A Guide to Your 2016 Benefits

Transcription

1 A Guide to Your 2016 Benefits To view your coverage or to participate in the annual Open Enrollment, log on to my.tcu.edu/employeecenter Collegiate Association REsource of the Southwest

2 Contact Information Use the following toll-free numbers and websites to get answers to questions you have about your TCU benefits. Be sure to have your Plan ID Card, Member ID number, or your Social Security Number available when you call or log on. SERVICE WHO TO CALL PLAN INFORMATION NUMBER TO CALL WEBSITE Medical Benefits and Eligibility Medical Provider Finder Medical Health Care Account (HCA) CDHP only BlueCross BlueShield of Texas Blue Card Access BlueCross BlueShield of Texas Network: Blue Choice PPO Group ID: HDHP Group ID: CDHP Group ID: (non-registered visitors) , (select option 2 and option 1) ID on card starts with CAP (registered member) (registered members or non-registered visitors) Prescriptions Express Scripts Group ID: JPXA Telephonic Medical Consultation Second Opinion Health Care Service Teladoc Best Doctors Health Care Advocate Patient Care Health Savings Account (HSA) HDHP only Employee Assistance Program (EAP) Flexible Spending Accounts (FSA) HSA Bank Magellan Health Services Discovery Benefits Group ID: Group ID: Dental Cigna DHMO Network: Dental Care (a six-digit ID number for a dentist is required when electing coverage) (non-registered visitors) (registered members) DPPO Network: Advantage Vision UnitedHealthcare Group ID: TCU Human Resources or

3 Welcome to your 2016 Benefits Resource Guide. TCU recognizes that a quality, comprehensive benefits program is a great way to show you just how valuable you are to the University. We understand that no two employees are alike, which is why we offer multiple benefit choices. This resource guide is designed to help you evaluate your unique needs and select the benefits program that fits your lifestyle best. The right program of benefits can help you get healthy and stay healthy. When you couple preventive care, quality healthcare when you are sick or hurt, and a healthy lifestyle, you are really making Healthy Choices!

4 4 TCU Benefits Handbook 2016 Healthy Choices Welcome to Healthy Choices your 2016 benefits program overview brought to you by TCU in partnership with the Collegiate Association REsource of the Southwest, Inc. (CARES). Each of the programs highlighted in this guide are designed to help you make healthy choices for yourself and your family. Whether it s choosing to schedule an annual physical or to call the Employee Assistance Program (EAP) when you need some guidance, each of these choices is a step towards a more healthy you. So read on! Healthy Choices are just around the corner. Eligibility You are eligible for coverage under the CARES Health Plan, CIGNA Dental Plan, and/or UnitedHealthcare Vision Plan if you are working at least 75% of full time (or at least 30 hours a week) in a regular position. You and/or your dependents are automatically enrolled in the Prescription Drug Program through Express Scripts with the election of a medical plan. Please see page 8 for more information. Your dependents are also eligible for TCU benefits, including: Medical Dental Vision Employee Assistance Program Which Dependents Are Eligible? Eligible dependents include: Your legal spouse Dependent children younger than age 26 Unmarried, dependent children of any age who become mentally or physically disabled Domestic partners How to Enroll Current employees can choose their benefits each year during the Open Enrollment period through my.tcu.edu. For the 2016 plan year, you must enroll to: re-elect your current benefit elections for coverage make a change to your current benefit elections participate in a Flexible Spending Account (Dependent Care and/or Health Savings) enroll in a new benefit. Note: If you do not re-enroll, you will not have coverage during the 2016 plan year. Open Enrollment Current employees must choose or waive benefits each year. To elect benefits for the 2016 plan year, current eligible employees must participate in TCU s annual Open Enrollment. Open Enrollment for benefits in 2016 will be held October 26 - November 6, Employees will elect their benefits online through the Open Enrollment process at my.tcu.edu/employeecenter. Adding Dependents Prior to electing benefits, employees should verify that Human Resources has proof of dependent status for any dependents who are being added. This is not required if your dependents have previously been covered through a TCU insurance health plan. The following documents can be used as proof: marriage license for spouse birth certificates, adoption, or placement papers for children signed domestic partner affidavit (available from Human Resources). New Hire or Change in Employment Status If you are new to the TCU family or have recently become eligible for benefits, plan participation typically begins on the first of the month following your date of hire or change of status. Benefit Terms Quick Reference: Health Care Account (HCA) Health Savings Account (HSA) Flexible Spending Account (FSA)

5 2016 TCU Benefits Handbook 5 You have 31 days from your initial employment date (or when your employment status changes to 75% of full time in a regular position) to enroll in benefits. Otherwise, you must wait for the next annual Open Enrollment. In that case, your benefits will take effect the following January 1, unless you experience a qualifying event as described below. Making Changes You can only make changes between Open Enrollment periods if you have a qualifying change in status. Changes in status or qualifying events include: your marriage, divorce or legal separation birth, adoption or change in legal custody of an eligible child death of your spouse or covered child change in your or your spouse s work status that affects benefits eligibility change in residence or work site that affects your eligibility for coverage child s loss of dependent status, e.g. due to attaining age 26 (loss is effective on the last day of their birth month) change in your child s eligibility for benefits provided through a governmental or educational institution. If you experience a qualifying change in status, contact Human Resources immediately for assistance with changing your benefit elections. Changes must be submitted within 31 days of the date you experience a qualifying event. The election change must be consistent with the change in status. For example, enrolling in dental insurance would not be consistent with having a baby. You would only be able to add your baby to your existing elections. Failure to notify Human Resources of your dependent s change in status could result in termination of benefits. Benefit Terms Quick Reference: High Deductible Health Plan (HDHP) Consumer Driven Health Plan (CDHP) Preferred Provider Organization (PPO)

6 6 TCU Benefits Handbook 2016 Your Medical Choices Having medical insurance is a healthy choice for multiple reasons: coverage for doctor visits, hospital care, and prescription drugs can help you get healthy when you are sick or hurt preventive care benefits can help you stay healthy. As a TCU employee, you can choose from four CARES Medical Plan options. All plan options utilize the BlueCross BlueShield of Texas Blue Choice PPO network. All plans provide preventive care at no cost to the covered participant. What is a self-insured plan? Self-insured means that TCU pays your actual claims. Every time you go to the doctor or fill a prescription, your benefits are actually paid by CARES and TCU not an insurance company. TCU pays a fee that covers the cost of the plan s administration. Actual claims are paid by your premiums and TCU s contributions. Every dollar you save by making wise healthcare choices is a dollar saved by both you and TCU. Information about out-ofnetwork benefits. Each of our plans have an identical network of preferred doctors and other providers. These providers agree to discount fees and file claims for you in exchange for being part of the preferred network. Staying in network saves you money as the insured and also helps to control plan costs, which is important in our self-insured plan. If you choose to see an out-of-network provider: your deductible will be higher the percent of the cost that the Plan pays after the deductible is met is lower (so your cost is higher) you may be balance billed for charges that are above the Plan s allowable charge you may have to pay the bill in full and then file a claim for reimbursement. On the next page is a chart that compares each option s in-network benefits only. Each plan also offers coverage if you choose to use doctors and other providers that are outside the Plan s network. If you would like to see the out-of-network benefits for a particular option, please visit the TCU Human Resources website where you can view the summary of benefits for each plan. Benefit Terms Quick Reference: Health Care Account (HCA) Health Savings Account (HSA) Flexible Spending Account (FSA)

7 2016 TCU Benefits Handbook 7 Medical Plan Comparison (In-Network) All benefits shown below reflect in-network only coverage. For more information on out-of-network benefits, please visit HDHP with HSA You Pay CDHP with HCA You Pay PPO 90% You Pay PPO 80% You Pay Annual Deductible Individual Plus children Plus spouse or family Out-of-Pocket Maximum Individual Plus children Plus spouse or family TCU s Contribution Individual If you cover your children, spouse, or family Preventive Care (adults and children) Office Visits Primary Care Specialist $2,600 $5,200*** $5,200*** $ 6,450 $12,900*** $12,900*** To HSA: $ 500 $1,000 $1,350 $2,550 $2,700 $ 6,350 $12,700 $12,700 To HCA: $ 500 $1,000 $ 550 $ 950 $1,100 $3,050 $5,950 $6,100 N/A $ 950 $1,350 $1,500 $ 5,950 $11,350 $11,500 No charge No charge No charge No charge 20%* 20%* 30%* 30%* Teladoc (see p. 10) 20%* 30%* $10 $10 Urgent Care Facility 20%* 30%* $75+10% (no deductible) $20 $40 N/A $25 $50 $75+20% (no deductible) Laboratory and Radiology 20%* 30%* 10%* 20%* Hospital Admission 20%* 30%* $200+10%* $200+20%* Outpatient Facility 20%* 30%* $100+10%* $100+20%* Emergency Room 20%* 30%* $150**+10% (no deductible) Prescription Drug Base Plan Retail (30-day supply) Generic Formulary Non-Formulary Mail Order (90-day supply) Generic Formulary Non-Formulary Lifetime Maximum Benefit 20%* 20%* 20%* 20%* 20%* 20%* $150**+20% (no deductible) 20% with no deductible (minimum and maximum limits to charges apply) Minimum Maximum $ 0 $15 $20 $45 $50 $75 $ 0 $ 30 $ 40 $ 90 $100 $150 Unlimited * After the appropriate deductible is met. ** Waived if admitted. *** If you cover any dependents, the Individual deductible will apply as an embedded deductible. That means, for example, if one family member reaches $2,600 as a participant on the HDHP, the co-insurance portion for services will be 20% until the maximum out-of-pocket is reached. Further, your family s expenses will be combined together to determine if the total $5,200 Family deductible has been met. Benefit Terms Quick Reference: High Deductible Health Plan (HDHP) Consumer Driven Health Plan (CDHP) Preferred Provider Organization (PPO)

8 8 TCU Benefits Handbook 2016 Prescription Drug Buy-Up Plan The Prescription Drug Base Plan (as described in the chart on page 7) is included in the premium you pay for PPO and CDHP medical coverage. The High Deductible Plan (HDHP) treats prescription drugs as any other medical expense, subject to the Plan deductible and coinsurance. You can choose to keep the included Base Plan coverage or receive the benefits of the Prescription Drug Buy-Up Plan instead. You will pay an additional premium for this enhanced benefit. If you choose the Buy-Up Plan, you pay a set copayment for all prescription drugs. There is no deductible, no coinsurance, and no minimum payment. Prescription Drug Buy-Up Benefits Network Retail Pharmacy (up to 30-day supply) Express Scripts Mail Order (up to 90-day supply) Generic $10 $20 Formulary $20 $40 Non-Formulary $35 $70 The CDHP and HDHP Plans The Consumer Driven Health Plan (CDHP) works in a way that is similar to the High Deductible Health Plan (HDHP). Following is an overview of the two plans. STAGE 1: Pay the deductible. A deductible is the amount of money that you pay in one year before the Plan starts paying benefits. Note: The Plan pays 100% of the cost of your preventive visits including annual check-ups, mammograms, baseline cancer screenings, OB/GYN exams, well-child visits, immunizations, and some preventive care medications. STAGE 2: Split the cost with the Plan. After you have paid the deductible, you start splitting the bill with the Plan. The Plan will pay a portion of your medical bills and you pay a portion. STAGE 3: The Plan pays 100% of your expenses. The Plan limits how much money you will have to pay for covered medical expenses in one year. The amount of the limit depends on whether you cover only yourself or if you also cover family members. If you have very high medical bills enough so that your portion of the cost reaches that limit the Plan pays 100% of your bills for the rest of the year, as long as you use providers, e.g. doctors and hospitals, that are in the network. The CDHP and the Health Care Account The CDHP offers a unique benefit: TCU will contribute funds that you can use to pay for your medical expenses. The CDHP includes a Health Care Account or HCA which acts basically like a bank account. TCU deposits funds into your HCA, and when you have a medical expense such as a visit to the doctor you can use the money in your HCA to pay the bill. If you have Individual coverage, TCU will contribute $500 into your HCA for If you cover any dependents, TCU will contribute $1,000 into your HCA for Benefit Terms Quick Reference: Health Care Account (HCA) Health Savings Account (HSA) Flexible Spending Account (FSA)

9 2016 TCU Benefits Handbook 9 In conjunction with the HCA, you can also elect a Health Care Flexible Spending Account (FSA), which can be used to pay for additional out-of-pocket health care expenses. You fund this FSA account yourself on a pre-tax basis through payroll deduction for eligible health care expenses incurred during the calendar year. For more information on the Health Care FSA, see page 17. What You Can Pay for Using Your... Health Care Account (HCA) Health Care Flexible Spending Account (FSA) The HDHP and the Health Savings Account When you choose to enroll in the HDHP, you are automatically enrolled in a Health Savings Account (HSA), through BlueCross BlueShield of Texas HSA vendor partner, HSA Bank. HSAs are an effective and flexible way to save money tax-free for medical expenses because: they have higher contribution limits than a Health Care FSA unused money can stay in the account year after year your balance can grow without limits you can contribute your own funds in your HSA you own the account and can take it with you if you leave TCU you can even use the account balance to make COBRA payments or pay for expenses after retirement. Medical expenses not paid by Plan: deductibles coinsurance amounts charged by non-network providers that are over coverage limits Note: You cannot use HCA dollars to pay for prescription drugs. Medical expenses not paid by Plan: deductibles coinsurance amounts charged by non-network providers that are over coverage limits Expenses paid by FSA: dental vision prescription drugs NEW! TCU is making your HSA even better by: increasing contributing funds to your account: - $500 per year if you have individual coverage - $1,000 per year if you cover any family members (pro-rated on a quarterly basis for new employees and those with changes due to qualifying life events, other than during Open Enrollment) allowing you to choose during Open Enrollment to contribute via payroll deduction through a one-time annual election Notes: 1. If you would like to participate via payroll deduction and receive the contribution from TCU, you are automatically enrolled in a new HSA through HSA Bank. If you have a previously-established HSA from a previous employer, you can still use the existing balance to pay for medical expenses, but no new contributions will be permitted. 2. Medicare-covered and Tri-care covered employees cannot contribute to an HSA. Managing your accounts You may be wondering what happens to money left in your accounts at the end of the year or if you leave TCU. HCA HSA Health Care FSA At the end of the year Unused money rolls over to next year and there is no limit on the account balance. Unused money rolls over to next year. There is no limit on how much money you can accrue in your HSA. However, there are federal limits to how much you can contribute annually. The 2016 annual limits for HSA contributions yours and TCU s combined contributions are: $3,350 if you cover only yourself $6,750 if you cover any family members. You forfeit any money that is left over after you have filed all eligible calendar year reimbursement claims. However, if you have money left in your account on December 31, you may use that money to pay for medical expenses you have from January 1 March 15 of the following year.. If you leave TCU You give up any unused money in your HCA. You cannot cash out the account or take the money with you. These funds are also forfeited if you elect another medical plan. Your HSA is yours to keep both your contributions and TCU s. You surrender any unused money in your Health Care FSA. Benefit Terms Quick Reference: High Deductible Health Plan (HDHP) Consumer Driven Health Plan (CDHP) Preferred Provider Organization (PPO)

10 10 TCU Benefits Handbook 2016 Which Plan is Best for Me? Will we go to the doctor a few times... or many? What if someone ends up in the ER? What if we plan on having a baby? These are just a few of the questions that may go through your head when trying to choose a Medical Plan. It s hard to estimate year-to-year just what your actual expenses will be. TCU understands, and is providing this comparison to help you compare different situations. Remember that actual out-ofpocket expenses will depend on how you and your family utilize the benefits. Because most people try to use network providers whenever possible, we are only comparing in-network benefits payable from our four Medical options. Family Coverage Example (Employee, spouse, and two children) Family Expenses HDHP with HSA CDHP with HCA PPO 90% PPO 80% Annual checkups for parents (2) $0 $0 $0 $0 Mammogram $0 $0 $0 $0 Well-child checkups for children (2) $0 $0 $0 $0 Sick visits for children (3 per child at $80 each) Strep test for children (1 per child at $15 each) Generic antibiotics for children*** (1 per child at $5 each) Spouse s surgery ($4,000) Generic birth control*** (4 90-day refills at $10 each using mail-order) $480* $480* $120 $150 $30* $30* $30* $30* $10* $2,600* + $280* (Deductible + 20%) $40* $2 (20% of $5 = $1 per Rx) $2,190* + $362 (Deductible + 30%) $8 (20% of $10 = $2 per Rx) $2 (20% of $5 = $1 per Rx) $1,100* + $200(admission) + $270 (10%) $8 (20% of $10 = $2 per Rx) $2 (20% of $5 = $1 per Rx) $1,500* + $200 (admission) (20%) $8 (20% of $10 = $2 per Rx) Family s Responsibility $3,440 $3,072 $1,730 $2,350 Covered by TCU HSA/HCA Contribution -$1,000 -$1,000 -$0 -$0 Paid by the Family $2,440** $2,072** $1,730** $2,350** Annual Plan Premium $2, $5, $7, $5, The Family s Total Cost $5, $7, $9, $8, * Applies to deductible - deductible is included in OOP maximum ** This could be reimbursed with tax-free money if the family contributed their own money to their HSA or Heath Care FSA. *** Base Rx Plan Note:The above chart is for illustrative purposes only. This illustration is only meant to show a scenario and is in no way a guarantee of payment. Your individual costs will vary based on your unique circumstances. Please contact BCBSTX for exact pricing. Benefit Terms Quick Reference: Health Care Account (HCA) Health Savings Account (HSA) Flexible Spending Account (FSA)

11 2016 TCU Benefits Handbook 11 Individual Coverage Example Individual s Expenses HDHP with HSA CDHP with HCA PPO 90% PPO 80% Annual checkup $0 $0 $0 $0 Sick visit ($80) $80* $80* $20 $25 Trip to Urgent Care center for food poisoning ($150) Generic cholesterol medication*** (4 90-day refills at $115 each using mail-order) $150* $150* $82.50 $90 $460* $92 (20% of $115 = $23 per Rx) $92 (20% of $115 = $23 per Rx) $92 (20% of $115 = $23 per Rx) Individual s Responsibility $690 $322 $ $207 Covered by TCU HSA/HCA Contribution Paid by the individual -$500 -$322 -$0 -$0 $190** $0 ($178 left in HCA) $194.50** $207** Annual Plan Premium $ $1, $2, $2, Individual s Total Cost $1, $1, $3, $2, * Applies to deductible ** This could be reimbursed with tax-free money if individual contributed their own money to their HSA or Heath Care FSA. *** Base Rx Plan Note:The above chart is for illustrative purposes only. This illustration is only meant to show a scenario and is in no way a guarantee of payment. Your individual costs will vary based on your unique circumstances. Please contact BCBSTX for exact pricing. Medical Terms to Know Deductible: the fixed amount of money a covered member must pay out of pocket before the insurance company pays the claims. If a member s deductible is $500, then the insurance plan will not start paying for claims until the member has met the out-of-pocket $500 deductible. Co-insurance: the amount a member is responsible for paying for their health care coverage after meeting the deductible. This can be seen as sharing the cost with one s insurance company. Co-insurance is calculated based on a percent system. If a member has a $100 bill for a medical visit and their portion is calculated at 20%, then, assuming their deductible has already been met, the member will pay $20 of the bill and the insurer will pay the remaining $80 of the bill. Co-payment (co-pay): the fixed amount of money a patient pays for a covered health care service at the time of service. This is in addition to what the insurance company pays. Lifetime Maximum Benefit: the maximum amount an insurance company will pay during a covered member s entire lifetime for their health needs. Under the Affordable Care Act, there are no restrictions on benefits placed on most health plans or insurance policies, including TCU s plan. Out-of-Pocket Maximum (or Limit): the highest amount a covered member will pay in their policy period (typically in 12-months), before their medical insurance starts paying 100% of the covered medical expenses in their plan. The member s deductible and coinsurance are counted toward achieving their maximum. Benefit Terms Quick Reference: High Deductible Health Plan (HDHP) Consumer Driven Health Plan (CDHP) Preferred Provider Organization (PPO)

12 12 TCU Benefits Handbook 2016 Additional Medical Resources Medical insurance is important and TCU through CARES is providing several programs that work together with our Medical Plan to help you get the most from your benefits programs. All TCU employees who participate in a TCU Medical Plan are automatically eligible to use these additional resources. Best Doctors: When you want a second opinion Best Doctors provides a unique combination of information and access to the best medical care for members faced with a serious illness or injury. This benefit is free and confidential for you and your family members who are covered by the TCU Medical Plan. Through Best Doctors, you can receive a second opinion from some of the most qualified specialists and facilities worldwide to ensure that your diagnosis and treatment plans are on target. How to Use Best Doctors Call between 7:00 a.m.-8:00 p.m. Central Time. You will be connected to a member advocate who will take your medical history and make sure your questions about the service are answered. Best Doctors compiles all of your medical information and selects a doctor from their database of more than 40,000 world-renowned doctors, based on your individual situation. The doctor delivers their findings and recommendations back to your Best Doctors member advocate. Best Doctors will deliver an easy-to-understand, confidential report to you and, if you choose, your treating physician. Your report will summarize the expert s findings, confirming if they agree with your diagnosis and treatment plan. Your member advocate will review all of the information with you and answer your questions. Best Doctors is also available for followup questions. You can receive more information on this service at Teladoc: When you just can t get to the doctor Teladoc is a service that employs United States boardcertified doctors who specialize in internal medicine, pediatrics, family medicine, and emergency medicine. When you schedule a consultation, Teladoc will contact a doctor licensed in your home state to call you back. On average, you will receive a return call in less than 25 minutes. When Teladoc is appropriate Teladoc is good for routine issues such as: Cold and flu symptoms Bronchitis Allergies Poison ivy Pink eye Urinary tract infections Respiratory infection Sinus problems Ear infections When Teladoc is not appropriate Teladoc is not good for diagnoses that require lab tests, such as strep throat, or for injuries such as sprains and broken bones. Teladoc cannot write prescriptions for: drugs that are controlled by the DEA (like some pain medications and most ADHD medications) many drugs that have the potential for abuse or addiction drugs that do not treat a specific illness How to Use Teladoc Before your first call, you need to go online to open an account and set up your Electronic Health Record (EHR). Your EHR will contain information that you would normally provide on a patient medical history form when you have a doctor s office visit. Having a current EHR ensures that Teladoc has a good idea of your medical history before your visit. You can also choose to store credit card information to be used when you call Teladoc. Benefit Terms Quick Reference: Health Care Account (HCA) Health Savings Account (HSA) Flexible Spending Account (FSA)

13 2016 TCU Benefits Handbook 13 When you elect to use Teladoc: Log onto your account at or call Teladoc ( ) to request a phone or online video consultation with a Teladoc doctor. You will also give them your credit card or FSA debit card information if you do not have a credit card on file. A U.S. board-certified doctor or pediatrician licensed in your state reviews your EHR, then contacts you. Your doctor will listen to your concerns and ask you questions, similar to an in-person doctor s appointment. Your Teladoc doctor will recommend treatment for your issue. If a prescription is necessary, it is sent to the pharmacy you choose. Teladoc will charge you for your visit. If you participate in the HDHP or the CDHP, you are responsible for the full cost of the visit if you have not met your deductible. If you participate in any PPO, you pay a $10 copay for using Teladoc. You can request a detailed receipt that you can use for reimbursement through a flexible spending account or health savings account, if applicable. Your EHR will be automatically updated by your Teladoc doctor with the information from your consultation. Teladoc can even send a record of your consultation to your primary physician at your discretion. Use Patient Care to: Resolve claims Correct billing errors Schedule appointments Find the right doctor, hospital, or testing facility (especially if you are traveling) Assist with the transfer of medical records Navigate your insurance plan Explain conditions and treatments Locate eldercare services Resolve Medicare questions If you have a healthcare or insurance-related issue, call Patient Care: Monday-Friday, 7:00 a.m. 8:00 p.m. Central Time Saturday, 8:00 a.m. 1:00 p.m. Central Time You ll be assigned a Personal Health Advocate, who works with you one-on-one to find solutions to otherwise time-consuming issues. Patient Care: When you need expert assistance We ve all been perplexed by medical issues, claims, or bills. Wouldn t it be nice to have an expert by your side to explain the intricacies of healthcare to ensure that you receive the care you need and that your claims are processed properly? You can. TCU offers you the assistance of Patient Care, a health advocacy service, whenever you need it. From understanding your Explanation of Benefits to researching larger concerns or questions about your personal medical care, your Personal Health Advocate will provide the confidential, value-added expertise to help you navigate complex health care issues. Benefit Terms Quick Reference: High Deductible Health Plan (HDHP) Consumer Driven Health Plan (CDHP) Preferred Provider Organization (PPO)

14 14 TCU Benefits Handbook 2016 Employee Assistance Program: When You Need an Extra Hand Family and work activities are stressful at times. Counseling and referrals are available through the Employee Assistance Program (EAP), provided by Magellan Healthcare, at no cost to you. All benefits-eligible employees and their dependents may utilize the program regardless of participation in TCU s medical insurance plan. EAP: Confidentiality is Key Any assistance you receive from the EAP is completely confidential. Your name, records, and other confidential information are not shared with TCU. When to Use the EAP Counseling is available through the EAP for personal issues such as: Family and marital conflicts Parenting concerns Emotional difficulties Health coaching and support Drug and alcohol dependency Stress management Grief over death of loved one or other losses Eating disorders Questions about legal or financial concerns Questions about child or elder care How to Use the EAP If you need assistance, you can call and speak to an EAP counselor. Counselors are available 24 hours a day, including holidays. The toll-free phone number to call is: Magellan Health Services Sometimes a telephone call is all it takes. But if you want or need additional counseling, you can schedule an appointment with an EAP counselor for face-to-face assessment. TCU will pay for up to three sessions per person, per issue each year. The EAP can also provide referrals to other providers or community resources if you need additional assistance. The EAP Online You can also access the EAP services online, including reference materials and more, at You can contact an EAP specialist via the Magellan Health Service s website, as well as review a complete collection of articles, resources, and interactive tools to assist you with situations affecting your work and life. To register: Click on the Register or Enter as a Guest button Enter the CARES Member phone number: Enter the name of the organization: TCU Complete the registration process Benefit Terms Quick Reference: Health Care Account (HCA) Health Savings Account (HSA) Flexible Spending Account (FSA)

15 2016 TCU Benefits Handbook 15 Dental Routine dental visits help you maintain your existing teeth, as well as prevent or address potential dental disease that, if left untreated, could cause serious health problems due to infection. The TCU benefits program includes two Dental options to consider. About Your Dental Insurance The Cigna Dental HMO has a restricted network of dentists from which you can choose. When you use a network dentist, you pay only a set fee for covered services. The Cigna Dental PPO also has a network of dentists, but you may choose to use dentists outside the network as well. When you use dentists in the network, your out-of-pocket cost is typically less because they agree to limit their charges to the Plan s negotiated rates. If your dentist is not in the network, they may charge more than these limits. In that case, you would also be responsible for paying any additional charges. Both Dental Plan options cover the four main types of routine dental expenses: Preventive and diagnostic care (routine exams and cleanings, fluoride treatments, sealants, and bitewing x-rays) (2 per year) Basic treatment (full-mouth x-rays, pulling teeth, fillings, root canals, and oral surgery) Major treatment (dentures, bridges, and crowns) Orthodontia (braces and other appliances, including installation, removal, and follow-up care) o PPO (children up to age 19 are covered) o Dental HMO (children and adults are covered) Annual Deductible Individual Family Cigna DHMO When you see a network dentist, you pay None None Cigna Dental PPO Choice When you see the dentist, you pay $50 $150 Preventive & Diagnostic Care No charge No charge Basic Restorative See schedule of benefits for fees. 20% after deductible Major Restorative See schedule of benefits for fees. 50% after deductible Orthodontia Lifetime maximum, per person Annual Maximum Benefit One Person Can Receive in addition to orthodontia benefits See schedule of benefits for fees. Note: some orthodontia treatment can be paid on a monthly basis. (available for children and adults) 50% after $50 deductible $1,000 maximum benefit (available for children up to age 19) No limit $1,500 Maximum can increase in future years if you receive preventive care. NEW! PPO Plan Only Get Your Checkup and Earn More Coverage! We all know that getting dental checkups is important. But now they can save you money! If you receive preventive care in 2016 cleanings, exams, and/or x-rays the Plan will pay up to another $150 towards your dental care the next year. This applies to each family member for example, if your dependent gets their teeth cleaned in 2016 but you don t, then the next year, your dependent s annual maximum benefit will be $1,650 but yours will still be at $1,500. Let s see how this would work year-to-year if you never get a checkup but your dependent does. PPO Maximum Dependent s Benefit (per member) Maximum Benefit 2016 $1,500 $1, $1,500 $1, $1,500 $1, $1,500 $1,950 (the max amount that you can have) Even if your dependent stops getting check-ups, their maximum benefit will never go down. It will stay at $1,950 per year as long as they participate in the plan. Benefit Terms Quick Reference: High Deductible Health Plan (HDHP) Consumer Driven Health Plan (CDHP) Preferred Provider Organization (PPO)

16 16 TCU Benefits Handbook 2016 Vision Care UnitedHealthcare s Vision Care Plan gives you two different ways to receive benefits: use the network and pay a set copayment for most expenses go to a doctor outside the network and receive a reimbursement for part of the cost of your exams, glasses, and/or contacts. NEW! Frames & Diabetic Treatment i ncrease to frames allowance (from $130 to $150 retail) patients managing diabetes can have up to two exams annually covered at the copay amount UnitedHealthcare Vision When you use the network, you pay Exams (once every 12 months) Glasses (frames every 24 months; lenses every 12 months) lenses o single o lined bifocal o lined trifocal o lenticular frames Contacts (every 12 months, instead of eyeglasses) $10 When you do not use the network the plan will reimburse you Up to $40 $25 Included Included up to $50 wholesale (private practice provider) or $150 retail (chain provider) $25 Including fitting/evaluation, contacts, and two follow-up visits. For those who choose disposable lenses, up to 4 boxes are included. Up to $40 Up to $60 Up to $80 Up to $80 Up to $45 Medically necessary: Up to $210 Not medically necessary: Up to $125 Note: Exams are covered twice each 12 months for diabetics. In addition, Retinal Screening Photography at a network provider is covered at no charge for diabetics patients. Benefit Terms Quick Reference: Health Care Account (HCA) Health Savings Account (HSA) Flexible Spending Account (FSA)

17 2016 TCU Benefits Handbook 17 Flexible Spending Accounts Through the TCU Flexible Spending Accounts (FSA) program, you can use tax-free dollars to pay for: most medical, dental, and vision care out-of-pocket expenses like copayments, deductibles, and prescription drugs dependent care expenses like day care, babysitters, after-school programs, or elder care programs. Note: Dependent care spending is limited to the amount contributed from each paycheck. Each pay period, you make a contribution to your Health Care and/or Dependent Care FSA similar to using a savings account. Then, like a savings account, when you need money, you take it out. There are two ways to use the money in your FSA: Use Your FSA Debit Card from Discovery Benefits You will receive a debit card that you can use to access your Health and Dependent Care FSA without incurring out-ofpocket expenses on most services. The total amount of your annual contribution is available immediately. After you ve received service from a provider, e.g. physician s office or day care provider, you can use your debit card, and you ll actually pay the expense with money from your FSA. Please note you may be required to provide proof of an expense. How Much You Can Contribute There are IRS limits on the amount you can contribute to your FSAs. Health Care FSA Limits A maximum of $2,550 per year Dependent Care FSA Limits A maximum of $2,500 if you and your spouse file separate tax returns A maximum of $5,000 if you are single or if you and your spouse file a joint return File a Paper Reimbursement Form or Submit Online You may also pay for services and products out-of-pocket and submit a reimbursement form with proof of purchase that reflects dates and type of service through Discovery Benefits. For more information on eligible expenses and how to file a claim, please visit Discovery Benefits website: or call Make the Most of your FSAs Effectively calculating your annual contribution amount is key to managing your FSA. By contributing to an FSA account, you can reduce your overall tax liability by using pre-tax dollars to pay for medical expenses and dependent care. IRS rules state that, unlike a savings account, if you do not use all of the funds in your flexible spending account(s) each year, you forfeit the remaining amount (see page 9 for more information.) So, it s best to be conservative in your estimates when deciding how much to contribute. Benefit Terms Quick Reference: High Deductible Health Plan (HDHP) Consumer Driven Health Plan (CDHP) Preferred Provider Organization (PPO)

18 18 TCU Benefits Handbook 2016 Income Protection Benefits Basic Life Insurance TCU provides Basic Employee Life at no cost to you. NEW for Basic AD&D Insurance TCU now provides basic Accidental Death & Dismemberment (AD&D) insurance at no cost to you. AD&D insurance pays a benefit to your beneficiary if you die in an accident. However, it also pays benefits if you have certain disabling injuries. Basic Life Insurance 1x your annual base pay (Minimum coverage of $25,000) Basic AD&D Insurance 1x your annual base pay (Minimum coverage of $25,000) Voluntary Term Life Insurance In addition to Basic Life Insurance, you may choose to buy Voluntary Term Life Insurance for yourself and your dependents. Employees electing any Voluntary Life Insurance, other than during their new hire period, will be required to complete the Evidence of Insurability (EOI)*, regardless of the amount. Voluntary Life Insurance for yourself Voluntary Life Insurance for spouse Voluntary Life Insurance for each child Maximum coverage of 4x your annual base salary up to $800,000, including basic life In increments of $10,000 No more than 50% of your Voluntary Life Insurance, up to $100,000 In increments of $10,000 Age 2 weeks 25 years: $1,000 - $10,000 In increments of $1,000 * Please note: Evidence of Insurability (EOI) is required to enroll in Voluntary Life Insurance, other than during your new hire period. EOI is the documentation of the good health when enrolling or increasing your amount of Voluntary Life Insurance. Benefit Terms Quick Reference: Health Care Account (HCA) Health Savings Account (HSA) Flexible Spending Account (FSA)

19 2016 TCU Benefits Handbook 19 Long-Term Disability Coverage LTD Insurance is designed to continue a portion of your salary as long as you are disabled. You can choose from two different levels of coverage. Plan 1 Plan 2 Benefit you will receive 60% of salary 70% of salary Maximum benefit that you can receive $10,000 /month $10,000 /month When benefits start 26-week elimination period 26-week elimination period How long you may receive benefits while still disabled Until age 65 or your Social Security Normal Retirement Age, whichever comes first. If your disability starts after you turn 62, benefits may be payable past this limit. Until age 65 or your Social Security Normal Retirement Age, whichever comes first. If your disability starts after you turn 62, benefits may be payable past this limit. Benefit Terms Quick Reference: High Deductible Health Plan (HDHP) Consumer Driven Health Plan (CDHP) Preferred Provider Organization (PPO)

20 Health Wealth Living Learning About This Guide This guide summarizes the benefit plans and policies available to you as an eligible employee of Texas Christian University. The details of these plans and policies are contained in the official plan and policy documents, including some insurance contracts. This guide is meant only to cover the major points of each plan or policy and it does not contain all of the details that are included in your summary plan description. While every effort has been made to ensure the accuracy of information in this guide, if there is ever a question about one of these plans and policies, or if there is a conflict between the information in this guide and the formal language of the plan or policy documents, the formal wording in the plan or policy documents will govern. Please note that the benefits described in this guide may be changed at any time, do not alter the employment-at-will relationship, and do not represent a contractual obligation on the part of Texas Christian University. For more information: Collegiate Association REsource of the Southwest