Workforce Management Organization COBRA Benefits Overview After Employment or Loss of Eligibility Options

Transcription

1 Workforce Management Organization 2015 COBRA Benefits Overview After Employment or Loss of Eligibility Options Revised 7/2015

2 When Benefits Coverage Ends? Your benefit coverage will end at midnight on the last day of the month in which: o Your regular work schedule is reduced to less than 50% of full-time benefits eligibility o Your assignment is reduced to less than seven months o Your employment with the University ends due to resignation, termination, or death o You stop paying your share of coverage during an unpaid leave of absence Dependent coverage ends: o When your coverage ends o The end of the month in which they turn 26 2

3 What are my options? After employment with the University ends or loss of eligibility of benefits occurs, you have several options to consider. If you wish to continue your medical, dental, vision, and healthcare flexible spending account coverage, you may do so through the Consolidated Omnibus Budget Reconciliation Act (COBRA). You also have the ability to review options that may be available to you under the Affordable Care Act at: This presentation will provide you information regarding how Tulane benefits will change for your post-employment or loss of eligibility. 3

4 When will my Tulane benefits be terminated? o Understanding COBRA Coverage All Tulane benefits will terminate at midnight on the last day of the month in which separation of employment occurs. In addition, all benefits will terminate at midnight on the last day of the month that a dependent(s) attains the age of 26, or at midnight on the last day of the month in which they get married. How can I continue my Medical, Dental, Vision, and Healthcare Flexible Spending Account benefits? o If you are currently enrolled in any of the above referenced plans, you will have the option to continue benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA) for 18 months (dependents may be able to continue for 36 months) with the exception of the Healthcare Flexible Spending Account, which can be continued through the end of the current calendar year. There isn't any tax benefit to continue on this account. Will I receive a notification stating I am eligible for COBRA? o Yes. You will receive a notice stating your right to choose to continue benefits provided by the plan from Tulane s COBRA administrator, WageWorks. This notice is for the employee and all beneficiaries on any of the eligible plans. Will I need to provide proof of prior coverage? o Yes. A certificate of group health coverage will be provided by United Healthcare if you were enrolled in one of the University s medical plans. You may need this certificate for your new group or individual plan to provide evidence of your prior coverage. 4

5 Timeline of COBRA Benefits Within 30 days of separation from the University or eligibility change, Tulane will notify WageWorks. You have 60 days to notify WageWorks of accepting coverage. Once payment is received, backdate of your coverage will occur. Once covered, you can submit any bills you may have paid out-ofpocket in the interim. Within 14 days from being notified, WageWorks will send you a packet outlining what is available. After notifying WageWorks of your intent to take COBRA coverage, you have 45 days to pay them for coverage. Once COBRA coverage is chosen, you are required to pay for 102 percent of the cost of coverage. Reminder: None of this can take place until your Department processes your termination or eligibility change in the HCM system. You cannot get the paperwork from WageWorks prior to your termination. Tulane is unable to speed up or change this process. 5

6 MEDICAL BENEFITS COBRA allows employees and beneficiaries to continue their current coverage. Changes to their elections may only happen during an open enrollment period. In 2015, Tulane offered two medical coverage options with our partner, United Healthcare. Please see the following chart for a summary of services for each of the two plans Health Reimbursement Account (HRA) and Point of Service (POS). HRA Plan Employee Pays (In-Network) POS Plan Employee Pays (In-Network) Annual Deductible Single: $1,500 Family: $3,000 Single: $500 Family: $1,000 HRA Funding $500 Single/$1,000 Family Pays after the initial $1,000 Single/ $2,000 Family deductible has been paid Net Deductible Single: $1,000 Family: $2,000 Single: $500 Family: $1,000 Out of Pocket Max. (including copays, deductibles, and coinsurance) Single: $4,000 Family: $8,000 Single: $2,500 Family: $5,000 Coinsurance 20% 20% Hospital Services 20% after deductible 20% after deductible Emergency Room $150 copay $150 copay Urgent Care Visit $50 copay $50 copay Office Visit Copay $25 copay PCP $50 copay Specialist N/A $25 copay PCP $50 copay Specialist Preventive Screening Covered in Full Covered in Full Separate Prescription Drug Deductible: $100 Retail Prescription Drugs Tier 1 - $10 copay, Tier 2 - $35 copay, Tier 3 - $60 copay Deductible is per person, three per family must satisfy Separate Prescription Drug Deductible: $100 Mail Order Prescription Drugs Tier 1 - $30 copay, Tier 2 - $105 copay, Tier 3 - $180 copay Deductible is per person, three per family must satisfy Please visit my.uhc.com for out-of-network covered services and costs. 6

7 2015 COBRA MEDICAL PLAN MONTHLY RATES* Total Monthly COBRA Rates: Medical HRA Plan POS Plan Employee $ $ Employee + Spouse $1, $1, Employee + Child(ren) $ $ Employee + Family $1, $1, * Rates do not include the 2% administrative fee. 7

8 2015 DELTA DENTAL INSURANCE Below is the summary of coverage and monthly COBRA contribution rates. BENEFITS AND COVERED SERVICES: High Plan Low Plan BASIC SERVICES: Diagnostic and preventive benefits: Exams, cleanings, x-rays, sealants 2015 COBRA DENTAL PLAN MONTHLY RATES* In-Network Out-of-Network In-Network Out-of-Network 100% 100% 100% 100% Fillings, simple tooth extractions, endodontics (root canals) treatment of tooth pulp except root canal treatment, periodontics maintenance of gums and bones supporting teeth and basic oral 80% 80% 80% 80% surgery, denture repairs MAJOR BENEFITS: Complex oral surgery, endodontics (root canals) root canal treatment, major periodontics services including surgical treatment of gums and bones. Crowns, inlays, onlays, general anesthesia or IV 50% 50% not covered sedation Orthodontic benefits: dependent children 50% 50% not covered DEDUCTIBLES: Per enrollee per calendar year: $50 $50 Per family per calendar year: $150 $150 BENEFITS AND COVERED SERVICES: High Plan Low Plan Diagnostic, preventive and orthodontic benefits, if applicable, are not subject to the deductible. MAXIMUM AMOUNTS: Per enrollee per calendar year: $1,500 $1,000 Lifetime for orthodontic services per enrollee under age 19: $1,500 not covered Low Option High Option Employee Only $17.19 $22.89 Employee + Spouse $35.52 $41.32 Employee + Child(ren) $37.97 $50.60 Family $62.39 $

9 VISION INSURANCE Below is a summary of covered vision care services and COBRA rates VISION PLAN COVERAGE SUMMARY Vision Care Services Member Cost (In-Network) Eye Exam (One Per Year) $10 Plain Lenses (One set every year - Single Vision, Bifocal, Trifocal, Lenticular) Frame (One Set Every Two Years) Contact Lenses Allowance in Lieu of Glasses Medically Necessary Contact Lenses $20, Additional Cost for Lens Options (tint, etc.) Included in Copayment Lenses ($140 allowance) $105 Allowance Paid in Full Please visit eyemed.com for out-of-network covered services and costs COBRA VISION PLAN MONTHLY RATES* Employee Only $6.15 Employee + Spouse $11.69 Employee + Child(ren) $12.30 Family $

10 Flexible Spending Account Healthcare FSA Former employees may continue to contribute to their healthcare FSA through the end of the plan year as long as they elect continued health coverage under COBRA. Since contributions are not through payroll deduction post-employment, contributions will be made post-tax. Employees have until April 30th following the end of the plan year to submit reimbursement requests for expenses incurred during the previous calendar year while under COBRA. If former employees choose not to elect continuation of their healthcare FSA under COBRA, coverage will cease at the employment termination date. Dependent Care FSA Former employees that make contributions to a dependent care FSA will lose coverage at the end of the employment termination date. Employees have until April 30th following the end of the plan year to submit reimbursement requests to eligible expenses incurred through the coverage end date (end of the month in which employment terminates) and cannot contribute to the account. 10

11 Additional Benefits In addition to the medical, dental, vision, and healthcare flexible spending account benefits, the following section will outline benefits that are available to you as a past employee of Tulane. These benefits are not provided through COBRA. The following benefits are available to a past employee: Life Insurance Retirement Tuition Waiver Employee Assistance Program (EAP) 11

12 Life Insurance You may elect to continue the Life Insurance you had with the University. If you wish to convert or port coverage, you must apply within 60 days of the date your group coverage ends by calling The Standard at (800) Rates are determined by The Standard on an individual basis. 12

13 Retirement Plans If you had a Retirement Account with TIAA-CREF or Fidelity Investments, you are not required to make an immediate withdrawal. You have the option of withdrawing your funds, rolling them to another qualified plan or leaving them within one of the Tulane Plans. For questions or to request the proper withdrawal/rollover forms, please contact TIAA-CREF or Fidelity Investments. TIAA-CREF can be reached at (800) and Fidelity Investments may be reached at (800) If you had a 457 plan, please contact WFMO benefits department at

14 Tuition Waiver Employees that are involuntarily terminated and are currently enrolled or have a dependent(s) currently enrolled in classes, are allowed to complete the semester in which they are currently enrolled using the tuition waver. However, the policy states if an employee submits a resignation at any time during the semester, the waiver will be reversed and the tuition is the student s responsibility. After the semester is complete, the employee or dependent(s) will not be eligible for the tuition waiver. The exceptions to the rules stated above are the following: The employee completed 25 years of full-time regular service with Tulane The employee is accepted for Long Term Disability Lastly, dependents are eligible if the employee dies during their service at the University. Call Workforce Management at (504) for more information about Tuition Waiver. 14

15 Employee Assistance Program (EAP) You will have the option to continue EAP benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA) for 18 months, rate is $1.02 per month. The University recognizes that employees who experience personal and workplace problems may need professional assistance, which is why the University contracts with an outside vendor to provide an Employee Assistance Program (EAP) now managed by Optum. Our EAP offers solutions for living well at home and at work. Optum counselors provide confidential support for a variety of concerns, from coping with stress to information and support on financial issues, child care, legal issues, relationships, and other life challenges. Their goal is to help you live a happier, more fulfilling life today and every day. These services are available to you and your household members 24 hours a day, 7 days a week, and are completely confidential. Reach Optum professionals by telephone at , or visit the website at (access code: Tulane). 15

16 BENEFIT PLAN CONTACTS Medical Plan United HealthCare: Phone Number: , Group #: , Website: Dental Plan Delta Dental: Phone Number: , Group #: LA15266, Website: Vision Plan Eye Med: Phone Number: , Group #: , Website: COBRA Plan WageWorks: Phone Number: WAGEWORKS ( ), Website: Life Insurance The Standard: Phone Number: (800) Retirement Plans Fidelity: Phone Number: (800) TIAA-CREF: Phone Number: (800) Tuition Waiver Workforce Management: Phone Number: (504) , EAP Optum: , (access code: Tulane). Vacation Accrual Workforce Management, Payroll: Phone Number: (504) , 16

17 Workforce Management Organization tulane.edu/wfmo