2016 OPEN ENROLLMENT GUIDE

Transcription

1 H O U S E S T A F F WHAT S INSIDE THIS GUIDE? PAGE WHAT S NEW AND STAYING THE SAME 2 MEDICAL 3 HEATLH CARE ACCOUNTS 4 DENTAL 5 VISION 6 LIFE AND DISABILITY INSURANCE 7 OTHER BENEFIT OPTIONS 8 IMPORTANT NOTICES 9 HOW TO ENROLL OPEN ENROLLMENT GUIDE

2 OPEN ENROLLMENT IS NOVEMBER 4TH 20TH. You ll find a range of helpful tools on Creighton.edu/hr/benefits WHAT S NEW AND WHAT S STAYING THE SAME IN 2016? What s new Single Sign On Logging on will be easier than ever! Don t worry about finding that old ADP user ID and password because this year single sign on is set up giving you quick access. Simply go to my.creighton.edu, click the Employee Benefits icon and use your Net ID and BLUE password to get into the benefit system. Employee Benefits Those who completed the SimplyWell health screening and online health questionnaire will see no increase in their monthly premiums. If you were unable to complete these steps, benefits@creighton.edu to discuss options. If you enroll in either the PPO 1 or PPO 2 medical plans for 2016, the maximum prescription amount for tier 2 or tier 3 medications will increase slightly. See page 3 for details. United Healthcare (UHC) has rolled out enhanced customer service support to improve your experience when you have questions or need help. As a result, new medical cards will be issued for UHC is there to help you in making informed decisions about your healthcare choices and can assist with questions like: Is this treatment covered? How much might I have to pay for a treatment? What does this charge mean on my bill? Can you help explain my benefits and what I need to do? Beginning January 1, 2016, UHC is rolling out Virtual Visits a new way to seek treatment for minor conditions. A network of care providers offering virtual visits will enable you to see and speak with an in-network doctor using real-time video technology to obtain a diagnosis for minor medical needs including allergies, sinus and migraine/headaches, bronchitis and other minor conditions. Most visits last minutes and doctors can write prescriptions if needed, that you can pick up at your local pharmacy. A virtual visit lets you see and talk to a doctor through or the Health4Me app without an appointment or physical visit to a physician s office. Additionally, CHI Health also offers VirtualCARE. You can access this service at UHC s Health4Me app provides instant access to you and your family s critical health information anytime/anywhere. Whether you want to find physicians near you, research the cost of a prescription, check the status of a claim or speak directly with a nurse, Health4Me is your go-to-resource. Key features include: Search for physicians or facilities by location or specialty Locate urgent care facilities and ERs Look up medication costs or generic alternatives View and share member health plan ID card information Contact an experienced registered nurse 24/7 for advice regarding any kind of medical question Check status of deductible and out-of-pocket spending View claims Virtual Visits CCAP medical plan participants can contribute even more to their Heath Savings Account (HSA). For 2016, the IRS maximum HSA contribution is $3,350 for individuals and $6,750 for family coverage. What s staying the same We re offering the same medical plans as we did in 2015 and the key features such as annual deductibles, coinsurance and per pay period premiums aren t changing. We ll continue to contribute the same amount to health saving accounts for eligible employees as in 2015 ($500 employee/$750 family). There will be no increase to the Dental and Vision premiums and no change in plan benefits. 2

3 WHAT DOES UNITED HEALTHCARE DO? Our plan is self-insured, which means the United Healthcare administers the payment of claims according to our medical plan benefits. They negotiate rates with hospitals and doctors on your behalf and offer a variety of wellness benefits and resources, while Creighton and you pay the bills. WHAT COMES OUT OF MY PAY? Annual Premium The annual cost to purchase medical coverage is spread across the year, so you pay a portion of it each pay period. Annual premiums differ based upon the plan you elect and the number of dependents you cover. Your premium will also be based on whether or not you completed SimplyWell. WHAT WILL I PAY WHEN I BEGIN RECEIVING MEDICAL CARE? Annual Deductible You won t pay for in-network preventive care covered under health care reform, such as your annual wellness visit. Generally, for all other covered care, including visits to the doctor, you ll pay the amount of your annual deductible before the plan starts to pay. WHAT S THE MOST I D HAVE TO PAY OUT OF MY OWN POCKET? Out-of-pocket Maximum This is the most you d pay for covered medical services in a calendar year. Think of it as your financial safety net. Once you meet it, the plan pays the full cost of additional covered care. Need help, use the Plan Cost Estimator at WHAT S IMPORTANT TO KNOW ABOUT THE MEDICAL INSURANCE? Evaluate your medical options and choose what is best for you and your family. DEDUCTIBLE Individual COINSURANCE Coinsurance Out-of-Pocket Individual OUT-OF-POCKET MAXIMUM (Includes Deductible & Rx) Individual Preventive Care Services Physicians/Specialists Urgent Care Emergency Room Prescription Drugs Network $2,000* $4,000* $1,000 $2,000 $3,000* $6,000* 0% 2016 MEDICAL PLANS HOUSE STAFF CCAP PPO2 PPO1 Non-Network $4,500* $9,000* $4,500 $9,000 $9,000* $18,000* 40% Network $850 $1,700 $3,650 $7,300 $4,500** $9,000** 0% $50 copay** Non-Network $2,350 $4,700 $6,650 $13,300 $9,000** $18,000** * All medical and pharmacy benefits continue to apply to deductible and Out-of-Pocket Maximums on the CCAP plan **To comply with ACA requirements, medical and pharmacy benefits apply to the PPO 1 & PPO 2 Out-of-Pocket Maximums EMPLOYEE MONTHLY PREMIUMS Employee and Spouse Employee and Child(ren) CREIGHTON MONTHLY PREMIUMS Employee and Spouse Employee and Child(ren) EMPLOYEE MONTHLY PREMIUMS Employee and Spouse Employee and Child(ren) CCAP $ $ $ $ $ $1, $ $1, CCAP with Wellness Credit $ $ $ $ Network $500 $1,000 $3,000 $6,000 $3,500** $7,000** 0% $50 copay** Non-Network $2,000 $4,000 $5,000 $10,000 $7,000** $14,000** 40% 20% after deductible at UHP network pharmacies See prescription drug plan for details See prescription drug plan for details PPO 2 $ $ $ $ $ $ $ $1, PPO 2 with Wellness Credit $ $ $ $ PPO 1 $ $ $ $ $ $ $ $1, PPO 1 with Wellness Credit $ $ $ $ PPO 1 & PPO 2 CUMC OPTUMRX NETWORK Tier 1 Tier 2 Tier 3 Tier 1 Tier 2 Tier PRESCRIPTION DRUG PLAN 31-Day Supply Cost $ % ($100 max) 35% ($150 max) 90-Day Supply Cost $ % ($300 max) 35% ($350 max) $ % ($100 max) 40% ($150 max) $ % ($300 max) 35% ($450 max) Tip: Filling your prescriptions at the CUMC Clinic Pharmacy offers you the lowest cost, with outstanding service and free delivery on campus. Call or cumcpharmacy.creighton.edu for more information. 3

4 WHAT ARE MY HEALTH CARE ACCOUNT OPTIONS, AND HOW MUCH CAN I CONTRIBUTE TO THEM? Health care accounts can help you pay for certain eligible expenses with pretax dollars. Which plan is this account available for? What would I use this account for? What is the maximum amount that Creighton and I combined can put in this account? What does the company put in? When are the funds available? What happens if I don t use the money during the year? Election option HEALTH FLEXIBLE SPENDING ACCOUNT (FSA) PPO1 AND PPO2 Any eligible health care expenses $2,550 The IRS pretax contribution limit Creighton does not contribute to this account Your entire contribution amount is available at the beginning of the year Up to $500 in unused funds will roll over automatically to pay for eligible expenses in the following year System default is WAIVED if no election is made during Annual Enrollment; 2015 Annual elections does not rollover TIPS FOR FLEXIBLE SPENDING ACCOUNT (FSA) ELECTIONS : FSA elections must be made each year; the benefits system assumes no election, so if you want to contribute to an FSA, you must log into the system and enter an election dollar amount. Remember, FSA elections should be considered carefully as the use it or lose it rule does apply. The $500 carryover allows up to $500 of unused money to move and be available HEALTH SAVINGS ACCOUNT (HSA) CCAP To save for future health care expenses, or expenses you incur today See chart below $500 /$750 depending on your medical election Your funds are available as they come out of your paycheck and are deposited into your account Unused funds will roll over to the next year; you can take HSA funds with you when you leave An HSA offers flexibility to elect or change your contribution amount at any time during the year; if you contributed to a health spending account in 2015, that election will carry over in to spend in Note, if you have a 2015 expense that is not submitted by Dec. 31, 2015, you must log on to healthhub.com to complete an online claim; do not use your HSA card in 2016 for 2015 expenses. If you have any questions regarding your current Health FSA, please contact PayFlex at or access your account online at HSA CONTRIBUTIONS FOR CCAP PARTICIPANTS Creighton HSA contributions are contingent upon: 1. Completing SimplyWell HRQ 3. Enrolling in the CCAP plan 2. Completing Health Screening 4. Opening HSA at PayFlex $500 Employee + Spouse $750 Employee + Child(ren) $750 $750 *Add $1,000 if age 55 or older LIMITED PURPOSE FLEXIBLE SPENDING ACCOUNT (LIMITED PURPOSE FSA) CCAP You can only use this account for eligible vision and dental expenses $2,550 The IRS pretax contribution limit Creighton does not contribute to this account Your entire contribution amount is available at the beginning of the year Up to $500 in unused funds will roll over automatically to pay for eligible expenses in the following year System default is WAIVED if no election is made during Annual Enrollment; 2015 Annual elections does not rollover CU EMPLOYEE $2,850 $6,000 $6,000 $6, IRS MAX $3,350* $6,750* $6,750* $6,750* TIPS FOR CCAP/HSA PARTICIPANTS If you contributed to a health savings account in 2015, that election will carry over in 2016 if you don t make a change. The IRS raised the limit for HSAs in 2016 to $6,750. If you would like to contribute to this new limit, you will need to make this election, it is not automatic. As you are making your annual election for your HSA, please remember to include the $500/$750 contribution made by Creighton if you completed SimplyWell. Special Note for 2015 FSA participants who are planning to switch to CCAP/HSA for 2016: If you wish to have your HSA begin as of January 1, 2016, please be sure all funds are depleted in your Health FSA by December 31, Plan participants are not eligible to have an active HSA and Health FSA at the same time. If you have any questions regarding your current Health FSA, please contact Payflex. 4

5 WHICH DENTAL PLAN IS RIGHT FOR ME? PREVENTIVE The Preventive dental plan offers the most basic care covering 100% of your cleanings. If a dental problem arises, while the plan won t pay, using a MetLife network provider will get you discounts on the services needed. BASIC The Basic dental plan offers coverage that works for the majority of participants. Included are your routine cleanings and exams, and help paying for the basic and major restorative procedures like fillings, extractions, crowns and bridges. This plan promotes good dental hygiene through preventative care, and helps cover dental services you may need at a low cost. ENHANCED The Enhanced dental plan offers the same comprehensive coverage as Basic, but also covers orthodontia for children. While what you pay in coinsurance and deductibles vary slightly, the difference in premium should be closely considered. If you don t have a child needing orthodontia, this plan is probably not worth the extra monthly premium because the maximum benefit like the Basic dental plan is limited to $1,500 per year. WHAT ARE MY DENTAL PLAN OPTIONS? For 2016, MetLife will continue to be our Dental Plan Provider, with no changes in plan benefits or premiums. EMPLOYEE MONTHLY PREMIUMS Employee + Spouse Employee + Child(ren) CREIGHTON MONTHLY PREMIUMS Employee + Spouse Employee + Child(ren) DENTAL BENEFITS PLAN COVERAGE Type A: Preventive Care Type B: Basic Restorative Type C: Major Restorative Type D: Orthdontia (children only) ANNUAL DEDUCTIBLES Per Person Deductible Deductible BENEFIT MAXIMUMS Annual Benefit Maximum Per Person (Type A, B, & C Services) Lifetime Orthodontia Benefit Maximum PREVENTIVE $ 0 $ 9.80 $ 8.86 $ $ $ $ $ PREVENTIVE BASIC ENHANCED In-Network 100% Out-of-Network 100% In-Network 100% 70% Out-of-Network 100% In-Network 100% 80% Out-of-Network 100% $0 $0 $500 BASIC $ 9.43 $ $ $ $ $ $ $ $0 $0 $500 ENHANCED $ $ $ $ $ $ $ $ $50 $150 $1,500 $150 $300 $1,500 $35 $125 $1,500 $1,500 $150 $300 $1,500 $1,500 Note: If you seek care from an out-of-network dentist, you may incur additional charges. 5

6 WHAT ARE MY VISION PLAN OPTIONS? Vision exams are as important to your health as your dental cleanings or annual wellness exam with your physician. A comprehensive eye exam can help lead to early detection of diabetes or hypertension. That s why Creighton s vision coverage through VSP provides a free eye exam each year and other benefits to help ensure you see clearly. BENEFIT WellVision Exam PRESCRIPTION GLASSES Frame DESCRIPTION YOUR COVERAGE WITH A VSP DOCTOR Focuses on your eyes and overall wellness $130 allowance on a wide selection of frames $150 allowance for featured frame brands 20% off amount over your allowance EMPLOYEE MONTHLY PREMIUMS Employee + Spouse Employee + Child(ren) CREIGHTON MONTHLY PREMIUM Employee + Spouse Employee + Child(ren) COPAY $0 $25 $ 3.48 $ 7.66 $ 6.26 $ $ 3.48 $ 7.66 $ 6.26 $ Included in Prescription Glasses FREQUENCY Every 12 months See frame and lenses Every 24 months HOW CAN A VISION PLAN BENEFIT ME? $ SAVE MONEY. VSP members save an average of $350 per year! Lenses Lens Enhancements Contacts (Instead of glasses) Single vision, lined bifocal and lined trifocal lenses Polycarbonate lenses for dependent children Standard progressive lenses Premium progressive lenses Custom progressive lenses Average savings of 20-25% on other lens enhancements $130 allowance for contacts and the contact lens exam (fitting and evaluation) 15% savings on a contact lens exam (fitting and evaluation) Included in Prescription Glasses $55 $95 - $105 $150 - $175 $0 Every 12 months Every 12 months Every 12 months STAY HEALTHY. You ll get an annual WellVision Exam the most thorough eye exam. Diabetic Eyecare Plus Program Extra Savings Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal screening for eligible members with diabetes. Limitations and coordination with medical coveragemay apply. Ask your VSP doctor for details. $20 As needed Glasses and Sunglasses Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details. 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12months of your last WellVision Exam. Retina Screening No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam Laser Vision Correction Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities LOOK GREAT. Access hundreds of frame options for you and your family. YOUR COVERAGE WITH OUT-OF-NETWORK PROVIDERS Visit vsp.com for details, if you plan to see a provider other than a VSP doctor Exam...up to $45 Frame...up to $70 Single Vision Lenses...up to $30 Lined Bifocal Lenses...up to $50 Lined Trifocal Lenses...up to $65 Progressive Lenses...up to $50 6 Contacts...up to $105

7 QUICK QUIZ YES NO Will you need more than company basic life insurance to meet your survivors needs? Do others depend on your income? Would you have significant additional expenses if your spouse/parter were to die? Would your survivors lack financial resources if you were to die? If you answer yes to any of the questions above, you may want to consider the life and disability insurance options available to you. TIPS FOR LIFE INSURANCE Life insurance coverage will carry over if you don t make any elections during open enrollment. Open enrollment is a good time to review your designated beneficiary(ies) for all of your insurance and retirement benefits. During open enrollment, if you are currently enrolled in Voluntary Term Life and your election is below the guaranteed issue amount ($150,000 for employee and $50,000 for spouse coverage), you or your spouse can increase your coverage by one level without underwriting. For example, if you currently have $120,000 of Voluntary Term Life coverage, during Open Enrollment you can increase your coverage by $10,000 to $130,000. If your spouse has $30,000 currently, you could increase their coverage $5,000 to $35,000 for If you are electing additional life insurance for yourself or your spouse for the first time during open enrollment you will be required to provide Evidence of Insurability.* *Mutual of Omaha may charge a $90 fee for the medical exam if required for underwriting approval. WHAT ARE MY LIFE INSURANCE OPTIONS? Some life insurance is provided automatically to you at no cost; other voluntary coverage is available for you to purchase based on the needs of you and your family. GROUP LIFE INSURANCE Annual salary x 1 Rounded to the next $1,000 up to a maximum of $100,000 VOLUTARY LIFE INSURANCE EMPLOYEE GUARANTEED ISSUE AMOUNT: $150,000* Minimum Coverage: $20,000 Maximum Coverage: $500,000 UNITS $10,000 increments, not to exceed 5x annual salary LIMITATIONS Benefit reduces at age 70 WHAT ARE MY DISABILITY INSURANCE OPTIONS? VOLUTARY LIFE INSURANCE SPOUSE GUARANTEED ISSUE AMOUNT: $50,000* Minimum Coverage: $5,000 Maximum Coverage: $100,000 UNITS $5,000 increments, not to exceed of employee's coverage LIMITATIONS Must be under age 70 and not a CU employee *Guaranteed Issue Amounts apply to new hires or newly eligible employees. If you previously waived coverage, you may apply for coverage subject to underwriting review and requirements. Disability insurance can provide income protection for you and your family if you can no longer earn a living. Benefits begin after (Elimination Period) Benefit amount Maximum benefit period Maximum benefit Pre-existing conditions exclusion Who pays for this benefit? Loan payoff benefit SHORT TERM DISABILITY 14 days post illness, accident or maternity 67% of Weekly Salary Up to 11 weeks $2,500 per week tax-free benefit Disabilities that occur during the first 6 months of coverage due to a condition that existed during the 3 months prior to coverage, are excluded Employee is automatically enrolled and the premiums are based on the individual employees salary. This is paid with after-tax dollars so you can decline at any time. Not Applicable VOLUNTUARY LIFE INSURANCE DEPENDENT(S) GUARANTEED ISSUE AMOUNT: N/A Minimum Coverage: $2,000 Maximum Coverage: $10,000 UNITS $2,000 increments up to $10,000 for all enrolled children LIMITATIONS Must be at least 15 days old and less than 26 years of age LONG TERM DISABILITY-PRE TAX 90 days post injury or illness 60% of Monthly Salary Social Security normal retirement age $3,500 per month taxable benefit Disabilities that occur during the first 12 months of coverage due to a condition that existed during the 3 months prior to coverage, are excluded Employee is automatically enrolled and Creighton pays the cost of this benefit. You are unable decline enrollment. When a claim is filed, the benefit received is taxable to the employee. Up to $200,000 7

8 WHAT ARE MY OTHER BENEFIT OPTIONS? We offer several benefit options for you and your family. BENEFITS DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT (DCFSA) METLAW - PREPAID LEGAL EMPLOYEE ASSISTANCE PROGRAM (MAGELLAN HEALTHCARE) WHAT WE OFFER You can pay for eligible dependent care expenses with pretax dollars, including: Adult day care centers Babysitters and nannies Summer day camp Before-and after-school programs Child day care You can use this account for dependent care expenses incurred so you and your spouse can work, or so your spouse can attend school full time. If your spouse stayshome full time, you are not eligibleto participate. You have access to experienced attorneys for many personal legal services and unlimited advice through Hyatt Legal Plans. The plan covers: Estate planning documents Financial matters Real estate matters Immigration assistance /elder law services Traffic offenses Document preparation And more For $18 per month you receive fully covered legal services for you, your spouse and dependents. Creighton s EAP is provided at no cost to you and no election is needed. The EAP offers confidential, solution focused help and resources for all types of life issues and is available 24 hours a day, seven days a week online or by phone. Services provided include: Child and elder care services Financial consultation services Legal consultation services Convenience services Parenting Relationship issues Work issues Counseling WHO'S ELIGIBLE Employees with children under age 13 and anyone who is a dependent under IRS rules, or is mentally or physically incapable of taking care of himself or herself. All benefit eligible employees are eligible to enroll in this benefit. All employees, dependents and household members are eligible to participate in this program. ACTIONS YOU CAN TAKE Contribute up to $5,000 per year to the account (or $2,500 if you are married and filing separate tax returns). You are only able to enroll in MetLaw during Annual Enrollment and must remain in the plan for the full year. Call or visit for more informaiton. 8

9 IMPORTANT NOTICES Women s Preventive Care Creighton University qualifies under the religious employer exemption, so the United Healthcare will continue to administer coverage and payment for covered preventive care medications and services through a Contraceptive Services Only plan. Enrollment in this separate policy is required and can be requested by calling Upon enrollment, plan materials and a separate ID card will be mailed to the participant s home. The Affordable Care Act required coverage of FDA-approved contraceptive methods for women at 100 percent, without charging a copayment, coinsurance or deductible, when filed at a network pharmacy. Therefore, Tier 1 contraceptives will be available at no cost to women who remain covered or enroll in the Contraceptives Services Only plan. The Women s Health and Cancer Rights Act As required by the Women s Health and Cancer Rights Act of 1998, each medical plan provides the following medical and surgical benefits with respect to mastectomy: Reconstruction of the breast on which the mastectomy has been performed Surgery and reconstruction of the other breast to produce a symmetrical appearance Prostheses and treatment of physical complications of all stages of the mastectomy, including lymphedema These services must be provided in a manner determined in consultation with the attending physician and the patient. This coverage may be subject to annual deductibles and coinsurance applicable to other such medical and surgical benefits provided under the plan. Other Notices Additionally, you can find the following legal notices at creighton.edu/hr/benefits: Medicare Part D - Notice of Credible Coverage Premium Assistance under Medicare and the Children s Health Insurance Program (CHIP) Newborns and Mother s Health Protection Act Summary of Benefits and Coverage (SBC) As a result of the Patient Protection and Affordable Care Act, Creighton University is required to provide standardized Summaries of Benefits and Coverage (SBCs). The SBCs summarize, in a standard format, important information about the University s health plans. Availability of Notice of Privacy Practices Creighton University s Benefit Program (the Plan ) maintains a Notice of Privacy Practices that provides information to individuals whose protected health information (PHI) will be used or maintained by the Plan. Employee Benefits System Dependent Verification Center Magellan Health MetLaw/ Hyatt Legal Plan MetLife PayFlex The Principal TIAA-CREF SimplyWell United HealthCare VSP HELPFUL CONTACT INFORMATION Benefits Enrollment Access through My Creighton Dependent Verification Service Employee Assistance Program Legal Services Plan Access code: GetLaw Dental Group # Flex Spending Accounts Health Savings Accounts or local Retirement Plan Plan ID: or local Wellness Portal Access through My Creighton Medical & Pharmacy Group # Vision Service Plan

10 WHEN AND HOW DO I ENROLL? REMEMBER! Open Enrollment is November 4 through November 20, n You must enroll online using the Employee Benefits icon on the my.creighton.edu website. n The Solution Center is available at from November 4 through November 20, n If you wish to participate in a flexible spending account in 2016, you MUST enroll again even if you elected coverage in n Elections and/or changes MUST be made by 4:00pm CST on November 20th. After this deadline, no changes will be accepted unless you have a qualifying event. n Logout of the benefits system and close the browser after you have completed your enrollment. REMINDER: All of your 2015 benefit elections will rollover to 2016 with the exception of your Flexible Spending Accounts (you will need to actively elect these accounts if you wish to participate in 2016). We do recommend you log on the Employee Benefit System to review your elections and beneficiary designations to ensure they are still up-to-date. WHAT DO I NEED TO CONSIDER FOR OPEN ENROLLMENT? When choosing your medical coverage for 2016, you have some important decisions to consider Evaluate your current medical plan. Could moving to another plan save you money with lower premiums? Remember, the Plan Cost Estimator can help - Calculate how much you want to contribute to the health savings account or flexible spending account that works with your medical plan. In addition to your medical coverage, there are a few more actions to think about Do you want to change your dental or vision plan? Do you want to purchase voluntary life or disability insurance? Do you want to enroll in prepaid legal services? Add or remove family members Do you need to change which family members are covered under your benefits? Do you need to add or change beneficiary designations for life insurance or retirement? NOTE: Documentation verification for dependents: In order to cover your family members, Creighton University requires verification of dependent eligibility. If you are adding a dependent for the first time during Open Enrollment, know you will be asked to provide documentation verifying your relationship like a marriage or birth certificate. Watch your mail at home for a letter from the Dependent Verification Center detailing the documents that must be submitted and the deadline. If documents are not received, your dependent s coverage may be cancelled. 10

11 NOTES: 11

12 H O U S E S T A F F 2500 California Plaza Omaha, Nebraska First Class Presort U.S. POSTAGE PAID PERMIT #227 OPEN ENROLLMENT IS NOV. 4-20