Guide for UPlan Benefits Enrollment. Current Employees make Open Enrollment changes for 2014 New Employees enroll in UPlan benefits for 2014

Transcription

1 Guide for UPlan Benefits Enrollment Current Employees make Open Enrollment changes for 2014 New Employees enroll in UPlan benefits for 2014 Employee Benef its

2 GENEral GENERAL ENROLLMENT ENrollmENT INFORMATION INformaTIoN Using Employee Self-Service to enroll in UPlan Benefit Programs With Self-Service, you can log in, make some selections, save your work, and come back to complete it at another time. Open Enrollment: The last elections you submit before the deadline will be your choices for the plan year. Your deadline is December 2. New Employee: You can submit your choices only one time. Your deadline is days from date of employment or benefit eligibility. It may take up to three business days to process your enrollment. You will receive an when it is done. Log in to view your Benefits Summary at that time or any time during the year. Three important tips 1. Scroll Down. There is often more information than will fit on a screen. Be sure to scroll down to see all of your choices. 2. Wait - PROCESSING. It may take a while to process information as you make your benefits selections. When you see the word PROCESSING flashing in the upper right corner of your screen, wait. Do not click another selection until the page refreshes. Need help? Internet ID and Password: Crookston: Duluth: Morris: Twin Cities and anywhere in the state: (1-HELP) or help@umn.edu Benefits Enrollment not available (down for maintenance): Mon-Sat: 4 a.m. - 6 a.m. Sun: 4 a.m. - 1 p.m. Three ways to log out: Return to the Internet Login Successful screen and use the LOGOUT button. Close ALL application windows. From any browser window, go to 3. Final Submit Button. After you make your selections, you will see a Submit Benefits Choices page. Be sure to click Submit at the bottom of this page to send your information to Employee Benefits. You will see the Submit Confirmation page when you have successfully completed your enrollment. To submit your choices online 1. Go to the Employee Self-Service website: 2. Select Benefits Enrollment. 3. Log in using your Internet ID and password. 4. Select Benefits Enrollment. 5. Select the open benefit event. Open Enrollment: Use the Open Enrollment page as a base page to begin entering each of your selections. New Employee: Use the Benefit Enrollment page as a base page to begin entering each of your selections. Information needed for enrollment: To add dependents, you need the birth date and, if required, a primary care clinic number. Your same-sex domestic partner must be registered to complete enrollment online. If your spouse/same-sex domestic partner is age 45 or older, his/her Social Security number is required. If changing plans, check whether you need a primary care clinic number.

3 Table of Contents General Enrollment Information... Page 2 Open Enrollment What you can do during Open Enrollment... Page 4 Computer Assistance... Page 4 Employee Health & Benefits Fair... Page 6 New Employee Employee Eligibility Guidelines... Page 7 Effective Date of Your Benefits... Page 8 Waiting Period Medical Coverage... Page 8 Definition of UPlan Medical and Dental Plan Eligibility... Page 10 Dependent Eligibility Verification... Page 10 Overview of Retirement Plans... Page 11 General Benefits Information Definition of Eligible Dependents... Page 12 Family Status Change... Page 16 Medicare Eligible... Page 17 Medical Plan Options... Page 18 Medical Plan Descriptions... Page 20 Pharmacy Benefits... Page 21 Zones and Base Plan... Page 22 Plan Availability... Page 23 Plan Comparison... Page 24 UPlan Wellness Achievement Rates per Pay Period... Page 28 UPlan Standard Rates per Pay Period... Page 29 Walk-in Clinics... Page 30 Consult A Doctor 24/7... Page 31 Travel Program... Page 32 FrontierMEDEX (Emergency Medical Assistance)... Page 32 Wellness... Page 33 Wellness Points Chart... Page 36 Medication Therapy Management... Page 38 Notice about your Prescription Drug... Page 39 Coverage and Medicare Dental Plan Options... Page 41 Dental Plan Descriptions... Page 42 Plan Availability... Page 43 Plan Comparison... Page 44 Rate Contributions per Pay Period... Page 46 Flexible Spending Accounts... Page 47 Health Care... Page 49 Dependent Daycare... Page 50 Life Insurance... Page 54 Rates... Page 57 Short-term Disability... Page 58 Rates... Page 58 Long-term Disability... Page 59 Rates... Page 59 Notice about the Early Retiree Reinsurance Program... Page 60

4 General enrollment InformaTIon What the Guide contains This Guide includes information for two groups of employees: Employees making changes in their UPlan benefits coverage during 2013 Open Enrollment for January 1, 2014, effective date. New employees eligible for UPlan benefits coverage during the 2014 calendar year. Some information in the Guide is specific to your group, and some is general information that applies to all eligible employees. Read the information for your group and the general benefits information to learn what you need to do to successfully enroll in your benefits. Open Enrollment: Information and guidelines for employees making benefits changes during Open Enrollment are on pages 4-6. New Employees: Information and guidelines for new employees electing benefits coverage for the 2014 calendar year are on pages General Benefits Information: This section includes information that applies to both groups. The plan comparison charts, biweekly rates, plan descriptions, plan availability, and dependent eligibility are the same for both groups of employees. This section starts on page 12. How to Enroll: Each group has different guidelines for electing coverage. These will be pointed out in the description section for each benefit option under How to enroll. An example of the different guidelines is that new employees can elect certain amounts of life insurance without evidence of good health within their first days of employment while current employees must provide health history information for underwriting even during Open Enrollment. Plan provider directories Plan provider directories are available in electronic and print formats. We recommend checking that the medical or dental clinic you want to use is in the network directory before you make your final plan election. Your department s benefit contact person has provider directories you can review. Or you can access directories on the Employee Benefits website where you will find links to the plans websites and search tools. Benefits Enrollment Page 2

5 General Enrollment Information Open Enrollment dates November 1 through December 2 Enroll online Enroll online in Employee Self-Service: Where to go for answers The Employee Benefits Service Center staff is available to help you with your benefits questions and enrollment. The Benefits Service Center s phone number is or : The Benefits Service Center s address is benefits@umn.edu. The Employee Benefits website is at Regular office hours are from 8 a.m. to 4:30 p.m. Monday through Friday. Telephone language interpretation services are available through Employee Benefits. Employee Benefits is located in the Donhowe Building at th Ave SE on the East Bank campus in Minneapolis. Customer Service Center For questions you have about your benefit options: Medica: or HealthPartners Dental: or Delta Dental: or Prime Therapeutics Pharmacy Program: Fairview Specialty Pharmacy: or Plan group numbers The group numbers for the plan options are provided below in case you need to call the plan s customer service center before you receive your member ID card in the mail. Medical Plans Medica Twin Cities Elect/Essential: Medica Duluth Elect/Essential: Medica Choice Regional: Medica Choice National: Medica ACO Plan: Fairview & North Memorial Vantage Plan: Inspiration Health by Health East: Park Nicollet First: Ridgeview Connect: Insights by Medica: Medica HSA Single Options PPO Network: Medica HSA Family Options PPO Network: Dental Plans Delta Dental PPO: 6100 HealthPartners Dental: Delta Dental Premier: 6090 HealthPartners Dental Choice: University Choice (Delta Dental): 6113 Benefits Enrollment Page 3

6 Open Enrollment What you can do during Open Enrollment Open Enrollment is the one time each year when the University announces benefit plan changes and biweekly contribution rates for the next calendar year. You may choose different medical and dental plans. If you do not have medical or dental coverage, you can add it, or if you no longer need it, you can cancel coverage. You can add or cancel dependents on your coverage. If adding dependents, review the Definition of UPlan Medical and Dental Program Eligibility on page 10 and the Definition of Eligible Dependents on page 12. You can also add Child Life coverage without evidence of good health. You can add up to $200 of short-term disability without evidence of insurability if you have an existing amount of short-term disability. You can add or increase the amount of long-term disability if you are a civil service or labor represented employee. Open Enrollment is also when you need to enroll in or re-enroll in the flexible spending accounts for participation in the 2014 calendar year. Open Enrollment dates: November 1 - December 2 Online enrollment is available in Employee Self-Service from Friday, November 1, through Monday, December 2. You must be sure to enroll online before the deadline. We encourage you to submit your choices as soon as possible. If your newly eligible benefits are effective by November 1, complete your initial benefits enrollment soon because it needs to be processed before you can go online to do Open Enrollment elections. Please remember the deadline for Open Enrollment. To have your changes effective January 1, 2014, you must complete your online enrollment before the self-service site is closed on Monday, December 2. An Open Enrollment presentation is available on the Employee Benefits website at Computer assistance You will need to use a computer to make your benefit changes online for Open Enrollment. If you do not have one available to you at work or home there are some options: Computers will be available at the Employee Health & Benefits Fairs in Minneapolis, St. Paul, and Duluth. Computers may be available at your local library. Computer lab sessions will be available in 315 Donhowe on the Minneapolis campus at these dates and times: November 25, 26, 27, and December 2 8 a.m. to 4:30 p.m. Benefits Enrollment Page 4

7 Open Enrollment Member ID cards You will receive new member ID cards at your home address from your Medica medical plan whether or not you change options. HealthPartners and Delta Dental will send new dental member ID cards only if you change options. Prime Therapeutics will send a member ID card if you are electing medical coverage for the first time. Medical plan options You can enroll in a different medical plan. You can add eligible dependents to your medical coverage. You have the choice to add or cancel medical coverage. If you want to change your primary care clinic, you must do that directly with the medical plan as a clinic change cannot be made online. It is also a good idea to check with your medical plan each year to confirm that your clinic still participates in your plan option. Dental plan options You can enroll in a different dental plan or add eligible dependents to your dental coverage. You have the choice to add or cancel dental coverage. It is also a good idea to check with your dental plan each year to confirm that your dentist still participates in your plan option. Flexible spending accounts You can enroll or re-enroll in a pre-tax Dependent Daycare or Health Care Flexible Spending Account (FSA). Deposits are made into these accounts on a calendar year basis; however, you may file claims for expenses incurred from January 1, 2014, to March 15, 2015, against the 2014 deposits. Refer to the Flexible Spending Accounts section in the guide for information on these accounts, especially the definition of qualified health expenses under the health care FSA. Long-term disability As a civil service or labor represented staff employee, you can add or increase long-term disability without evidence of good health; however, this amount is subject to pre-existing conditions. Short-term disability You can increase your existing amount of short-term disability coverage by up to $200 without evidence of insurability. The total amount can replace up to 66-2/3 percent of your salary but not more than $5,000 per month. This year you will make your election using a paper application that is available at Optional benefits Additional life insurance Employee and spouse/same-sex domestic partner life coverage is NOT part of Open Enrollment, but is included in the guide for your convenience. If you want to add or increase the amount of life insurance coverage, you will need to complete health history questions for underwriting. Follow the directions for enrollment found in the applicable section of this guide. Benefits Enrollment Page 5

8 Open Enrollment When your coverage goes into effect Your Open Enrollment elections for medical, dental, flexible spending accounts, and short-term and long-term disability amd child life insurance become effective on January 1, If you are on a leave of absence on January 1, 2014, coverage may be delayed until you return to work. Please contact Employee Benefits for more information. Optional coverages requiring evidence of insurability will become effective based upon the underwriting approval date of the insurance carrier. Employee Health & Benefits Fair The annual Employee Health & Benefits Fair, sponsored by Employee Benefits and Boynton Health Service, will be held at the U of M campuses this fall. The schedule is: October 31 November 7 November 11 November 12 November 13 Ballroom, Kirby Student Center, Duluth 10 a.m. to 2:30 p.m. Bede Ballroom, Sargeant Student Center, Crookston 12 to 2 p.m. Oyate Hall, UMM Student Center, Morris 11 a.m. to 1 p.m. North Star Ballroom, Student Center, St. Paul 10 a.m. to 3:30 p.m. Great Hall, Coffman Memorial Union, Minneapolis 10 a.m. to 3:30 p.m. At the Employee Health & Benefits fair, you can talk to the medical and dental plan administrators and pharmacy benefit manager about your plan options and visit with representatives from your life, disability, and retirement plans, along with a number of University departments. The fair is also the place to participate in health promotion activities, including flu shots at some fair locations. Benefits Enrollment Page 6

9 new employee benefits enrollment employee eligibility guidelines You are eligible for UPlan benefits if: you are a new hire, or your appointment increased to percent time, or your appointment increased to percent time AND all of the following apply to your appointment: eligible classification 50 percent time or greater three months or longer basic benefits You qualify for benefits provided by the University of Minnesota because you are either a new employee or in a newly benefits-eligible position. This guide highlights your benefits and rates and is designed to help you complete the online enrollment process. The basic benefits offered to you are employee medical and dental coverage and employee basic life insurance. If you have an appointment that is 75 percent time or greater, the University will contribute toward the cost of your rates. If your appointment is 50 percent to 74 percent time, you will pay the full cost of the rates. You need to elect your medical and dental plan options within the first days of employment or benefits eligibility. If for any reason you elect to change to another plan within this day period, the new plan will be retroactive to your initial date of active coverage. optional benefits The optional benefits available to you include: medical and dental coverage for eligible dependents; additional life insurance for you, your spouse/registered same-sex domestic partner, and dependent children; disability insurance; and the flexible spending accounts. Certain amounts of life and disability coverage can be obtained without underwriting if you apply within your first days of eligibility. enroll to have coverage You must make your benefits elections online in Employee Self- Service for yourself, your spouse/registered same-sex domestic partner and dependent children within your first days of employment or benefits eligibility. Employee Benefits will contact you by after they have prepared the Employee Self-Service site for you to enroll. Waive benefits or do not enroll Since you are not required to choose a medical or dental plan, you can elect to waive or not have benefits. This is also true for the optional benefits. However, if you do not enroll during the day window you will not have an opportunity to elect medical and/ or dental coverage for yourself and your dependents until the next available open enrollment period. Benefits Enrollment Page 7

10 New Employee Benefits Enrollment New employee effective date Example: Date of employment: February 12 Effective date of basic benefits: March 1 Example: Date of employment: May 1 Effective date of basic benefits: June 1 If you are newly hired, your basic employee medical, dental, and life insurance coverage will become effective on the first day of the month following your first day of employment. You can determine the effective date of your basic benefits by using the chart below Monthly Effective Date Chart Employed during Coverage effective date January 2014 february 1, 2014 February 2014 march 1, 2014 March 2014 april 1, 2014 April 2014 may 1, 2014 May 2014 June 1, 2014 June 2014 July 1, 2014 July 2014 august 1, 2014 August 2014 september 1, 2014 September 2014 october 1, 2014 October 2014 november 1, 2014 November 2014 December 1, 2014 December 2014 January 1, 2015 January 2015 february 1, 2015 Waiting period medical coverage You may purchase medical coverage for the waiting period from your first day of employment until your active coverage begins. You may elect a medical plan, other than Medica HSA, for this coverage. You need to enroll within 30 days of your first day of employment and pay the full cost of the coverage for the full waiting period. Please contact the Employee Benefits Service Center at or to request an enrollment form and the rate for waiting period medical coverage. You may elect a different plan and coverage level when you enroll online for your active coverage. Newly eligible employee effective date Example: Date of eligibility change: February 3 Effective date of basic benefits: March 1 Example: Date of eligibility change: May 1 Effective date of basic benefits: May 1 If you are a current employee who becomes newly eligible for coverage as a result of an appointment change, your basic employee medical, dental, and life insurance coverage will become effective on the first day of the month following the date of the eligible change. If your newly eligible appointment begins on the first of the month, then your coverage becomes effective on that day. You can use the Coverage effective date column above to determine the effective date of your basic benefits. If you are not actively at work due either to your or your depen- Benefits Enrollment Page 8

11 New Employee Benefits Enrollment When you are actively at work affects coverage start date dent s health status or medical disability on the date that your coverage is scheduled to begin, medical and dental coverage will still take effect. (However, life and disability coverage will be delayed until you return to work.) If you are not actively at work on the initial effective date of coverage due to a reason other than hospitalization or medical disability for yourself or your dependent, then medical and dental coverage will be delayed until the first day of the pay period coinciding with or following your return to work. Medical and dental coverage for your dependents, additional life, disability insurance coverage, and the flexible spending accounts will go into effect on the same date as your basic coverage if you enroll on a timely basis and you are actively at work. Otherwise, the effective date may be delayed. Optional coverage requiring evidence of good health will go into effect on the first day of the pay period coinciding with or following approval by the insurance company, provided that you are actively at work. If you have any questions on determining your effective date of coverage, please call the Employee Benefits Service Center at or If you have an academic appointment If you work for the University only during the academic year, generally on a 9- or 10-month appointment, your coverage will continue during the summer months that you are not scheduled to work provided that you return to work at the beginning of the new academic year. To pay for your contribution toward coverage during the non-work period, rate amounts will be deducted in arrears from your paycheck when you return to work. Note: If you do not return to work for the following academic year, your benefits terminate on the last day of the pay period in which you last worked. Rates paid on a pre-tax basis The rates you pay for your medical or dental coverage for you and your dependents are automatically deducted from your paycheck on a pre-tax basis. The pre-tax payment saves you money because your contributions for medical and dental coverage are subtracted from your salary before federal, state, and Social Security taxes are withheld. As a result, your taxable salary and your taxes are reduced. Because you pay less in taxes, your take-home pay may be greater. Since pre-tax benefits reduce the salary on which Social Security benefits are calculated, you may have a slight reduction in your Social Security benefits if your annual salary is less than the Social Security base. Benefits Enrollment Page 9

12 New Employee Benefits Enrollment Rates paid on an after-tax basis Rates for life and disability insurance are paid only on an after-tax basis. Effective January 1, 2014, you will no longer have the choice to pay your share of medical and dental rates on an after-tax basis. Definition of UPlan Medical and Dental Program eligibility The University of Minnesota develops eligibility criteria for its employees and their dependents (subject to collective bargaining agreements and compensation plans) that may change during a Plan Year. You are eligible to participate in the University of Minnesota UPlan Medical and Dental Program (the Plan) if you are working at the University with an appointment in an eligible classification of at least 50 percent time and lasting at least three months in duration. The University contributes a significant portion of the cost of medical and dental benefits if you have an appointment of 75 percent time or greater. If your appointment is at least 50 percent to 74 percent time, you are eligible to participate in the Plan but must pay full cost of coverage. There is no University contribution at this level of employment. In no event can you receive coverage as both an employee and as a dependent of another Plan member. For example, you may not have coverage for yourself as an employee and be a dependent on the coverage of a spouse/registered same-sex domestic partner or a parent who has family coverage as a University of Minnesota employee. In no event can you include a dependent on the Plan who is ineligible for coverage. You will be subject to disciplinary action if you provide false, incorrect, or fraudulent information on your enrollment, including enrollment of dependents. The Plan reserves the right to request documentation to verify eligibility of your enrolled dependents. Dependent eligibility verification The University has a responsibility to ensure UPlan resources are well managed and to apply the dependent eligibility rules fairly and equally. For both these reasons, you will be asked to verify eligibility of your dependents if they are added to your UPlan coverage during Open Enrollment, when you are a new employee, or when you acquire a new dependent. You will need to verify the eligibility of these dependents by providing documentation such as a tax form, birth or marriage certificate, same-sex domestic partner registration information, or a birth or adoption certificate. Please respond to the verification request from Employee Benefits promptly to ensure coverage for your dependents. Benefits Enrollment Page 10

13 New Employee Benefits Enrollment Overview of retirement plans The University provides basic retirement plans for both faculty and staff. Your required contributions are taken on a pre-tax basis. For more detailed information about the retirement plan available to you, refer to the Employee Benefits website at retiresave/index.html. Civil Service and Labor Represented staff Civil service and non-faculty labor represented staff are covered by Minnesota State Retirement System (MSRS). Participation is mandatory and begins from the first day of employment. There is no waiting period. Retirement deductions are a percentage of total salary and are paid into the Retirement Fund. This money is credited to your individual MSRS account and is tax sheltered from both federal and state income tax. The employer contribution is not credited to individual accounts. It is used to help pay the monthly annuities and benefits received from the Retirement Fund. Rates are subject to change by the Legislature. Faculty and Professional & Administrative staff Faculty and Professional & Administrative staff who hold a 67 percent time or greater appointment for not less than nine months in duration are eligible (with some exceptions) to participate in the Faculty Retirement Plan. For some Professional & Administrative staff, participation begins after a waiting period based on appointment type, years of service, and salary. You are immediately covered by the Academic Disability Program, which provides medical leave benefits and long-term disability insurance. Voluntary retirement plans The University also offers two voluntary retirement savings plans the Optional Retirement Plan and the Section 457 Deferred Compensation Plan. All faculty and staff who are paid on a continuous basis may participate. No minimum appointment is required. You can contribute, in each calendar year, the amount allowed under the federal limits. Contributions may be invested in any of more than 200 no-load investment options offered by leading insurance and mutual fund companies. You pay no federal or state income taxes on the money you put into the plans or on any investment gains until you withdraw funds. And because your contributions are tax-deferred, you reduce your taxable income and pay less in taxes on your take-home pay. You can increase or decrease your contributions during the year. You may also stop contributions and restart them at a future date. Refer to the Employee Benefits website to learn more about the voluntary retirement savings plans and to request an enrollment kit for either plan. Allow about four weeks for your Optional Retirement Plan enrollment and up to eight weeks for your Section 457 Plan enrollment to be completed. Applications received after November 28 may apply to the next calendar year. Benefits Enrollment Page 11

14 General Benefits Information Definition of eligible dependents The chart specifies the criteria for coverage along with whether the dependent is considered qualified for favorable tax treatment under the Plan. Relationship to Employee Spouse Criteria for Coverage Must be legally married. Your spouse must not be working full-time for an employer and receiving cash or credits 1) in place of medical coverage or 2) in exchange for medical coverage with a deductible of $750 or greater. Is Dependent Qualified for Tax Favored Treatment( 1) Qualified Same-Sex Domestic Partner Must be registered as same-sex domestic partner. Your registered same-sex domestic partner must not be working full-time for an employer and receiving cash or credits 1) in place of medical coverage or 2) in exchange for medical coverage with a deductible of $750 or greater. Usually non-qualified. Refer to same-sex domestic partner information in the Definition of Eligible Children Dependent Child Dependent child birth through age 25 (up to the 26th birthday) An eligible child can include your unmarried or married biological child, legally adopted child or child placed for the purposes of adoption, foster child, stepchild, or any other child state or federal law requires be treated as a dependent. Note: The spouse of your eligible married dependent child is not eligible for coverage. Qualified Dependent child of registered same-sex domestic partner birth through age 25 (up to the 26th birthday) An eligible child can include your same-sex domestic partner s unmarried or married biological child, legally adopted child or child placed for the purposes of adoption, foster child, stepchild, or any other child state or federal law requires be treated as a dependent. Note: The spouse of your same-sex domestic partner s eligible married dependent child is not eligible for coverage. Usually non-qualified Disabled child age 26 or above (no maximum) if physically or mentally disabled and either: lives with you and does not provide over 50% of his/her own support, or does not live with you but is at least 50% dependent on you Qualified Dependent Grandchild A grandchild is eligible for coverage if he/she is placed in your legal custody; or if the grandchild is legally adopted or placed with you for the purpose of adoption. The grandchild must be dependent upon you for more than one-half of his/her support, and you must claim the grandchild as a dependent on your tax return. Your unmarried grandchild is also eligible for coverage if (1) he/she is in your legal custody and dependent upon you for principal support and maintenance, but is a qualified tax dependent of another person or (2) your unmarried grandchild is the dependent child of your unmarried dependent child, and even though the grandchild may be dependent upon you for principal support and maintenance, he/she would not be eligible to be your tax dependent under tax regulations. In these instances, the contributions made by the University to your grandchild s coverage as well as your contributions are considered taxable income on your tax returns. Qualified Usually non-qualified (1) Tax Favored Treatment refers to how dependent coverage is treated for tax purposes. Benefits Enrollment Page 12

15 General Benefits Information Notes about eligible dependent children An eligible child, unmarried or married, can include your own biological child, legally adopted child or child placed for the purposes of adoption, foster child, stepchild, and any other child state or federal law requires be treated as a dependent. Eligible child can also include the unmarried or married child of your registered same-sex domestic partner, although that coverage is generally not available on a tax favored status. For a child who is being adopted, the date of placement means the date you assume and retain the legal obligation for total or partial support of the child in anticipation of your adoption of the child. A child s adoption placement terminates upon the termination of the legal obligation of total or partial support. To be considered a dependent child, a foster child must be placed by the court in your custody. To be considered a dependent child, a stepchild must be the child of your spouse/same-sex domestic partner by a previous marriage/ partnership Note: The spouse of your eligible married dependent child is not eligible for coverage. The child of your same-sex domestic partner can be considered a dependent child if your same-sex domestic partner is registered with the University and the child satisfies all other requirements to be an eligible child. This applies to both the children of your registered same-sex domestic partner from your current partnership or his/her previous marriage/partnership. If both you and your spouse/registered same-sex domestic partner work for the University of Minnesota, then either of you, but not both, may cover your eligible dependent children/grandchildren. This also applies to two divorced or unmarried employees who share legal responsibility for their dependent children or grandchildren. Notes about dependent grandchildren Your unmarried grandchild is eligible for coverage if he/she is your tax dependent; if the grandchild is placed in your legal custody; or if the grandchild is legally adopted or placed with you for the purpose of adoption. The grandchild must be dependent upon you for more than one-half of his/her support, and you must claim the grandchild as a dependent on your tax return. In these instances, the contributions made by the University and your pre-tax contributions are not considered taxable income on your tax returns. Your unmarried grandchild is also eligible for coverage if (1) he/she is in your legal custody and dependent upon you for principal support and maintenance, but is a qualified tax dependent of another person or (2) your unmarried grandchild is the dependent child of your unmarried dependent child, and even though the grandchild Benefits Enrollment Page 13

16 General Benefits Information may be dependent upon you for principal support and maintenance, he/she would not be eligible to be your tax dependent under tax regulations. In these instances, the contributions made by the University to your grandchild s coverage as well as your contributions are considered taxable income on your tax returns. Notes about eligibility of spouse/registered samesex domestic partner If both you and your spouse/registered same-sex domestic partner work for the University of Minnesota, then either of you has the option of adding the other as a dependent to his/her family coverage. The spouse/ registered same-sex domestic partner added to the family coverage must waive employee coverage. If your spouse or registered same-sex domestic partner works full-time for an employer and receives cash or credits (1) in place of medical coverage, or (2) in exchange for a medical coverage with a deductible of $750 or greater, then he/she is not considered to be an eligible dependent under the Plan. Same-sex domestic partner registration criteria: 1. Engaged in a committed relationship and intend to remain together indefinitely; 2. Are the same sex and for this reason are unable to marry each other under Minnesota law; 3. Are at least 18 years of age and have the capacity to enter into a contract; 4. Are jointly responsible to each other for the necessities of life; and 5. Are not related by blood closer than permitted under Minnesota marriage laws. Contact the Employee Benefits Service Center at or for the forms to register your same-sex domestic partner. Notes about the taxability of coverage for your registered same-sex domestic partner and the child/children of registered same-sex domestic partner Under IRS rules, the value of the medical and dental benefits provided by the University to your registered same-sex domestic partner and the child/children of your registered same-sex domestic partner is generally considered taxable income to you as the employee. The only exception to the taxability of these benefits is if your registered same-sex domestic partner and his or her children meet the following IRS definition of a dependent. A registered same-sex domestic partner and his/her children can meet the definition of a dependent for the purposes of family coverage if the following conditions are met: 1. They lived with you for the entire year as a member of your household. Benefits Enrollment Page 14

17 General Benefits Information 2. They were U.S. citizens or resident aliens of the U.S. or residents of Canada or Mexico for part of the calendar year in which your tax year began. 3. They did not file a joint tax return. 4. You provided over half of their support for the calendar year. 5. They are not a dependent child for tax purposes of any other individual. If your registered same-sex domestic partner and children meet all of the above requirements, you will need to complete a Certification of Dependent Status form. Information and the form can be found on the website at index.html or by contacting the Employee Benefits Service Center. Note: Most same-sex domestic partner expenses are not eligible to be reimbursed through the HSA, per IRS regulations. Coverage of disabled children of any age Your dependent child of any age is eligible for coverage and tax favored status if he/she is incapable of self-sustaining employment by reason of mental retardation, mental illness, mental disorder, or physical disability, and is chiefly dependent upon you for his/her support and maintenance (meaning you provide for more than onehalf of the child s support). A dependent child must be certified by the UPlan Medical Plan Administrator to be disabled prior to age 26, based on proof that the child meets the above requirements. If for any reason, you drop coverage for a disabled dependent prior to age 26, then wish to cover the child again, coverage must be added prior to the child turning age 26, and his/her disabled status recertified by the Plan Administrator. Once your disabled child has reached age 26, the child must be continuously covered under the Plan in order to maintain eligibility. A disabled dependent child who is 26 years of age or older and unmarried at the time of your initial eligibility for coverage in the Plan may be enrolled for coverage if: you (the employee) enroll for coverage during your initial eligibility period, and; the UPlan Medical Plan Administrator certifies that the dependent meets the above requirements. Proof of disability status must be provided within 31 days of your initial date of eligibility and enrollment in the Plan. The disabled dependent shall be eligible for coverage as long as he/she continues to be disabled and dependent, unless coverage otherwise terminates under the Plan. Benefits Enrollment Page 15

18 General Benefits Information A dependent child who is considered to be disabled by the UPlan Medical Plan Administrator will be eligible for tax favored coverage under the Plan, regardless of age. The disabled child of a registered same-sex domestic partner will not be eligible for tax favored coverage. Children covered by Child Support Order Children of the employee who are required to be covered by reason of a Qualified Medical Child Support Order are eligible, as required by federal and state law, to assure that children who do not live with both of their biological parents have adequate medical coverage. This provision does not apply to children of the spouse/registered same-sex domestic partner who are not also children of the employee. Not eligible For purposes of coverage under the Plan, your parents, grandparents, in-laws, brothers, sisters, aunts, uncles, cousins and other extended family members, non-registered same-sex domestic partners and their children, and unmarried opposite-sex domestic partners and common-law spouses are not eligible dependents. Family status change To make changes in your medical, dental, optional life coverage, or flexible spending accounts after you are first eligible or outside of the annual open enrollment period, you must have a change in family status. The coverage change must be consistent with the family status change. A request for change in your coverage due to a family status change must be made within 30 days of the date of change. If you fail to apply for a change in coverage within 30 days of the family status change, you will not be able to make a change until the next available open enrollment period. Family status changes include: Change in legal marital status, including marriage, divorce, or annulment Registration of your same-sex domestic partnership or termination of same-sex domestic partnership Death of your spouse/registered same-sex domestic partner or last eligible dependent child Birth or adoption of your eligible dependent child Change in last dependent child s eligibility because of age Commencement or termination of employment for you, spouse/ registered same-sex domestic partner, or dependent Change in your or your spouse/registered same-sex domestic partner s employment status from part time to full time or from full time to part time Benefits Enrollment Page 16

19 General Benefits Information Change in the place of residence or worksite for you, spouse/ registered same-sex domestic partner, or dependent to a location outside of the current plan s service area and the current plan is not available Call the Employee Benefits Service Center if you have more specific questions about changes in your coverage. Transition of Care If you are in the middle of treatment for a serious medical condition, you may need special assistance to change to a new medical plan. Transition of care allows for a short-term continuation with your current provider before you begin receiving care from a provider in your new medical plan s network. A current course of treatment is defined as having received consultation or treatment from a provider for a specific condition within 90 days prior to your effective date with Medica. The care coordinators at Medica will work with your medical providers and assist you with completing the form and other steps for short-term continuation with your current provider. Medicare eligible? Let your medical plan know If you or a covered family member have Medicare Part A or B, please be sure to contact your medical plan to let the plan know. You must provide information about Medicare participation so your files can be updated and your claims processed correctly. If you are age 65 or older and actively working (or your dependent is age 65 or older), enrollment in Medicare Part B should be delayed until you are no longer working. Contact the Employee Benefits Service Center if you need additional information. For employees who are actively at work, their medical plan must pay first (primary) on all claims. Your medical plan carrier will then submit any remaining charges to Medicare for possible payment. Also, please request that your health care provider submit any claims to your medical plan not to Medicare. If you or any of your dependents have Medicare Parts A or B due to age or disability, please contact your medical plan to let them know. Benefits Enrollment Page 17

20 medical: Plan options basic benefit Your medical plan options provide regular medical care and pharmacy benefits for the diagnosis and treatment of most illnesses and injuries in a number of formats, ranging from limited network plans to open access and tiered network plans to a high deductible health plan. The plan options include a wide range of providers at different rates, deductibles, and copayments. The medical plans do not have a pre-existing condition clause. This means that you and your eligible dependents have coverage for any medical condition, including pregnancy, as soon as your coverage becomes effective. The plan options cover in-network preventive care at no cost to you and provide physician and hospital care on a worldwide basis, subject to copays. The UPlan medical options have out-of-network coverage available at 70 percent coinsurance after a $600 deductible and subject to an overall in- and out-of-network maximum. The options that are available to you differ by geographic location or zone. Each zone has a base plan that offers the lowest rates and copayments. You may choose a medical plan that is available where you live or work. For example, if you live in the Greater Minnesota zone but work in the Duluth area zone, you can choose a plan in either zone. Coverage available You elect coverage from one of four rate tiers: Employee only; Employee and spouse/same-sex domestic partner; Employee and child/children; and Employee and both spouse/same-sex domestic partner and child/children. You may also waive or elect not to have coverage. rates The University of Minnesota pays 87 percent of the cost of employeeonly coverage (employee pays 13 percent) and 80.5 percent of the cost of each tier of family coverage (employee pays 19.5 percent) for the base plan for your geographic zone. For other plans, your rate will include the additional cost of that plan. How to enroll Open Enrollment: Enroll or make your change online in Employee Self-Service from November 1 through December 2. If you cancel coverage, the plan you terminate will send a Certificate of Creditable Coverage to verify that you cancelled coverage. New Employee: Make your election online in Employee Self-Service within the first days of employment or benefits eligibility. The medical plan in which you enroll will send a member ID card to your home. Contact your new clinic If the clinic you chose under your medical option is new to you, you may want your new physician to have your records. Have your current clinic send a copy of your records to your new clinic by your effective date of coverage. Benefits Enrollment Page 18

21 Medical: Plan Descriptions Medica Elect/Essential Medica: TTY Toll Free: Web: Medica Elect/Essential, the base plan for Duluth and the Twin Cities area, is a combination of two networks, each of which includes major care systems. Each care system includes a comprehensive network of physicians, specialists and other types of care providers, clinics, and hospitals. You have low biweekly rates and reasonable out-of-pocket costs with the base plan. The out-of-network benefit and in-network travel benefit give you additional flexibility in selecting a provider. You will need to select a primary care clinic (PCC) when you enroll in this plan. Family members may select their own primary care clinics. You and your family members can choose separate primary care clinics from care systems in either the Elect or Essential networks. Clinics can be changed monthly. When you contact Medica s member services by the 20th of the month, the change goes into effect the first of the following month. Your PCC will work with you to coordinate your care including, when appropriate, referral to specialists. Each care system establishes its own access procedures for seeing specialists. Some require a referral from your primary care clinic; others allow you to directly access a specialist affiliated with your care system. You must follow your care system s access procedures to receive the highest level of benefits. To be referred to an out-of-network provider and obtain the highest level of benefits, you also need Medica s approval. Medica Choice Regional Medica Choice Regional is the base plan for Greater Minnesota including Crookston, Morris, and Rochester. It is an open access plan that uses the statewide Medica Choice network. You have low biweekly rates and reasonable out-of-pocket costs with the base plan. The out-of-network benefit and in-network travel benefit give you additional flexibility in selecting a provider. You have access to any provider who is part of the network, and you do not need to select a primary care clinic when you enroll. You can see any specialist within the plan network without getting a referral from your primary care doctor. Medica ACO Plan Medica ACO Plan is available to you if you live in the 11-county, Twin Cities metro area. In an ACO, Medica and the network of primary care and specialty providers work together to deliver coordinated health care and support to the member. You will have benefits that are slightly higher and biweekly rates that are slightly lower than the base plan. Your ACO options include Fairview & North Memorial Vantage Plan with Medica (including Boynton and UMP); Inspiration Health by HealthEast with Medica; Park Nicollet First with Medica; and Ridgeview Connect with Medica. You need to select one ACO for your entire family. ACO enrollments are for a full year, so mid-year changes cannot be made. You don t need a referral to see any primary care provider or specialist within the network. The out-of-network benefits and in-network travel benefit give you additional flexibility. Benefits Enrollment Page 19

22 Medical: Plan Descriptions Insights by Medica Insights by Medica is available in the Twin Cities metro area, Duluth, Morris, and some areas in Greater Minnesota. Insights is an open access, tiered network plan in which health care providers are analyzed on cost, efficiency, and quality measures and then ranked into three tiers. Copayment amounts on services differ for each tier. You have access to any provider in the network, in any tier, without a referral, and you do not need to select a primary care clinic when you enroll. If you obtain services from network providers that are in a lower tier you will have greater overall value and lower copayments. Medica Choice National Medica Choice National is an open access plan with a statewide network of over 13,000 physicians and more than 200 hospitals. You also have national coverage access to more than 600,000 physicians and health care providers through United Healthcare Options PPO network when traveling or working outside the service area. You have access to any network provider without a referral, and you do not need to select a primary care clinic when you enroll. The out-ofnetwork benefit gives you additional flexibility in selecting a provider. Medica HSA Due to federal law, if you have any other medical coverage, including any part of Medicare, you are not eligible to enroll in Medica HSA. However, if you are age 65 or older and delay taking Social Security benefits and Medicare Part A, you remain eligible for Medica HSA. Medica HSA is a high deductible plan that allows you to make decisions about how you spend your health care dollars. This plan also uses the Medica Choice statewide network and the United Healthcare Options PPO national network with the same provider access described in Medica Choice National. The University will contribute $750 to your HSA for employee-only coverage and $1,500 for family coverage that is contributed over the 26 pay periods in 2014 for coverage effective January 1, When enrolling mid-year, the HSA amount will be prorated monthly; however, the deductible amount is not prorated. The amount you receive depends on when coverage becomes effective and is contributed over the number of pay periods remaining in the year. While the HSA amount is tax-sheltered from federal and state taxes in most states (including Minnesota), for federal reporting the amount the University contributes to your HSA will be shown on your pay statement. Enrollment in Medica HSA means that you are not eligible to participate fully in a health care Flexible Spending Account. You may only use the pre-tax FSA plan to cover out-of-pocket costs for eligible dental and vision expenses. You will have a special debit card to spend HSA dollars for pharmacy or medical expenses. You pay the doctor or pharmacy until the annual deductible is met, and you can be reimbursed from the health savings account as funds are available. After the deductible is satisfied, Medica pays 90 percent. You own the HSA contributions and can decide whether to use them for current expenses or save them for future expenses when you retire. You can also make your own pre-tax contributions to the HSA and invest them in options from Wells Fargo. If you leave the University, the account balances are portable. Benefits Enrollment Page 20