The 2014 Employee Benefits Guide has been designed to help you select the benefit plans that are right for you and your family. Please review all the benefits information that you have been given. These materials are designed to help you weigh the costs and benefits of each plan and to help you choose the coverage that is right for you and your family.
What’s New for 2014
3
Eligibility & Enrollment
4
Medical
5, 6
Medical Plan Comparison
6
HSA
7
Dental
8
Vision
9
Flexible Spending Accounts (Health / Dependent Care)
10
Wellness
11
Employee Assistance Program
12
Short and Long Term Disability
13
Basic Life & AD&D
14
Voluntary Life & AD&D
14
Legal Updates
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Carrier Contact
15
Summary of 2014 Health Insurance Rates
16
Next Steps
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Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum
To contact Covered California: https://www.coveredca.com/
Or call (800) 300-1506
Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum
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Full-time faculty and staff are able to enroll in benefits. You become eligible for coverage on the first day of the month following your hire date. You may also enroll your eligible dependents in the Medical, Dental, Vision, and Voluntary Life and AD&D insurance plans. Your eligible dependents include: • Spouse – any gender • Domestic Partner* (an opposite sex partner when you or your partner is at least age 62; a same-sex domestic partner) • Unmarried dependent children up to age 26 (including stepchildren, adopted children, and your domestic partner’s children) • Disabled children who have reached the maximum age and who are (or become) physically or mentally incapable of self-support (medical certification required); • Any child for whom you are required to provide coverage under a Qualified Medical Child Support Order
Medical Plans
You pay $75 of the employee only premium for the Kaiser or Anthem Premier HMO, and $50 for the employee only premium for the Anthem Classic HMO or Lumenos Plan.
Dental Plan
Otis College will pay 100% of the employee only premium for the Aetna Dental Plan
Vision Plan
Otis College will pay 100% of the employee only premium for the VSP Plan
Basic Life & AD&D, LTD, STD
Otis College pays 100%
Voluntary Plans (Dep. Life and AD&D)
You pay 100% through payroll deductions
Employee Assistance Program
Otis College pays 100%
*You may enroll your domestic partner in the following programs: medical, dental, vision, and supplemental insurance. You may also enroll your domestic partner’s child(ren) who meet the IRS definition of dependent child(ren) and are eligible to participate in the benefits programs. The Internal Revenue Code requires that any portion of domestic partner dependent premium cost funded by Otis College of Art and Design be included in the employee’s gross income for Federal income taxes and FICA employment taxes. In addition, any portion of domestic partner premium cost funded by the employee must be paid for with post-tax dollars (not pre-tax through the Section 125 plan). Please speak with your tax and legal advisors to insure that you understand all the tax implications.
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As a benefits eligible employee, you may choose between four medical plan options: Kaiser HMO Plan, Anthem Premier and Classic HMO Plans, and Anthem Lumenos Plan.
You can save time and money when you order your prescription drugs by mail. Ordering prescription refills is a safe, convenient way to obtain medications you take on a daily basis for a long period of time because you get a 90-day supply of medication for less money. This feature is already covered under the health plans offered by Otis and is available at no additional cost to you, including standard shipping. For Anthem members, you may order refills by mail, phone, or at www.anthem.com/ca. for Kaiser members, you can call the phone number on your prescription label or visit www.kp.org/myhealthmanager and click on “Pharmacy Center”.
Anthem Blue Cross pharmacy program puts all prescriptions into four categories, Tiers 1 – 4 and they fall into each category depending on how costly they are. Here is the breakdown: • Tier 1 drugs have the lowest copayment because they offer the greatest value compared to others that treat the same conditions. Some of these are generic versions of Brand-name drugs. • Tier 2 drugs have a medium copayment because they are considered “preferred” among other drugs that treat the same conditions. Drugs in this tier are Brand-name drugs that are generally more affordable. • Tier 3 drugs have the highest copayment because they are higher costing Brand-name drugs. Many of these drugs may have generic versions covered in Tier 1. • Tier 4 drugs are considered “specialty” drugs because they are typically used to treat complex, chronic conditions and may require special handling and/or management.
A Health Maintenance Organization (HMO) is a network of doctors and health care facilities that closely manage your medical care to control your out-of-pocket costs. There are no deductibles to pay or claim forms to fill out on an HMO plan. If you enroll in one of the HMO plans, you (and each of your enrolled dependents) must choose a Primary Care Physician (PCP). Whenever you have a medical need, your PCP should be contacted, including emergencies, as quickly as possible. Specialist care is also available when authorized in advance through your PCP or physician group. You do not have to choose the same physician group or PCP for all members of your family. If you are hospitalized, your PCP will assist you in the entire process. In the event of an emergency, you must contact your PCP for the proper procedure for treatment.
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This chart shows how the plans work and how each type of service is covered. For more detailed information, please refer to the official benefit summaries. Please note that Anthem has a 4-Tier Prescription Drug Plan. Please refer to official drug list, review which drugs you are filling, and locate the tier they are listed under. If you enroll in the Kaiser HMO Plan, you must visit Kaiser facilities for medical care and see only Kaiser doctors.
MEDICAL HMO PLAN HIGHLIGHTS | This chart compares the main feature of your HMO health plan options. EMPLOYEE Cost
ANTHEM PREMIER HMO
ANTHEM CLASSIC HMO
KAISER PERMANENTE
$75 $454.30 $643.92 $850.18
$50 $359.34 $514.00 $682.22
$75 $381.24 $534.34 $706.60
$1,500 ind. / $3,000 family
$2,000 ind. / $4,000 family
$1,500 ind. / $3,000 family
Office visit
$15 copay
$40 copay
$15 copay
Preventive services
No copay
No copay
No copay
Emergency services
$100 copay (waived if admitted)
$100 copay (waived if admitted)
$100 copay (waived if admitted)
$100 per day (3-day max)
$500 copay
$100 per day (3-day max)
$15 copay (100 visits/calendar year)
$40 copay (100 visits/calendar year)
No copay
Outpatient services
No copay
No copay
$15 copay
Acupuncture
$15 copay
$40 copay
Not covered
$15 copay (ltd to 60-day period)
$40 copay (ltd to 60-day period)
Not covered
No copay
No copay
No copay
No copay $15 ccopay
No copay $40 ccopay
No copay $15 copay
30-day supply
30-day supply
30-day supply
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family Annual out-of-pocket maximum
Hospitalization Home health care
Chiropractic care (when ordered by a PCP) X-Ray and laboratory services Mental health & substance abuse -inpatient visit -outpatient visit Prescription drugs
Tier 1 Tier 2 Tier 3 Tier 4
$10 $25 $45 20%
Tier 1 Tier 2 Tier 3 Tier 4
$20 $40 $60 20%
Generic Brand-name
$10 copay $20 copay
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This chart shows how the LUMENOS HSA PPO plan works. Essentially, it is a PPO plan with a high deductible. You must satisfy the deductible prior to any plan benefits except for preventive care. In addition to the PPO benefits, the plan includes a Health Savings Account. The HSA bank account allows you to put pre-tax dollars to save for a rainy day when you may need to pay your deductible for you and/or your family. All pre-tax dollars saved in your HSA bank account are vested and are yours to use for life for qualified health expenses. Otis College will contribute $500 for each employee and $1,000 for each family to your HSA plan in 2014. For 2014, an individual’s maximum pre-tax contributions to an HSA is $3,300 and $6,550 for family. MEDICAL ANTHEM LUMENOS HSA PLAN HIGHLIGHTS EMPLOYEE Cost Employee Only Employee + Spouse Employee + Child(ren) Employee + Famly
$50 $391.50 $562.26 $946.44 In-Network
Annual Deductible Individual Family Annual out-of-pocket maximum Individual Family
Out-of-Network $1,250 $2,500
$2,500 $5,000
$5,000 $10,000
10%
30%
Preventive services
No copay
Not covered
Emergency services
10%
10%
Hospitalization
10%
30%
Outpatient services
10%
30% ($350 / day max benefit)
Acupuncture
10% ($30 / 12 visit max benefit)
30% ($30 / visit max benefit)
Chiropractic
10%
30% ($25 / visit max benefit)
X-Ray and laboratory services
10%
30% ($800 max benefit for imaging)
Mental health & substance abuse -inpatient visit -outpatient visit
10% 10%
30% 30%
Office visit
Prescription drugs Generic Brand-name Brand Non-formulary Specialty drugs
30-day supply $15 copay $30 copay $50 copay 30% of max allowed amount
Not covered
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Justin is a healthy 28-year old single man who is active in sports and goes to the gym three times a week. He contributes $1,000 each year to his Health Savings Account (HSA). His plan’s annual deductible is $1,250 for individual coverage. If Justin uses his HSA to pay for covered services, this will reduce his out-of-pocket amount needed to meet his deductible before traditional health coverage begins. Here is a look at the first two years of Justin’s HSA plan, assuming the use of in-network providers.
YEAR 1 HSA - $1,000 contribution
$1,000
Total Expenses: Prescription drugs - $150 Routine Physical / Lab tests - $350
$500
Amount paid by preventive care benefit – not deducted from HSA
$350
Amount paid from HSA
$150
HSA Rollover to Year 2
$850
Since Justin did not spend all of his HSA dollars, he did not need to pay any additional amounts out-of-pocket this year.
YEAR 2 HSA Balance: $850 from Year 1, plus $1,000 contribution for Year 2
$1,850
Total Expenses: Office visits - $100 Blood work - $150 Prescription drugs - $200
$450
Paid by preventive care benefit – not deducted from HSA
$150
Amount paid from HSA
$300
HSA Rollover to Year 3
$1,550
Once again, since Justin did not spend all of his HSA dollars, he did not need to pay any additional amounts out-of-pocket this year.
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This chart shows how the dental plan works and how each type of service is covered. For more detailed information, please refer to the official benefit summary.
DENTAL PLAN HIGHLIGHTS EMPLOYEE COST USING YOUR BENEFITS WISELY • To pay the least amount out-of-
DMO
PPO NETWORK & NON-NETWORK
$0 $50.58 $52.88 $103.12
$0 $50.58 $52.88 $103.12
Deductible – applies to basic and major services only
None
$50 individual $150 family
Preventive services Exams, cleanings, x-rays
100%
100%
Basic services – Fillings, simple extractions
100%
80%
Major services – Oral surgery, root canal, crowns
60%
50%
Annual benefit maximum
None
$2,000
Office visit copay
None
N/A
Orthodontic Deductible Lifetime maximum
50% None None
50% $50 $1,500
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
pocket, always use in-network dentists. • Use your preventive benefits and get cleanings for you and your family twice a year. • If your services are estimated to be $350 or more by your dentist, be sure to have your dentist get predetermination of benefits through Aetna to ensure services are covered and to get an estimate of what the plan will pay.
The coverage reflected online at Otis is what you initially elected. Please call Aetna if you are uncertain about which plan you are currently enrolled in. If you do switch plans, please request a new ID card from Aetna at 877-238-6200.
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Vision Service Plan (VSP) provides coverage for yearly eye examinations and provides an allowance for contacts or frames each year. The plan features network (VSP Signature) and non-network option allowing you to see any vision provider you wish. A new feature of the VSP network is the inclusion of COSTCO vision centers. Using COSTCO retail locations can add additional convenience for you and your family.
ADDITIONAL BENEFIT: If you are enrolled in Aetna’s Dental Plan, you can receive Aetna Vision Discounts for a savings of 5% to 40% off the retail price of eye exams at participating providers. Please visit www.aetna.com
If you utilize the services of a network provider listed in VSP’s Signature Network, your benefits include routine vision exams for a $25 copay, and preferred pricing on a large selection of brand-name, designer frames, lenses, and lens options. If you see a non-VSP provider, you will receive an allocated reimbursement as listed in the summary below. For more detailed information, please refer to the official benefit summary. To find a network contracted provider, please visit www.vsp.com/eyedoctor.html. The chart below shows how the vision plan works and how each type of service is covered. For more detailed information, please refer to the official benefit summary.
or call (800) 793-8616 for a list of
VISION PLAN HIGHLIGHTS
participating providers.
EMPLOYEE MONTHLY COST
VSP
Employee only
No cost
Employee + one
$5.12
Family
$13.52
VSP Choice – Plan B Frequency of benefits Exam Lenses (contacts included) Frames
Network
Once every 12 months Once every 12 months Once every 24 months
Deductible Exam Lenses Single Bifocal Trifocal Frame Additional pairs Contacts
Non-Network
None $25 copay
Up to $50 reimbursement
Covered in full “ “
Up to $50 reimbursement Up to $75 reimbursement Up to $100 reimbursement
$130 frame allowance
Up to $70 reimbursement
30% discount
Not covered
Up to $130 allowances (can be used for Contacts or frames)
Up to $105 retail
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The Health FSA offered through Otis College is administered by TASC FlexSystem. When you enroll in a Health FSA, you elect the dollar amount you wish to contribute based on your estimated expenses for the upcoming year. The funds will be deducted pre-tax in equal amounts from each paycheck throughout the plan year. For your convenience, Otis has provided you with a TASC Card to purchase eligible medical expenses with your FSA funds at the point of purchase. Use it just like a debit card, but make sure to keep a copy of all receipts for your records. In the event you lose or misplace your card, simply submit a request for reimbursement to TASC. PLACEHOLDER FOR TEXT Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard
For the Dependent Care FSA or if you do not have your TASC card, simply submit a request for reimbursement to TASC. FlexSystem offers multiple methods for requesting a reimbursement: Online, Text Message, Mobile App, Fax, or mail. You may use any of the following self-service options to access your FlexSystem accounts and TASC card transactions:
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• MyTASC text messaging: elect through your MyTASC account online
typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets
EXAMPLE HEALTHCARE FSA ESTIMATE WORKSHEET ANTICIPATED ANNUAL EXPENSES FOR YOU AND YOUR DEPENDENTS
containing Lorem Ipsum passages, and
ESTIMATED AMOUNT
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Coinsurance, co-payments and deductibles
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Dental expenses (crowns, root canals, routine examinations, etc.)
$
Monthly orthodontia expense (see restrictions in the above section)
$
Prescription drug expenses
$
Eyeglasses, contact lenses, solution, etc.
$
Chiropractic and massage therapy expenses
$
Over-the-counter meds (must be prescription)
$
Annual Total (cannot exceed $2,500)
$
Divide by 12 (except for new hires) for monthly amount
$
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As a benefits eligible employee, you are provided with the Employee Assistance Program (EAP) at no cost to you. The EAP is a confidential counseling and referral service that can help you and your dependents deal with life’s challenges.
• 3 face-to-face sessions per issue at an office convenient to your home or work; there is no limit to the number of issues. All calls and counseling FOR 24-HOUR EAP HELP, CALL
sessions are confidential, except as specified by law (such as when a
TOLL-FREE:
person’s emotional condition is a threat to him or herself or others, or if
(888) 238-6232
there is child or elder abuse).
or visit: www.aetnaeap.com and enter company ID: EAP4OTIS
• Easy access to services and crisis counseling 24 hours a day, 7 days a week, via a toll-free telephone number and website (please see sidebar for login information). • Accessibility to employees and anyone in the household. Employee assistance professionals will listen to your concerns with an open mind and help you identify the cause of your problem. They will work with you and the EAP’s network of specialized providers to develop a practical solution as quickly as possible.
• Work-related issues • Family problems • Marital and relationship issues • Alcohol and drug abuse, and co-dependency issues • Emotional problems • Physical concerns • Financial and legal issues
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Otis provides full-time employees with Short-Term and Long-Term Disability income benefits, and pays the full cost of this coverage. Short-Term Disability is intended to protect your income for a short duration of time in case you become ill or injured. You are not eligible to receive Short-Term Disability benefits if you are receiving Worker’s Compensation benefits. In the event you continue to be disabled after six (6) months, Long-Term Disability PLACEHOLDER FOR TEXT
income benefits are provided as a source of income.
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SHORT-TERM DISABILITY Benefits begin
15th day for an accident 15th day for an illness
Maximum weekly benefit
60% of weekly salary up to $1,000 per week
Maximum benefit duration
24 weeks
Benefit reductions may occur
If you are receiving benefits from any compulsory benefit, act, or law such as a state disability plan; If you are receiving sick leave pay from your employers
book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum
LONG-TERM DISABILITY Benefits begin
After180 days of being disabled
Maximum monthly benefit
60% of salary up to $6,000 per week
Maximum benefit duration
Later of age 65 or Social Security Normal Retirement Age
Benefit limitations
Mental illness: 24 months Substance abuse: 24 months Specified illness: no limit
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Otis College of Art and Design provides full-time employees with group Life and Accidental Death and Dismemberment (AD&D) insurance in the amount of 1 times your basic annual earnings at a maximum of $50,000, and pays the full cost of this benefit. Please contact Human Resources to update your beneficiary information.
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• Benefit Reduction: 35% at age 70; an additional 15% of the original
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Employees who want to enhance the group life insurance benefits provided by Otis may purchase additional coverage. When you enroll yourself and/or your dependents in this benefit, you pay the full cost through payroll deductions. The minimum amount of coverage you can purchase for yourself is $10,000 and the maximum is $500,000 with Guarantee Issue of $200,000 or 300% of your salary if you purchase when first eligible (under age 70). The minimum you can purchase for your spouse is $5,000 and the maximum is $500,000, with Guarantee Issue of $30,000 (under age 60). Your spouse may not elect more than 100% of the employee elected amount. Evidence of Insurability (EOI) may be required for applicants who did not purchase when first eligible. Please be aware that if you do not apply for this option when you are first eligible, you will need to wait until Open Enrollment to apply and will be considered a Late Entrant. You will need to complete an EOI Form and the total amount of insurance you apply for will be subject to medical underwriting. You will be notified of either approval or disapproval of the coverage amount for which you applied. Until you have been notified, you do not have the additional coverage. Please see the benefit summaries for the premium amounts.
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PLACEHOLDER FOR TEXT
BENEFIT
GROUP ID
PHONE / WEBSITE
Kaiser Permanente
111784
(800) 464-4000 www.kaiserpermanente.org
Anthem
275328
(877) 811-3107 www.anthem.com
Aetna Dental
879962
(877) 238-6200 www.aetna.com
VSP
00114144
(800) 877-7195 www.vsp.com
TASC
4601-64679863
(800) 422-4661 www.tasconline.com
-
(888) 238-6232 www.aetnaeap.com
Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and
UNUM Aetna Resources for Living EAP
more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum
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Page to be updated with Gallagher’s support center information
MEDICAL
ANTHEM PREMIER HMO
EMPLOYEE MONTHLY COST
Employee Employee + Spouse Employee + Child(ren) Employee + Family MEDICAL
ANTHEM CLASSIC HMO Employee Employee + Spouse Employee + Child(ren) Employee + Family
MEDICAL
Employee Employee + Spouse Employee + Child(ren) Employee + Family
All health insurance deductions are made before taxes except for domestic partners.
ANTHEM LUMENOS
MEDICAL
KAISER Employee Employee + Spouse Employee + Child(ren) Employee + Family
DENTAL
AETNA DENTAL Employee Employee + Spouse Employee + Child(ren) Employee + Family
VISION
VSP VISION Employee only Employee + 1 Dependent Employee + Family
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