Employee Benefits Guide

Employee Benefits Guide Plans effective January 1, 2017 Full-Time Faculty

Welcome to Montgomery County Community College! Montgomery County Community College (the College) strives to offer you and your dependents a competitive and comprehensive benefits package. We encourage you to take the time to review the benefits available to you, presented in this Guide, and choose the ones that best suit your needs. Once you have made your elections, you will not be able to change them until the next Open Enrollment period, unless you experience a qualified change in status. If you have any questions please contact Brett Schorle in Human Resources. Who is eligible to elect benefits? If you are a full-time faculty employee and your employment begins on or before the 15 th day of the month, your benefits coverage will be effective the first day of the month following your date of employment. (Example: If your employment begins on February 12 th, your benefits coverage becomes effective March 1 st.) If you are a full-time faculty employee and your employment begins on or after the 16 th day of the month, your benefits coverage will be effective the first day of the second month following your date of employment. (Example: If your employment begins on February 16 th, your benefits coverage becomes effective April 1 st.) Please remember that only eligible dependents can be enrolled. Eligible dependents include all of the following: Spouse Children until the end of the month of their 26 th birthday How often can I change plan elections? Unless you experience a qualified change in status, you cannot make changes to the benefits you elect until the next Open Enrollment period. Qualified status changes include: marriage, divorce, birth or adoption of a child, change in child s dependent status, death of spouse, child or other qualified dependent, or change in your spouse s or domestic partner s benefits or employment status. If you are enrolling a dependent(s) for the first time, you will need to provide proof of your dependents eligibility (e.g. birth certificate, marriage certificate, proof of full-time student status, etc.). You must notify Human Resources within 30 days of experiencing a qualified change in status. 1

Medical Plans: Independence Blue Cross Below is a summary of the Personal Choice PPO BASE medical plan effective January 1, 2017. To find a participating provider, please visit www.ibx.com. Deductible Single Family Personal Choice Base Plan In-Network $750 $1,500 Out of Network $1,000 $2,000 Out-of-Pocket Max Single $2,000* Family $4,000* Primary Care Physician (PCP) Office Visit Specialist Office Visit Preventive Care Plan pays 100% NO deductible $2,000 $4,000 $15 copay Plan pays 70% after deductible $30 copay Plan pays 70% after deductible Plan pays 70% NO deductible Outpatient Laboratory Plan pays 85% after deductible Plan pays 70% after deductible Outpatient Radiology Plan pays 85% after deductible Plan pays 70 % after deductible Inpatient Hospital Plan pays 85% after deductible Plan pays 70% after deductible Outpatient Surgery Plan pays 85% after deductible Plan pays 70 % after deductible Emergency Room $100 copay after in-network deductible, waived if admitted Durable Medical Equipment Plan pays 85% after deductible Plan pays 70% after deductible Vision Davis Vision $75 Reimbursement Plan *Includes copays, deductible and coinsurance. 2

Medical Plans: Independence Blue Cross Below is a summary of the Personal Choice PPO BUY-UP medical plan effective January 1, 2017. To find a participating provider, please visit www.ibx.com. Deductible Single Family Personal Choice Buy-Up Plan In-Network $500 $1,000 Out of Network $1,000 $2,000 Out-of-Pocket Max Single $1,500* Family $3,000* Primary Care Physician (PCP) Office Visit Specialist Office Visit Preventive Care Plan pays 100% NO deductible $2,000 $4,000 $10 copay Plan pays 70% after deductible $20 copay Plan pays 70% after deductible Plan pays 70% NO deductible Outpatient Laboratory Plan pays 90% after deductible Plan pays 70% after deductible Outpatient Radiology Plan pays 90% after deductible Plan pays 70 % after deductible Inpatient Hospital Plan pays 90% after deductible Plan pays 70% after deductible Outpatient Surgery Plan pays 90% after deductible Plan pays 70 % after deductible Emergency Room $100 copay after in-network deductible waived if admitted Durable Medical Equipment Plan pays 90% after deductible Plan pays 70% after deductible Vision Davis Vision $75 Reimbursement Plan *Includes copays, deductible and coinsurance. 3

Prescription Drug Plan: Express Scripts Below are the prescription drug benefits for the 2017 Plan Year. If you elect to participate in either medical plan, you are automatically enrolled in the prescription drug plan. You will receive a separate ID card for the prescription drug plan. In-Network Prescription Drug Plan nn Out-of-Network Retail (up to a 30-day supply) Generic Preferred Brand Non-preferred Brand Mail Order (up to a 90-day supply) Generic Preferred Brand Non-preferred Brand $10 copay $30 copay $50 copay 50% $20 copay $60 copay $100 copay Why should I use mail order instead of the retail pharmacy? Using the mail order program for your maintenance medications will save you money. You will receive a 90-day (3-month) supply for the equivalent of two (2) retail copays. In addition to the savings, your prescriptions will be delivered right to your home. To begin using mail order, simply complete a mail order form and send along with your prescription(s) written for a 90-day supply of medication. Forms can be obtained online at www.express-scripts.com. 4

Dental Plan: Delta Dental The Delta Dental of PA dental plan is available to College employees at no cost the College pays 100% of the premium. Your dependent child (ren) are covered for dental until the end of the month in which they turn 26. Proof of full-time student status is not required. Below is a summary of the dental plan effective January 1, 2017. You can visit any dentist you wish. However, if you visit a dentist from Delta s Premier preferred provider network, you can reduce your out-of-pocket expenses. To find an in-network provider, please visit www.deltadentalins.com. If you utilize an out-of-network provider, you may be subject to balance billing the provider can bill you for the difference in what they charge and what Delta Dental pays for the service. In-Network Dental Plan Out-of-Network Annual Maximum (per patient) $1,500 $1,500 Orthodontia Benefits (child age 19 and under) Preventive Care Visits, X-rays and Teeth cleaning Plan pays 50% up to a lifetime maximum amount of $1,500 Plan pays 100% Plan pays 50% of UCR* charges up to a lifetime maximum amount of $1,500 Plan pays 100% of UCR* charges Basic Care (excluding periodontal services) Inlays & Crowns, Oral exams, Full mouth X-rays, Fluoride treatments, Lab work & tests, Fillings, Oral surgery, Endodontics & General Anesthesia, Vizilite Basic Care Periodontics Plan pays 100% Plan pays 80% Plan pays 100% of UCR* charges Plan pays 80% of UCR* charges Major Care Pontics (artificial teeth), Removable bridge, Denture, Repair to crown & bridges Plan pays 50% Plan pays 50% of UCR* charges *UCR refers to the usual, customary and reasonable charges for the service as per Delta Dental s guidelines. 5

Vision Plans: Davis Vision Davis Vision Both the Personal Choice Base and Buy-Up PPO plans have a $75 vision rider included in the medical plan at no cost to you. This allows reimbursement to a member for covered eyewear purchases up to $75 every 24 months. Find a participating provider at www.davisvision.com. $75 Vision Program Eye Exam Including refraction and glaucoma screening and dilation as indicated Frames: Participating or Davis Collection Lenses Single Vision Bifocal Trifocal Lenticular Contact Lenses In lieu of eyeglasses (Including standard, specialty and disposable lenses and evaluation and fitting) In-Network Benefits Out-of-Network Reimbursements $10 copay Up to $35 Up to $60 Davis Collection $0-$20 Up to $75 $0 copay $0 copay $0 copay $0 copay Up to $75 Up to $75 Up to $75 Up to $75 Up to $75 Up to $75 Frequency Comprehensive Exam Lenses Frames Contact Lenses Every 24 Months All Services

Vision Plans: Superior Vision Superior Vision Employees enrolled in the Personal Choice PPO Plan may also elect a different vision plan through Superior Vision. The premium is 100% paid by the employee. Please refer to the chart below for a list of benefits. Your dependent child(ren) are covered for vision until the end of the year in which they turn 26. Proof of full-time student status is not required. To find a participating provider, visit www.superiorvision.com. Superior Vision Plan Gold Preferred Plan Comprehensive Eye Exam By an Ophthalmologist By an Optometrist In-Network Benefits $10 copay $10 copay Out-of-Network Reimbursements Up to $52 Up to $44 Frames Up to $100 Up to $54 Lenses Single Vision Bifocal Trifocal Lenticular Contact Lenses Medically Necessary Cosmetic (Elective) Standard Contact Lens Fitting Exam Fee Specialty Contact Lens Fitting Exam Fee $25 copay $25 copay $25 copay $25 copay Covered in full Up to $100 $25 copay $25 copay Up to $40 Up to $56 Up to $72 Up to $100 Up to $210 Up to $100 Not covered Not covered Frequency Comprehensive Exam Lenses Frames Contact Lenses Once every 12 months Once every 12 months Once every 24 months Once every 12 months 7

Sick Leave and Disability Insurance Sick Leave For the first sixty (60) calendar days of an illness, a faculty member will receive full base salary. After that, the individual is eligible to receive sixty percent (60%) of regular base salary for the next one hundred and twenty (120) calendar days, or until the individual meets the eligibility time period for the College s Long-Term Disability plan. Short-Term Disability Short-term disability (STD) is a period of extended sick leave during which the employee is eligible to be paid. Upon presentation of acceptable medical certification, the STD plan is available to College employees after thirty (30) days from the date of hire. The STD period begins when the illness continues more than 60 consecutive days from the date of the original illness or medical certification until the start of the long-term disability (LTD) benefits. Benefit Percent Short-Term Disability (STD) Plan 60% of weekly earnings Elimination Period 60 days Extended Sick Leave After sixty (60) calendar days, an eligible employee shall receive 60% of his/her pay until the employee is no longer disabled or they have met the 180-day elimination period under the College s Long-Term Disability coverage. Long-Term Disability: Voya Financial All active, full-time administrative employees are eligible for the Long-Term Disability (LTD) Plan on the first day following 365 days of service. The College pays 100% of the LTD premium. Long-Term Disability (LTD) Plan Elimination Period Benefit Amount 180 consecutive days of total disability 60% of your monthly earnings **but not more than the maximum monthly amount of $7,500 ** Disability insurance shall be paid on the Faculty Member s annual base salary on the eligibility date and overload salary calculated from the previous academic year. 8

Basic Life and AD&D Basic Life and AD&D: Voya Financial All active, full-time faculty employees are eligible for the Basic Life and Accidental Death and Dismemberment (AD&D). This plan is available to College employees, at no cost the College pays 100% of the Basic Life and AD&D premium. Benefit Amount Basic Term Life and AD&D Plan 2 times your salary up to a maximum of $600,000 9

Healthcare & Dependent Care Flexible Spending Accounts (FSAs) The College provides you with the opportunity to pay for out-of-pocket medical, dental, vision and dependent care expenses with pre-tax dollars through the Flexible Spending Account administered by Benefit Express. You can save approximately 25% of each dollar spent on these expenses when you participate in an FSA. Contributions to your FSA come out of your paycheck before any taxes are taken out. This means that you don t pay federal income tax, Social Security taxes and state and local income taxes on the portion of your paycheck you contribute to your FSA. The Flexible Spending Account plan year runs from January 1 st through December 31 st. You should contribute the amount of money you expect to pay out-of-pocket for eligible expenses for the plan period. However, the plan allows for up to $500 of unused balances in the Healthcare FSA to be rolled over for qualified medical expenses incurred during the following plan year. As per IRS regulations, you must choose to participate in an FSA every year this election will never carry over. You can choose to participate in either or both FSAs as described below: A Healthcare Flexible Spending Account is used to reimburse out-of-pocket medical expenses incurred by you and your dependents. The maximum that you can contribute to the Healthcare FSA is $2,600, in accordance with the new IRS regulations. Eligible expenses include, but are not limited to, amounts paid to satisfy a deductible, copays, coinsurance and out-of-pocket dental, vision and hearing expenses. Over-the-counter medications are not eligible for FSA reimbursement unlessyou have a prescription from a doctor. A Dependent Care Flexible Spending Account is used to reimburse expenses related to care of eligible dependents while you and your spouse work. The maximum that you can contribute to the Dependent Care FSA is $5,000 if you are a single employee or married filing jointly, or $2,500 if you are married and filing separately. For more information on FSAs, contact Benefit Express at 877-837-5017 or visit www.myfsaexpress.com. You can also contact Brett Schorle in Human Resources. 9

Additional Benefits Tuition Waiver Full-time faculty employees are eligible to participate in the tuition waiver program for courses at Montgomery County Community College. Qualified dependent children (age 25 or younger) and the legally married spouse of a full-time administrative employee are eligible to participate in the tuition waiver for courses at Montgomery County Community College as well. Tuition Reimbursement Eligible to all full-time regular employees of the College who have completed a minimum of six months of continuous satisfactory employment with the College at the time of their application for educational assistance. Courses are required to be taken through an accredited educational institution. The rate per credit is based on Temple s annual credit rate for each new academic year. Expenses for tuition, fees and books are eligible for reimbursement as per noted in the procedures. The program is administered by the Human Resources Department. Retirement Plan TIAA/CREF 403(b) retirement plan is offered by the College. Employees contribute 5% of their annual salary and the College contributes 11% into the plan. If you are a current member of PSERS or SERS, you may elect to continue that retirement plan. If you are not a current member, these plans are not available. Participation in a retirement plan is mandatory 10

Per Pay Employee Contributions Employee Contributions The medical, prescription drug and vision contributions will be deducted each pay period effective January 1, 2017. These reflect Semi-Monthly (24 pays) contributions. Tiers Personal Choice Base PPO Plan / Express Scripts Rx Employee Contributions <=$40,000 > $40,000 - $60,000 > $60,000 - $80,000 > $80,000 - $100,000 > $100,000 Single $8.01 $16.02 $24.04 $30.45 $35.98 Parent/Child $12.70 $25.26 $33.73 $42.19 $50.66 Parent/Children $16.87 $32.76 $44.97 $57.19 $69.40 2 Adults $18.43 $33.76 $46.48 $59.20 $71.92 Family $23.63 $41.02 $57.36 $73.71 $90.05 Tiers Tiers Personal Choice Buy-Up Plan / Express Scripts Rx Employee Contributions <=$40,000 > $40,000 - $60,000 > $60,000 - $80,000 Superior Vision Plan Employee Contributions Single $2.90 Parent/Child $7.29 Parent/Children $7.29 2 Adults $7.29 Family $7.29 > $80,000 - $100,000 > $100,000 Single $24.20 $32.21 $40.23 $46.63 $52.16 Parent/Child $37.48 $50.05 $58.51 $66.98 $75.44 Parent/Children $52.63 $68.51 $80.73 $92.94 $105.16 2 Adults $55.65 $70.99 $83.71 $96.43 $109.14 Family $71.47 $88.86 $105.20 $121.55 $137.89 11

Per Pay Employee Contributions The medical, prescription drug and vision contributions will be deducted each pay period effective January 1, 2017. These reflect contributions based on 18 pays. Tiers Personal Choice Base PPO Plan / Express Scripts Rx Employee Contributions <=$40,000 > $40,000 - $60,000 > $60,000 - $80,000 > $80,000 - $100,000 > $100,000 Single $10.68 $21.35 $32.05 $40.60 $47.97 Parent/Child $16.93 $33.68 $44.97 $56.26 $67.54 Parent/Children $22.50 $43.68 $59.97 $76.25 $92.54 2 Adults $24.57 $45.02 $61.98 $78.93 $95.89 Family $31.51 $54.70 $76.49 $98.28 $120.07 Tiers Tiers Personal Choice Buy-Up Plan / Express Scripts Rx Employee Contributions <=$40,000 > $40,000 - $60,000 > $60,000 - $80,000 Superior Vision Plan Employee Contributions Single $3.87 Parent/Child $9.71 Parent/Children $9.71 2 Adults $9.71 Family $9.71 > $80,000 - $100,000 > $100,000 Single $32.27 $42.94 $53.64 $62.18 $69.55 Parent/Child $49.97 $66.74 $78.02 $89.31 $100.59 Parent/Children $70.17 $91.35 $107.64 $123.92 $140.22 2 Adults $74.20 $94.66 $111.62 $128.58 $145.52 Family $95.29 $118.48 $140.27 $162.07 $183.86 12

Questions & Answers When is the completion date for all enrollments? All enrollments and/or waivers must be completed within 30 days of becoming eligible. Please return your completed forms to Brett Schorle in Human Resources. Whom should I contact with questions? Contact Brett Schorle in Human Resources. At what age does a Dependent Child become no longer eligible for coverage under my plan? Medical plans: coverage for the dependent(s) will terminate at the end of the month they turn age 26. No proof of full-time status will be required. Dental plan: coverage will terminate at the end of the month they turn age 26. No proof of full-time status will be required. Vision plan: coverage for dependent child(ren) will terminate at the end of the year in which they turn age 26. No proof of full-time status will be required. I need to change my beneficiaries. What do I do? Beneficiary information may be updated at any time of the year. You can change your beneficiaries for Life and Disability by contacting your Human Resources Department for the appropriate forms. To change your beneficiary information with TIAA-CREF, contact them directly at 800-842-2276 or www.tiaa-cref.org. 13

Questions & Answers Will I receive a separate Prescription Card? Yes, you will receive a separate prescription ID card from our carrier, Express Scripts. Please present this card to the pharmacy when presenting your prescription to be filled. For a card or assistance, call 800-711-0917. If I sign up for the PPO plans with vision will I receive a separate Vision Card? No, the card that you receive for your medical benefits also includes your vision benefits. Please present this card at the time of service. How do I check the balance remaining in my Flexible Spending Account? You can check your balances by calling 877-837-5017 or log on to www.myfsaexpress.com. What is the deadline for incurring or submitting Flexible Spending Account claims? The Flexible Spending Account plan year runs from January 1st through December 31st. You have until April 15 th, 2018 to file for reimbursement for claims incurred from January 1 st, 2017 through December 31 st, 2017. Additionally, the plan allows for up to $500 of unused balances in the Healthcare FSA to be rolled over for qualified medical expenses incurred during the following plan year. Montgomery County Community College reserves the right to modify, amend, suspend or terminate any plan, in whole or in part, at any time. The information in this Enrollment Guide is presented for illustrative purposes and is based on information provided by the employer. The text contained in this Guide was taken from various summary plan descriptions and benefit information. While every effort was taken to accurately report your benefits, discrepancies, or errors are always possible. In case of discrepancy between the Guide and the actual plan documents the actual plan documents will prevail 14