Welcome! This guide provides information about your benefits with The Claremont Colleges at the click of a mouse! Use this guide as your go-to source when you re first enrolling for your benefits, when changing your benefits at Open Enrollment, or throughout the year as a benefits resource. Click the link below to get started. Bienvenidos! Esta guía le da información acerca de sus beneficios de The Claremont Colleges con solo un clic en su computadora! Utilice este guía como fuente útil al inscribirse por primera vez en sus beneficios, al cambiar sus beneficios en las Inscripcion Abiertas o durante el año como un recurso para sus beneficios. Dé un clic en los enlaces abajo para empezar. English Español Using This Guide The guide works like a website. Click underlined words to jump to more information about that topic. You can also use the Last Viewed, and buttons to move through the guide at your pace. Use esta Guía... El guía trabaja como un sitio Web. Dé un clic en las palabras subrayadas para saltar más información sobre ese tema. Puede utilizar los botones Última Página Visitada Regresar y Avanzar para trasladarse en la guía a su propio ritmo.
Guide Your benefits are an important part of your overall compensation. The Claremont Colleges is pleased to offer a comprehensive array of benefits to protect your health, your family and your way of life, including: Health care coverage, including medical, dental and vision benefits Financial protection for you and your family, including disability, life and accident insurance coverage Retirement savings opportunities Work-life resources through the Employee Assistance Program Other voluntary benefits include Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs) and other financial benefits. Check it Out! This electronic and interactive guide will not only help you find information easily, but it s environmentally friendly. The guide works like a website. Click underlined words to jump to more information about that topic. You can also use the Last Viewed, and buttons to move through the guide at your pace.
The following benefit programs are available to you. Click the benefit plan below for more information. Medical Benefits Kaiser Permanente HMO Anthem Blue Cross HMO Anthem Lumenos HSA Mellon Health Savings Account Dental Benefits MetLife DHMO MetLife PPO Vision Benefits Anthem Core Plan Anthem Buy-Up Plan Employee Assistance Program FSAs Health Care FSA Limited Scope Health FSA Dependent Care FSA Long-Term Disability Basic Coverage Supplemental Life Insurance Benefit Accidental Death & Dismemberment Insurance (AD&D) Long-Term Care
Your Medical Benefits The Claremont Colleges offers three medical plans for you to choose from. Click the plan name for more detail: Anthem Blue Cross (California Care) HMO Kaiser Permanente HMO Anthem Lumenos HSA Anthem Blue Cross (California Care) HMO and Kaiser Permanente HMO Plans The HMO plans offer affordable health care for you and your family through a network of health care providers. When you enroll in an HMO plan, you (and each enrolled family member) will be asked to select a primary care physician (PCP) from the network. The PCP you choose will help you manage all aspects of your health care. You have the right to designate any primary care provider who participates in the plan s network and who is available to accept you or your family members. Plan Features: 1. You must select and use a primary care physician (PCP) from the HMO network to coordinate your care. 2. HMOs do not have s or coinsurance. Instead, you pay a copay when you visit your PCP or a specialist whom you have been referred to by your PCP. 3. If you use doctors, hospitals, labs, pharmacies or other health care facilities outside the HMO, you are responsible for paying the full cost (except in an emergency). 4. There are no claim forms to file. More
Anthem Blue Cross (California Care) HMO and Kaiser Permanente HMO Plans (Continued) Here s what you need to know about the difference in receiving care from the plans: Anthem Blue Cross (CaliforniaCare) HMO You must receive all of your non-emergency care from doctors and hospitals in the Anthem Blue Cross (CaliforniaCare) HMO network, and the care must be under your PCP s direction or the plan will not pay benefits. Women may go directly to a gynecologist in their PCP s medical group or practice association without a referral from their PCP. Care received from an out-of-network provider will not be covered (except for emergency care). Kaiser Permanente HMO You have the option of going to any Kaiser Permanente facility to receive your care. Care received from a non- Kaiser facility will not be covered (except for emergency care).
Anthem Lumenos HSA With the Anthem Lumenos HSA Plan, you have the flexibility to choose any doctor or facility and receive benefits. However, if you go to Anthem Lumenos HSA network doctors and facilities, you will pay less because Anthem Lumenos HSA network providers have agreed to charge lower, negotiated rates. Plan Features: 1. Flexibility to go to in-network and out-of-network providers 2. Lower out-of-pocket expenses when you see in-network providers 3. 100% coverage for preventive care with in-network providers 4. Coinsurance for most services once you meet the plan s 1 5. Out-of-pocket maximum(s) to help protect you from the expense of a possible catastrophic illness or injury 6. A tax-advantaged Health Savings Account (HSA) for those individuals who are not enrolled in Medicare Parts A and/or B. Go to Health Savings Account (HSA) for more information about this unique savings account. 1 When you use in-network providers, the coinsurance percentage is lower due to negotiated rates. If you use out-of-network providers, the coinsurance percentage is higher and is based on Reasonable and Customary charges. You must also pay any amount over the R&C limit. Think About Participating in the Limited Scope Health Care FSA Need More Detail? Click here to review A Guide to the Anthem Lumenos HSA Plan. This guide has more detail about how the Anthem Lumenos HSA plan works, and how to make the most of the tax-advantaged Health Savings Account (HSA). If you enroll in the Anthem Lumenos HSA Plan and open a Health Savings Account (HSA), a Limited Scope Health FSA is available to you. The Limited Scope Health FSA allows you to pay for eligible dental and vision expenses (i.e., s, copays, coinsurance). You can also use the Limited Scope Health FSA to pay for medical expenses and prescription drugs AFTER you ve met your plan s.
How the Anthem Lumenos HSA Works How does an HSA Plan work? It s metaphorically like a house. ROOF OUT-OF-POCKET MAXIMUM 2nd FLOOR COINSURANCE 1st FLOOR ANNUAL DEDUCTIBLE FOUNDATION PREVENTIVE CARE FREE Don t forget to open your HSA! 1. Roof: Your annual out-of-pocket maximum for innetwork usage caps your expenses, like the roof of a house. Once you reach the annual out-of-pocket maximum for in-network usage, the plan pays 100% of your costs for the rest of the year. Please note: your out-of-pocket expenses could exceed your maximums when using out-of-network providers and facilities. 2. Second Floor: Comprehensive coverage with coinsurance paid by you and the medical plan. Once you meet the, the plan pays a percentage of the cost and you pay the rest. You can pay for your portion with the tax-free money you contribute to your HSA. 3. First Floor: Your contribution to your. The first floor of this house represents the first expenses you will pay for your health care. You can use the tax-free money that you contribute to your HSA to cover this amount. 4. Foundation: Preventive care is the plan s foundation, covered at 100% by the medical plan. This is the point from which you grow your most valuable health knowledge and healthy habits. Most appropriate preventive care received in-network is free to you and your family. If you enroll in the Anthem Lumenos HSA and you are not enrolled in Medicare Parts A and/or B, you have the option to enroll in a Health Savings Account (HSA) with Mellon Financial. An HSA is a special account that lets you pay eligible expenses like s, coinsurance and prescription drugs with tax-free dollars. An HSA can be offered only with a medical plan that meets the IRS high health plan requirements like the Anthem Lumenos HSA. Go to the Health Savings Account (HSA) section to learn more about the HSA and how it works.
Health Savings Account (HSA) If you choose to enroll in the Anthem Lumenos HSA plan, you have the option to enroll in a Health Savings Account (HSA) as long as you are not enrolled in Medicare Parts A and/or B. An HSA is a personal savings account created from pre-tax employee contributions to be used for qualified medical expenses. Federal regulations limit HSAs for plans with a high, like the Anthem Lumenos HSA plan. Keep in mind that if you enroll in an HSA and an FSA, you will only be eligible for the Limited Scope FSA, due to IRS regulations. An HSA can also be used as an investment tool. Your account balance can roll over from year to year. And, the HSA is completely portable you can take it with you if you change jobs or retire. You can then use this tax-free money to pay for eligible medical expenses for you or your dependents (excluding domestic partners). You can make pre-tax contributions into an interest-bearing account managed by Mellon Bank. When you enroll in an HSA, you will receive a welcome kit from Mellon Bank with more information about using your HSA. Once you open your HSA, you will receive a debit card linked to your HSA account. You can use this debit card to pay for any eligible expenses, and the money will be taken directly from your account. For information about the fees and rate schedule for your HSA account, please visit Mellon Bank online at www.mellon.com, or call 877-472-4200. HSA Basics Funding Qualified Expenses FSA Participation You can contribute to your HSA directly from your salary on a pre-tax basis if you select Mellon as your HSA provider. You can also contribute to another financial institution HSA using post-tax dollars up to the IRS limit: The maximum annual contribution is $3,300 per individual* The maximum annual contribution is $6,550 per family* If you are 55 years of age or older, there is a catch-up contribution option in the amount of $1,000 * These amounts include any employer contributions. Only non-highly compensated participants (employees who had an annual compensation of less than $115,000 in 2013) who are not enrolled in Medicare A and/or B are eligible for the employer contribution. The money that you put into the HSA can be used to pay for qualified medical expenses, including the Lumenos HSA s or coinsurance, and other out-of-pocket health care expenses like dentist visits and eye exams. Additionally, the money that you roll over can be used for future eligible expenses, including long-term care. There may be restrictions on who the plan will cover, for more details see A Guide to the Anthem Lumenos HSA Plan. If you are also enrolled in a Health Care FSA, eligible expenses under the FSA will be reimbursed on a limited-scope basis. Limited-scope FSA reimbursements are for non-medical related expenses that you choose not to use your HSA to reimburse, such as dental or vision copays or coinsurance payments. Refer to Limited Scope Reimbursements for more information.
Medical Benefits at a Glance The chart below provides an overview of the most commonly used benefits. For more detail about any of the plans provisions, click the plan name in the table heading. Benefit Kaiser HMO Anthem Blue Cross (CaliforniaCare) HMO Kaiser Permanente Network Anthem Blue Cross Providers In-Network Anthem Lumenos HSA Out-of-Network Employer HSA Contribution for employees who earned less than $115,000 in 2013 (when through Mellon Bank) Employee Only N/A N/A $450 Family N/A N/A $900 Employee HSA N/A N/A $2,850 (employee only)/$5,650 (family) contribution maximum (not including the employer contribution) Employee HSA catch-up N/A N/A $1,000 contribution (ages 55 and over) Calendar-year Employee Only None None $1,500 Family None None $3,000 (includes insured employee & one or more members of the employee s family) Out-of-pocket maximum (per calendar year) Some benefits do not apply toward the out-of-pocket maximum Employee Only $1,500 $1,500 $3,000 $6,000 Family $3,000 $3,000 (two party)/ $4,500 (family) $6,000 $12,000 Lifetime Maximum Unlimited Unlimited Unlimited Inpatient Services Inpatient Hospital $200 copay per admission $300 copay per admission Plan pays 80% after Continued
Medical Benefits at a Glance (Continued) Benefit Kaiser HMO Anthem Blue Cross (CaliforniaCare) HMO Kaiser Permanente Network Anthem Blue Cross Providers In-Network Pre-Admission Testing Plan pays 100% Plan pays 100% Plan pays 80% after Drugs, Medicine, Casts, Dressings, Special Duty Nursing (when prescribed and medically necessary) Plan pays 100% Plan pays 100% Plan pays 80% after X-ray, Laboratory Plan pays 100% Plan pays 100% Plan pays 80% after Physical Therapy Plan pays 100% Plan pays 100% Plan pays 80% after (maximum 24 visits combined with occupational therapy) Cost of Administering Blood Transfusions Plan pays 100% Plan pays 100% Plan pays 80% after Whole Blood Plasma No charge if replaced Plan pays 100% Plan pays 80% after Hospice Care Plan pays 100% Plan pays 100% Plan pays 80% after Skilled Nursing Facility Outpatient Services Office Visits Plan pays 100% (limit 100 days per calendar year) You pay a $20 copay (PCP), or You pay a $30 copay (specialist) Plan pays 100% (limit 100 days per calendar year) You pay a $25 copay (PCP), or You pay a $40 copay (specialist) Plan pays 80% after (limit 100 days per calendar year) Plan pays 80% after Anthem Lumenos HSA Out-of-Network (maximum 24 visits combined with occupational therapy) (limit 100 days per calendar year) Continued
Medical Benefits at a Glance (Continued) Benefit Kaiser HMO Anthem Blue Cross (CaliforniaCare) HMO Kaiser Permanente Network Anthem Blue Cross Providers In-Network X-rays, Laboratory Tests Plan pays 100% Plan pays 100% Plan pays 80% after Anthem Lumenos HSA Out-of-Network Routine Exams Plan pays 100% Plan pays 100% Plan pays 100% Routine Immunization Plan pays 100% Plan pays 100% Plan pays 100% Preventive Care Plan pays 100% Plan pays 100% Plan pays 100% Outpatient Surgery (at a Plan facility) Short-Term Rehabilitation (physical, occupational, or speech therapy) You pay a $30 copay You pay a $100 copay Plan pays 80% after You pay a $20 copay per visit; benefits are limited to medically necessary therapy authorized by a Plan physician. You pay a $25 copay per visit ($40 for specialist); limited to a 60-day period of care after an illness or injury; additional visits available when approved by your medical group Chiropractic Care Not covered $25 per visit, short term (referral from PCP required) Acupuncture Not covered You pay a $25 copay per visit ($40 for specialist) Cardiac/Pulmonary Rehabilitation You pay a $15 copay per visit You pay a $40 copay per visit Plan pays 80% after (maximum 24 visits) Plan pays 80% after Plan pays 80% after (limited to $30/visit, 12 visits per calendar year) Plan pays 80% after ; benefit limited to $25/visit (maximum 24 visits) ; benefit limited to $25/visit (limited to $30/visit, 12 visits per calendar year) Continued
Medical Benefits at a Glance (Continued) Benefit Kaiser HMO Anthem Blue Cross (CaliforniaCare) HMO Health Care Emergency Services Emergency Room Services and Supplies Ambulance Kaiser Permanente Network Plan pays 100% (limited to 100 2-hour visits per calendar year) You pay a $100 copay; waived if admitted You pay a $50 copay per trip Anthem Blue Cross Providers You pay a $25 copay per visit (limited to 100 visits per calendar year) You pay a $100 copay; waived if admitted Plan pays 100% Maternity Care Office Visits (for mother) Plan pays 100% You pay a $25 copay per visit Hospital (for mother) You pay a $200 copay You pay a $300 copay per admission per admission Office Visits (for baby) Plan pays 100% for well baby visits, up to age 23 months Outpatient Family Planning Elective Interrupted Pregnancy You pay a $25 copay per visit In-Network Plan pays 80% after (limited to 100 visits) Plan pays 80% after Plan pays 80% after Plan pays 80% after Plan pays 80% after Plan pays 80% after You pay a $20 copay You pay a $150 copay Plan pays 80% after Tubal Ligation You pay a $20 copay You pay a $150 copay Plan pays 80% after Vasectomy You pay a $20 copay You pay a $100 copay Plan pays 80% after Counseling & Consultation You pay a $20 copay You pay a $25 copay ($40 for specialist) Plan pays 80% after Anthem Lumenos HSA Out-of-Network (limited to 100 visits) Plan pays 80% after Plan pays 80% after Continued
Medical Benefits at a Glance (Continued) Benefit Kaiser HMO Anthem Blue Cross (CaliforniaCare) HMO Medical Equipment Durable Medical Equipment Mental Health Inpatient Care Outpatient Care Substance Abuse Inpatient Care Outpatient Care Kaiser Permanente Network Plan pays 80%; in accordance with DME formulary and prescribed by a Kaiser physician You pay $200 per admission You pay a $20 copay per visit/individual therapy You pay a $10 copay per visit/group therapy You pay a $200 copay per admission You pay a $20 copay per visit for individual therapy You pay a $5 copay per visit for group therapy Anthem Blue Cross Providers Plan pays 100% You pay $300 per admission You pay a $25 copay per visit ($40 for specialist) You pay a $300 copay per admission You pay a $25 copay per visit ($40 for specialist) In-Network Plan pays 80% after Plan pays 80% after Plan pays 80% after Plan pays 80% after Plan pays 80% after Anthem Lumenos HSA Out-of-Network Continued
Medical Benefits at a Glance (Continued) Benefit Kaiser HMO Anthem Blue Cross (CaliforniaCare) HMO Kaiser Permanente Network Anthem Blue Cross Providers In-Network Anthem Lumenos HSA Prescription Drugs Preventive Preventive N/A N/A Plan pays 100% Prescription Drugs Retail (up to a 30-day supply) Generic You pay a $10 copay You pay a $10 copay Plan pays 80% after Brand Formulary You pay a $25 copay You pay a $25 copay Plan pays 80% after Brand Non-formulary You pay a $25 copay You pay a $40 copay Plan pays 80% after Prescription Drugs Mail-order (up to a 100-day supply) Generic You pay a $20 copay You pay a $10 copay Plan pays 80% after Brand Formulary You pay a $50 copay You pay a $50 copay Plan pays 80% after Brand Non-formulary You pay a $50 copay You pay a $80 copay Plan pays 80% after Vision Care Out-of-Network Not covered Preventive Eye Exams Plan pays 100% Plan pays 100% Plan pays 100%
Your Dental Benefits Dental coverage is key to your overall health. Eligible employees are offered a choice of two dental plans: MetLife DHMO MetLife DPPO Use In-Network Providers To search for providers who participate in your dental plan s network, follow the steps below: 1. Go to www.metlife.com. 2. Click Find a Dentist located on the right side of the home page. 3. Select Dental PPO or Managed Dental Plan (Dental DMO), depending on your choice of plan. 4. Enter the ZIP code of the city in which you want to find a dentist. Click Go. For the PPO plan, you will be directed to a list of dentists within a 30 mile radius of the ZIP code you entered. You can modify your search by using the Modify Your Search options at the top of the Find a Dentist page. For DMO coverage, you will be directed to the Find a Dentist Advanced Search page where you will input the plan name using the drop down menu. Select Met3757. You can also modify the mile radius option in the Location box to narrow down or broaden your search. Click Search. Alternatively, you can call 800-942-0854. Quick guide to dental services: Preventive services include: semi-annual check-ups (including X-rays), cleanings and fluoride treatments (for children) Basic services include: diagnostic X-rays, fillings and extractions Major services include: bridges, crowns and dentures
MetLife DHMO The MetLife DHMO plan works much like a medical HMO plan. When you enroll in a DHMO plan, you (and each enrolled family member) will be asked to select a Primary Care Dentist (PCD) from the network. Plan Features: 1. You must select and use a primary care dentist (PCD) from the MetLife network to coordinate your care, including referrals to specialists within the network 2. There are no s or annual dental maximum 3. Preventive and basic services are covered at 100% with the exception of prophylaxis cleaning, sealants and space maintainers 4. General services such as fillings and simple extractions are subject to copays 5. Major dental services, such as crowns, inlays and dentures, require a copay 6. If you use a dentist outside the DHMO network, you are responsible for paying the full cost (except in an emergency).
MetLife DPPO With the MetLife DPPO Plan, you have the flexibility to choose any dentist and receive some benefits. However, if you go to a MetLife network dentist, you will pay less because MetLife dentists have agreed to charge lower, negotiated rates. Plan Features: 1. You can choose any dentist, but will pay less if you choose a MetLife dentist 2. You pay the first $50 in eligible expenses per person ($150 maximum per family) each year, then the plan pays benefits (out-of-network s are $75 per person or $225 per family) 3. Preventive services are covered at 100% and aren t subject to the (covered 90% for out-of-network services) 4. Basic services are covered at 80%, and major services are covered at 50%, after you ve met the 5. The MetLife DPPO Plan covers up to $2,000 of eligible dental expenses per covered family member each calendar year. Diagnostic and preventive benefits are not counted toward the annual maximum 6. The MetLife DPPO Plan has a lifetime maximum of $2,000 per covered family member for orthodontia services. Coverage levels are different when using an out-of-network provider. See Dental Benefits at a Glance for more details. How the Dental DPPO Works See any PPO network provider Pay a and any applicable coinsurance, and you will pay less because rates are negotiated See a provider outside the PPO network Flexibility of choosing any dentist, but you will pay a higher ; the rates are not negotiated, so you may be charged more
Dental Benefits at a Glance The chart below provides an overview of the most commonly used dental benefits. For more details about any of the plans provisions, click the plan name in the table heading. Benefit MetLife DHMO MetLife DPPO In-Network In-Network Out-of-Network Calendar-Year Deductible* None Individual: $50/Family: $150 Individual: $75/Family: $225 Calendar-Year Maximum Benefit* Unlimited Plan pays up to $2,000 per person/year Plan pays up to $2,000 per person/year Preventive/Diagnostic* Routine Examination: Cleaning (once every 6 months), Fluoride Treatment (including bitewing X-rays) Office Visits General Services (Restorative) Fillings: Amalgam Composite/ Resin You pay $0 (for up to 2 cleanings per year, additional cleanings require a $35 copayment) You pay a $5 copay ($25 after hours) You pay $0 to a $240 copay (depending on number of surfaces) Plan pays 100%; does not apply Plan pays 80% after Plan pays 80% after Plan pays 90%; does not apply Plan pays 80% after Plan pays 80% after Simple Extractions You pay a $5 copay Plan pays 80% after Plan pays 80% after Major Services Caps, Crowns, Dentures Copays as listed in the Plan pays 50% after Plan pays 50% after schedule of covered services and copays Orthodontia Adults You pay a $1,695 copay Dependent Children (to age 19) You pay a $1,695 copay Evaluation and Consultation You pay a $100 copay Plan pays 50% up to $2,000 lifetime maximum benefit; does not apply Treatment Plan and Records You pay a $200 copay Retention $250 copay *Deductible and calendar-year Maximum are not applicable to preventive or diagnostic services.
Vision Benefits Eligible employees are automatically enrolled in the core vision coverage through Anthem at no cost. This plan includes coverage for eye exams and eyeglasses or contact lenses. You receive a higher level of coverage when you use network providers. Anthem uses a network of nationwide providers, including national retailers like Target and LensCrafters. Increased coverage is available for purchase through the Buy-Up Plan. Vision Benefits at a Glance The chart below provides an overview of the most commonly used vision benefits. For more details about any of the plans provisions, click the plan name in the table heading. Benefit Core Plan Buy-Up Plan In-Network In-Network Out-of-Network Eye Exam (Once every 12 months) Plan pays 100% after a $10 copay Plan pays 100% after a $10 copay Plan pays up to $79 Frames (Once every 12 months) You receive a 35% discount Plan pays up to a $130 allowance; you Plan pays up to $100 receive a 20% discounts on amounts over allowance Lenses (Once every 12 months) Single Vision Lined Bifocal You receive a 20% discount Lined Trifocal Contact Lenses (Once every 12 months) You receive a 15% discount on doctor s professional fees. Materials are paid at usual & customary rates Plan pays 100% after a $15 copay Plan pays up to a $130 allowance; you receive a 15% discount on doctor s professional fees. Materials are paid at usual & customary rates Plan pays up to $36 Plan pays up to $60 Plan pays up to $79 Plan pays up to $115 Find the right Anthem doctor for you at www.anthem.com.
Employee Assistance Program (EAP) Confidential advice and counseling are available at no cost to you through the Employee Assistance Program (EAP). When you contact the EAP you can speak confidentially to a counselor or other professional who can help with issues, such as: Parenting issues Loss or grieving issues Relationship problems Substance abuse issues Self-improvement Mental health issues Financial concerns Legal-referral assistance Employees and their legal spouse, domestic partner and eligible dependents receive up to five (5) counseling sessions with a licensed/certified therapist by phone or in person per family member, per issue, each calendar year. Access to the EAP is available 24/7 year-round. All records, including medical information, referrals and evaluations, are kept strictly confidential in accordance with federal and state laws. More information is available in the EAP Brochure. Did you know? The EAP is 100% paid by The Claremont Colleges!
Flexible Spending Accounts (FSAs) FSAs help you make your money go further by letting you set aside before-tax dollars to pay for certain out-of-pocket eligible expenses and dependent care costs. Here s how they work: You make contributions from your pay on a pre-tax basis. Contributions and eligible reimbursed expenses aren t subject to federal income tax, Social Security tax, and, in most cases, state income tax. The tax savings help offset the cost of eligible health care and dependent care expenses. You are not taxed on reimbursements from your FSAs. The Claremont Colleges offers two types of FSAs: Health Care FSA To pay for eligible medical, dental, and vision expenses (limited-scope reimbursements are also available for those who participate in an HSA or those enrolled in Medicare Parts A and/or B) Dependent Care FSA To pay for eligible child and elder care expenses Making FSA Contributions The annual amount you contribute to your FSA is deducted from your paychecks in equal installments, on a pre-tax basis, from January through December 31, 2014, and credited to your FSA account(s). Incurring Claims You can incur claims for eligible expenses from January 1 through March 15 of the following year. You have until June 30 to submit claims for reimbursement. More
Health Care FSA You can use the funds in your Health Care FSA to pay for eligible expenses like s, copays and coinsurance for you and your eligible dependents. You can contribute up to $2,500 per plan year, before tax. You don t have to have medical, dental or vision coverage through The Claremont Colleges to enroll in the Health Care FSA. Eligible/Ineligible expenses Here are a few common examples of expenses you can reimburse from your Health Care FSA: Ambulance services Artificial teeth/limbs Copays Chiropractic care Contact lenses Crutches Deductibles and coinsurance Hearing aids Here are some examples of ineligible expenses: Cosmetic surgery (if not medically necessary) Teeth bleaching Insulin Laser eye surgery Health insurance premiums For a full list of eligible and ineligible expenses, go to www.benesyst.net. Don t forget: if you don t use it you will lose it! Long-term care expenses Stop-smoking programs Over-the-counter medications More When estimating your annual expenses, consider only those that you are reasonably certain you will incur. Any amount left in your FSA after March 15, 2015 is forfeited. This is called the Use it or Lose it rule. Your account will be left open for claims until June 30 of the following calendar year. All FSA claims must be submitted within 90 days of termination or unpaid leave of absence.
Reimbursements If you enroll in the Health Care FSA, you will receive a debit card you can use for eligible health care expenses. Even if you use the debit card, be sure to save all receipts in the event the administrator needs to verify eligibility. If you don t use your debit card to pay for expenses, you may submit a claim for any eligible expenses. Both reimbursement options require that you submit your receipts for eligible expenses to the FSA administrator. Reimbursements are generally paid through direct deposit or check by a third party administrator. You do not pay federal income, state income or Social Security taxes on FSA expenses. Limited-Scope Reimbursements If you participate in an HSA or if you are enrolled in Medicare Parts A and/or B, you can participate in a Health Care FSA called a Limited Scope Health FSA. You can contribute up to $2,500 for eligible expenses. This FSA offers limited-scope reimbursements for eligible non-medical expenses, such as dental and vision plan s, copays and coinsurance. Additionally, once you ve met your medical plan s, you can use the Limited Scope Health FSA to cover medical expenses and prescription drug costs. Keep in mind that you cannot use a Limited Scope Health FSA for any of the expenses that are not eligible for reimbursement from a regular Health Care FSA. The Limited Scope Health FSA is a great option if you want to save the money in your HSA for future health care expenses (because HSA funds roll over each year). To learn more about an HSA, go to Health Savings Account (HSA). More
Dependent Care FSA The Dependent Care FSA may be used to pay for expenses that allow you (or your spouse, if married) to work. A dependent child is one under the age of 13 or any disabled tax dependent who is living with you. In any calendar year, you can contribute, before tax, up to $5,000 ($2,500 if married and filing separately). The limit applies to all contributions made by you and your spouse to any dependent care spending accounts through The Claremont Colleges and any other employer combined. Eligible/Ineligible expenses Here are some examples of eligible expenses you can reimburse from your Dependent Care FSA: At-home child and elder day care Before- or after-school care Care at certain child and elder day care centers Charges from certain child and elder day care providers Pre-school and nursery schools Summer day camp Here are some examples of ineligible expenses: Tuition Child or elder day care provided by someone living in your home Overnight camp Eligible Dependents An eligible dependent is a person who shares the same primary place of residence with you for more than six months each year and is: Your child under age 13 whom you can claim as a dependent on your federal income tax return; Your spouse who is mentally or physically disabled; or Your dependent who is mentally or physically disabled and whom you can claim on your federal income tax return. In most cases, your life partner and children of your domestic partner are not considered eligible dependents for purposes of your Dependent Care FSA. More
Reimbursements To be reimbursed, you must save your receipts and submit a claim for any eligible expenses. Reimbursements are generally paid through direct deposit or check by a third party administrator. You do not pay federal income, state income or Social Security taxes on FSA expenses. You can only be reimbursed from contributions you have made to your account. More
Life Insurance All benefits eligible employees receive Basic Life Insurance. You also have the option to purchase additional coverage for yourself and your eligible dependents. Basic Life Insurance Basic Life Insurance is fully paid by The Claremont Colleges. Coverage is automatic you don t have to enroll in it. However, you do need to select a beneficiary. The beneficiary or beneficiaries receive your benefit amount in the event of your death. The amount of the benefit is equal to one times your basic annual earnings (rounded to the next $1,000). The minimum coverage amount is $20,000, and the maximum coverage amount is $50,000. Keep in mind Conversion options are available should Supplemental Life Insurance you leave The Claremont Colleges. You may choose to purchase additional insurance coverage for yourself through Anthem Blue Cross on a post-tax basis. This coverage would be in addition to the basic benefit provided by the Company. You can also purchase supplemental coverage for your eligible dependents, subject to Evidence of Insurability (see following page). Coverage for supplemental life insurance is available in the following amounts: Beginning on the first of the year following your 65th birthday, your life insurance coverage amount decreases. Your premiums will be based on the reduced coverage amount. Anthem Blue Cross pays a percentage of your premium amount as follows: Age 65 to 70 = 65% Age 70 to 75 = 50% Age 75+ = 30%. Conversion Privilege Eligible Member Coverage Amount Employee 1 4 times your basic annual earnings (rounded to the nearest $1,000), to a maximum of $1,000,000 (combined with Basic Life) Spouse $10,000 increments, to a maximum of $250,000 or 50% of your combined Basic and Supplemental Life Insurance coverage Child(ren) (birth 6 months) $100 Child(ren) (6 months and older) $5,000
Evidence of Insurability (EOI) When you purchase Supplemental Life Insurance for yourself, your spouse or your dependents, you may need to provide Evidence of Insurability (EOI). If you purchase Supplemental Employee Life Insurance, Spouse Life Insurance, or Child Life Insurance when you are first eligible (within 30 days of your hire date), you do not need to provide Evidence of Insurability (EOI) unless you purchase coverage above a certain amount: For yourself: Amounts above two times your annual earnings or $355,000 For your spouse: Amounts above $20,000 After this 30-day period, you will be required to provide EOI if you choose to enroll in or increase your coverage amount at any time throughout the year. An EOI form is available on the and page.
Long-Term Disability Coverage You are automatically enrolled for Long-Term Disability Insurance on your first day of employment if you work 30 hours our more per week. After you have been disabled for 180 days, you may apply for long-term disability coverage which could pay 66⅔% of your covered monthly salary, up to a maximum benefit of $15,000 per month. Did you know? The long-term disability premium is 100% paid for by The Claremont Colleges. RSABG employees pay 50% of the cost of LTD coverage, and coverage is voluntary for these employees.
Accidental Death & Dismemberment Plan The Claremont Colleges also offers employees voluntary coverage to protect you and your family in the event of an accident-related death or dismemberment. You can choose individual or family coverage (according to IRS regulations). You pay the full cost for this coverage. At age 70, for you and your insured dependents, the principal sum will be reduced based on your previous principal sum according to the following schedule: Age at Date of Loss Loss Percent of Principal Sum 70 74 65% 75 79 45% 80 84 30% 85 & Over 15% Conversion Privilege Conversion options are available should you leave The Claremont Colleges. Coverage for Accidental Death & Dismemberment is available in the following amounts: Type of Coverage Coverage Amount Employee $25,000 increments, up to $500,000, but not exceeding 10x your annual salary if the selection is over $250,000 Spouse Insured employee s coverage amount (principal sum) Children $50,000 More
Long Term Care Insurance The Claremont Colleges sponsors a Group Long Term Care Insurance Plan for active employees and their eligible family members. Genworth is the administrator of the Group Long Term Care Insurance Plan. Long term care insurance provides enrollees with access to personal assistance from care coordinators who are knowledgeable in the field of long term care. In addition to conventional nursing home coverage, the policy covers services received in your own home; other types of care facilities may be covered. More Information Go to www.genworth.com/ groupltc for more information about the long-term care coverage available through Genworth. You will have guaranteed acceptance into the plan regardless of your current health status if you are a newly-hired eligible employee or newly-eligible employee age 18 69, and you apply within 60 days of first becoming eligible for this benefit. Your age and the plan you select when you first enroll determine your monthly premium rate for the coverage. The younger you are when you become insured, the lower your cost will be. Active faculty and staff and their spouses or qualified domestic partners pay premiums through direct billing or automatic bank withdrawal.
for Health Benefits The Claremont Colleges offers benefits to full-time, part-time and temporary employees who meet eligibility requirements. You can also enroll your spouse or domestic partner and your eligible child(ren) for coverage. Full-time Faculty & Staff Part-time Faculty & Staff Temporary Employees You are eligible to participate in The Claremont Colleges benefits if you are a regular full-time employee scheduled to work at least 20 hours per week. You are eligible to participate in The Claremont Colleges benefits if you are a regular part-time employee scheduled to work at least 20 hours per week. Long-term disability coverage is not available for part-time employees. You are eligible to participate in The Claremont Colleges benefits (medical and dental only) if: You ve been hired for a limited period of time, normally not exceeding 12 consecutive months, You work at least 20 hours per week for a defined period of time that is greater than six consecutive months; and You met the six-consecutive-month minimum service requirement. Long-term disability coverage is not available for temporary employees. More
Eligible Dependents When you enroll, you can enroll your eligible dependents in the coverage for which you ve enrolled, including medical, dental and vision coverage, as well as supplemental life and accident insurance. Your eligible dependents include: Your spouse Your domestic partner Your children (including the children of your domestic partner) who are: Less than 26 years old Any age who are mentally or physically disabled and meet certain requirements. To enroll your dependents for coverage You will need: the dependent(s) name, relationship to employee, marriage/birth certification or other form of documentation proving life event, dependent Social Security number and date of birth. Domestic Partner Coverage The IRS does not recognize domestic partners as legal dependents for purposes of tax reporting. For this reason, The Claremont Colleges must report the value (employer subsidy) of medical and dental benefits. Employee contributions for domestic partner benefits are made after tax. For California-registered domestic partners or married domestic partners, deductions are made on a pre-tax basis for state withholding. The employer contributions of health and/or dental benefits must be included in the employee s taxable income for federal and state withholding for any state other than California for registered and married domestic partners.
How to Enroll When to Enroll Once you ve taken the time to review the benefits that are available to you in the section of this guide, it s time to enroll! This section will help you log on to the online enrollment system and provides information about when you can enroll both when you are first eligible and when you have a qualified life event during the year. How to Enroll For Faculty and staff of CUC, CMC, HMC, Scripps, and Pitzer To enroll for new coverage or make changes to your current benefits coverage, follow these steps to complete the online enrollment process: 1. Log on to Ultipro using the link through your school s website 2. Enter your login information If you need your login information, contact Human Resources 3. Once logged on, click Myself and then Open Enrollment You can also view the Quick Tour video for instructions on how to make their elections. 4. Follow the instructions that appear on your screen to make changes, enroll or cancel your health benefit elections. Please be sure to click Finish to complete your enrollment or change. 5. You may request a Confirmation Statement confirming your elections for your records. Faculty and staff of KGI and CGU, see the next page. Please contact CUC Benefits Administration if you need assistance logging in to the Benefits Enrollment Website. See for CUC Benefits Administration.
How to Enroll How to Enroll When to Enroll FOR FACULTY AND STAFF OF CGU AND KGI: To make changes or elections for the 2014 plan year, follow the instructions below: 1. Log in to https://portal.adp.com. 2. Select User Login Input your User Name and Password. (If you do not have a user name and password, select First Time Users Register Here to obtain your user name and password. You will be asked to enter a registration code. Enter code cgu1-91711 (CGU) or cgukgi-91711 (KGI).) 3. Select the Benefits Tab and click Review/Change Benefits. All employees must update their KGI provided life insurance beneficiary located in the Benefits Tab, Review/Change Beneficiaries 4. At the Welcome page, you will be guided through the Open Enrollment portal where you can change existing coverage and/or elect coverage for you and your dependents. 5. Once you ve completed your enrollment, you will be able to print a benefit summary of your 2014 elections and coverage for your records. CONTACT INFORMATION: CGU: Sarah Verrill at sarah.verrill@cgu.edu KGI: Cheryl Merritt at cheryl_merritt@kgi.edu or (909) 607-7853 Sarah Verrill at sarah.verrill@cgu.edu or (909) 607-8828
When to Enroll How to Enroll When to Enroll When You are First Eligible When you are first eligible for benefits coverage, you have 30 days from your hire date to enroll in health benefits. If you don t enroll during the first 30 days after your hire date, you will only be enrolled in coverage that s automatically provided to you (Core vision, Employee Assistance Program, basic life, long-term disability and the Academic Retirement Plan). When a Qualified Life Event Occurs After your initial eligibility enrollment period, you may change your benefits during Open Enrollment or when you experience a qualified life event. Qualified life events include: Marriage, divorce, or legal separation Birth or adoption A dependent that becomes ineligible for coverage Death of your spouse or one of your children Change in work status of your spouse/domestic partner Employee enrolls in Medicare Part B If you experience a qualified life event, you may change your coverage within 30 days of the event. Necessary documentation will be required. When Coverage Begins Benefits elected when you are first eligible will be effective on the 1st of the month following hire or, if you are hired on the 1st of the month, benefits will be effective immediately.
The charts below list the amounts that you will pay per month for your benefit coverage from January 1 through December 31, 2014. All benefit premium deductions for health, dental, vision, health savings account (HSA) and flexible spending accounts (FSA) coverage are taken on a pre-tax basis unless otherwise requested. If you are a new hire joining The Claremont Colleges after January 1, or if you are leaving the Colleges mid-year, your deductions for benefits coverage may be adjusted accordingly. (See Joining (or Leaving) Mid-Year? for more information.) At no cost to you... The Claremont Colleges pays 100% of the cost of coverage for: Core vision coverage (employee only) Basic Life Insurance Long-term disability Employee Assistance Program (EAP). Monthly Employee Rates Medical Plans Kaiser HMO Anthem Blue Cross HMO Anthem Lumenos HSA (CaliforniaCare) Employee Only $44.00 $46.07 $42.08 Two Party $184.81 $193.47 $176.71 Family $396.02 $414.20 $378.35 Monthly Employee Rates Dental Plans* MetLife DHMO MetLife DPPO Employee Only $5.27 $53.49 Two Party $17.54 $120.02 Family $28.58 $180.50 More Rates * Rancho Santa Ana Botanic Garden (RSABG) is not participating in the employer subsidy for MetLife and therefore all dental premiums shown on the above chart will be increased by $7.00 for RSABG employees.
Monthly Employee Rates Vision Plans Anthem Core Plan Anthem Buy-Up Plan Employee Only $0.00 $4.48 Two Party $1.36 $7.57 Family $3.05 $12.53 Monthly Employee Rates Supplemental Life Insurance Rates for employees and spouses/domestic partners are based on the employee s age. Anthem Supplemental and Spouse/Domestic Partner Life Insurance Age Monthly Rate (per $1,000 of coverage) Age Monthly Rate (per $1,000 of coverage) Under 30 $0.05 50-54 $0.40 30 34 $0.06 55-59 $0.62 35 39 $0.08 60-64 $0.97 40 44 $0.14 65-69 $1.74 45 49 $0.24 70 + $3.11 Dependent Child(ren) Life Insurance: $0.50 per $5,000 of coverage, per family (regardless of the number of children covered) More Rates
Employee Rates Accidental Death & Dismemberment (AD&D) Insurance Plan Principal Sum 1,2 Employee-Only Family Coverage Coverage $25,000 $0.50 $0.98 $50,000 $1.00 $1.95 $75,000 $1.50 $2.93 $100,000 $2.00 $3.90 $125,000 $2.50 $4.88 $150,000 $3.00 $5.85 $175,000 $3.50 $6.83 $200,000 $4.00 $7.80 $225,000 $4.50 $8.78 $250,000 $5.00 $9.75 Principal Sum 1,2 Employee-Only Family Coverage Coverage $275,000 $5.50 $10.73 $300,000 $6.00 $11.70 $325,000 $6.50 $12.63 $350,000 $7.00 $13.65 $375,000 $7.50 $14.63 $400,000 $8.00 $15.60 $425,000 $8.50 $16.58 $450,000 $9.00 $17.55 $475,000 $9.50 $18.53 $500,000 $10.00 $19.50 1 Coverage amounts in excess of $250,000 may not exceed ten times annual base salary. 2 Principal sum amount cannot be increased after age 70.
Joining (or Leaving) Mid-Year? If you are a new hire, joining The Claremont Colleges after January 1, or if you are leaving the Colleges mid-year, your deductions for benefits coverage may be adjusted accordingly. If You Are a New Hire When you join The Claremont Colleges mid-year, you become benefit eligible on the first day of the month following your date of hire. If you elect to enroll in benefits, you may need to pay contributions for this coverage, which will be deducted from your paychecks. Because the colleges distribute paychecks on a bi-weekly basis, the number of pay periods for the remainder of the year may not be enough to cover the total contribution amounts that you owe for the benefits you elected. Therefore, initial paychecks you receive may be adjusted for any additional contribution amount you owe. If this situation affects you, you will be contacted by Benefits Administration to determine the amount still owed and how the payment will be made. If You Are Leaving The Claremont Colleges When you leave The Claremont Colleges, your existing benefits coverage will continue through the end of the month in which you leave. You will be responsible for any employee contributions for that full month of coverage. If your last day of work occurs before the end of the month, the full premiums for your last month of benefits coverage will be deducted from the final paycheck you receive. If you have any questions, please contact The Claremont Colleges Benefits Administration.
The Claremont Colleges recognizes that wellness is an important component of helping you create and maintain a healthy lifestyle. The wellness programs offered by Anthem Blue Cross HMO (CaliforniaCare)/Anthem Lumenos and Kaiser Permanente provide tools and information that can help you make important Start Today! To access these helpful tools visit www.anthem.com/ca to get started healthy lifestyle choices. These programs enhance your core benefits by offering savings on alternative health and wellness products and services. All employees are eligible to participate in the wellness programs offered by their respective health plans. Whether you are looking for help to quit smoking, creating an exercise plan, or need some nutritional guidance, these programs offer you the tools to help you get there. Anthem Blue Cross HMO (CaliforniaCare) and Anthem Lumenos HSA Members Anthem Blue Cross and Anthem Lumenos offer a variety of programs to guide members through the process of creating a healthy lifestyle. Some of the programs available to members are: 24/7 NurseLine: This 24-hour help line, staffed with registered nurses, helps members with many of their medical needs 360 Health: Offers an online library of health-related information and tools to help members with anything from managing a condition to organizing health records Future Moms: Includes educational programs for eligible pregnant members to improve understanding of pregnancy and delivery HealthyExtensions: Provides special offers and discounts on health products and services to relieve stress and pain or to help improve fitness and nutrition MemberAccess: Offers tools to help locate in-network doctors, view benefits and print temporary ID cards.