Annual Open Enrollment

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1 Bryn Athyn College Important News for the Plan Year: Everyone needs to do something. Employees must log-in to the ADP Portal and take action. Even if you are not electing our coverage we require you to go into the system and "WAIVE" or reselect your current coverage. Medical: Bryn Athyn College will remain with UnitedHealthcare (UHC) as the medical provider with slight plan design changes. Please refer to pages 2 and 3 for more details. HSA: New for , employer contributions have increased! GC/ANC will also continue to pay the monthly HSA fees. Contributions: There will be a slight increase to the medical and dental contributions. Dental: We will remain with MetLife Dental with no changes to the plan design. Vision: New this plan year, the medical plan no longer includes eye exams or reimbursements. You will have a choice between a core and buy-up plan through UHC. See details under the vision section. Please make sure to plan, consider your choices, and choose wisely. What s Inside... Dependent Eligibility, Medical Plans 2 Medical & Prescription Benefits 3 Health Savings Account 4 Prescription Drug Coverage 5 Health & Wellness 6 MetLife Dental 7 Vision Plan through UHC 8 Contributions, Basic Life/ AD&D Insurance, Supplemental Life, Long- Term Disability, Long Term Care How to Enroll 10 Contact Information 11 Important Regulations Plan Year Open Enrollment Newsletter Welcome to Bryn Athyn College s Annual Open Enrollment This year s Open Enrollment period will be held on May 19 th May 31st Bryn Athyn College is pleased to present your Open Enrollment information. It s your once-a-year chance to make changes to your benefit elections without having a qualified life event as shown below. This Open Enrollment newsletter explains the benefit options available to you and what is changing for the new plan year. Our benefit plan year is from July 1, 2014 through June 30, Bryn Athyn College offers comprehensive benefits and decision tools, which demonstrates our commitment to your health, while promoting smart behaviors when using your benefits. Each year, we take a close look at our benefits package to ensure that we offer the best value and quality coverage for you and your family. For this plan year, please make sure to evaluate your needs, learn about your benefit options and make smart decisions about your health and wellbeing. We will continue to offer a comprehensive selection of benefits that you and your family can use to protect your health, finances and future. Qualified Life Events The choices you make during enrollment will be in effect for the 12-month plan year from July 1, 2014 to June 30, However, you may make changes during the year if you experience a qualified life event. If you need to report a qualified life event during the year, you will need to contact the Human Resources Department with the necessary changes Birth or adoption of a child Marriage Divorce and/or legal separation Death or loss of a dependent (including loss of dependent status) Change in your spouse s employment status causing loss or gain of benefits coverage Change in your own employment status Change in residence that affects the benefits offered to you Eligibility for Medicare Human Resources Contact Information Karen Day Stoeller Director of Human Resources General Church and Academy of the New Church Karen.Stoeller@anc-gc.org Office: (267) Cell: (215) Fax: (267) Christina Irwin Payroll and Benefits Administrator General Church for the New Jerusalem Muriel Brisbon Director of Human Resources Bryn Athyn College Office: (267) Fax: (267) Christina.Irwin@anc-gc.org Office: (267) Fax: (267)

2 Dependent Eligibility You may enroll your eligible dependents when you enroll yourself. Dependents who are eligible for benefit coverage include: Your legally married spouse Your dependent children Included in the definition of dependent child(ren) are: Medical: Your naturally born child(ren), legally adopted child(ren), stepchild(ren) or court-ordered dependent child(ren) for whom you are the court-appointed legal guardian Your dependent child(ren) up to age 26 whether they are a full time student or not. Coverage ends at the end of the month following the date they turn 26 Your continuously disabled dependent child(ren) [if disabled prior to age 26] who are incapable of self-sustaining employment and dependent upon you for support, regardless of age UHC Medical Plan Bryn Athyn College will continue to offer medical coverage through UHC for the plan year. To ensure that we offer quality health care options and to keep in pace with the changing health care environment, we will be making a few changes to the current plan design. Read below for a brief description of the medical plans and refer to the chart on the following page for plan benefits and changes. UHC offers a large network of health care professionals that provide quality and cost-effective care. To find a network provider, go to and click on Find Physician, Laboratory or Facility. Choice Plus High Deductible Health Plan (HDHP) w/ Health Savings Account (HSA) The Choice Plus HDHP w/ HSA is a type of insurance plan that has lower premiums, a higher annual deductible, and a higher out-of-pocket maximum than traditional health plans. The HDHP pairs with an HSA to help you save on qualified medical expenses (see page 4 for more information on how the HDHP w/ HSA plan works). Once the deductible is met, the plan pays 90% for in-network services. You save money when you use in-network providers because they charge a lower negotiated fee, and the plan pays a higher amount for covered charges. Under the HDHP w/ HSA, you are not required to select a Primary Care Physician (PCP) to coordinate your care, nor are you required to obtain a referral to see a specialist for services. You have the option to visit any out-of-network provider who does not participate in the PPO network, but you may be subject to higher out-of-pocket costs such as deductibles, coinsurance and copays. We understand that the deductible is a large amount for you to pay out-of-pocket; therefore, we will be increasing the contribution amount to $1,000 towards your deductible for single coverage, and $2,000 towards your deductible for family coverage. In addition, we will continue to pay the monthly HSA fees. Insurance Terms You Should Know Coinsurance This is the percentage of health care expenses you pay after your deductible. Your health plan pays the rest up to any benefit or lifetime maximum. Copayment (Copay) A fixed dollar amount that you pay toward the cost of covered medical services under the health plan. Deductible The amount you pay for covered services before the health plan begins to pay. Out-of-Pocket Maximum The amounts such as coinsurance, copays and deductibles that you are required to pay toward the cost of health services covered by the benefits plan before the plan pays 100% of additional out-of-pocket costs Plan Year

3 UHC Medical & Prescription Drug Benefits The below chart provides a snapshot of the UHC medical plan. The chart highlights basic details including copayment and coinsurance levels for both in and out-of-network providers. The UHC medical plan includes a Prescription Drug Benefit as highlighted below. Please refer to the Summary of Benefits for more details on each plan. Plan design changes are shown in bold. Annual Deductible: - Individual - Family Services In-Network $2,000 $4,000 UnitedHealthcare Choice Plus HDHP w/ HSA (Option 2) Based on Calendar Year Member Pays Out-of-Network $4,500 $9,000 Referral Required? No N/A Out-of-Pocket Maximum: - Individual - Family $4,000 $8,000 $9,000 $18,000 Selection of PCP Required? N/A N/A Primary Care Doctor Copay Specialist Doctor Copay Diagnostic Procedures Copay - Outpatient Lab Pathology - MRI/MRA, CT/CTA Scan - Routine Radiology Overall Lifetime Maximum Unlimited Unlimited Preventive Care Copay - Routine GYN Exam - Routine Mammogram - Routine Eye Exam $0 $0 (See new vision coverage) Hospital Care Copay - Inpatient Stay - Outpatient Surgery Emergency Room Copay (not waived if admitted) Durable Medical Equipment (Limited to $2,500 per year) Prescription Drug Coverage In-Network Out-of-Network Retail (up to 30-day supply) After Deductible, you pay: Generic: $10 Brand: $35 Non-Formulary: $60 After Deductible, you pay: Generic: $10 Brand: $35 Non-Formulary: $60 Mail Order (31 to 90-day supply) Generic: $25 Brand: $87.50 Non-Formulary: $150 Generic: $25 Brand: $87.50 Non-Formulary: $150 Open Enrollment Newsletter 3

4 HSA and High Deductible Health Plan (HDHP) How they Work Bryn Athyn College is committed to helping you and your family manage the high costs of healthcare by providing you with a Health Savings Account (HSA) program that you can use in conjunction with the High Deductible Health Plan (HDHP). An HSA provides tax-free dollars for qualified out-of-pocket health expenses if you are enrolled in a HDHP. The following are a few important things you should know about the HSA/HDHP. Pairing your HDHP with an HSA An HSA is a tax-advantaged account that is used in combination with a qualified high deductible health insurance plan. The money you put into your health savings account can help pay your health insurance plan s annual deductible, as well as any other qualified medical expenses that may not be covered by your health insurance plan after you meet your deductible. Contributions to your HSA account cannot be used to pay for health insurance premiums. Some of the Benefits of an HSA include: Pre-tax contributions: If you are an HSAeligible individual, you can make tax-free contributions to your HSA, up to the statutory maximum. Tax-free withdrawals: Withdrawals are tax-free when HSA funds are used for qualified medical expenses. Portability: Your HSA stays with you, even if you change employers or health plans. Who is eligible to establish an HSA? You are eligible to open an HSA provided you have met the following criteria: Must be enrolled in an HDHP and not also be covered by another health plan that is not an HDHP Not listed as a dependent on another person s tax return Not be entitled to benefits under Medicare What expenses are applied towards your deductible? (information below for in-network services, information varies when using out-of-network providers) Under the HDHP, any services received with the exception of Preventative Care, are applied towards your deductible. This includes (but is not limited to): All office visits Hospitalization Emergency room visits/care Lab tests/scans/x-rays Prescription drug coverage After the deductible is met, the plan will pay for 90% of the care, given you access an in-network provider. What does it mean to pay a deductible? The deductible must be satisfied each year before the insurance company pays on any medical claims. Single vs. Family Deductible Under the HDHP, if you are covering any dependents, the entire family deductible must be met prior to the plan paying for coverage. For example, if an associate and spouse are enrolled in coverage, between the two members, the full $4,000 must be paid out-of-pocket prior to the plan paying for coverage. Contributing to your HSA Account The maximum amount you can contribute to your HSA account during the plan year is $3,300 for single enrollments and $6,550 for family enrollments. The contributions maximums are set by IRS at the beginning of each year. Changing your contribution amount You are eligible to change the amount you contribute to your HSA account throughout the year as long as you do not contribute over the maximum allowed amount. Who Administers the HSA? The custodian and administrator of the HSA is Wells Fargo. Visit their website at When you enroll in the qualified high deductible health plan, you will be able to set up an HSA account with Wells Fargo and make pre-tax deposits through payroll deductions. How Health Care Reform Impacts Your Health Savings Account (HSA) Your medical health plan with Bryn Athyn College allows you to provide coverage for your eligible dependents until they reach age 26. But, the IRS tax law did not change the definition of a dependent for Health Savings Accounts. A tax-dependent is defined as up to age 19 or, if full-time student, age 24. There can be instances where you can have an adult dependent child covered under your health plan as allowed under the Affordable Care Act (less than age 26) BUT they are not a dependent for tax purposes. If you use the pretax dollars from your Health Savings Account to pay for health expenses for your covered dependent (who is not a dependent for tax purposes) you ll pay a penalty plus taxes. Here is an option you can take to avoid tax issues: Your covered adult dependent child may open his or her own Health Savings Account and contribute up to the allowed individual maximum ($3,300). To do so, call a Wells Fargo HSA customer service representative at and ask what is required. Please be aware that the deposits to the account will be on a posttax basis and are not handled through any payroll deductions. You may also continue to save up to the maximum family contribution amount in your own HSA ($6,550; if 55 or older an additional $1,000). No penalty will apply as long as you do not use your HSA to cover eligible expenses for a non-tax dependent child Plan Year

5 UHC Prescription Drug Coverage When you enroll in the Bryn Athyn College medical plan, you automatically receive prescription drug coverage through UHC. The Pharmacy Management Formulary Program provides a defined list of FDA-approved medications chosen for their medical effectiveness and value. The formulary list includes both generic and brand-name drugs. Your share of the cost will always be less for drugs that are on the formulary list; however, coverage is available for many non-formulary drugs. The formulary drug program is divided into copayment categories called tiers. After the in-network annual deductible is met, your copay under the first tier will be $10 for all generic formulary drugs, $35 for brand formulary drugs under the second tier, and $60 for nonformulary drugs under the third tier. To get an updated copy of the tiered formulary list of drugs, visit Using Mail Order services allows you to: Minimize trips to the pharmacy with delivery to you within 7 calendar days from the day the order is placed Save time by managing your prescription refills online or with a quick phone call Order refills, check order status, and pay your bill online Manage prescription for you and your family And enjoy free standard shipping Save Money - Use Mail Order! The prescription plan also includes a Mail Order program managed by OptumRx Mail Service Pharmacy, which allows you to purchase a 90-day supply of medications you take on an ongoing basis (known as maintenance drugs). When you order prescriptions through the mail, you pay two and a half copays rather than three for a 90-day supply. To use the mail order program, have your doctor fill out your prescription and fill out an order form. Mail your form to OptumRx, P.O. Box , San Diego, CA You can also speak to a representative by calling the number on the back of your member ID card or you can speak directly to an OptumRx Customer Service Advocate at Go Generic! Keep You and Your Wallet Healthy 1. What are generic drugs? Generic drugs are prescription medications that have the same active ingredients, dosage amounts, strength, safety, and quality as brand-name prescription medications. 2. Are generic drugs just as safe as brand-name drugs? Yes. Laboratories that produce generic drugs must meet the same high FDA standards as the facilities of brand-name drugs, and all generic drugs are FDA-approved to be therapeutically equivalent to brand-name drugs. 3. Why are generic drugs less expensive? Generic drug manufacturers do not have to research, develop, or clinically test their medications, and they do not have marketing or advertising expenses to promote their brand. This makes the generic-drug equivalent of your brand-name prescription much more affordable. 4. What is different about generic? The appearance of brand-name drugs is protected by law, so generic drugs will have different shapes, flavors, or colors. However, since the active ingredients are the same, they will work the same way in your body as the brand-name drug. 5. Does every brand-name drug have a generic drug equivalent? No. Pharmaceutical companies have a patent on their brand-name medications, so new drugs will not have a generic equivalent until the patent expires. 6. What if my brand-name drug is not available in generic form? Even if your brand name drug is not available in generic form, there may be a generic drug that could work just as well. Ask your doctor if a therapeutic alternative might be right for you. A generic therapeutic alternative is the equivalent for a different brand-name drug and treats your condition using a different active ingredient. If your doctor agrees, you can feel confident about using the generic therapeutic alternative and feel good about saving money too! Open Enrollment Newsletter 5

6 Health and Wellness through UnitedHealthcare There are added-value benefits available through your medical plan that are designed to encourage healthy behaviors. Additionally, discounts are available on products and services to help improve your health and save you money. Provider Directory: Log on to your member account through Myuhc.com to locate a provider near you information participating provider Gives access to information about providers that is not available in paper directories Log into MyUHC.com to: Update personal health record Help with managing care Treatment decision support - Connect with a specially trained registered nurse to get information about your diagnosis, understand your treatment options, and learn which questions to ask your doctor. Care management for hospital stays - When your care requires hospitalization, you ll receive preadmission counseling, inpatient advocacy and readmission prevention from a registered nurse. Emotional Support - Use Care24 any time of day for help dealing with life s challenges. A master s-level specialist will offer advice and counseling for stress, anxiety, depression, marital difficulties and more. Discounts - Save typically 10 to 50 percent on wellness products and services generally not covered by insurance with the Health Discount Program. Examples include: Jenny Craig, Curves, NordicTrack, SpaFinder, nutrition supplements, laser eye surgery (LASIK), teeth whitening, fitness club memberships and nicotine replacement therapy. Tips and tools for improving your health Online Health Coach Program The Online Health Coach Program generates health improvement plans designed to motivate and encourage. Use the customized information and tracking tools to: Lose weight Reduce stress Improve nutrition Quit smoking Manage your diabetes or heart health Visit and register to access these programs and more Plan Year

7 MetLife Dental Plan Dental insurance helps cover the cost of dental care for you and your family. Bryn Athyn College will continue to offer comprehensive dental coverage through MetLife Dental ranging from x-rays and routine cleanings to fillings and orthodontia care. We are pleased to provide you with MetLife Dental s PPO plan option. Dental Preferred Provider Organization (DPPO) Under the MetLife dental plan, you have the option of going in or out of the MetLife Preferred Dentist network. You may choose whether or not you use a participating dentist. The network is extensive and the benefits are similar in- or out-of-network; however, your benefit level is higher if you use in-network providers. In-network dentists are required to accept the MetLife Dental negotiated fee as payment in full. If you decide to use a nonparticipating dentist, however, your out-of-pocket expenses may be higher and you may be responsible for the difference between the dentist s actual charge and the plan s benefit payment. Preventive Care is covered at 80% in or out of the network (subject to plan limits). To find a participating dentist near you, visit the MetLife Dental website at and click on Find a Dentist. Be sure to select the PDP Plus Network. MetLife Dental Feature/Service In-Network DPPO Out-of-Network Member pays: Individual Calendar Year Deductible $50 Family Calendar Year Annual Deductible $150 Annual Maximum/Person $1,000 Preventive and Diagnostic (deductible waived for preventive) services) 20% 30% Basic Services 20% 30% Endodontic/Periodontal 20% 30% Major Services 50% 60% Orthodontia (children only) Maximum Rollover Included MetLife Dental Plan provides: Guaranteed Coinsurance/Copayment - Participating dentists agree to accept MetLife Dental s determination of fees. In-Network dentists won t bill you over MetLife Dental s approved amount. Reliable claims payment - Dentists usually handle claims for you and you can manage your plan in minutes online or by phone. An extensive network - You have access to one of the largest dental networks. When scheduling an appointment, please be sure to inform the provider that you are a MetLife Dental member. Open Enrollment Newsletter 7

8 Vision Plan through UHC The medical plan no longer includes coverage for eye exams or reimbursements. However, you now have a choice between two new plan options through UHC a Core and Buy-up plan. Bryn Athyn College will pay for the Core plan, which covers only an annual eye exam after a $10 copay. For additional benefits, you would need to select the Buy-up option, which covers eyewear materials such as frames, lenses and contacts. UHC Vision has a large network of providers that offers a wide selection of eyewear for you to choose from. You ll receive the most out of this benefit when you visit a UHC Vision eye doctor including discounts on non-covered services and selections. To locate a UHC vision care participating provider near you, visit the website at or call customer service at Feature/Service Frequency of Services UHC Vision Core Buy-Up In-Network Out-of-Network In-Network Out-of-Network Exams Lenses Frames Contacts Copays Exam Copay $10 Once every 12 months Up to $40 reimbursement Once every 12 months Once every 12 months Once every 12 months Once every 12 months $10 Up to $40 reimbursement Materials Copay $25 See below Basic Lenses (Included in Prescription Glasses) Single Vision Lined Bifocal Lined Trifocal Lenticular All basic lenses covered in full, after $25 copay Up to $40 reimbursement Up to $60 reimbursement Up to $80 reimbursement Up to $80 reimbursement Frames (Included in Prescription Glasses) Frame Allowance $130 retail allowance after $25 copay, then 30% off amount over allowance Up to $45 reimbursement Contact Lenses (Instead of Glasses) Covered Selection Allowance Non-Selection Allowance Medically Necessary Up to 4 boxes $105 allowance Covered-in-full after $25 copay Up to $105 reimbursement Up to $105 reimbursement Up to $210 reimbursement Plan Year

9 Contributions Each year Bryn Athyn College reviews our benefit programs and make revisions and updates to ensure that we continue to offer a competitive, cost-effective benefit program to you and your family. Below is a chart outlining your semi-monthly benefit contributions for the plan year. We are pleased to announce that Bryn Athyn College will pay 100% for the Core vision benefit and the Buy-up vision contributions are highlighted below. Level of Coverage Medical Dental Vision UHC Choice Plus w/hsa MetLife DPPO UHC Core UHC Buy-up Single $44.09 $7.12 $0.00 $1.90 Employee + Spouse $ $15.20 $0.00 $3.45 Employee + Child $85.89 $13.54 $0.00 $4.05 Employee + Children $85.89 $13.54 $0.00 $4.05 Family $ $23.49 $0.00 $6.02 Supplemental Life AD&D Insurance Bryn Athyn College also offers an option to purchase Supplemental Life and AD&D insurance through MetLife, which is an additional layer of coverage to help financially protect your family if you die. All active full-time employees are eligible for this benefit. Benefits are as follows: Basic Life and Accidental Death & Dismemberment, Supplemental Life and Long-Term Disability We will continue to provide Basic Life, LTD and AD&D insurance to regular full-time employees at no cost. Basic Life and AD&D Insurance Life insurance helps to protect your family in case something happens to you your designated beneficiary will collect a financial benefit upon your death. We will continue to provide you with Basic Life and AD&D insurance coverage to regular full-time employees at no cost to you. This benefit will be paid to your beneficiary in the amount of up to 2 times your base annual earnings, up to a maximum benefit of $450,000. A reduction of 35% will occur at age 65 and 50% at age 70. Also included is AD&D coverage, which provides an additional level of protection if you die or are seriously injured in an accident. This benefit is equal to your life insurance amount. Although there are no enrollment forms to complete, you are encouraged to update your beneficiary designations. Employee: $10,000 increments, up to a maximum of 5 times your basic annual earnings or $500,000. Spouse: $10,000 increments, up to a maximum of $100,000. Dependent child: $1,000 for a child 15 days to 6 months; 6 months and older, up to $10,000. Long-Term Disability (LTD) Disability insurance protects you and your family against financial catastrophe by helping you meet daily expenses bills, mortgages and other expenses and maintain your standard of living. The LTD plan provides income during an extended period of disability if you are disabled and unable to return to work after 180 consecutive days. The plan pays a monthly benefit of 60% of your monthly pre-disability earnings, up to a maximum monthly benefit of $5,000. You may receive monthly LTD benefits as long as you are deemed disabled by the insurance carrier. Long-Term Care through Unum This benefit is designed to help you pay for long-term facility and professional home care services that would otherwise be paid outof-pocket. Bryn Athyn College provides a base-plan coverage at no cost to you. You also have the option of purchasing a buy-up option. The base plan provides $1,000 per month for care at a facility for 3 years, or $1,000 per month professional home care for 6 years. This benefit terminates upon retirement; conversion to individual policy is an option. Open Enrollment Newsletter 9

10 You Have Easy Access to all of Your Benefits How to Enroll You have online access to your benefits information 24 hours a day, seven days a week. All employees can log onto the Employee Access self-service portal, which can be used to: Update personal information Review current benefit plans Update beneficiaries/ dependents Review other benefit related information To review and/or make changes to your current benefits for plan year please follow the below steps: Go to the ADP self-service portal which is You will be prompted to put in your current user name and password: User name: First initial + Last name (example: CIrwin@ANCGC) Password: Password retrieval can be done by clicking on the Forgot your Password link. Please do this before your third try. After your third failed password attempt the system will lock you out. Please call Christina Irwin to reset your password if you have been locked out. You can access Open Enrollment under the Benefits Tab. Follow the steps in the wizard to make any changes to your medical, dental and vision selections. Even if you do not want to make any changes to your current coverage you will need to log in to the ADP Portal and make the same selections. If you want to waive coverage, you will need to log-on to the ADP We encourage everyone to access the online Employee Access Self Service Portal to review and confirm personal information. All benefit selections/changes must be entered between May 19 th and May 31 st. Please remember to print a confirmation page of all benefit changes. If you have any questions or concerns, please contact the Human Resources Department Plan Year

11 Do you have a question about your coverage? Contact the appropriate vendor directly for help with: Benefits questions Claims process Choosing a doctor ID cards Copayments and deductibles Prescription drug coverage Contact Information Benefit Provider Web Site Phone Number Benefit Enrollment Medical Pharmacy Dental Life and AD&D Supplemental Life Long-Term Disability Contact the phone number on the back of your ID card OR Contact the phone number on the back of your ID card OR Life: Disability: Long-Term Care Health Savings Account Human Resources Contact Information Name Contact Location Karen Day Stoeller Director of Human Resources Muriel Brisbon Director of Human Resources Christina Irwin Payroll and Benefits Administrator Karen.Stoeller@anc-gc.org Office: (267) Cell: (215) Fax: (267) Muriel.Brisbon@brynathyn.edu Office: (267) Fax: (267) Christina.Irwin@anc-gc.org Office: (267) Fax: (267) General Church and Academy of the New Church Bryn Athyn College General Church of the New Jerusalem Open Enrollment Newsletter 11

12 Important Regulations Patient Protection Patient Access to Obstetrical and Gynecological Care You do not need prior authorization from Independence Blue Cross or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact UnitedHealthcare at Women s Health and Cancer Rights Act On October 21, 1998, the Women s Health and Cancer Rights Act became effective. This law requires group health plans that provide coverage for mastectomies to also cover reconstructive surgery and prostheses following mastectomies. As the Act requires, we have included this notification to inform you about the law s provisions. The law mandates that a plan participant receiving benefits for a medically necessary mastectomy who elects breast reconstruction after the mastectomy will also receive coverage for: 1. Reconstruction of the breast on which the mastectomy has been performed 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance 3. Prostheses 4.Treatment of physical complications of all stages of mastectomy, including lymphedema. This coverage will be provided in consultation with the attending physician and the patient, and will be subject to the same annual deductibles and coinsurance provisions that apply for the mastectomy. Health Insurance Portability and Accountability Act (HIPAA) State Children's Health Insurance Program (SCHIP) Loss of other coverage: If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents' other coverage). However, you must request enrollment within 31 days after your or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage). Loss of Medicaid or SCHIP coverage: If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children's health insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after you or your dependents' coverage ends under Medicaid or a state children's health insurance program. New dependent: If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependents. However, you must request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption. Eligibility for Medicaid or SCHIP premium assistance: If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a state children's health insurance program with respect to coverage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60 days after your or your dependents' determination of eligibility for such assistance. Medicaid and the Children s Health Insurance Program (CHIP) Offer Free Or Low-Cost Coverage CHIP is short for the Children s Health Insurance Program a program to provide health insurance to all uninsured children who are not eligible for or enrolled in Medical Assistance. CHIPRA is the reauthorization act of CHIP which was signed into law in February Under CHIPRA, a state CHIP program may elect to offer premium assistance to subsidize employer-provided coverage for eligible low-income children and families. All employers are required to provide employees notification regarding CHIPRA. Please refer to the Human Resources Department for a copy of the full annual notice. Medicare Part D Creditable Coverage / Non-Creditable Coverage Notice The Centers for Medicare and Medicaid (CMS) requires employers to notify their Medicare Part D-eligible individuals about their creditable coverage status prior to the start of the annual Medicare Part D election period that begins on October 15 of each year. Please refer to the Human Resources Department for a copy of the full annual notice. This Open Enrollment newsletter covers only the highlights of Bryn Athyn College s Benefits Programs. While we have tried to be as accurate as possible in developing this information, the official plan documents govern in all cases. Bryn Athyn College intends to continue these programs but reserves the right to change or end them at any time. Participation in the programs does not imply a contract of employment.