Open Enrollment November 5 to November 23, 2018 pg. 1
Table of Contents General Information. 3 Open Enrollment Checklist.. 4 What s New for 2019?... 5 NEW Optional Life Insurance. 6 2019 Employee Premiums 8 Low Deductible PPO Health Plan. 9 High Deductible PPO Health Plan & HRA.10 Prescription Drug Plan..11 Dental Plan 12 Vision Plan.13 Flexible Spending Accounts.. 14 Wellness Rewards Program..15 pg. 2
General Information Franklin & Marshall College is pleased to offer eligible employees a comprehensive and valuable benefits program. Open Enrollment is the period when eligible employees have the opportunity to enroll into or change their options for health and welfare benefits. The changes you make during Open Enrollment will be effective January 1, 2019. The elections you make during Open Enrollment will remain in effect for the entire year, January 1, 2019 through December 31, 2019, unless you have a qualified life event. Qualified life events include: Marriage Divorce Legal Separation Status change Birth or adoption of a child Change in child s dependent status Death of a spouse, child or other qualifying dependent Change in spouse s benefits or employment status Open Enrollment Time Period Open Enrollment will be held beginning November 5 and ending November 23, 2018. During this time period you may do the following: Enroll in or change coverage Add and/or remove an eligible dependent from your coverage, including dependent children up to age 26 Opt out of coverage* Elect your annual contribution to the Medical and/or Dependent Care Flexible Spending Account. Your current election DOES NOT roll over from year to year. * You may decline health insurance offered by Franklin & Marshall College - this is called a Waiver of Coverage. If you waive coverage for yourself, you may not cover dependents under the F&M health plan. Note that if you decline coverage considered affordable and adequate under the Patient Protection and Affordable Care Act, you will not qualify for government subsidies to purchase individual health insurance. Electing to Opt Out of coverage through open enrollment, or allowing your opt out status to continue constitutes a Waiver of Coverage. The decision to waive coverage has consequences. If you refuse employer coverage and don t obtain coverage on your own (through another plan such as a spouse s plan, Medicaid, or Medicare), you may be subject to a tax penalty. pg. 3
Open Enrollment Checklist Evaluate Think about your health history and your health care needs. Review your current Flexible Spending Account contributions and expenses to determine if you d like to make an election based on your anticipated expenses for 2019. Determine if your current, spouse s, and/or child(ren) s life insurance coverage provides adequate protection if you or your family were to experience a loss. Gather your dependent and beneficiary information, including Social Security numbers, dates of birth, addresses and phone numbers. Engage Read through this Enrollment Guide to make sure you understand the full spectrum of benefits available to you. Attend a 60-minute Group Education Session to learn about all your benefits and the upcoming benefit changes for 2019. Sessions will be available: o Tuesday, November 6 at 11:30 am in 1787, College Square o Monday, November 12 at 3:00 pm in Stahr Auditorium Review the Open Enrollment website. Contact Human Resources to assist with any questions you may have. Enroll Complete and save your 2019 elections during the Open Enrollment Time Period (Monday, November 5 through Friday, November 23, 2018) at Inside F&M. If you go back into your elections to view or make a change to your initial elections, you must remember to click Complete for your updates to be saved. Complete your optional life insurance Evidence of Insurability, if required. An email with instructions would have been sent to you if this step is required. Confirm your elections were saved by reviewing your Benefits Summary at Inside F&M. o For monthly change your As Of Date field to 1/1/2019 o For bi-weekly change your As Of Date field to 12/9/2018 pg. 4
What s New for 2019? Optional Life Insurance The College will be offering a variety of life insurance products through The Standard Company. You have the opportunity to purchase optional coverage for yourself, spouse and dependent child(ren) up to age 26. Therapy Services The annual deductible requirement for Physical Medicine, Respiratory Therapy, Speech Therapy and Occupational Therapy will be removed and a $20 co-pay for these services will be added. Emergency Room (ER) Visit Co-Pay The co-pay for emergency room visits will increase from $100 to $150. This co-pay is waived if you are admitted to the hospital. Specialty Drug Tier There will be a new tier for specialty drugs that will only allow a 31 day supply to be purchased at a time. Coverage for these drugs will remain the same. You pay 35% of the drug cost, with a $50 minimum and $80 maximum co-pay per prescription. Prescription Drug Refill Threshold The prescription drug refill threshold will increase from 60% to 75%. For example, if you currently have a 30 day supply, you can only refill the prescription 22 days after the last fill date. Flexible Spending Accounts & Health Reimbursement Account Highmark is changing their administrator for these accounts. All enrollees for 2019 will receive a brand new debit card in late December. Enrollees will also have instant access to a free powerful mobile app. Domestic Partner Coverage Due to the 2015 US Supreme Court ruling allowing same-sex couples the constitutional right to marry, the College will no longer provide coverage for newly designated Domestic Partners beginning January 1, 2019. Education Benefits for Dependent Child(ren) The eligibility requirement for education benefits for dependent child(ren) is being reduced. The new eligibility requirement is two years (24 months) of full-time employment and will begin with the Fall 2019 semester. The November 15, 2018 Tuition Exchange application deadline for the Fall 2019 semester remains unchanged. Separate communications detailing this change will be coming soon. Tobacco/Nicotine Surcharge In the spirit of promoting health and wellness on Campus, and in an attempt to control rising healthcare costs, the College will be implementing a tobacco/nicotine surcharge on users with our next open enrollment period in 2020. Separate communications detailing the surcharge and opportunities to participate in cessation programs will be coming soon. pg. 5
NEW - Optional Life Insurance It s always a good idea to plan ahead, especially when it comes to protecting you and your family. That s what these extra benefits are all about. New for 2019, the College will be offering a variety of fully portable or convertible insurance products through The Standard Company. You have the opportunity to purchase optional coverage for yourself, spouse and dependent child(ren) up to age 26. The Standard Company www.standard.com For general questions: 1-800-348-3226 For Evidence of Insurability questions: 1-800-843-7979 Employee Optional Life Coverage Benefit Schedule $10,000 increments up to $500,000 Minimum Coverage $10,000 Maximum Coverage $500,000, not to exceed 6x Annual Salary when combined with your employer-paid life insurance coverage *Guaranteed Issue Amount $150,000 Age Reduction Schedule 65% at Age 65 Additional 50% at Age 70 Additional 35% at Age 75 *This is the amount you can enroll into without having to complete Evidence of Insurability. Spouse Optional Life Coverage You must enroll in Employee Optional Life Coverage in order to elect coverage for your Spouse. Spouse and child(ren) coverage cannot exceed 100% of the employee s optional life coverage. Benefit Schedule $5,000 increments up to $250,000 Minimum Coverage $5,000 Maximum Coverage $250,000 *Guaranteed Issue Amount $50,000 Age Reduction Schedule 65% at Age 65 Additional 50% at Age 70 Additional 35% at Age 75 *This is the amount you can enroll into without having to complete Evidence of Insurability. Dependent Child(ren) Optional Life Coverage You must enroll in Employee Optional Life Coverage in order to elect coverage for your dependent child(ren). Benefit Schedule Flat $10,000 pg. 6
NEW - Optional Life Insurance (continued) Evidence of Insurability (EOI) If you elect an amount above the Guaranteed Issue Amount for Employee and/or Spouse Optional Life Coverage, you will be asked to provide proof that you and/or your spouse are in good health, otherwise known as Evidence of Insurability. If you make an election that is subject to EOI, you will be asked to complete your EOI online. Human Resources will enroll you and/or your spouse at the Guaranteed Issue Amount. Once The Standard Company reviews your EOI, they will notify you directly if you were approved. They will also let Human Resources know what coverage amount you were approved for. Human Resources will then adjust your election appropriately. When completing your EOI online, you ll need the following information: Group Name: Franklin & Marshall College Policy Number: 756762 Optional Life Premiums Premiums for both Employee and Spouse Optional Life Coverage are based on the employee s age as of the prior year s January 1 st. Employee s Age Rate per $1,000 of Coverage per Month 20-29 $0.06 30 34 $0.08 35 39 $0.09 40 44 $0.10 45 49 $0.15 50 54 $0.23 55 59 $0.43 60 64 $0.66 65 69 $1.27 70 74 $2.06 75 + $6.82 Child(ren) Coverage $0.20 For detailed information about these plans, please visit the Optional Life Insurance webpage. pg. 7
2019 Employee Premiums Medical and Prescription Drug Plan Employee s share of the premium will increase by 2% in 2019. Low Deductible Plan: Monthly Cost Bi-Weekly Cost Employee Only $113.58 $52.42 Employee + One $185.50 $85.61 Employee + Family $302.69 $139.70 High Deductible Plan: Monthly Cost Bi-Weekly Cost Employee Only $76.05 $35.10 Employee + One $124.42 $57.42 Employee + Family $202.39 $93.41 Dental Plan Employee s share of the premium will increase by 5% in 2019. Monthly Cost Bi-Weekly Cost Employee Only $28.72 $13.25 Employee + One $50.21 $23.17 Employee + Family $75.04 $34.64 Vision Plan Employee s share of the premium remains the same for 2019. Monthly Cost Bi-Weekly Cost Employee Only $3.33 $1.54 Employee + One $4.88 $2.25 Employee + Family $9.13 $4.21 pg. 8
Low Deductible PPO Health Plan Health Plan Provisions: Highmark Blue Shield www.highmarkblueshield.com 1-800-345-3806 Provisions In-Network Out-of-Network Annual Deductible Individual: $450 $1,125 Family: Coinsurance Coins. Out-of-Pocket Max Individual: Family: Office Visit Copays: Primary Care Physician Telemedicine Services Urgent Care Center Specialist Emergency Room Visit In-Patient Hospital Stay Routine Preventive Care: Physical Exams Immunizations Routine Gynecological Exam Mammograms Diagnostic Services $900 Plan pays 95% after deductible $1,000 $2,000 $20 per visit $15 per visit $30 per visit $40 per visit $150 per visit $100 per stay $2,250 Plan pays 70% after deductible $5,000 $10,000 Not covered $150 per visit $750 per stay 70% (no deductible) For detailed information about this plan, please visit the Health & Prescription Coverage Plan webpage. pg. 9
High Deductible PPO Health Plan & HRA Health Plan Provisions: Highmark Blue Shield www.highmarkblueshield.com 1-800-345-3806 Provisions In-Network Out-of-Network Annual Deductible Individual: $1,500 $3,000 Family: Coinsurance Coins. Out-of-Pocket Max Individual: Family: Office Visit Copays: Primary Care Physician Telemedicine Services Urgent Care Center Specialist Emergency Room Visit In-Patient Hospital Stay Routine Preventive Care: Physical Exams Immunizations Routine Gynecological Exam Mammograms Diagnostic Services $3,000 Plan pays 95% after deductible $1,000 $2,000 $20 per visit $15 per visit $30 per visit $40 per visit $150 per visit $100 per stay $6,000 Plan pays 70% after deductible $5,000 $10,000 Not covered $150 per visit $750 per stay 70% (no deductible) For detailed information about this plan, please visit the Health & Prescription Coverage Plan webpage. Health Reimbursement Account (HRA) For those enrolling in the High Deductible PPO Health Plan, the College contributes money into a Health Reimbursement Account (HRA) to help offset the costs of the higher deductibles of this plan, as well as help cover the costs of copays and coinsurance. For detailed information about this plan, please visit the Health Reimbursement Account (HRA) webpage. Coverage Tier Annual Contribution Employee Only $420 Employee + One $840 Employee + Family $1,260 pg. 10
Prescription Drug Plan Plan Provisions: Regardless of which Health Plan you enroll into, the following prescription drug plan applies to both. Highmark Blue Shield www.highmarkblueshield.com 1-800-345-3806 Tier 1: Generic Drugs Participating Retail Pharmacy (31 day supply) You pay 15% of the drug cost Minimum $5; Maximum $15 Express Scripts Mail Order (90 day supply) You pay 15% of the drug cost Minimum $12; Maximum $37 Tier 2: Brand Name Drugs You pay 25% of the drug cost Minimum $20; Maximum $50 You pay 25% of the drug cost Minimum $40; Maximum $100 Tier 3: Non-Formulary Drugs You pay 35% of the drug cost Minimum $50; Maximum $80 You pay 35% of the drug cost Minimum $100; Maximum $160 Tier 4: Specialty Drugs You pay 35% of the drug cost Minimum $50; Maximum $80 Not available Annual Maximum $1,500 per person; $3,000 per family per calendar year For detailed information about this plan, please visit the Health & Prescription Coverage Plan webpage. pg. 11
Dental Plan Plan Provisions: Deductible (Only applies to Basic and Major Services) Annual Maximum Delta Dental www.deltadentalins.com 1-800-932-0783 $50 per person; $150 per family each calendar year $1,500 per person each calendar year Diagnostic & Preventive Services Exams Cleanings X-rays Sealants Basic Services Fillings Endodontics (root canals) Periodontics (gum treatment) Oral Surgery Major Services Crowns Inlays Onlays Cast restorations Bridges Dentures Implants Orthodontic Dependent children to age 19 Delta Dental PPO Dentists Non-Delta Dental PPO Dentists* 100% 100% 80% 80% 50% 50% 50% 50% Orthodontic Maximum $1,500 Lifetime $1,500 Lifetime *Participants who visit a non-participating dentist will still receive coverage, but will likely pay higher out-of-pocket costs since you will be responsible for the coinsurance listed above, plus all fees charged by your dentist in excess of Delta Dental s normal reimbursement rates to participating dentists. For detailed information about this plan, please visit the Dental Plan Coverage webpage. pg. 12
Vision Plan Plan Provisions: NVA National Vision s www.e-nva.com 1-800-672-7723 Group # 12600001 Benefit Frequency Participating Provider Non-Participating Provider Examination Once Every Calendar Year Covered at 100% Reimbursed Amount: Up to $30 Lenses Once Every Calendar Year Single Vision Bifocal Trifocal Lenticular Solid Tints Prisms Frame Once Every Two Calendar Years Contact Lenses Once Every Calendar Year Elective Contact Lenses Medically Necessary Standard Glass or Plastic Covered at 100% Retail Allowance Up to $60 (20% discount off balance) In lieu of Lenses Up to $75 Covered at 100% Reimbursed Amount: Up to $25 Up to $35 Up to $45 Up to $80 N/A N/A Reimbursed Amount: Up to $25 In lieu of Lenses Up to $55 Up to $150 For detailed information about this plan, please visit the Vision Plan webpage. pg. 13
Flexible Spending Accounts Flexible Spending Accounts provide a convenient way to contribute pre-tax dollars for qualified medical and dependent care expenses. A Flexible Spending Account is commonly known as the use it or lose it account as funds not used by the deadlines defined below will be forfeited. You do not have to participate in a Health Plan at the College to participate in a Flexible Spending Account. You must re-enroll into a Flexible Spending Account each year. Your current elections will not rollover into the new plan year. Medical Flexible Spending Account Highmark Blue Shield www.highmarkblueshield.com 1-800-345-3806 Annual Maximum $2,650 Deadline Expenses incurred from January 1, 2019 to March 15, 2020 must be submitted for reimbursement by March 31, 2020. Eligible Expenses Expenses such as co-pays, co-insurance and deductibles for medical, dental, prescription drug and vision plans not covered through the insurance plan. For a complete list of eligible expenses, visit http://irs.gov/publications/p502. Dependent Care Flexible Spending Account Highmark Blue Shield www.highmarkblueshield.com 1-800-345-3806 Annual Maximum $5,000 ($2,500 if married but filing separately) Deadline Expenses incurred from January 1, 2019 to December 31, 2019 must be submitted for reimbursement by March 31, 2020. Eligible Expenses Expenses such as the cost of childcare services for children through age 12. For detailed information about these plans, please visit the Flexible Spending Accounts webpage. pg. 14
Wellness Rewards Program Tier 1 (Required): $75 Reward Complete Real Age Test through Share Care Register for Telemedicine (N/A if already registered) Complete Preventive Check Up About the Program Take advantage of simple wellness rewards program offered by Franklin & Marshall College. As you complete these requirements, you ll make strides toward a healthier you! Tier 2 (Choose 3): $200 Reward Dental exam Mammogram/Pap test Vision exam Prostate exam Colorectal screening Osteoporosis screening Flu Shot Program Dates June 1, 2018 through April 30, 2019 to earn your Wellness rewards. Participants will be provided a survey form beginning in March 2019 to submit the completion of their Wellness Rewards Activities. All rewards are taxable and will be distributed through payroll before June 30, 2019. Eligibility All Franklin & Marshall full-time employees. Skin Health assessment Tier 3 (Choose 3): $300 Reward Enroll in Tobacco Cessation program Stress assessment Completion of 2 on-campus wellness seminars Set a goal with a health coach Set any goal in My Health Assistant Completion of an organized community walk/run Utilize Connect Care 3 Nurse Navigator Completion of a financial consultation with a TIAA advisor or Cigna financial specialist. Use the Wellness Website as a Resource Check out the Wellness Website for updates on F&M Wellness Events and Activities Track Your Progress Use the Wellness Rewards Information and Progress Sheet to monitor your activities over the course of the year. Questions? Contact the Wellness Committee at wellnessask@fandm.edu pg. 15