LAFAYETTE COLLEGE OFFICE OF HUMAN RESOURCES EMPLOYEE BENEFITS SUMMARY

Transcription

1 LAFAYETTE COLLEGE OFFICE OF HUMAN RESOURCES EMPLOYEE BENEFITS SUMMARY 2011

2 The Lafayette College Benefits Program This enrollment brochure provides you with detailed information about the health, welfare, and retirement benefit programs for which you make elections during the enrollment process. This brochure is intended to assist you in making decisions concerning your benefits by providing a concise summary of the various categories of coverage available to you at Lafayette College. If after reviewing this brochure you have any questions regarding the enrollment process, please contact the Office of Human Resources. Loss of Dependent Status When a dependent loses dependent status, it is the employee s responsibility to contact Human Resources to establish continuation of coverage for the affected dependent under COBRA provisions. (Ceridian CobraService is the administrator for all coverage continuation under COBRA.) Under Health Care Reform provisions, dependent children are permitted to be covered until the age of 26 under the medical plans. Dependent children are only covered to age 19 under the dental plan, unless they are full-time students, in which case coverage may extend to age 23. Your choices are in effect for the full plan year for each category. (Plan years may vary by insurance type.) It is important to note that the annual Open Enrollment Period is the only time you can make changes to your plans or add dependents to your coverage without having to demonstrate a Change in Status Event. There is no restriction on making changes during Open Enrollment. Eligibility All regular full-time ( FTE) staff and regular faculty are eligible for coverage under the College s medical, dental, and life insurance programs beginning on the first day of the month following, or concurrent with, the first day of employment. Visiting faculty, interns, and one-year appointments are not eligible for life and disability coverage. The Internal Revenue Service defines Change in Status Events as events which permit an election to change coverage due to any of the following reasons: Medical Plans Marriage or divorce The College offers comprehensive medical and prescription drug coverage. Prescription drug coverage under the plans is as good as, or better than, the standard Medicare Part D drug coverage qualifying it as creditable coverage. Your medical plan choices are: HealthAmerica PPO (PPOI) and HealthAmerica EPO (PPOII). If you do not want medical coverage, please complete the coverage waiver form. You then must also provide proof of other coverage. Benefit summaries for each of the medical plans follow on the next few pages of this brochure. Birth or adoption of a child Death of a dependent Change in employment status of you or your spouse Change in full-time student status of your unmarried dependent child Judgment, decree or order Medicare eligibility Change in benefits eligibility under a spouse s benefit plan (Any benefit change must be consistent with a life event change) You must notify Human Resources within 31 days of the life-event change. After this grace period, you will not be able to make any changes in your coverage until the next Open Enrollment period, effective the following January 1.

3 Medical Plan Options HealthAmerica PPO (PPOI) The HealthAmerica PPO (PPOI) plan is a fully insured plan administered by HealthAmerica. Locally, the plan utilizes the HealthAmerica PPO Network of hospitals and medical providers. A current listing of local providers can be accessed online at healthamerica.cvty.com. In addition, the Coventry Health Care Network is a nationwide provider network you may also use. A current listing of providers can be accessed online at coventryhealthcare.com. For more information about the HealthAmerica PPO (PPOI) call or visit their web site: healthamerica.cvty.com. Benefits In-Network Out-of-Network Deductible Inpatient Hospital Services (professional fees and facilities) Surgery & Anesthesia Outpatient Hospital Services (professional fees, facilities, lab, x-ray, radiation therapy, chemotherapy, anesthesia and surgery) $400 per person (three per family) applies to all services unless a co-payment is applied or otherwise noted $800 per person (three per family) applies to all services unless a co-payment is applied or otherwise noted Coinsurance Member pays 10% Plan pays 90% Member pays 30% Plan pays 70% Coinsurance Maximum Lifetime Maximum Physician Office Visits Preventive (Pediatric/Adult Exams) Maternity/Newborn Baby Care $500 per person (three per family) Unlimited $15 co-pay $1500 per person (three per family) Unlimited Benefits In-Network Out-of-Network Radiology Testing/Imaging (x-rays, MRI, CT, PET) Emergency Room Services Ambulance Service for Emergency Care Home Health Care (90 visits per benefit period) Hospice Care Prescription Drugs (Medco) Annual Mammogram (age 40 and over) Preventive Gynecological Exam Annual Pap Smear Test Mental Health Inpatient Care Mental Health Outpatient Services Substance Abuse Care: Inpatient Outpatient Durable Medical Equipment Covered in full/$50 ER co-pay (waived if admitted); Covered in full; $100 per person deductible (three per family) generic $25 co-pay brand preferred $40 co-pay brand non-preferred Retail up to a 31-day supply Mail order up to a 90-day supply (two co-pays required) covered in full; covered in full; $15 co-pay $15 c0-pay Covered in full/$50 ER co-pay (waived if admitted); Coinsurance may apply; ; ; ; 4 5

4 HealthAmerica EPO (PPOII) The HealthAmerica EPO (PPOII) is a fully insured plan administered by HealthAmerica. Locally, the plan utilizes the HealthAmerica PPO Network of hospitals and medical providers. A current listing of local providers can be accessed online at healthamerica.cvty.com. In addition, the Coventry Health Care Network is a nationwide provider network you may also use. A current listing of providers can be accessed online at coventryhealthcare.com. For more information about the HealthAmerica EPO (PPOII) call or visit their web site: healthamerica.cvty.com. Benefits Deductible Physician Services: Office Visits (primary care) Specialist Surgeon In-Hospital Visits Preventive Services: Physicals /Exams Well-Baby/Well-Child Care Routine Immunizations Gynecological Preventive Exam Annual Mammograms (age 40 and over) Lifetime Maximum Maternity: Obstetrical Care (pre/post-natal care and delivery) Newborn Care (physician and hospital) In-network* $400 per person (three per family) applies to all services unless a co-payment is applied or otherwise noted Covered 100% Covered 100% Covered 100%, Covered 100%, Unlimited Covered 100% Covered 100% BENEFITS Inpatient Hospital Services (professional fees and facilities) Surgery and Anesthesia Radiology Testing/Imaging Laboratory Outpatient Hospital Services (professional fees, facilities, lab, x-ray, radiation therapy, chemotherapy, anesthesia and surgery) Emergency Room Services Ambulance Service for Emergency Care Home Healthcare Hospice Care Prescription Drugs (Medco) Mental Health Inpatient Care Mental Health Outpatient Services Substance Abuse Care: Inpatient Detoxification Inpatient Rehabilitation Outpatient Rehabilitation IN network* Covered 100% ; Covered 100% Covered 100% Covered 100% Covered 100% Covered 100% after $50 co-pay (waived if admitted) Covered 100% Covered 100% (100 visits per calendar year) Covered 100% $100 per person deductible (three per family) generic $25 co-pay brand preferred $40 co-pay brand non-preferred Retail up to a 30-day supply Mail order up to a 90-day supply (two co-pays required) Covered 100% Covered 100% Covered 100% *Out of network benefits are included, but very limited. 6 7

5 Dental Plan The College s dental plan, Concordia Flex, focuses on the importance of regular and preventive dental care. The plan is administered by United Concordia, a subsidiary of Pennsylvania Blue Shield. Concordia Flex is a feefor-service dental plan, which offers members the freedom to obtain dental services from any provider of their choice while receiving significant savings. The plan allows participants to obtain care either from within, or outside, an established network of dental providers. Concordia Flex provides coverage for the full range of dental care needs, such as routine diagnostic and preventive, basic and major restorative, and orthodontic services. The Concordia Advantage Plus Network is a nationwide network of dental providers who participate in the Concordia Flex plan. You can locate a participating dentist at their website: When you use a participating (in-network) dentist for diagnostic and preventive care, eligible services are covered at 100%. When you receive basic restorative, major restorative, or orthodontic services, you are responsible for the coinsurance amounts of 20%, 50%, and 50% respectively. If you use a non-network dentist, the plan pays the same set allowance for the particular dental service as it does for a participating dentist. You are responsible for the coinsurance amount plus the difference between the nonnetwork dentist s actual charges and United Concordia s established allowance. There is no deductible applicable for this plan. The maximum benefit amount per person, per plan year, is $1,000. The lifetime maximum benefit amount for a child s (up to age 19) orthodontic care is $1,000. Diagnostic and Preventive Basic Restorative Major Restorative Orthodontia Covered at 100% Routine Exams (one every six months) Covered at 80% Basic Restorations Endodontics Covered at 50% Inlays Onlays Covered at 50% Diagnostic Active Treatment Cleanings (one every six months) Denture Repairs Crowns (one per tooth Retention Treatment X-rays Simple Extractions in five years) (Covers children to Bitewings (one set of four Anesthesia Prosthetics (one per age 19) every six months) tooth in five years) Specialist $1,000 lifetime Full mouth (one every three years) Consultations Pontics maximum per Fluoride Treatments (one every Non-Surgical Surgical Periodontics patient six months till age 19) Periodontics Sealants (one tooth every three years; permanent first molars Oral Surgery to age 10; permanent second molars to age 15) Palliative Emergency Treatment For more information about United Concordia Flex Plan, call Or visit their website at: 8 Life Insurance (Coverage not provided to visiting faculty, interns, and one-year appointments.) The College provides a Basic Group Life insurance policy (Hartford Insurance), which covers all full-time regular employees without contribution on the part of the employee. The policy provides eligible employees with life insurance, effective on the first day of the month following, or concurrent with, the initial date of hire. The insurance is an amount equal to 1.5 times the base annual salary, to a maximum of $350,000, plus $15,000. Coverage reduces beginning at age sixty five and every five years thereafter under the following formula: 35% reduction at ages 65, 70, 75; 25% reduction at ages 80, 85, 90, 95. (In each case, the benefit is rounded up to the next higher multiple of $500.) The policy provides an accidental death benefit equal to the amount of the 1.5 times up to $350,000 benefit, which is payable over and above the base life benefit in case of such event. In addition to the above insurance, the College also offers voluntary Supplemental Life insurance (Hartford Insurance), which provides additional life insurance for employees over and above the non-contributory coverage. Coverage can be elected, in increments of $10,000, of an amount up to five times your annual salary, to a maximum level of $500,000. Premiums, which are determined by the amount of the insurance taken and the age of the employee based on age-banded rates, are fully paid by the employee. Upon termination of employment, an employee may elect to convert their employer-sponsored group life insurance coverage into an individual wholelife policy, for which they pay the full premium. Long Term Disability Insurance (Coverage not provided to visiting faculty, interns, and one-year appointments.) The College provides protection for qualified employees in the event of a lengthy disability, under its Long-Term Disability insurance (Hartford Insurance). This plan covers all regular full-time employees who become disabled because of their medically approved inability to work. The first six months of a continuous disability may be covered through the College by a combination of paid time off, vacation time, sick time, and/or unpaid time off. Once a disability continues beyond six months (180 days), the long-term disability plan provides income replacement for employees up to 60% of their monthly base salary, to a maximum benefit of $12,500 per month. Income replacement benefits continue until the person reaches full Social Security retirement age (FRA), if disabled prior to age 63. 9

6 Voluntary Vision Plan Employees may enroll in a voluntary vision discount program through National Vision Administrators (NVA). This program allows employees and their dependents to receive discounted vision care exams, services, and supplies through a national network of vision care professionals. The program is completely voluntary and funded entirely by employee premiums. Flexible Spending Accounts Employees may enroll in the Flexible Spending Accounts program. This program allows employees to set aside money on a pre-tax basis to pay for unreimbursed health/medical care expenses and dependent care expenses. You may contribute up to $4,000 per year for health/medical care expenses, and up to $5,000 per year for dependent/child care expenses. Employee contributions are free of federal, social security, and sometimes state taxes. The plan year is from Jan. 1 through Dec. 31. After qualified expenses are incurred and paid, the employee can receive reimbursement for the qualified expenses from his or her account. Reimbursements are, in essence, the employee s own money paid back tax-free. A debit card is also made available to employees as a way to receive direct reimbursement. Retirement Savings Plan Qualified employees of Lafayette College are eligible to participate in the Lafayette College Retirement Plan. This is a defined contribution retirement plan covered under Section 403(b) of the Internal Revenue Service Codes. All non-temporary employees of the College are eligible, at any time, to participate in the voluntary aspect of the Lafayette College Retirement Plan. This aspect allows qualified employees to make pre-tax contributions (elective deferrals) to investment funds, offered by TIAA-CREF and Fidelity Investments, which are selected by the employee. There are no employer (College) contributions on these amounts. Qualified employees who work 900 or more hours per year are eligible to participate in the Lafayette College Retirement Plan and receive an employer contribution of either 9.5% or 8% (Category A / Category B respectively). Qualified faculty and exempt staff employees receive a 9.5% of base pay employer contribution and must make a mandatory (required) employee contribution equal to 5% of annualized base pay in excess of $15,000 (prorated each pay). Eligibility for this group of employees occurs on the first day of the first full pay period of the month following the employee s date of hire. Qualified non-exempt staff employees receive an 8% of base pay employer contribution, but do not have a mandatory (required) contribution requirement. Eligibility for this group of employees occurs on the first day of the first full pay period of the month following the employee s two-year anniversary. In addition to employer and mandatory contributions, eligible employees are also able to make voluntary pre-tax contributions to the investment funds offered at the College through TIAA-CREF and Fidelity. Both companies offer a wide variety of investment vehicles that collectively cover all major asset classes. Employer and employee contributions are fully (100%) and immediately vested. Certain in-service withdrawals and loan allowances are available, but only from employee elective deferral sources (voluntary contribution sources). Tuition Remission, Tuition Exchange, and Tuition Grants Tuition Remission Immediate tuition remission is available for Faculty and Administrators, allowing them to take up to two courses per semester at Lafayette College. Spouses of Faculty and Administrators also are immediately eligible for tuition remission, allowing them to take an unlimited number of courses at Lafayette. Support Staff have a three-month waiting period before being eligible for tuition remission benefits. Spouses of Support Staff have a three-year waiting period before tuition remission eligibility. Qualified dependent children of Faculty and Staff members are eligible for tuition remission benefits after the Faculty/Staff member has completed five years of uninterrupted full-time service. Tuition remission is limited to a maximum of eight normal semesters of undergraduate study, plus three additional courses to be taken at Lafayette. Visiting Faculty, Interns, and their children, are not eligible for tuition remission benefits. Tuition Exchange Qualified dependent children of Faculty and Staff members are eligible for tuition exchange benefits after the Faculty/Staff member has completed five years of uninterrupted full-time service. This reciprocal scholarship program allows dependent children to attend school at over 500 participating higher education institutions managed by the national Tuition Exchange Headquarters in Washington, D.C. Eligibility for tuition exchange does not guarantee acceptance into the program. Visiting Faculty, Interns, and their children, are not eligible for tuition exchange benefits. Tuition Grants Qualified dependent children of Faculty and Staff members are eligible for tuition grant benefits after the Faculty/Staff member has completed 10 11

7 10 years of uninterrupted full-time service. The maximum grant allowed is equal to 50% of Lafayette s tuition in the year of attendance. Tuition grant is limited to a maximum of eight normal semesters of undergraduate study, plus three additional courses to be taken at Lafayette. Tuition grant benefits are limited to a maximum of three dependent children per family. Visiting Faculty, Interns, and their children, are not eligible for tuition grant benefits. LVAIC Tuition Remission Qualified full-time employees, and spouses, are eligible to enroll in two undergraduate courses each semester at any Lehigh Valley Association of Independent Colleges (LVAIC) institution. Tuition costs are covered in full for these courses. Any special fees charged to the applicant are not covered. Each host institution will determine whether the applicant qualifies under that institution s admissions standards for such purpose. Admission is granted only if space is available after all regular students and that institution s employees have registered. Office of Human Resources Staff Leslie Muhlfelder Vice President and General Counsel (610) Lisa Rex Director, Human Resources / Employment (610) Charles Crawford Director, Human Resources / Benefits (610) Janice Hoffman Manager, HR Information Systems (610) Deborah Blache Benefits Specialist (610) Patricia Cerankowski HR Administrator and Tuition Coordinator (610) Jody Poniatowski Secretary to General Counsel (610) Phone: (610) Fax: (610) Website: About this brochure This brochure presents a brief summary of the various employee benefit programs offered to eligible employees of Lafayette College and is not meant to be a governing plan document, summary plan description, or a contract of employment between you and the College. In the event of a conflict between this brochure and the legal plan documents or summary plan descriptions, contracts, and insurance policies, the legal plan documents, contracts, and insurance policies always will govern. While Lafayette College intends to continue these programs, the College reserves the right to terminate, suspend, withdraw, amend, or modify any benefit plan at any time /11