New Employee Benefit Guide

Transcription

1 Revised 01/2018 New Employee Benefit Guide This guide will provide you with general details about your medical, dental, flexible spending and other benefits.

2 In hac habitasse platea dictumst. General Information Customer Service Centers For questions about your benefit options: Highmark (800) Delta Dental (800) NVA Vision (800) Contact Fill (866) TIAA (800) Contacts Kelly Bertani Christine Callender Lori Bush Coverage Effective Date Coverage begins the first of the month following the date of hire.

3 Dependent Information Eligible Dependents Eligible Dependents are a covered employee s legally recognized spouse or same sex Domestic Partner as defined by the College s policies and dependent children through age 25 (under age 26). Non-Eligible Dependents Coverage is not provided to an employee s grandchild(ren); to the spouse or children of an employee s adult child; or to other relatives not listed above. Definition of Dependent Child A dependent child is defined as: a child who is under age 26 (coverage is provided through age 25), and a covered employee's biological child; step-child; legally-adopted child; child legally placed for lawful adoption; eligible foster child, defined as a child placed with the employee by an authorized placement agency or by judgment, decree, or other order of any court of competent jurisdiction; or the child of the employee's same-sex Domestic Partner. Sed et tellus at quam sagittis pharetra. Donec faucibus sagittis justo. An eligible dependent child who is mentally or physically incapable of earning a living and chiefly dependent on the covered employee for support (the employee provides over half of the child's financial support) will continue to be eligible for coverage through the Plan, provided that the onset of incapacity occurred before the age of 19. Proof of Dependent Status Verification of dependent status (such as a marriage or birth certificate, a copy of the most recent tax return, a copy of a court order, etc.) must be provided to the office before a dependent may be enrolled in any of the plans.

4 2018 Premiums Low Deductible Plan $450: Medical/Prescription Plan Monthly Cost Bi-Weekly Cost Employee Only $ $51.39 Employee + One $ $83.94 Employee + Family $ $ High Deductible Plan $1,500: 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 $1.54 Employee + One $4.88 $2.25 Employee + Family $9.13 $4.21

5 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 check-ups, 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 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

6 Prescription Drug Plan (applies to both plans) Prescription Drug The listed copays will apply when purchasing prescription drugs through a participating pharmacy or the Express Scripts mail order program. Tier 1 Generic Drugs Tier 2 Brand Name Drugs Tier 3 Non-Formulary and Specialty Drugs Retail Pharmacy (31 day supply) 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 Mail Order (90 day supply) 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 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 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

7 Health Reimbursement Account (HRA) Features (High Deductible Health Plan Only) Health Reimbursement Account (HRA) HRA Annual Contributions Carryover of Balances To help those who elect the High Deductible Health Plan pay the deductible, copays and coinsurance, the College will contribute 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 employees HRA as of December 31 will carry over to the next year, providing the individual remains employed and enrolled in the High Deductible Health These funds will be added to the contribution the College makes on behalf of each participant that year. 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? An HRA participant may receive reimbursement from his/her HRA by either charging eligible expenses to an HRA debit card, or by paying for the health care expense and requesting reimbursement online, via fax, or mail. HRA claim forms are available from. 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. Only when the FSA is exhausted, will expenses be reimbursed from your HRA. A faculty or staff member who elects 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.

8 Flexible Spending Account (FSA) Plan Medical FSA Dependent Care FSA What is a Flexible Spending Account? Will my elections carry over from year to year? Flexible Spending Accounts provide a convenient way to contribute pretax 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 below deadlines are forfeited. For this reason, please plan your FSA contributions carefully. Your FSA elections will NOT carry over. You must elect a contribution via the online Open Enrollment process if you would like to participate in the next year. Annual Maximum Limits Deadline for Using Funds Eligible Expenses- Medical Eligible Expenses- Dependent Care What if I have an HRA and a Medical FSA? Medical $2,650 Dependent Care $5,000 ($2,500 if married but filing separately) Medical Expenses incurred from January 1, 2018 March 15, 2019 must be submitted by March 31, 2019 Dependent Care Expenses incurred from January 1, 2018 December 31, 2018 must be submitted by March 31, 2019 The Medical FSA can be used for expenses such as copays, deductible expenses, dental and prescription drugs which are not reimbursed through any insurance plan. For a full list of eligible expenses, visit The Dependent Care FSA can be used for expenses such as the cost of childcare services for children through age 12. 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 to Get Reimbursed Participants may pay for eligible medical expenses (but not dependent care expenses) with a special debit card issued by the College s FSA Administrator, Highmark. You may also submit a claim for reimbursement to Highmark online, fax, or mail. You may elect to be reimbursed by check or by direct deposit. Claim forms and direct deposit forms are available from.

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). Maximum Annual 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.

10 Education Benefits Employee Eligible upon hire to attend F&M part time free of charge. Spouse/Significant Other After 5 years, may attend F&M part time free of charge or full time with 85% of tuition waived. Dependent Children Grant-in-aid After 5 years of full time employment an employee may receive a grant equal to 85% of tuition for eligible child(ren) attending F&M. Children s Scholarship After 5 years of full time employment, you may apply for a scholarship for dependent child(ren) at any accredited college or university. You will receive15% of F&M tuition or full tuition at chosen school, whichever is less. Tuition Exchange Program After 5 years of full time employment, you may enroll dependent child(ren) for undergraduate study at another participating Tuition Exchange institution. The scholarship will offset full tuition fees. These scholarships are limited and not guaranteed.

11 Retirement & Insurance Benefits College Funded Retirement Savings Plan Funded by the College after 2 years of full time employment. 12% of gross base pay put in a 403b plan managed by TIAA. Prior employment at an institution of higher education may waive some or all of the waiting period. Every 2 years of full time uninterrupted employment waives 6 months. Voluntary Retirement This is optional, you may enroll, change, or opt out at any time. $18,500 maximum annual contribution. Group Life Insurance Provided by the College upon hire. Provides for 1.5 x base pay up to $100,000 maximum. Group Long Term Disability Provided by the College after one year of full time employment. Wait may be waived if you had coverage within the last 90 days.

12 Leave Benefits Family & Medical Leave Sick Leave Eligible for up to 12 weeks unpaid leave in a 12 month period if worked at least 1,250 hours and have been employed for at least 12 months. Professional Staff Exempt staff is eligible for 12 paid sick days; non-exempt staff receives 3 additional family illness days. Unused sick days will go to an Extended Sick Leave Bank (ESLB). Faculty eligible for 20 sick leave days with increases for years of service. Vacation Bereavement Holidays Professional Staff Exempt staff is eligible for 24 days/year; non-exempt staff receives 10 days/year with increases for years of service. Full time employees can be eligible for up to 10 days or more for the death of an immediate family member; days are at the supervisor's discretion. Full time employees are eligible for 13 paid holidays per year.