2014 OPEN ENROLLMENT & BENEFIT GUIDE

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1 2014 OPEN ENROLLMENT & BENEFIT GUIDE This guide contains important information about Wheaton College s annual benefits open enrollment for our medical, dental and flexible spending accounts plan. Also included is information about other benefit plans. Please review it carefully as you consider changes for you and your family for Our open enrollment period will run from May 5, 2014 through May 31, All benefit elections will become effective July 1, Wheaton will be transitioning to a January 1, renewal date for all employee benefit plans. The benefit plans you elect will be effective July 1, 2014 through December 31, Our next open enrollment will be for a January 1, 2015 effective date and will take place in the fall. Wheaton is currently evaluating additional plan design alternatives to be provided to employees for January 1, It is a pleasure to announce that there will be no change in the cost of your benefits for July 1, We encourage all employees to use the annual enrollment period as an opportunity to re-evaluate all of your current benefit elections to ensure that you are enrolled in the appropriate coverage for you and your family. This is your opportunity to enroll in or make changes to your health care and dental coverage as well as enroll in the flexible spending accounts, which begin July 1, All changes in enrollment can be made online through WINDOW. Make your changes online by accessing the Open Enrollment Option in WINDOW (available May 5 th ) inside.wheatoncollege.edu/ Please remember that you must re-enroll in the flexible spending accounts in order for participation to continue from July 1 st December 31 st. There is a new online open enrollment feature this year to add or terminate dependents from your coverage. Please print your confirmation page which will identify what you have elected for health and dental coverage, your flexible spending election for the next six months and the dependents covered under your plans. Human Resources will be available in the Science Center Training room on Wednesday, May 14 th from 10-11, Tuesday, May 20 th from 2-3:30 and Thursday, May 22 nd from 10-11:30 to assist or answer questions. Please review this guide carefully and contact Human Resources, extension 8206 or with any questions. 1

2 Overview Eligibility You are eligible to enroll in Wheaton s benefits program if you are a full time or part time staff member as outlined below. Faculty eligibility is based on the number of courses taught per semester per year. Full-Time Benefit Eligible: Full-time benefit eligible employees are those with a full-time equivalency (FTE) of.75 of greater. Part-Time Benefit Eligible: Part-time benefit eligible employees are those with a regular work schedule of at least 910 hours per fiscal year. You may enroll qualified dependents in the medical and dental insurance plans. Qualified dependents include: Spouse Domestic Partner (Same and Opposite Sex) Dependent children who have not attained age 26 Dependent children of any age if they became physically or mentally incapable of self-support before age 19 and remain incapacitated and enrolled in the plan Adopted children Making Changes During the Plan Year Under IRS rules, your health and insurance benefit elections will remain in effect until the next plan year unless you have a qualifying change in status. Qualifying changes in status include: Marriage, divorce, legal separation or annulment Birth or adoption of a child (or placement of a child for adoption) Death of a dependent Ineligibility of a dependent (for example, your child turns 26) A change in you or your partner s employment, if it results in a loss or gain in eligibility for coverage If you have a qualifying change in status during the plan year, you must notify HR within 31 days of the status change to request a change to benefit elections. Otherwise, you will have to wait until the open enrollment for the following plan year. 2

3 Health Plan Options Harvard Pilgrim will continue to be Wheaton s medical and prescription drug insurance provider. The following pages detail the two medical plan choices available to Wheaton employees. Due to Healthcare Reform, there will now be an out of pocket maximum on both the HMO and PPO Plan designs of $2,000 for an individual and $4,000 for a family. All copays will contribute towards the out of pocket maximum with the exception of the pharmacy copays. Once a member has met the out of pocket maximum the plan will pay 100%. Harvard Pilgrim HMO In-Network Only Annual Deductible Preventive Care Office Visits Specialist Visits Emergency Room Admission Inpatient Facility Outpatient Facility Durable Medical Equipment None Covered in Full $20 copay $20 copay $100 copay (waived if admitted) Covered in Full Covered in Full 20% Coinsurance Lab Tests & X-Rays Covered in Full High End Radiology $75 copay per procedure (Only one copay applies per member per calendar year for all high end radiology scans for cancer diagnoses) Mental Health & Substance Abuse Inpatient Outpatient Covered in Full Group Therapy: $10 Copay Individual Therapy: $20 Copay Coinsurance 20% Out of Pocket Maximum Individual Family $2,000 $4,000 Pharmacy Retail Prescription Drugs Generic Preferred Brand Non-Preferred Brand Mail Order Prescription Drugs Generic Preferred Brand Non-Preferred Brand $15 $30 $50 $30 $60 $150 3

4 Health Plan Options (continued) The second option available to Wheaton employees is the Harvard Pilgrim PPO plan Harvard Pilgrim PPO In-Network Out-of-Network Preventive Care Covered in Full Deductible, then 20% Office Visits $20 copay Deductible, then 20% Specialist Visits $20 copay Deductible, then 20% Emergency Room Admission $100 copay (waived if admitted) Inpatient Facility Covered in Full Deductible, then 20% Outpatient Facility Covered in Full Deductible, then 20% Durable Medical Equipment 20% Coinsurance Deductible, then 20% Lab Tests & X-Rays Covered in Full Deductible, then 20% High End Radiology Mental Health & Substance Abuse Inpatient Outpatient $75 copay per procedure (Only one copay applies per member per calendar year for all high end radiology scans for cancer diagnoses) Covered in Full Group Therapy: $10 Copay Individual Therapy: $20 Copay Deductible, then 20% Deductible, then 20% Group Therapy: Deductible, then 20% Individual Therapy: Deductible, then 20% Coinsurance 20% 20% Out of Pocket Maximum Individual Family $2,000 $4,000 $2,000 $4,000 Pharmacy Retail Prescription Drugs Generic Preferred Brand Non-Preferred Brand $15 $30 $50 N/A Mail Order Prescription Drugs Generic Preferred Brand Non-Preferred Brand $30 $60 $150 N/A 4

5 Dental Coverage Wheaton offers to employees and dependents a dental PPO through Blue Cross Blue Shield of Massachusetts. Below you will find a description of the plan available and how services are covered. When a BCBS MA provider is used, no claim forms are necessary, out-of-pocket costs are reduced, and you will not be balancebilled. Dental PPO Plan In Network Out of Network Annual Maximum $1,250 Per Person each Calendar Year Annual Deductible $50 Per Person / $150 Per Family Deductible Waived for Diagnostic & Preventive Services Services Diagnostic & Preventive Basic Restorative Endodontics Periodontics Oral Surgery Major Restorative Prosthodontics Orthodontics 100% 50% 50% 100% of Maximum Plan Allowance 100% 50% 50% 100% of Maximum Plan Allowance Orthodontia Maximum $1,500 Lifetime Diagnostic & Preventive services count toward maximum 5

6 Flexible Spending Account (FSA) Employees can participate in a Flexible Spending Account (FSA) program. Enrollment in an FSA is not dependent on whether you are enrolled in a Wheaton medical or dental plan. With an FSA you estimate your out-of-pocket medical or dependent care expenses for the upcoming plan year, set aside the money each payroll on a pre-tax basis and are reimbursed for those expenses with tax free dollars. The Flexible Spending Accounts will be for a shortened plan year and the election you make will be for the time period of July 1, 2014 through December 31, Wheaton will be completing an open enrollment period in the fall for the Flexible Spending Account elections for January 1, 2015 through December 31, You must re-enroll in the flexible spending accounts to continue to participate. There are two types of FSA plans: Medical FSA This account will reimburse you with pre-tax dollars for healthcare expenses (including dental and vision) not reimbursed under your healthcare plan (s) such as office visit co-pays, prescription drug co -pays, dental co-insurance and deductibles, elective surgery, and laser eye surgery. The maximum amount you may contribute to this account for the shortened 2014 plan year is $1,250. Dependent Care FSA This account will reimburse you with pre-tax dollars for your daycare expenses for your child(ren) and other qualifying dependents so that you (and your spouse) may be gainfully employed or attend school full-time. Eligible dependent care expenses include daycare, before and after school programs, nursery school or preschool, summer day camp and adult daycare. The maximum amount you may contribute to this account for the shortened 2014 plan year is $2,500. Wheaton College offers the Flex Debit Card as a convenient enhancement to your Medical Flexible Spending account (FSA). By using the card for eligible products and services, you will not need to wait for reimbursement. After using your Flex Debit Card to make a purchase, transactions are reviewed by Crosby Benefit Systems. Some card transactions are automatically approved and need no further action. Other transactions will require submission of receipts to prove that the FSA expenses are eligible according to IRS rules. If a card transaction does not meet the necessary requirements for automatic approval, you will be notified by or mail. For additional informational regarding how the Flexible Spending Account works, and how it may be of value to you and your family, please see the following page. 6

7 Flexible Spending Account (FSA) Health Care and Dependent Care Flexible Spending Accounts Participation provides you the opportunity to pay for out-of-pocket medical, dental, vision and dependent care expenses with pre-tax dollars through Flexible Spending Accounts. You must enroll in the plan to participate for the plan year. You can save approximately 25 percent of each dollar spent on these expenses when you participate in a FSA, as a result of paying with pre-tax dollars. A health care FSA is used to reimburse out-of-pocket medical, dental, and vision expenses incurred by you and your dependents. A dependent care FSA is used to reimburse expenses related to care of eligible dependents while you and your spouse are gainfully employed or attend school full-time. Contributions to your FSA come out of your paycheck before taxes are taken out. This means that you don t pay federal income tax, Social Security taxes, or state and local income taxes on the portion of your paycheck you contribute to your FSA. Use It or Lose It Rule: You must carefully consider the contribution amount you expect to pay during the plan year for out-of-pocket expenses. If you do not use the money you contributed it will not be refunded to you or rollover to a future plan year. You cannot change the contribution amount during the plan year unless you have a qualified life status change (marriage, birth, divorce, etc.). The following example shows how you can save money with a Flexible Spending Account. Bob s income is $30,000. He has one child in day care and he wants to have Lasik eye surgery done this year which is not covered by his medical benefits or eye insurance. Since Bob knows he will spend $2,000 on the eye surgery and $3,300 for day care, he s enrolled in Health Care FSA = $2000 and Dependent Care FSA = $3,300. Below shows the same expenses with and without FSA assistance: Without FSAs With FSAs Gross income: $30,000 $30,000 FSA contributions: 0-5,300 Gross income: 30,000 24,700 Estimated taxes: Federal -2,550* -1,755* State -900** -741** FICA -2,295-1,890 After-tax earnings: 24,255 20,314 Eligible out-of-pocket Medical and dependent care expenses: -5,300 0 Remaining spendable income: $18,955 $20,314 Spendable income increase: $1,359 *Assumes standard deductions and four exemptions. ** Varies this example assumes 3%. The example above is for illustrative purposes only. Every situation varies and we recommend that you consult a tax advisor for all tax advice. 7

8 Life & Disability The college offers Basic Life and AD&D, Optional Life and AD&D and Long Term Disability Insurance through The Standard Insurance Company. Basic Life and AD&D Insurance Eligibility Full and part-time benefit eligible employees insurance is effective the first day of the month following three months of employment. Benefit The value of the policy equals one times your annual earnings, rounded to the next thousand. The benefit amount is reduced by 50% the July 1st after turning age 70. The minimum benefit is $15,000. Cost Full Time: Wheaton pays 100% Part Time: Wheaton pays 50% and the employee pays 50% Optional Life and AD&D Insurance: Eligibility Full and part-time benefit eligible employees insurance is effective the first day of the month following three months of employment. Benefit Employees have the option of purchasing additional life insurance through the Standard. Employees can elect from 1x up to 3x s their annual salary. Employees age 60 and over can also purchase insurance equal to 1/2 times annual earnings. Proof of insurability may be required. Cost Full Time & Part Time: Employee pays 100% There is an overall maximum of $400,000 coverage for the combined total of basic and optional insurance. Evidence of insurability is required if you elect to enroll in more than the Guaranteed Issue Amount for the Basic Life and Optional Life Insurance. Life Insurance may be subjected to taxation, in accordance with federal regulations Long Term Disability Insurance Eligibility Full and part-time benefit eligible employees insurance is effective the first day of the month following one year of employment. New employees who had similar coverage within three months from a former employer may be eligible to join immediately. Benefit Long term disability insurance provides a monthly income when a disability extends beyond three months. The value of the benefit equals 60% of your monthly salary up to a $12,000 monthly maximum. Cost Full Time: Wheaton pays 50% and the employee pays 50% Part Time: Wheaton pays 25% and the employee pays 75% 8

9 2014 Benefit Rate Summary The employee contributions effective July 1, 2014 are noted below and represented on a monthly basis Wheaton MONTHLY Harvard Pilgrim HMO Contributions Full Time Part Time Individual $ $ Two Person $ $ Family $ $1, Wheaton MONTHLY Harvard Pilgrim PPO Contributions Full Time Part Time Employee $ $ Employee + 1 $ $1, Family $ $1, Wheaton MONTHLY BCBS MA Dental Contributions Full Time Part Time Employee $20.43 $30.64 Employee + 1 $43.25 $64.88 Family $70.77 $

10 2014 Benefit Rate Summary The employee contributions effective July 1, 2014 are noted below and represented on a bi-weekly basis Wheaton BI-WEEKLY Harvard Pilgrim HMO Contributions Full Time Part Time Individual $58.43 $ Two Person $ $ Family $ $ Wheaton BI-WEEKLY Harvard Pilgrim PPO Contributions Full Time Part Time Employee $ $ Employee + 1 $ $ Family $ $ Wheaton BI-WEEKLY BCBS MA Dental Contributions Full Time Part Time Employee $9.43 $14.14 Employee + 1 $19.96 $29.95 Family $32.66 $

11 Retirement Benefit 403(b) Wheaton College offers a 403(b) retirement plan through TIAA-CREF Eligibility: The college begins contributing to a TIAA-CREF plan after you have completed one year of benefit eligible service. New employees who have completed one year of benefit eligible service at another institution of higher learning prior to employment at Wheaton may be eligible to receive the college contribution immediately. Wheaton College Contributions: For employees under age 30, Wheaton contributes 7% of your base salary For employee age 30 or older, Wheaton contributes 9% of your base salary Employee Contributions: Although not required, all employees are encouraged to contribute to the TIAA-CREF retirement plan or supplemental retirement plan. The plan permits savings for retirement on a federal and state tax-deferred basis. 11

12 Required Notices Newborns Act Disclosure Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother s or newborn s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Women s Health and Cancer Right Act of 1998 If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomyrelated benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: All stages of reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; Prostheses; and Treatment of physical complications of the mastectomy, including lymphedema. These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. If you would like more information on WHCRA benefits, call your plan administrator. Additional Information This guide describes the benefit plans and polices available to you as an employee of Wheaton College. Details of these plans and polices, including insurance contracts are contained in the official plan and policy documents. This guide is meant only to cover the major points of each plan or policy. It does not contain all of the details that are included in your Summary Plan Description (as described by ERISA). If there is ever a question about one of these plans and polices, or if there is a conflict between the information in this guide and the formal language of the plan or policy documents, the formal working in the plan or policy documents will govern. Please note that the benefits described in this guide may be changed at any time and do not represent a contractual obligation on the part of Wheaton College. 12