Flexible Spending Accounts (FSA) let you set aside money from your paycheck before federal, state or city income taxes and Social Security taxes are deducted. When the money is used for eligible expenses, reimbursement is tax free, too. You pay no taxes on the money you contribute to and receive from either reimbursement account. There are two types of flexible spending accounts you can elect: a Health Care Reimbursement Account (HCRA) for qualified medical, dental and vision expenses, and a Dependent Care Reimbursement Account (DCRA) for dependent day care expenses incurred while you and your spouse are working or a ending school full me. If you are currently enrolled in a HCRA or DCRA and wish to con nue in 2016, you MUST re enroll during Open Enrollment. You can set up an HCRA or DCRA by comple ng the online enrollment. You designate how much you want to contribute into each account annually, and each pay period the amount you specified will be put into your personal account(s) to use in paying for health and/or dependent day care expenses not covered by insurance. The accounts are mutually exclusive. You cannot use HCRA funds for Dependent Care expenses, or vice versa. Health Care Reimbursement Account (HCRA) You may set aside any dollar amount from a minimum of $64 to a maximum of $2,550 per year in your HCRA. You may receive your full reimbursement amount for eligible health care expenses at any me during the year. You can use this money to pay for a variety of eligible expenses, such as: Deduc bles and copays (including prescrip on costs) Expenses not covered by any health plan by which you may be covered Expenses in excess of medical or dental coverage limits, such as your share of orthodon a treatment cost Expenses for eye exams, contact lenses and eyeglasses Over the counter drugs when you receive a wri en prescrip on from your physician In most instances, expenses must be incurred between January 1, 2016 December 31, 2016 to be eligible for reimbursement. Call Meritain at for a copy of all eligible expenses under the HCRA. Rollover Rules for your HCRA: If you do not use all your 2015 HCRA funds, up to $500 of your unused funds will automa cally rollover into your 2016 account. Please note the following: Any amount over $500 will be forfeited. The rollover amount will be in addi on to the 2016 annual contribu on maximum. Rollover funds will become available for use in April You do not need to elect a HCRA in 2016 in order to use your 2015 rollover funds, however you do need to be an ac ve Oakland University employee. If you elect to contribute to your HCRA in 2016 and also have rollover funds, Meritain will first use your 2016 elected funds, then use the 2015 rollover funds. At the end of the 2016 plan year, any unused funds in either account (up to the $500 maximum) will rollover into Rollover does not apply to the Dependent Care Account. Page 17

18 Flexible Spending Account Overview (continued) Dependent Care Reimbursement Account (DCRA) You may set aside any dollar amount from a minimum of $64 to a maximum of $5,000 per year in the DCRA. If you are married and your spouse par cipates in a similar account through his or her employer, you may set aside no more than $5,000 combined per year. This account is designed to help you pay for dependent care expenses so you, or you and your spouse, can work. You also can use the account to pay dependent expenses if your spouse a ends school full me or is mentally or physically handicapped and unable to care for your children. In order to be eligible for the DCRA, you and your spouse must work or your spouse must be a full me student. Eligible dependent care can be provided in your home or in someone else s home, or in a care facility (except for a nursing home). When you submit a claim for expenses, you must show your caregiver s tax iden fica on number (for individuals, this usually is their Social Security number). The amount you may use from your DCRA is based on the amount in your account when you submit your claim. Generally, your dependents include: Children under age 13 who qualify as dependents on your federal income tax return. Any dependents unable to care for themselves. For example, an incapacitated older child or spouse or an elderly parent who regularly spends at least eight hours a day in your home and otherwise qualifies as a dependent under IRS rules. Any le over funds in your DCRA at year end cannot be returned to you. This means you must plan carefully before deciding to contribute money to the DCRA. Use the worksheet in this workbook to help you plan properly. If you contribute to a Dependent Care Reimbursement Account, you must file an IRS Form 2441 with your Federal Income Tax Return. Form 2441 is simply an informa onal form on which you report the amount you pay and who you paid for day care. Special Rules for Health Care and Dependent Care Reimbursement Accounts Because the reimbursement accounts provide significant tax savings, the IRS imposes the following rules: Your HCRA and DCRA accounts are completely separate. You may not transfer money from one account to another. In addi on, you may not use your HCRA to pay for dependent care expenses, or vice versa. If you claim an expense for reimbursement through either account, you may not claim the same expense as a deduc on or a credit on your income tax return. Last Day for 2016 Plan Year Claims Submission for Health Care and Dependent Care Reimbursement Accounts: You have un l January 31, 2017 to submit dependent care reimbursement claims incurred in You have un l March 31, 2017 to submit health care reimbursement claims incurred in If you leave the University before the end of the year, you have a run out period in which to submit claims incurred prior to your termina on date. For Dependent Care Reimbursements, you must submit your claims within 30 days following your termina on date. For Healthcare Reimbursements you must submit your claim within 3 months following your termina on date. Page 18

19 Flexible Spending Account Overview (continued) Reimbursements Reimbursement payments will be mailed to your home address unless you have signed up for direct deposit. If you do not currently have direct deposit and would like to begin, you can download the direct deposit form from the Meritain website at and mail it to Meritain. How Much Should You Contribute? Before you set up your HCRA and/or DCRA, you should es mate how much you will spend on eligible expenses during the January 1 December 31 plan year. Use the Eligible Annual Expense Worksheet below to help calculate your health care and dependent care expenses. Es mate your reimbursement account expenses as accurately as possible and be conserva ve, because the Internal Revenue Service requires you to forfeit HCRA funds over $500, and any DCRA funds you do not use by the end of the year. Note, too, that the maximum you can contribute to a FLEX account for health care expenses is $2,550. The maximum you and your spouse can contribute to a dependent care account is $5,000. Using Your Health Care Reimbursement Account To receive payment for an eligible health or dependent care expense, simply fill out a Reimbursement Request Form and submit it with your itemized receipt. Eligible Annual Expense Worksheet Health Care Reimbursement Account: Medical Expenses Deduc bles $ Office Visits, Service Fees $ Copay $ Dental Copay $ Orthodon c Copay $ Vision Expenses $ Hearing Expenses $ Total Es mated HCRA Expenses $ Dependent Care Reimbursement Account: Dependent Day Care Expenses Child Day Care $ Adult Day Care $ Total Es mated DCRA Expenses $ To determine your Bi Weekly per pay contribu on, divide the total by 26 To determine your Monthly per pay contribu on, divide the total by 12 Reimbursements are processed promptly every week. You will be repaid for the full amount of your Health Care Reimbursement Account request, up to the total contribu ons you specified for the year. You will be reimbursed for expenses up to the amount contributed to your Dependent Care Reimbursement Account at the me your request is submi ed. If your reimbursement request is more than the amount available in your account, the remainder will be paid as addi onal funds are deposited. Keeping Track of Your Accounts To help you keep track of your FLEX account(s) and avoid forfeiture, Meritain Health will a ach an account statement with each check a er they have processed your reimbursement request. Meritain Health will also send you quarterly statements detailing your account deposits, reimbursement requests, disbursements, and balances. Please review carefully to ensure accuracy. You can check the status of your Flexible Spending Account on the web at Meritain Health s automated claim status system is also available, from any phone in the United States, at If you have ques ons about your Oakland University Flex plan, contact the Meritain Health Flexible Benefits Department at , or visit their web site at Page 19

20 COBRA Con nua on Coverage Rights Legal Notices Introduc on You are receiving this no ce because you have recently become covered under a group health plan (the Plan). This no ce contains important informa on about your right to COBRA con nua on coverage, which is a temporary extension of coverage under the Plan. This no ce generally explains COBRA con nua on coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it. The right to COBRA con nua on coverage was created by a federal law, the Consolidated Omnibus Budget Reconcilia on Act of 1985 (COBRA). COBRA con nua on coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For addi onal informa on about your rights and obliga ons under the Plan and under federal law, you should review the Plan s Summary Plan Descrip on or contact the Plan Administrator. What is COBRA Con nua on Coverage? COBRA con nua on coverage is a con nua on of Plan coverage when coverage would otherwise end because of a life event known as a qualifying event. Specific qualifying events are listed later in this no ce. A er a qualifying event, COBRA con nua on coverage must be offered to each person who is a qualified beneficiary. You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA con nua on coverage must pay for COBRA con nua on coverage. If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens: Your hours of employment are reduced, or Your employment ends for any reason other than your gross misconduct. If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happens: Your spouse dies; Your spouse s hours of employment are reduced; Your spouse s employment ends for any reason other than his or her gross misconduct; Your spouse becomes en tled to Medicare benefits (under Part A, Part B, or both); or You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they will lose coverage under the Plan because any of the following qualifying events happens: The parent employee dies; The parent employee s hours of employment are reduced; The parent employee s employment ends for any reason other than his or her gross misconduct; The parent employee becomes en tled to Medicare benefits (Part A, Part B, or both); The parents become divorced or legally separated; or The child stops being eligible for coverage under the plan as a dependent child. Page 20

21 COBRA Con nua on Coverage Rights (con nued) Legal Notices (continued) Some mes, filing a proceeding in bankruptcy under tle 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to Oakland University, and that bankruptcy results in the loss of coverage of any re red employee covered under the Plan, the re red employee is a qualified beneficiary with respect to the bankruptcy. The re red employee s spouse, surviving spouse, and dependent children will also be qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan. When is COBRA Coverage Available? The Plan will offer COBRA con nua on coverage to qualified beneficiaries only a er the Plan Administrator has been no fied that a qualifying event has occurred. When the qualifying event is the end of employment or reduc on of hours of employment, death of the employee, commencement of a proceeding in bankruptcy with respect to the employer, or enrollment of the employee s becoming en tled to Medicare benefits (under Part A, Part B, or both), the employer must no fy the Plan Administrator of the qualifying event. You Must Give No ce of Some Qualifying Events For the other qualifying events (divorce or legal separa on of the employee and spouse or a dependent child s losing eligibility for coverage as a dependent child), you must no fy the Plan Administrator within 60 days a er the qualifying event occurs. You must send this no ce to: Oakland University s Human Resource Department. You must include the address of the former dependent with your no fica on. How is COBRA Coverage Provided? Once the Plan Administrator receives no ce that a qualifying event has occurred, COBRA con nua on coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA con nua on coverage. Covered employees may elect COBRA con nua on coverage on behalf of their spouses, and parents may elect COBRA con nua on coverage on behalf of their children. COBRA con nua on coverage is a temporary con nua on of coverage. When the qualifying event is the death of the employee, the employee's becoming en tled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separa on, or a dependent child's losing eligibility as a dependent child, COBRA con nua on coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduc on of the employee's hours of employment, and the employee became en tled to Medicare benefits less than 18 months before the qualifying event, COBRA con nua on coverage for qualified beneficiaries other than the employee lasts un l 36 months a er the date of Medicare en tlement. For example, if a covered employee becomes en tled to Medicare 8 months before the date on which his employment terminates, COBRA con nua on coverage for his spouse and children can last up to 36 months a er the date of Medicare en tlement, which is equal to 28 months a er the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduc on of the employee s hours of employment, COBRA con nua on coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18 month period of COBRA con nua on coverage can be extended. Page 21

22 COBRA Con nua on Coverage Rights (con nued) Legal Notices (continued) Disability extension of 18 month period of con nua on coverage If you or anyone in your family covered under the Plan is determined by the Social Security Administra on to be disabled and you no fy the Plan Administrator in a mely fashion, you and your en re family may be en tled to receive up to an addi onal 11 months of COBRA con nua on coverage, for a total maximum of 29 months. The disability would have to have started at some me before the 60th day of COBRA con nua on coverage and must last at least un l the end of the 18 month period of con nua on coverage. This no ce should be sent to: Oakland University s Human Resource Department. A copy of the Social Security Administra on s determina on le er should be provided with no fica on. Second qualifying event extension of 18 month period of con nua on coverage If your family experiences another qualifying event while receiving 18 months of COBRA con nua on coverage, the spouse and dependent children in your family can get up to 18 addi onal months of COBRA con nua on coverage, for a maximum of 36 months, if no ce of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving con nua on coverage if the employee or former employee dies, becomes en tled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. In all of these cases, you must make sure that the Plan Administrator is no fied of the second qualifying event within 60 days of the second qualifying event. This no ce must be sent to: Oakland University s Human Resource Department. If You Have Ques ons If you have ques ons about your COBRA con nua on coverage, you should contact Oakland University s Human Resources Department or you may contact the nearest Regional or District Office of the U.S. Department of Labor s Employee Benefits Security Administra on (EBSA). Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA s web site at If You Have Ques ons Ques ons concerning your Plan or your COBRA con nua on coverage rights should be addressed to the contact or contacts iden fied below. For more informa on about your rights, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affec ng group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor s Employee Benefits Security Administra on (EBSA) in your area or visit the EBSA website at (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA s website.) Keep Your Plan Informed of Address Changes In order to protect your family s rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any no ces you send to the Plan Administrator. Plan Contact Informa on Oakland University s Human Resources Department 401 Wilson Hall Rochester, MI Voice: 248/ Fax: 248/ Page 22

23 Legal Notices (continued) Pa ent Protec on BCN and Priority Health generally require the designa on of a primary care provider (PCP). You have the right to designate any PCP who par cipates in the network and who is available to accept you or your family members. Un l you make this designa on, the carrier designates one for you. For informa on on how to select a PCP, and for a list of the PCP providers, contact your carrier. For children, you may designate a pediatrician as the primary care provider. For obstetric or gynecological care, you do not need prior authoriza on from the carrier or from any other person (including a PCP) in order to obtain access to obstetrical or gynecological care from a health care professional in the network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authoriza on for certain services, following a pre approved treatment plan or procedures for making referrals. For a list of par cipa ng health care professionals who specialize in obstetrics or gynecology, contact your carrier. Women s Health and Cancer Rights Act of 1998 The Women s Health and Cancer Rights Act (WHCRA) of 1998 is also known as Janet s Law. This law requires that our health plan provide coverage for: All stages of reconstruc on of the breast on which the mastectomy has been performed; Surgery and reconstruc on of the other breast to produce a symmetrical appearance; and Prostheses and physical complica ons of mastectomy, including lymphedemas, in a manner determined in consulta on with the a ending physician and the pa ent. Benefits will be payable on the same basis as any other illness or injury under the health plan, including the applica on of appropriate deduc bles, coinsurance and copayment amounts. Please refer to your benefit plan booklet for specific informa on regarding deduc ble and coinsurance requirements. If you need further informa on about these services under the health plan, please contact the Customer Service number on your member iden fica on card. Newborns and Mothers Health Protec on Act of 1996 Under Federal law, group health plans and health insurance issuers offering group health insurance coverage generally may not restrict benefits for any hospital length of stay in connec on with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a delivery by cesarean sec on. However, the plan or issuer may pay for a shorter stay if the a ending provider (e.g., your physician, nurse midwife, or physician assistant), a er consulta on with the mother, discharges the mother or newborn earlier. Also, under Federal law, plans and issuers may not set the level of benefits or out of pocket costs so that any later por on of the 48 hour (or 96 hour) stay is treated in a manner less favorable to the mother or newborn than any earlier por on of the stay. In addi on, a plan or issuer may not, under Federal law, require that a physician or other health care provider obtain authoriza on for prescribing a length of stay of up to 48 hours (or 96 hours). However, to use certain providers or facili es, or to reduce your out of pocket costs, you may be required to obtain precer fica on. For informa on on precer fica on, contact your plan administrator. Page 23

24 Legal Notices (continued) Coverage Under Michigan s Abor on Insurance Opt Out Act Fully insured plans in Michigan can no longer cover elec ve abor on unless a rider is purchased. Our medical plans, insured by BCBSM, BCN and Priority Health, provide coverage for elec ve abor on; therefore the rider is included. This rider applies to all plan par cipants covered by the insured group medical plan; coverage under this rider cannot be declined on an individual basis. An employee s covered dependents may use this coverage without no ce to the employee. 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, using funds from their Medicaid or CHIP programs. If you or your children are not eligible for Medicaid or CHIP, you will not be eligible for these premium assistance programs, but you may be able to buy individual coverage through the Health Insurance Marketplace. For more informa on, 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, contact your state Medicaid or CHIP office or dial KIDS NOW or to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow 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 ques ons about enrolling in your employer plan, contact the Department of Labor at or call 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 informa on on eligibility. ALABAMA Medicaid Website: Phone: ALASKA Medicaid Website: h p://health.hss.state.ak.us/dpa/programs/medicaid/ Phone (Outside of Anchorage): Phone (Anchorage): COLORADO Medicaid Medicaid Website: h p:// Medicaid Customer Contact Center: FLORIDA Medicaid Website: h ps:// Phone: GEORGIA Medicaid Website: h p://dch.georgia.gov/ Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP) Phone: INDIANA Medicaid Website: h p:// Phone: IOWA Medicaid Website: Phone: KANSAS Medicaid Website: h p:// Phone: Page 24

25 Legal Notices (continued) Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP) (con nued) KENTUCKY Medicaid Website: h p://chfs.ky.gov/dms/default.htm Phone: LOUISIANA Medicaid Website: h p://dhh.louisiana.gov/index.cfm/subhome/1/n/331 Phone: NORTH CAROLINA Medicaid Website: h p:// Phone: NORTH DAKOTA Medicaid Website: h p:// Phone: MAINE Medicaid Website: h p:// assistance/ index.html Phone: TTY: MASSACHUSETTS Medicaid and CHIP Website: h p:// Phone: MINNESOTA Medicaid Website: h p:// Click on Health Care, then Medical Assistance Phone: MISSOURI Medicaid Website: h p:// cipants/pages/ hipp.htm Phone: MONTANA Medicaid Website: h p://medicaid.mt.gov/member Phone: NEBRASKA Medicaid Website: Phone: NEVADA Medicaid Medicaid Website: h p://dwss.nv.gov/ Medicaid Phone: NEW HAMPSHIRE Medicaid Website: h p:// Phone: NEW JERSEY Medicaid and CHIP Medicaid Website: h p:// clients/medicaid/ Medicaid Phone: CHIP Website: h p:// CHIP Phone: NEW YORK Medicaid Website: h p:// Phone: OKLAHOMA Medicaid and CHIP Website: h p:// Phone: OREGON Medicaid Website: h p:// h p:// Phone: PENNSYLVANIA Medicaid Website: h p:// Phone: RHODE ISLAND Medicaid Website: Phone: SOUTH CAROLINA Medicaid Website: h p:// Phone: SOUTH DAKOTA Medicaid Website: h p://dss.sd.gov Phone: TEXAS Medicaid Website: h ps:// Phone: UTAH Medicaid and CHIP Medicaid Website: h p://health.utah.gov/medicaid CHIP Website: h p://health.utah.gov/chip Phone: VERMONT Medicaid Website: h p:// Telephone: VIRGINIA Medicaid and CHIP Medicaid Website: h p:// programs_premium_assistance.cfm Medicaid Phone: CHIP Website: h p:// programs_premium_assistance.cfm CHIP Phone: Page 25

26 Legal Notices (continued) Premium Assistance Under Medicaid and the Children s Health Insurance Program (CHIP) (con nued) WASHINGTON Medicaid Website: h p:// index.aspx Phone: , ext WEST VIRGINIA Medicaid Website: h p:// Pages/ default.aspx Phone: , HMS Third Party Liability WISCONSIN Medicaid Website:h ps:// htm Phone: Page 26 WYOMING Medicaid Website: h ps://wyequalitycare.acs inc.com/ Telephone: To see if any more states have added a premium assistance program since July 31, 2015, or for more informa on on special enrollment rights, contact either: U.S. Dept. of Labor, Employee Benefits Security Administra on: Phone: EBSA (3272) U.S. Dept. of Health and Human Services, Centers for Medicare & Medicaid Services: Phone: , menu op on 4, extension Important No ce from Oakland University About Your Prescrip on Drug Coverage and Medicare No ce of Creditable Coverage Please read this no ce carefully and keep it where you can find it. This no ce has informa on about your current prescrip on drug coverage with Oakland University and about your op ons under Medicare s prescrip on drug coverage. This informa on can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescrip on drug coverage in your area. Informa on about where you can get help to make decisions about your prescrip on drug coverage is at the end of this no ce. There are two important things you need to know about your current coverage and Medicare s prescrip on drug coverage: Medicare prescrip on drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescrip on Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescrip on drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. Oakland University has determined that the prescrip on drug coverage offered by our medical plans is, on average for all plan par cipants, expected to pay out as much as standard Medicare prescrip on drug coverage pays and is therefore considered Creditable Coverage. Because your exis ng coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

27 Legal Notices (continued) Important No ce from Oakland University About Your Prescrip on Drug Coverage and Medicare (con nued) When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15 th through December 7 th. However, if you lose your current creditable prescrip on drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Oakland University coverage may be affected. For more informa on, please refer to the benefit plan s governing documents. If you do decide to join a Medicare drug plan and drop your current Oakland University coverage, be aware that you and your dependents may not be able to get this coverage back. For more informa on, please refer to the benefit plan s governing documents. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with Oakland University and don t join a Medicare drug plan within 63 con nuous days a er your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 con nuous days or longer without creditable prescrip on drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescrip on drug coverage. In addi on, you may have to wait un l the following October to join. For More Informa on About This No ce Or Your Current Prescrip on Drug Coverage Contact the person listed below for further informa on. NOTE: You ll get this no ce each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Oakland University changes. You also may request a copy of this no ce at any me. Page 27

28 Legal Notices (continued) Important No ce from Oakland University About Your Prescrip on Drug Coverage and Medicare (con nued) For More Informa on About Your Op ons Under Medicare Prescrip on Drug Coverage More detailed informa on about Medicare plans that offer prescrip on drug coverage is in the Medicare & You handbook. You ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more informa on about Medicare prescrip on drug coverage: Visit Call your state Health Insurance Assistance Program (see the inside back cover of your copy of the Medicare & You handbook for their telephone number) for personalized help Call MEDICARE ( ). TTY users should call If you have limited income and resources, extra help paying for Medicare prescrip on drug coverage is available. For informa on about this extra help, visit Social Security on the web at or call them at (TTY ). Date: October 15, 2015 Name of En ty/sender: Oakland University Contact Posi on/office Ron Watson Address: 401 Wilson Hall, Rochester Hills, MI Phone Number: Remember: Keep this Creditable Coverage no ce. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this no ce when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty). Page 28

29 Monthly Medical Premium Rates effec ve 1/1/16 Liberty Mutual Auto Insurance MetLaw Informa on InfoArmor Informa on Appendix Page 29

30 65% SPECIAL LECTURERS Monthly Medical Premium Rates Effective 1/1/16 January April 2016 Total Premium OU's Contribution Employee Contribution Blue Cross/Blue Shield PPO "A" Single $1, $ $ Two Party $3, $1, $2, Three or more $4, $1, $3, Blue Cross/Blue Shield PPO "B" Single $1, $ $ Two Party $3, $1, $1, Three or more $4, $1, $2, Blue Care Network Healthy Blue Living HMO Single $1, $ $ Two Party $2, $1, $1, Three or more $3, $1, $1, Priority Health HealthbyChoice Achievements HMO Single $1, $ $ Two Party $2, $1, $ Three or more $2, $1, $1, Delta Dental Single $66.92 $43.50 $23.42 Two Party $ $86.08 $46.36 Three or more $ $ $85.36 Davis Vision Single $8.70 $5.66 $3.04 Two Party $17.38 $11.30 $6.08 Three or more $21.72 $14.12 $7.60 Blue Cross Vision Single $7.60 $4.94 $2.66 Two Party $18.26 $11.86 $6.40 Three or more $22.82 $14.84 $7.98

31 You work hard for your students. We work hard for you. At Liberty Mutual Insurance, we re giving you something in return for everything you give to students. We ve partnered with Oakland University to offer exclusive auto insurance savings and benefits to people like you who work to enrich the lives and minds of today s scholars. AUTO INSURANCE BENEFITS New Car Replacement: If your car is totaled in the first year, you ll get the money for a brand new car, not just the depreciated value. 1 Accident Forgiveness: We won t raise your price due to your first accident Hour Claims Assistance: Our dedicated team is always available to settle your claim. Call, go online, or use your mobile device, anytime. Life Event Features and Savings: Liberty Mutual offers multiple savings opportunities to support you no matter where you are in life. ExCLUSIve GROUp SavINGS As an Oakland University employee, you could also receive Exclusive Group Savings on your auto and home insurance. 3 Contact me to learn more or to get a quote. Michael Meyers Lakeside Circle - Suite 110 Executive Sales Representative Sterling Heights, MI ext michael.meyer@libertymutual.com Please mention client # Applies to a covered total loss. Your car must be less than one year old, have fewer than 15,000 miles and have had no previous owner. This program does not apply to leased vehicles, nor is it available in NC or WY. Deductible applies. 2 To qualify, you must be accident-free for five reports, and in most states, not received a driving violation for the past 5 years. Accident Forgiveness coverage is subject to terms and conditions of Liberty Mutual s underwriting guidelines, and varies by state. Not available in CA or NC. 3 Discounts and savings are available where state laws and regulations allow and may vary by state. To the extent permitted by law, applicants are individually underwritten; not all applicants may qualify. Coverage underwritten and provided by Liberty Mutual Insurance Company and its affiliates, 175 Berkeley Street, Boston, MA Liberty Mutual Insurance Company. All rights reserved.

32 MetLaw SPONSOR Oakland NAME Smart. Simple. Affordable. University Telephone & Office Consultations MetLaw provides you with telephone and office consultations for an unlimited number of matters with the attorney of your choice. During the consultation, the attorney will review the law, discuss your rights and responsibilities, explore your options and recommend a course of action. Legal Representation Estate Planning Money Matters Real Estate Matters Elder Law Matters Simple Wills Complex Wills Revocable Trusts Irrevocable Trusts Powers of Attorney (healthcare, financial, childcare) Healthcare Proxies Living Wills Codicils Personal Bankruptcy/Wage Earner Plan Debt Collection Defense Foreclosure Defense Repossession Defense Garnishment Defense Identity Theft Defense Tax Collection Defense Negotiations with Creditors Tax Audit Representation (Municipal, State, Federal) Sale, Purchase or Refinancing of primary, second or vacation home Home Equity Loans for primary, second or vacation home Eviction & Tenant Problems (for tenant) Security Deposit Assistance (for tenant) Boundary or Title Disputes Property Tax Assessments Zoning Applications Consultation & Document Review for issues related to your parents: Medicare Medicaid Prescription Plans Nursing Home Agreements Leases Notes Deeds Wills Powers of Attorney Family Law Traffic Offenses* Document Preparation Immigration Assistance Adoption & Legitimization Guardianship Conservatorship Name Change Prenuptial Agreement Protection from Domestic Violence Defense of Traffic Tickets (excludes DUI) Driving Privileges Restoration (includes License Suspension due to DUI) Affidavits Deeds Demand Letters Mortgages Promissory Notes Review of Any Personal Legal Document Advice & Consultation Review of Immigration Documents Preparation of Affidavits Preparation of Powers of Attorney Juvenile Matters Consumer Protection Defense of Civil Lawsuits Personal Property Protection Juvenile Court Defense (includes Criminal Matters) Parental Responsibility Matters Disputes over Consumer Goods & Services Small Claims Assistance Civil Litigation Defense Incompetency Defense Administrative Hearings School Hearings Pet Liabilities Consultation & Document Review for personal property issues Assistance for disputes over goods & services For More Information: Visit info.legalplans.com and enter access code GETLAW or call our Client Service Center at (Monday Friday, 8 am to 7 pm EST/EDT). $25.50 per month covers employee, spouse and dependents The cost is automatically deducted from your paycheck. Additional Plan Features Reduced Fees Network attorneys provide representation for personal injury, probate & estate administration matters at reduced fees. E-Services Family Matters ** Available for an additional fee. Separate plan for parents of participants for estate planning documents. Attorney Locator; Law Firm E-Panel ; Free, downloadable legal documents; Life Guide; Links to financial planning, insurance & work/life matters resources Group Legal Plans and Family Matters are provided by Hyatt Legal Plans, Inc., a MetLife company, Cleveland, Ohio. In certain states, group legal plans and Family Matters are provided through insurance coverage underwritten by Metropolitan Property and Casualty Company and Affiliates, Warwick, Rhode Island. Please contact Hyatt Legal Plans for complete details on covered services including trials. No service, including advice and consultations, will be provided for: 1) employment-related matters, including company or statutory benefits; 2) matters involving the company, MetLife and affiliates, and Plan Attorneys; 3) matters in which there is a conflict of interest between the employee and spouse or dependents in which case services are excluded for the spouse and dependents; 4) appeals and class actions; 5) farm matters, business or investment matters, matters involving property held for investment or rental, or issues when the Participant is the landlord; 6) patent, trademark and copyright matters; 7) costs or fines; 8) frivolous or unethical matters; 9) matters for which an attorney-client relationship exists prior to the Participant becoming eligible for plan benefits. For all other personal legal matters, an advice and consultation benefit is provided. Additional representation is also included for certain matters listed above under Legal Representation. *Not available in all states. **For Family Matters, different terms and exclusions apply. L [exp0815][All States][DC]

33 Sources: 1. Javelin Strategy and Research: 2015 Identity Fraud Report / 2. ITRC Identity Theft: The Aftermath 2008 P R O T E C T I N G W H A T M A T T E R S M O S T A GROWING CRISIS: IDENTITY THEFT 12.7 MILLION IDENTITY THEFT VICTIMS IN 2014 / $16 BILLION STOLEN FROM FRAUD 1 VICTIMS IN 2014 / EVERY 2 SECONDS AN IDENTITY IS STOLEN1 / 2 IN 3 DATA BREACH VICTIMS BECAME AN IDENTITY FRAUD VICTIM IN / WORK HOURS TO REMEDIATE A CASE OF IDENTITY THEFT 2 1 MORE THAN MONITORING INFOARMOR S PRIVACYARMOR PROVIDES COMPREHENSIVE PROTECTION THAT GOES FAR BEYOND CREDIT MONITORING AND FREE BREACH SOLUTIONS. Our identity and credit monitoring solution deploys cutting-edge technology and professional service to detect, intercept, and remediate the misuse of personal information that puts your identity at risk.

34 INFOARMOR: PROTECTING YOUR FINANCES, PRIVACY, AND REPUTATION Identity & Credit Monitoring / Let us give you peace of mind by proactively monitoring for the most damaging types of identity fraud. * By uncovering and resolving issues early, we can help minimize damages. We also monitor your credit through TransUnion. Credit Scores and Reports / Gain access to a monthly credit score and a credit report each year from TransUnion. Stay informed and protect your financial assets by detecting credit misuse quickly. Password Protection / Our secure vault automatically saves and syncs your passwords across desktop and mobile devices. This tool makes using complex passwords simple and safe. Social Media Reputation Monitoring / We monitor Facebook, LinkedIn, Twitter, and Instagram profiles, generating actionable alerts that help defend you and your family from reputational damage or cyberbullying. * PLANS AND PRICING $7.95 per person per month $13.95 per family per month Wallet Protection / InfoArmor can easily replace the contents of a lost or stolen wallet through an online, secure vault that conveniently stores important documents. Digital Identity Report / Our deep internet search creates a snapshot of your exposed information online, giving you a chance to take control of your privacy. Privacy Advocate Remediation / Have an expert on your side to guide you through the identity restoration process and fight back against identity thieves. $1,000,000 Identity Theft Insurance Policy / If you are a victim of fraud, we will reimburse your out of pocket costs to reinforce your financial security. Solicitation Reduction / Guidance on how to limit exposure to fraud while reducing annoying calls, mail, and preapproved credit offers. LEARN MORE AT: QUESTIONS? CALL: *Network provides comprehensive coverage, although no solution can detect all suspicious activity. Nonetheless, our Privacy Advocates will work tirelessly to restore your identity regardless of when or how the damage was done. Identity theft insurance underwritten by insurance company subsidiaries or affiliates of AIG. The description herein is a summary and intended for informational purposes only and does not include all terms, conditions and exclusions of the policies described. Please refer to the actual policies for terms, conditions, and exclusions of coverage. Coverage may not be available in all jurisdictions.