EDMC OE 2013 Guide_Layout 1

Transcription

Educated Choices
EDMC OE 2013 Guide_Layout 1 10/5/12 9:30 AM Page 1
2013 Benefit Enrollment Guide
Make educated choices for your health,
wealth and wellness.
Educated Choices
for your health, wealth and wellness
In This Guide:
Educated Choices… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Get Ready to Enroll. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Your 2013 Choices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Benefit Costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Waiving Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Eligibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Enrollment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
When Participation Ends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Your Health… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Medical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Prescription Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Dental. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Your Wealth… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Life Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Disability Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Flexible Spending Accounts (FSAs). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
The Retirement Plan – 401(k). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Commuter Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
More Benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Your Wellness… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Employee Assistance Program (EAP). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Wellness Programs from ActiveHealth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Wellness Incentive Program – Healthy Rewards Pricing. . . . . . . . . . . . . . . . . . . . . . . . . . 33
Important Notices for Participants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Patient Protection and Affordable Care Act. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Notice of Privacy Practices for Protected Health Information. . . . . . . . . . . . . . . . . . . . . .34
Notice of Women’s Health and Cancer Rights Act of 1998. . . . . . . . . . . . . . . . . . . . . . 36
Important Notice of Creditable Coverage and Information
About Your Prescription Drug Coverage and Medicare. . . . . . . . . . . . . . . . . . . . . . . . . . 36
Medicaid and the Children’s Health Insurance Program (CHIP) Notice. . . . . . . . . . . . . 37
Questions? Contact HR One Connect at 1.888.471.3362 (1.888.HR1.EDMC).
Educated Choices
Your Educated Choices program offers you health, wealth and wellness benefits in one total package.
You receive:
• Engaging health benefits that help you control costs
• Financial benefits that offer peace of mind
• Wellness programs to help you focus on what’s truly important — living life to the fullest
Many of the Educated Choices products, programs and services work together, giving you and your family well-rounded
protection for your mind, body and wallet.
Here are just a few ways your health, wealth and wellness benefits can work together:
• Take advantage of wellness programs and preventive care coverage to help you realize your best health potential.
• Have a nurse case manager, who knows both your health and prescription drug plans, help you manage your chronic condition(s).
• Enroll in a flexible spending account (FSA) to save on taxes, then use that money to cover eligible out-of-pocket medical costs.
• Participate in the wellness program to earn an incentive that reduces your health plan premium.
Get Ready to Enroll
1.
Understand how your benefits work. Understanding your
options is key to selecting benefits that best fit your needs,
so please take time to review this guide. You can also find
helpful information and educational tools on the HR One
Connect Employee Resource website (https://ess.edmc.edu).
2.
Compare your benefit options using the Health Plan
Educator tool. This fun and interactive tool can be found on
Employee Resource. After answering a few questions about
yourself, your guide “David” will explain the plans and assist
you in choosing the medical plan which best meets your needs.
4.
Look at other benefits that can give you and your family
added protection. EDMC provides basic life and accidental
death and dismemberment insurance as well as short-term
disability coverage. To give you and your family added
protection, you may be able to buy additional life insurance
for yourself and your dependents, and long-term disability
coverage. See pages 21 through 26 for more information.
5.
Enroll Online. Visit Employee Resource (https://ess.edmc.edu)
to make your educated benefit choices.
3.
Consider ways to lower your out-of-pocket costs.
• Flexible Spending Accounts (FSAs). FSAs are a great way to
put aside money — free of federal and most state and local
taxes — to pay for expenses that may not be covered by your
plans (see page 27 for more details).
• The EDMC Wellness Program. You can qualify for reduced
medical plan premiums when you participate in programs and
take actions that promote a healthy lifestyle. More information
about the program is available on page 32.
1
Your 2013 Choices
To help you get started reviewing your benefit choices, here are all your options at a glance. You can find detailed information
about each option in the applicable sections of this guide or online on Employee Resource.
Benefit Programs
Options
Medical and
650 Deductible Plan
Prescription Drug 450 Deductible Plan
250 Deductible Plan
Who’s Eligible
Who Pays the Cost
You and
EDMC
Share in
the Cost
You Pay
the Full
Cost at
Discounted
Group Rates
Deductions
Full Time
Grandfathered
Part Time*
EDMC
Pays the
Full Cost
Before
Taxes
X
X
X
X
Dental
Basic Plan
Premium Plan
X
X
X
X
Vision
Premium Plan
X
X
X
X
X
X
Basic Life/AD&D 2 times annual salary
(maximum of $500,000)**
for full-time employees
X
After
Taxes
N/A
$25,000 for part-time*
employees
Additional
Life/AD&D
1-3 times annual salary
(maximum of $500,000)**
X
X
X
Dependent
Spouse Life
$10,000 - $100,000 of
coverage, in increments of
$10,000
X
X
X
Dependent
Child Life
$500 from age 14 days
to 6 months
X
X
X
$5,000 from 6 months
to age 26
Short-Term
Disability (STD)
Coverage ranging from
50% - 80% of your base salary
X
Long-Term
Disability (LTD)
Coverage available for:
50% of annual salary
662⁄3% of annual salary
X
X
X
Flexible Spending Health Care
Accounts (FSAs) Dependent Care
X
X
Employee
Assistance
Program
X
X
X
X
X
X
Available to employees
and their household
members
Retirement Plan 401(k) Plan
The Company matches
your contributions at 100%
up to 6% of annual salary
on a per-pay basis
Commuter
Program
*
Allows pre-tax payroll
deductions to pay your
commuter expenses
N/A
X
X
X
X
X
N/A
X
X
X
Part-time employees with hire dates prior to December 1, 2011 will retain benefits eligibility in a grandfathered status through December 31, 2013.
Part-time employees hired on or after December 1, 2011 are eligible for the Employee Assistance Program and the 401(k) plan only.
** Rounded to the next highest thousand.
*** To be added during 2013.
2
X***
Benefit Costs
If you choose to enroll in benefits, you and EDMC share in
some of the costs (see previous page). Your actual premium
rates can be found on Employee Resource.
Making your premium payments
You pay your premiums through convenient payroll deductions,
beginning with the first pay date after benefits begin.
For example, if your benefits begin January 1, your
first premium will be deducted from the first pay date
in January.
Waiving Coverage
Full-time employees who choose to waive
participation in the medical plan will receive a
waive credit as additional, taxable income in each
paycheck. In order to be eligible to receive the
waive credit, you must make an election to waive
participation during enrollment. Part-time*
employees are not eligible for the waive credit.
* Part-time employees with hire dates prior to
December 1, 2011 will retain benefits eligibility in a
grandfathered status through December 31, 2013.
Part-time employees hired on or after December 1, 2011
are eligible for the employee assistance program and
the 401(k) plan only.
3
Eligibility
Understanding who qualifies for benefits is an important part
of ensuring your coverage and that of your family.
New full-time employees are eligible to participate in most
benefits on the first day of the month following or coinciding
with 30 calendar days of employment. For example, if your
date of hire is June 12, your benefits would start on August 1.
Employees who transfer from a non-full-time position to a
full-time position may participate on the first day of the month
after the date of transfer. For example, if you transfer to a
full-time position June 15, your benefits become effective
on July 1. If you transfer to a full-time position on the first
of the month, your benefits become effective the first of the
following month. For example, if you transfer to a full-time
position June 1, your benefits become effective on July 1.
Who can enroll?
• You.
• Your legal spouse.
• Your domestic partner (see next page).
• Your or your domestic partner’s* child(ren) under
age 26. Dependents remain eligible to age 26
as long as they are not eligible for another
employer-sponsored health plan.
• Your or your domestic partner’s* unmarried,
dependent child(ren) ages 26 and above,
if disabled upon attainment of age 26.
* Please note: You can enroll your domestic partner’s child(ren) only
if you are enrolling your domestic partner.
Dependent eligibility verification
Enrolled dependents are subject to verification. You will
be asked to provide documentation to substantiate
that your dependent(s) meet the eligibility requirements
described above. If sufficient verification is not provided in
a timely manner, your dependent(s) will not be covered.
4
About domestic partner coverage
You can enroll your same-sex or opposite-sex domestic partner for medical, dental and vision coverage. To qualify, domestic
partners must be a “spousal equivalent,” meaning among other things, that you are in a long-term committed relationship and
share a primary residence and financial responsibility. As part of the dependent eligibility verification process, you will be required to
provide documentation, such as a Domestic Partner Affidavit form, to validate that your domestic partner is qualified.
You can find a Domestic Partner Affidavit form on Employee Resource. If you do not already have a notarized affidavit, you should
complete one at this time to submit when verification is requested.
Note: Under current regulations, domestic partners can only be enrolled if the employee is a new hire, or during the annual
Open Enrollment period. Domestic partners are not permitted to enroll outside of these two time frames and are not eligible
for qualifying life event changes.
If you elect domestic partner coverage, the cost for your partner’s benefit coverage will be deducted from your pay on an after-tax
basis, and you will be required to pay tax on the fair market value of a portion of the premium. This is called “imputed income.”
Have more than one plan?
When both you and your spouse have a health plan that covers
the same dependents, we must coordinate benefits with that
other health plan. You cannot file a claim for the same coverage
under both plans. Follow these guidelines:
• You: As an employee and subscriber of the plan, EDMC’s plan
is your primary carrier. Submit claims to our plan first. You may
then submit any unpaid expenses to your spouse’s plan. That
plan may or may not pay an additional amount.
• Your spouse: Your spouse should file claims under his/her
employer’s plan first. If the amount payable under our plan
is greater than what your spouse’s plan paid, you can then file
a claim for that difference under the EDMC plan.
• Your child(ren): If your child(ren) is/are covered under
both plans, payment of benefits depends on whether
your birthday or your spouse’s birthday occurs first in
the calendar year. For example, if your birthday is
before your spouse’s, submit your child(ren)’s bills
to our plan first, then to your spouse’s plan.
• Same employer? If you and your spouse or domestic
partner are both employed by EDMC, you may only
cover dependents under one plan.
5
Enrollment
Qualifying life events
When to enroll
New full-time employees: You have until your 30th calendar
day of employment to complete the enrollment process. If you
do not meet this 30-day deadline, you must wait until the next
annual Open Enrollment period. You will, however, be enrolled
in automatic benefits, including basic life/accidental death
and dismemberment, the employee assistance program (EAP)
and short-term disability.
Current employees: Open Enrollment is typically held in the
fall of each year for benefits effective January 1. If you do not
complete the enrollment process, you will automatically be
enrolled in the same plan(s) that you had the previous year, with
the exception of any flexible spending accounts (FSA). You must
complete the enrollment process each year to enroll in an FSA.
Verifying coverage: Verify that your expected premiums
are deducted from your first pay to be sure your elections took
effect. You have seven calendar days after the first impacted
pay date to notify us of any errors to your benefit elections.
If there are any errors, call HR One Connect at 1-888-471-3362
(1-888-HR1-EDMC) right away so we can make necessary
corrections. Your next opportunity to correct any errors will
be during the following annual Open Enrollment period.
How to enroll
1. Visit Employee Resource to access benefits information.
2. Be sure to update dependent and beneficiary information
before making benefit elections.
3.
Click through the enrollment screens to make elections
or changes.
4. Click “Finalize Your Elections” to submit your elections.
5. Print a copy of your confirmation statement for
your records.
Evidence of Insurability (EOI)
During enrollment, you may need to complete and
submit an EOI form. This form can be downloaded
from Employee Resource (see page 22).
6
Each year — during Open Enrollment — you have an
opportunity to select your benefits for the upcoming year.
Since your personal situation may change, this ensures that
you can always choose the right benefit coverage each year.
The choices you make will be effective from January 1 through
December 31. IRS regulations require that you cannot change
benefit options during the year unless you have a qualifying life
event. To make benefit changes due to a qualifying life event,
complete a Benefit Election Form (available on Employee
Resource) and provide written verification of the qualified
life event. Submit all required paperwork to HR One Connect
within 30 calendar days of the event. If you miss the 30-day
window, you must wait until the next Open Enrollment period
to make the change. Changes to your benefit elections will be
effective on the first of the month following or coinciding with
the date of the event.
Qualifying life events include:
• The birth, adoption or placement for adoption of an eligible
dependent child
• The death of an eligible dependent or spouse
• Your marriage, divorce, annulment or legal separation
(if recognized by state law)
• A change in your or your eligible dependent’s
employment status
• A dependent becomes eligible or ceases to be eligible
under the plan, including attainment of age 26
• A change in the place where you, your spouse or eligible
dependent(s) reside (if it affects your eligibility)
Requested changes must be consistent with the qualifying
life event. For example, the birth of a child allows you to
add coverage for your new dependent, but does not allow
you to add vision coverage for yourself.
Please note: Your newly enrolled dependent(s) are subject
to verification. You will be asked to provide documentation
to substantiate that your dependent(s) meet the
eligibility requirements described on page 4.
When Participation Ends
For medical, dental, vision and employee assistance program:
Participation will end on the last day of the month in which
the earliest of the events shown below occurs.
For other programs, including:
• short-term disability
• long-term disability
• basic and additional life/accidental death and dismemberment
• dependent spouse and dependent child life
• flexible spending accounts
Participation will end immediately on the date in which the
earliest of the events shown below occurs.
Eligible Employee:
• Your employment terminates
• You cease to be eligible to participate in the plan
Continue your benefits if you lose coverage
You and your eligible dependents can continue your medical,
dental, vision, employee assistance program and health care
flexible spending account, for a specified period of time, if you
become ineligible for benefits through EDMC by experiencing
a qualifying event. This continued coverage is afforded to you
under the Consolidated Omnibus Budget Reconciliation Act —
better known as COBRA.
With COBRA, you (or your dependent) must pay the
premium — on an after-tax basis and without employer
contribution — directly to the COBRA administrator.
You have 60 days to sign up for COBRA. This 60-day window
begins when your coverage ends or when you receive a notice
from us saying that you are eligible for COBRA (whichever
occurs last).
Here are a few examples that would qualify you or your
dependents for COBRA:
• EDMC discontinues the plan for any reason
• Your employment status changes to one that is not eligible
for that benefit
Eligible Dependent / Domestic Partner:
• You end your employment with EDMC
• The eligible employee’s participation ends
• Your dependent turns age 26 and loses eligibility
• The eligible dependent or domestic partner ceases to
be an eligible dependent or domestic partner
• Your spouse loses eligibility due to divorce
• EDMC discontinues the plan for any reason
You’ll receive instructions on how to enroll in COBRA benefits
with your eligibility notice.
See the Signature Benefits Plan Summary Plan Description
(available on Employee Resource) for more details.
Getting married? Having a baby?
Sending children off to college?
Check out the My Life section of Employee Resource to
discover important information to help you make critical
decisions regarding new or upcoming changes in your life.
7
Your Health
Brought To You By:
All full-time and part-time* employees can enroll in benefits for their health care needs — that includes
medical, prescription drug, dental and vision. Prescription drug coverage is included when you enroll in
any of the Aetna medical plan options. You’ll find premium information for each of the health plans on
Employee Resource. These premiums are all conveniently deducted from your paycheck before taxes
are calculated.
1-866-738-6737
www.aetna.com
Medical
How the plans work
The medical plans are administered by Aetna. The plans are
PPO plans by design, offering coverage both in and out of
network. However, they are known as Aetna Choice® POS II
on the Aetna website. Note this whenever you need to identify
the plan by name, for example, when searching for a doctor in
Aetna’s DocFind® directory.
You have the freedom to receive care from any licensed provider
and the opportunity to save when you use doctors within the
network. That’s because benefits are paid at a higher level
when you use in-network providers, which means you pay less
out of pocket for care.
Aetna plans come with valuable tools, wellness programs
and other extras — at no additional cost to you and your family.
Aetna is a world-class leader in integrating wellness with their
medical plans. They focus on giving you the tools you need to
make smart health care decisions along with the help you need
to reach your best health. You can read more about those
extras in this section and in the Wellness section of this guide
on page 31.
You have four medical plan options to choose from:
Option 1…. 650 Deductible Plan
Option 4…. Waive Coverage
Full-time employees who choose to waive participation in the
medical plan will receive a waive credit as additional, taxable
income in each paycheck. In order to be eligible to receive
the waive credit, you must make an election to waive
participation during enrollment.
Each year you will be responsible for paying a deductible,
after which the plan starts to pay benefits. Once you’ve
met the deductible, you pay a percentage of your covered
expense (coinsurance). The chart below shows your deductible
and what you pay for covered services. There are no primary
care provider (PCP) requirements and no referrals needed to
see specialists.
Save with “in-network” doctors
When you choose a doctor who participates in the Aetna
network, you generally pay a lower deductible and coinsurance.
That’s because Aetna network doctors and other health care
providers have contracted with the plan to charge reduced rates
for their services. That means, not only do you pay a lower share
of the cost, your percent share (coinsurance) is starting from a
lower amount — so you save twice.
Also, doctors who do not participate in the Aetna network may
bill you for the difference between what Aetna allows and their
actual charge. That’s another good reason to stay in the
network. Want more? Aetna network doctors will even file
claims for you, so there’s no paperwork involved.
The following is a quick view of differences between options. A more detailed view is shown in the Medical Benefits Summary on
page 10.
Medical Plan Options
Deductible
In Network
Out of Network
Copay**
PCP
Specialist
Coinsurance***
The Plan Pays
In Network
Out of Network
650 Deductible Plan
$650
$1,300
$20
$35
80%
60%
450 Deductible Plan
$450
$900
$20
$35
90%
70%
250 Deductible Plan
$250
$500
$20
$35
100%
80%
* Part-time employees with hire dates prior to December 1, 2011 will retain benefits eligibility in a grandfathered status through December 31, 2013.
Part-time employees hired on or after December 1, 2011 are eligible for the employee assistance program and the 401(k) plan only.
** Deductible does not apply.
*** After deductible, until out-of-pocket maximum is reached.
8
Want to use a doctor or hospital outside
Aetna’s network?
No problem. Aetna will still cover eligible expenses, just at
a lower benefit level — you can get your medical care from
any licensed doctor or health care provider.
See if your doctor is in the network
The DocFind directory is available at www.aetna.com/docfind.
Follow the prompts to search for a specific doctor’s name, or to
see a list of in-network doctors available in your zip code and
surrounding area. Be sure to choose “Aetna Choice® POS II
(Open Access)” under the Plan field.
After you enroll, your search can get even easier when you
enter DocFind through Aetna Navigator®, your secure
member website. That’s because the system prefills your
specific information, like your zip code and plan name.
Be confident with high-performance specialists
If you need to see a specialist, you can enjoy the confidence
of knowing that your doctor has passed Aetna’s tough
standards for quality and efficiency. The Aexcel® network
includes select doctors in the 12 most commonly needed
specialty areas: cardiology, cardiothoracic surgery,
gastroenterology, general surgery, neurology, neurosurgery,
obstetrics and gynecology, orthopedics, otolaryngology/ENT,
plastic surgery, urology and vascular surgery.
It’s easy to find Aexcel specialists — just look for the stars.
When searching the DocFind directory, you’ll see a blue
star (★) next to the Aexcel specialist’s name.
Preventive care covered at 100% after the
applicable copay
To keep our employees healthy, routine in-network preventive
care services are covered at 100% after the applicable copay —
regardless of which medical plan option you choose. This allows
you to get your necessary health screenings for just your normal
copay amount. You do not have to meet your deductible or pay
additional coinsurance to get this coverage. Be sure your doctor
codes the visit as a preventive care exam in order for Aetna to
be able to correctly process the claim and cover it at 100%.
Health advice available when you need it
If you’ve ever wondered about a health concern in the middle
of the night, you will appreciate the fact that you now have two
convenient 24/7/365 resources available to you.
The toll-free Informed Health® Line is available 24 hours a
day, seven days a week. Call 1-866-738-6737 and request to
be connected to an Informed Health Line registered nurse.
While the nurses aren’t authorized to diagnose illnesses or
prescribe drugs, they can:
• Answer health-related questions
• Tell you about simple steps you can take to address a
health problem until you can get to a doctor
• Help you understand health issues and treatment choices
• Give you some good questions to ask your doctor
• Provide information about the latest research on certain
treatments and procedures, and explain their risks
and benefits
The nurses can help you make sense out of your choices and
help you communicate better with your doctor. They’ll give you
the facts you need to make decisions you can feel good about.
Telemedicine services are also available wherever and whenever
you and your family need them. You have phone and online
access to a national network of board-certified physicians who
can diagnose, treat, and write prescriptions, when necessary,
for routine medical conditions or issues such as:
• Allergies
• Upper respiratory infection
• Bronchitis
• Sinus infection
• Ear infection
• Urinary tract infection
• Pink eye
• Vaginal yeast infection
• Flu
Telemedicine services are a convenient, cost-effective alternative
to hospital emergency rooms and urgent care clinics and you
can access this quality care from home, the office, or even while
traveling. Visit Employee Resource for more detailed information
about these services.
Emergency and out-of-area care
You are covered anywhere in the country for routine and
emergency care. That includes vacations, business travel
and even covered students who are away at college. You pay
the same amount as you would if you were at home. There is a
$75 copay for emergency room visits. This is waived if you are
admitted to the hospital. For routine care, your out-of-pocket
costs will be lower when you visit an in-network doctor.
9
Medical Benefits Summary
650 Deductible
In Network
Out of Network
Calendar Year
Benefit
Benefit Period
Individual Deductible
450 Deductible
In Network
Out of Network
Calendar Year
250 Deductible
In Network
Out of Network
Calendar Year
$650
$1,300
$450
$900
$250
$500
$1,300
$2,600
$900
$1,800
$500
$1,000
Payment Level/
Coinsurance
80% after
deductible until
out-of-pocket
maximum is met,
then 100%
60% after
deductible until
out-of-pocket
maximum is met,
then 100%
90% after
deductible until
out-of-pocket
maximum is met,
then 100%
70% after
deductible until
out-of-pocket
maximum is met,
then 100%
100% after
deductible
80% after
deductible until
out-of-pocket
maximum is met,
then 100%
Out-of-Pocket
Maximums
$2,000 Individual
$4,000 Family
$5,000 Individual
$10,000 Family
$1,000 Individual $2,500 Individual
$2,000 Family
$5,000 Family
Not Applicable
$2,500 Individual
$5,000 Family
Family Deductible
Lifetime Maximum
Unlimited
Unlimited
Unlimited
Unlimited
Unlimited
Physician Office Visits
100% after
$20 copayment*
Unlimited
60% after
deductible
100% after
$20 copayment*
70% after
deductible
100% after
$20 copayment*
80% after
deductible
Specialist Office Visits
100% after
$35 copayment*
60% after
deductible
100% after
$35 copayment*
70% after
deductible
100% after
$35 copayment*
80% after
deductible
Routine Physical Exams
100% after
$20 copayment*
Not Covered
100% after
$20 copayment*
Not Covered
100% after
$20 copayment*
Not Covered
Routine Gynecological
Exams, Including a
Pap Test
100% after
$20 copayment*
60%*
100% after
$20 copayment*
70%*
100% after
$20 copayment*
80%*
100%*
60%*
100%*
70%*
100%*
80%*
Routine Physical Exams
100% after
$20 copayment*
Not Covered
100% after
$20 copayment*
Not Covered
100% after
$20 copayment*
Not Covered
Pediatric Immunizations
100%*
60%*
100%*
70%*
100%*
80%*
Preventive Care — Adult
Mammograms
Preventive Care — Pediatric
Medical and Hospital Expenses
Emergency Room
Services
100% after $75 copayment*
(waived if admitted)
Ambulance
80% after in-network deductible
Inpatient
80% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
Outpatient
80% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
Maternity
80% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
Infertility Counseling,
Testing and Treatment
80% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
Assisted Fertilization
Procedures
Not Covered
Medical/Surgical Expenses
(except office visits)
Spinal
Manipulations
Not Covered
Not Covered
80% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
100% after
$20 copayment*
60% after
deductible
100% after
$20 copayment*
70% after
deductible
100% after
$20 copayment*
80% after
deductible
Combined limit: 25 visits/benefit period Combined limit: 25 visits/benefit period Combined limit: 25 visits/benefit period
10
Medical Benefits Summary
650 Deductible
In Network
Out of Network
Benefit
Diagnostic Services
(Lab, X-ray and
other tests)
Physical Therapy
Speech Therapy
Occupational Therapy
Skilled Nursing
Facility Care
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
100% after
$20 copayment*
60% after
deductible
100% after
$20 copayment*
70% after
deductible
100% after
$20 copayment*
80% after
deductible
Combined limit: 50 visits/benefit period Combined limit: 50 visits/benefit period
80% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
80% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
Limit: 100 days/benefit period
80% after
deductible
Home Health Care
60% after
deductible
90% after
deductible
Limit: 100 visits/benefit period
80% after
deductible
Private Duty Nursing
(excludes inpatient)
250 Deductible
In Network
Out of Network
80% after
deductible
Combined limit: 50 visits/benefit period
Durable Medical
Equipment, Orthotics
and Prosthetics
450 Deductible
In Network
Out of Network
70% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
100% after
deductible
80% after
deductible
80% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
100% after
$20 copayment*
60% after
deductible
100% after
$20 copayment*
70% after
deductible
100% after
$20 copayment*
80% after
deductible
Inpatient Detoxification
and Rehabilitation
80% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
Outpatient Hospital
80% after
deductible
60% after
deductible
90% after
deductible
70% after
deductible
100% after
deductible
80% after
deductible
100% after
$20 copayment*
60% after
deductible
100% after
$20 copayment*
70% after
deductible
100% after
$20 copayment*
80% after
deductible
Hospice
80% after
deductible
Mental Health
Inpatient and Outpatient
Hospital
Office Visits
Substance Abuse
Office Visits
* Deductible does not apply
This is not intended as a contract of benefits. It is designed purely as a
reference of the many benefits available under your program. For more
detailed information, visit Employee Resource.
11
Tools and programs to help you be
an active participant in your health
When you enroll in an Aetna medical plan, you automatically
get tools and programs to keep you engaged in both your
health benefits and your health care. And, all this is at no
additional cost.
Your secure online member website
Every Aetna member can register for their personalized
Aetna Navigator website. It has everything you need to
manage your benefits:
Save with healthy discounts
Aetna members have access to a network of vendors who offer
great discounts on health-related products and services, like
gym memberships, weight-loss products, hearing aids, vitamins,
massage therapy and so much more.
Join a wellness program
When you enroll in any of the medical plans, you automatically
are eligible to participate in the following wellness programs:
• Online health resources
• Personal health record (PHR)
• See who’s covered under the plan
• Healthy lifestyle coaches
• Download a claim form and track claims
• Chronic-condition nurse case managers
• Print a temporary ID card
• Maternity program
• Link to credible health information
Turn to page 31 to learn more about wellness programs.
• Contact Member Services and much more
Lower your premium
A condensed version of Aetna Navigator is available from
your smartphone or BlackBerry®. You can check medical plan
coverage details while standing in the doctor’s office. Or, find
an ear, nose and throat doctor for your child — and make an
appointment — during your bus or train ride home. Get access
to a prescription drug cost estimator — even driving directions
to your doctor. Now, you can take your medical plan information
with you.
When you join any of the medical plans, you can take
healthy actions toward lowering your premium. Participate in
the wellness program and qualify for Healthy Rewards Pricing
described on page 33. It’s a great way to save money while
you strive for your best health.
Get a preview now of what you’ll be able to do on
your secure member website.
Visit www.aetna.com and click on Aetna Navigator “Member
Log In” to find the “Take a Tour” link.
12
Brought To You By:
Prescription Drugs
When you enroll in a medical plan, you automatically receive prescription drug benefits, which are easy
to use. If you choose to waive medical coverage, you also waive prescription drug coverage.
1-866-738-6737
www.aetna.com
The prescription drug benefit, administered by Aetna, works the same way regardless of which medical
plan you choose. You must buy the medications from a pharmacy in the Aetna network or use the
mail-order service available. To find a list of participating pharmacies near you, go to www.aetna.com/docfind.
Choose “Pharmacy” under the provider category and follow the prompts.
Here’s how much you will pay for covered prescription medications:
Generic drugs
Brand-name nonformulary drugs
Generic drugs are approved by the FDA and are just as effective
as their brand-name counterparts, but they cost much less.
You can save even more by getting medications you take
every day through the convenient mail-order service. You pay:
These are brand-name medications that are not on the Aetna
Preferred Drug List (formulary). They generally cost more than
drugs on the formulary. You can talk with your doctor to see if it
is safe to switch to a medication that will cost you less. You pay:
Retail:
30-day supply = $10
Retail:
Mail order:
30-day supply = 30% coinsurance 90-day supply = 30% coinsurance
($35 minimum / $100 maximum) ($70 minimum / $200 maximum)
Mail order:
90-day supply = $20
Note: Approved smoking-cessation prescriptions are covered at
the generic copayment amount.
Brand-name formulary drugs
Over-the-counter Non-Sedating Antihistamines
or Proton Pump Inhibitors (PPIs)
A formulary is a list of medications that Aetna prefers to cover,
generally because they cost less than other equally effective
brand-name drugs. You can find a copy of the Aetna Preferred
Drug List (formulary) at www.aetna.com/formulary (when
prompted, select the “Three-tier Open Formulary”). You pay:
If needed, ask your doctor for a prescription for drugs such
as Claritin or Prilosec, specifying “OTC” on the prescription.
Give the prescription to the pharmacist to fill and you will
be charged the applicable copay amount. If you pick up the
product from the shelf and take it to the cashier, you will be
charged the store’s retail price. You pay:
Retail:
Mail order:
30-day supply = 30% coinsurance 90-day supply = 30% coinsurance
($20 minimum / $100 maximum) ($40 minimum / $200 maximum)
Retail: 30-day supply = $5
90-day supply = $10
Mail order: not available
A quick note about prescribed generic medications
You are responsible for the payment differential when a generic
drug is authorized by your physician and you elect to purchase a
brand-name drug. Your payment is the price difference between
the brand-name drug, and the generic drug, in addition to the
brand-name drug copayment or coinsurance amounts which
may apply.
13
Try these mail-order options for savings,
convenience and service
Aetna Specialty CareRxSM Program
For specialty medications, like those that need special
handling or refrigeration, you must order through Aetna
Specialty Pharmacy. You may, however, get your initial 30-day
supply at a retail pharmacy.
Aetna Rx Home Delivery® mail-order service
If you use medication on an ongoing basis (such as those used
to treat high blood pressure and high cholesterol), you can order
Delivery is free and doctors and nurses are on hand to answer
up to a 90-day supply and have it delivered right to your home
your questions — 24 hours a day, 7 days a week.
with the mail-order service. It can save you money, too.
There’s more to it than that. Registered pharmacists check
your order for accuracy. If you have questions or an emergency,
they’re just a phone call away, day or night.
Here’s how it works:
1. Ask your doctor for two initial prescriptions, one for a
30-day supply that you can fill right away at a retail
pharmacy and the other for a 90-day supply that you
can mail to Aetna Rx Home Delivery.
2. Complete an order form. Once an enrolled member, it’s
available by logging in to your secure member website at
www.aetna.com and selecting “Access your pharmacy
benefits.” Mail the form back with your prescription and
payment. Or, have your doctor fax your prescription and
completed order form.
Aetna Specialty Pharmacy typically limits your supply to 30 days.
This lets them check on you more often. It prevents waste
and saves you money if your medication or dose changes
between refills.
As an enrolled member, you can choose one of these three
ways to get started:
• Fill out a Patient Profile form. Then, send it in along with your
prescription. Visit www.AetnaSpecialtyRx.com and click
“Enroll” to access this form and directions to submit it.
• Ask your doctor to fax your prescription to 1-866-FAX-ASRX
(1-866-329-2779).
• To transfer a prescription to Aetna Specialty Pharmacy,
call toll free at 1-866-353-1892.
3. To reorder, you have three options: by phone, mail or online.
Instructions are included with each order.
14
Brought To You By:
Dental
1-866-851-7568
A healthy mouth and healthy body go hand in hand. Cavity protection isn’t the only reason
www.ucci.com
to take care of your teeth; a wide range of medical problems, including diabetes, heart disease,
and premature babies have been linked to poor oral health and gum disease. EDMC offers dental
plan options to help you and your family pay for quality dental care.
United Concordia is EDMC’s dental plan provider. United Concordia serves more than 6 million members with 40 years of
experience in group dental insurance.*
You have two plan choices that are very similar. The primary difference is your annual benefit maximum and orthodontia coverage.
Dental Plan Options
You have three options to consider for dental insurance:
Option 1…. Basic Plan
Option 2…. Premium Plan
The following is a quick view of differences. A more detailed view is shown in the Dental Benefits Summary on page 17.
Dental Plan
Deductible
Preventive Care
Orthodontia
(The plan pays)
Annual Benefit
Maximum
Individual
Family
(Per person)
Basic
$25
$75
100%
Not Covered
$750
Premium
$25
$75
100%
Covered
$1,500
** Based on United Concordia internal research and reports, 9/12.
15
Choose where you receive care
Visit any licensed dentist out of network
Both the Basic Plan and the Premium Plan allow you to go
to any licensed dentist — in or out of the United Concordia
Alliance network. But, there is a big advantage to using
network dentists.
• You pay your deductible and coinsurance.
Visit an in-network dentist
You can search for a United Concordia Alliance dentist by
visiting www.ucci.com and clicking on “Find a Dentist.”
• Network dentists charge reduced rates for services.
• You pay your deductible and coinsurance based on the
reduced rate.
• Network dentists will file claims for you.
• Network dentists undergo rigorous review and routine
verification of their credentials.
Also, most of the United Concordia Alliance dentists offer
discounts for all services — covered or not.* That means
you can:
• Get non-covered services at a discount — just look for
the dentists with a black box next to their name in
“Find a Dentist”.**
• Save on services above your annual maximum.
* Discount arrangements are available where allowed by law.
** Non-covered services are services in which no benefit payments, including
alternate benefit payments, are made by United Concordia. Discount levels
may vary by procedure and geographic area.
16
• You may also have to pay the difference between
United Concordia’s allowed amount and the actual charge.
• You may have to file claim forms.
Find it online
As an enrolled member, visit www.ucci.com, enter the
“Members” section and select “My Dental Benefits” to set
up your personal account. After you log in, you can:
• Search the network for dentists
• Download a claim form
• Print a temporary ID card
• Monitor your annual benefit usage and more
For more information about your dental benefits plan, visit
www.ucci.com or call Customer Service at 1-866-851-7568.
Are you expecting? Special care is available for
expectant mothers.
United Concordia’s Smile for Health program provides
additional cleanings and other protective services during
pregnancy. This can help prevent periodontal disease, which
has been linked to premature and low-birth-weight babies.
Visit www.ucci.com for more information.
Dental Benefits Summary
Benefit
Basic Plan*
Out of Network
In Network
In Network
Premium Plan*
Out of Network
Individual Deductible
$25
$25
$25
$25
Family Deductible
$75
$75
$75
$75
Annual Benefit Maximum
Per Person
$750
$750
$1,500
$1,500
Not Covered
Not Covered
$1,500
$1,500
100%
100%
100%
100%
Two per calendar year
Lifetime Orthodontia
Maximum Per Person
Prophylaxis (cleanings)
Cleanings During
Pregnancy**
One additional cleaning**
100%
Oral Examinations
One additional cleaning**
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Non-surgical Periodontics
Topical Fluoride
Treatments
One treatment per calendar year for
dependent children up to age 19
100%
100%
Full Mouth X-rays: One every 3 years
Bitewing X-rays: One set per calendar year for adults
Two sets per calendar year for children
X-rays
100%
Space Maintainers
100%
Dependent children up to age 19
100%
100%
One application every 3 years for each molar
for dependent children up to age 14
Sealants
100%
One treatment per calendar year for
dependent children up to age 19
100%
100%
Full Mouth X-rays: One every 3 years
Bitewing X-rays: One set per calendar year for adults
Two sets per calendar year for children
100%
100%
Dependent children up to age 19
100%
100%
One application every 3 years for each molar
for dependent children up to age 14
Basic Restorative Services
Fillings
(including posterior resin)
80% after deductible
Simple Extractions
Complex Oral Surgery
(impacted teeth)
Crown, Denture and
Bridge Repair/
Re-cementing
Endodontics
General Anesthesia
Periodontics (surgical)
Not Covered
Not Covered
In connection with oral surgery, extractions or other covered dental services
Major Restorative Services
Bridges and Dentures
Initial placement to replace one or more natural teeth
lost while covered by the Plan. Dentures/bridgework
replaced once every 5 years.
Crowns/Inlays/Onlays
Oral Surgery
Orthodontia
Not Covered
Not Covered
50%
50%
Employees, dependent spouses/ domestic partners
and dependent children
* The listed network percentages represent the portion of United Concordia’s maximum allowable charges (MAC) for which the plan will be responsible. Network
providers agree to accept United Concordia’s MAC for covered services as payment in full and also agree to file claims for you. If you or your covered dependents
receive services from an out-of-network provider, United Concordia will apply the percentages shown to United Concordia’s MAC for covered services and you
will be responsible for the difference, up to the provider’s charge. Plan exclusions and limitations apply.
**Part of the Smile for Health Benefit.
17
Brought To You By:
Vision
1-800-638-3120
Your eyes work hard for you every day. Whether you are staring at a computer screen, reading a book
www.myuhcvision.com
or driving home from work, it’s important to have excellent vision. Not only can a regular eye exam
uncover vision problems, but vision checkups can offer clues to other underlying health conditions, as well.
UnitedHealthcare Vision is EDMC’s vision plan provider.
With a state-of-the-art optical lab, diversified network,
electronic claims system and superior customer care, it’s clear
to see the emphasis UnitedHealthcare places on the quality
of the materials and services they provide.
Higher level of coverage, better service — when
you stay in the network
During enrollment, you have two options to consider:
Network providers will also file claims for you. Just show your
UnitedHealthcare vision member ID card at the time of your
visit and they’ll take it from there.
Option 1.… Premium Plan
Option 2.… Waive Coverage
To help make your decision, determine your usual annual
expenses for vision care and compare that against your annual
pre-tax contributions and any coinsurance you might pay
throughout the year.
Remember that you can also use a health care flexible spending
account (FSA) to pay for vision care expenses. Consider this as
an alternative if you are not sure whether you want to elect
vision benefits or not. See page 27 for more about the
tax-advantaged flexible spending accounts (FSAs).
18
While you are covered at any licensed vision care provider,
your coverage is greater if you visit a network provider. See the
vision benefits summary on the next page for details.
As an enrolled member, if you visit a provider who is not in the
network, go to www.myuhcvision.com for instructions on
how to file an out-of-network claim.
Finding a network provider near you is a quick
click or call away
Log in to www.myuhcvision.com and select the provider
locator option to look up participating vision care providers in
your area. No Internet access? Call 1-800-839-3242 — any
time, 24/7 — and follow the voice response prompts to find
a vision provider near you.
Vision Benefits Summary
Premium Plan
Benefit
In Network
Out of Network
12 month period from last date of service
Benefit Period
Vision Exams
(one every 12 months)
100%
Up to $60
Single Vision
100%
$40 allowance
Bifocal
100%
$60 allowance
Trifocal
100%
$80 allowance
Lenticular
100%
$80 allowance
Polycarbonate
100%
Not Covered
Scratch-Resistant Coating
100%
Not Covered
$130
$50
Elective-covered in full**
100%
$150
Elective-specialty***
$150
$150
Medically Necessary****
100%
$250
Lenses*
(once every 12 months)
Frames
Contact Lenses
Laser Vision Correction
Access to discounted laser vision correction procedures from numerous provider locations throughout the U.S. To find
a participating laser vision correction surgeon in your area, visit www.myuhcvision.com or call 1-877-28-SIGHT.
****One pair of standard single vision, lined bifocal, lined trifocal or standard lenticular lenses is covered in full. Options, such as progressive lenses, tints,
UV, and anti-reflective coating may be available at a discount.
****The fitting/evaluation fees, contacts (including disposables) and up to two follow-up visits are covered in full (after the applicable co-pay) for many of the
most popular brands on the market. If covered disposable contact lenses are chosen, up to 6 boxes (depending on your prescription) are included when
obtained from a network provider. UnitedHealthcare Vision’s covered-in-full contact lenses may vary by provider.
****Toric, gas permeable, and bifocal contacts are examples of contacts that are outside of the “covered-in-full” category.
****Necessary contact lenses are determined at the provider’s discretion for one or more of the following conditions: Following post-cataract surgery without
intraocular lens implant, to correct extreme vision problems that cannot be corrected with spectacle lenses and with certain conditions of anisometropia
or keratoconus. If your provider considers your contacts necessary, ask your provider to contact UnitedHealthcare Vision concerning the reimbursement
that UnitedHealthcare Vision will make before you purchase such contacts.
The chart shown above represents an overview of the covered services and plan limitations within each of the vision plan categories. The above overview is not a
complete description. The UnitedHealthcare Vision contract and benefit booklet for the plan will govern if any discrepancies exist between this overview and the
contract and/or actual benefit booklet.
19
Your Wealth
We offer a “wealth” of financially based benefits for full-time
employees and even a few options for part-time* employees.
These benefits offer you security for the future — some
unexpected events, like accidents and illnesses, and expected
events like your retirement.
Protect your loved ones and yourself with:
• Life insurance (basic and additional)
• Spousal and dependent life insurance
• Short- and long-term disability
• Flexible spending accounts (FSAs)
• The retirement plan – 401(k)
• Tax-advantaged commuter benefits, tuition
assistance and much more
*Grandfathered part-time employees are eligible for basic life
insurance, flexible spending accounts (FSAs), commuter benefits
and the 401(k) plan. Part-time employees with hire dates prior to
December 1, 2011 will retain benefits eligibility in a grandfathered
status through December 31, 2013. Part-time employees hired on
or after December 1, 2011 are eligible for the employee assistance
program and the 401(k) plan only.
20
Brought To You By:
Life Insurance
Life and accident insurance provide important financial protection in the event you die or
become dismembered while an employee of EDMC. When considering life insurance,
it’s important to give some serious thought to what expenses and income needs your
family would have if something happened to you.
1-866-502-8883
www.mylibertyconnection.com
Claimant services ID: EDMCDIS
PIN: Your Social Security number
To make sure you have the protection you need, EDMC offers:
Basic Life and AD&D
• Basic life insurance for full-time and part-time* employees
at no cost
EDMC automatically provides basic life and accidental death
and dismemberment (AD&D) insurance through Liberty Mutual®
to all full-time and part-time* employees. These benefits
are company paid. That means you don’t have to make
contributions to receive them.
• Accidental death and dismemberment (AD&D) insurance
to full-time and part-time* employees at no cost
• Additional life insurance for full-time employees needing
supplemental coverage
Full-time employees
• Basic life = 2X annual salary**
• Spouse and child life insurance options for full-time employees
(rounded to the next highest thousand, up to $500,000)
• Basic AD&D = 2X annual salary**
(rounded to the next highest thousand, up to $500,000)
Part-time* employees
• Basic life = $25,000
• Basic AD&D = $25,000
A note about imputed income
The total value of your basic life insurance that exceeds $50,000
is considered imputed income and is taxable to you. The income
is imputed on the cost of the life insurance, not the coverage
amount. You pay taxes on imputed income just as though it was
part of your regular paycheck. Imputed income is added to your
total annual compensation reported to the IRS and appears on
your W-2 statement.
*Part-time employees with hire dates prior to December 1, 2011 will retain
benefits eligibility in a grandfathered status through December 31, 2013.
Part-time employees hired on or after December 1, 2011 are eligible for the
employee assistance program and the 401(k) plan only.
**Annual salary is defined as current base salary plus any bonus paid the
previous calendar year.
21
Additional Life and AD&D
Everyone has different needs when it comes to life insurance.
The Educated Choices program allows you to tailor your life
insurance protection to your specific needs. The coverage you
purchase will be in addition to any company-provided coverage.
This is voluntary and for full-time employees only. You will pay
the entire premium amount as shown in your enrollment
materials. Payments will be deducted from your paycheck on
an after-tax basis.
You have four options:
Option 1 .… 1X Annual Salary*
Option 4 .… Waive Coverage
The combined maximum coverage allowed for basic life and
additional life is $1,000,000.
Don’t forget to update your beneficiary information
Your beneficiary is the person(s) who will receive your life
insurance benefit in the event of your death. You are
encouraged to designate a beneficiary when you first elect
life insurance, but it is a good idea to update that information
from time to time. You can review and make changes on
Employee Resource.
*Annual salary is defined as current base salary plus any bonus paid the
previous calendar year.
Evidence of Insurability: What you need to know
• New full-time employees are guaranteed coverage up to
1X annual salary, up to $500,000. If you elect 2X or 3X salary,
you must submit an Evidence of Insurability form. Any amount
over 1X salary will be subject to carrier approval. However, you
will be enrolled for 1X salary while your request for additional
coverage is processed.
• Employees who move from a non-full-time status to a
full-time status will be treated as new employees and will
be granted the 1X salary guarantee if they choose to enroll.
• Existing employees may request to add or increase coverage
during Open Enrollment or for a limited time after a qualifying
life event (if the request is consistent with the event), such
as the birth of a child. You must complete an Evidence
of Insurability form, subject to the carrier’s approval.
Your current level of coverage will continue while your
request for increased coverage is processed.
Evidence of Insurability: How does it work?
• Download, print and complete the Evidence of Insurability
form from Employee Resource. In order for Liberty Mutual to
determine eligibility, the form includes questions about your
health (or your spouse’s health for dependent spouse life).
Instructions for submitting the form to Liberty Mutual are
printed on the form.
• Liberty Mutual will process the form. If necessary, they may
ask you for more information or ask you to get a physical
examination or lab work through your doctor. You are
responsible for any expenses associated with the exam.
It is your responsibility to follow up with Liberty Mutual in
a timely manner.
• Liberty Mutual will advise you if your request is approved or
denied, or if the request is incomplete. If approved, the
amount will be effective the first day of the month
following approval.
22
Life Insurance: Take it with you if you leave the company
Your basic and/or additional life insurance coverage ends when
your employment ends. However, you will be eligible for a
portability option to continue your coverage and pay your
premiums directly to Liberty Mutual.
To qualify for the portability option, you must:
Dependent Spouse Life Insurance
Full-time employees may purchase dependent spouse life
insurance for their eligible spouses. Domestic partners are
not eligible for this benefit.
Choose from:
• Be under age 75
Option 1.… Coverage in $10,000 Increments
to a Maximum of $100,000
• Be a citizen or resident of the United States or Canada
• Not be a full-time member of the armed forces of any country
• Elect the portable life insurance option and not the conversion
option (converting to a personal policy as opposed to the
same group policy)
Guidelines for the portability option:
Spousal coverage is limited to 50% of the employee’s
total life insurance coverage, which includes both basic and
additional life. For example, if the employee has a total coverage
amount of $160,000, the spouse’s coverage cannot be more
than $80,000.
• AD&D coverage is not portable.
If you and your spouse are both employed by EDMC,
neither of you are eligible for dependent spouse life insurance
coverage. That’s because you both qualify for the employee
life insurance coverage.
• You must elect the portability option within 31 days of the
date your participation in the plan ends. Contact HR One
Connect for the appropriate paperwork at 1-888-471-3362
(1-888-HR1-EDMC).
You, the employee, are automatically listed as the beneficiary of
dependent spouse life insurance. You are responsible for the full
payment of the premium. Your premium will be deducted from
your paycheck on an after-tax basis.
• Waiver of premium does not apply.
• Accelerated death benefit does not apply.
• Ported coverage begins after the paperwork is completed
and received by Liberty Mutual.
• Ported coverage ends at age 75.
• You pay the premiums directly to Liberty Mutual.
• Portability life insurance coverage will remain in effect as long
as EDMC’s policy for life insurance coverage continues with
Liberty Mutual.
• When ported coverage terminates, you have the right to
convert coverage to a personal policy.
• In addition to the portability option, terminated employees
also have the option to convert life insurance to a personal
policy. Contact HR One Connect for the appropriate
paperwork at 1-888-471-3362 (1-888-HR1-EDMC).
23
Evidence of Insurability: What you need to know
• New full-time employees are guaranteed coverage up to
$50,000 in dependent spouse life insurance coverage (not to
exceed 50% of the employee’s total life insurance coverage).
If you request more than that, your spouse must submit an
Evidence of Insurability form. Any amount over $50,000 will
be subject to carrier approval. However, your spouse will
be enrolled for $50,000 while your request for additional
coverage is processed.
full-time status will be treated as new employees and will
be granted the $50,000 guarantee if they choose to enroll.
• Existing employees may request to add or increase dependent
spouse life insurance coverage during Open Enrollment or
for a limited time after a qualifying life event (if the request
is consistent with the event), such as the birth of a child.
You must complete an Evidence of Insurability form, subject
to the carrier’s approval. Your current level of coverage
will continue while your request for increased coverage
is processed.
Dependent Child Life Insurance
Full-time employees may elect dependent child life insurance
coverage for their eligible child(ren). Dependent children of
domestic partners are not eligible for this benefit.
Choose from:
Option 1…. $5,000 Coverage
You, the employee, are automatically listed as the beneficiary
of dependent child life insurance. Your election covers all of your
eligible children. The cost of coverage is a flat amount regardless
of the number of children you insure.
Covered dependent children from age 14 days to 6 months
will receive $500 in life insurance coverage. The coverage
automatically increases to $5,000 at age 6 months to age 26.
No Evidence of Insurability is required.
You are responsible for the full payment of the premium.
Your premium will be deducted from your paycheck on an
after-tax basis.
See “Evidence of Insurability: How does it work?” on page 22 for
information about completing the Evidence of Insurability form.
24
Brought To You By:
Disability Insurance
Accidents happen. Illness strikes. And, that can mean weeks, even years, of not being able
to earn a living. But, you can protect yourself with disability insurance, which replaces a
portion of your income while you are unable to work.
Short-Term Disability
No one wants to be ill or injured, especially if it means missing
work. That’s why EDMC provides short-term disability (STD)
coverage at no cost to eligible full-time employees. Employees
must satisfy an eligibility waiting period before the plan benefits
take effect.
The benefits payable under the STD plan range from
50% – 80% of your base salary for up to 90 calendar days.
Days paid during the 90-day period will only be for regularly
scheduled workdays and company holidays for which you are
absent and receive certification from Liberty Mutual. Base salary
is considered your salary in effect on the first day of your
disability and does not include overtime pay, bonuses or other
forms of special compensation.
Payment of STD benefits will only be made for the period of
time that the disability has been certified by Liberty Mutual.
You are eligible for payment of STD benefits as of the first day
of absence that:
1-866-502-8883
www.mylibertyconnection.com
Claimant services ID: EDMCDIS
PIN: Your Social Security number
Filing a disability claim
To file a short-term disability claim, follow these simple steps:
1. Notify your supervisor by completing a Request for Leave
form (found on Employee Resource).
2. Report the nature of your disability and the length of
time you will be unable to work to Liberty Mutual
by phone at 1-866-502-8883, or online at
www.mylibertyconnection.com. You will need your
claimant services ID (EDMCDIS) and your personal identification
number (PIN), which is your Social Security number.
Liberty Mutual will review your application and authorize
payments as applicable. If you have LTD coverage, you do not
have to file a claim. Liberty Mutual will automatically transfer
your STD claim to LTD for review.
• Extends more than five consecutive workdays, and
• Is due to pregnancy or non-work-related illness, accident
or injury.*
If Liberty Mutual certifies your disability, you will receive a
percentage of base salary for workdays up to a 90 calendar day
period. The chart below shows the percentage of base salary
you may be eligible for based on your length of service.
Service with EDMC
Percentage of base
salary for up to
90 calendar days
Less than 1 year
50% of base salary
1 year to 5 years
662⁄3% of base salary
More than 5 years
80% of base salary
*See the STD Booklet found on Employee Resource for a full listing of
plan exclusions.
25
Long-Term Disability
Long-term disability (LTD) coverage can be an important
benefit for you to choose. Many people think that Social
Security benefits will cover their needs if they become disabled.
The reality is that Social Security pays only a portion of your
income, and the rules for qualifying are strict. Consider what
would happen financially if you became disabled and could no
longer work due to a non-occupational injury or illness. It’s likely
that it would be a financial challenge to replace enough income
to meet your monthly expenses.
Only full-time employees may elect long-term disability insurance.
You must be absent from work for 90 calendar days before
you are eligible to receive benefits under the LTD plan. This is
called an “elimination period.” You may elect one of the
following options:
Option 1…. 50% of Annual Salary
Option 2…. 662⁄3% of Annual Salary
LTD: What you need to know
• The maximum monthly benefit is $10,000. For purposes of
calculating your LTD benefit amount, annual salary is defined
as current base salary plus any bonus paid the previous
calendar year.
• You pay the entire premium for LTD coverage. Your premiums
will be deducted from your paycheck on an after-tax basis.
• New employees who elect LTD insurance are guaranteed
coverage at either the 50% or 662⁄3% level.
full-time status will be treated as a new employee for
guaranteed coverage.
• Existing full-time employees may request to enroll in or
increase their existing level of coverage during Open
Enrollment, or as the result of a qualifying change of status
event (if the request is consistent with the event). However,
in either case, an Evidence of Insurability form must be
completed and your request will be subject to the carrier’s
approval. Your current level of coverage will be maintained
while your request is processed.
See “Evidence of Insurability: How does it work?” on
page 22 for information about completing the Evidence
of Insurability form.
• Benefits decrease if your income from other sources
increases — LTD benefit payments will be decreased by the
amount of income you receive from other sources, such as
Social Security and Workers’ Compensation. The LTD benefit
payments you receive will not be considered taxable income
since you pay the entire premium with after-tax dollars.
• Pre-existing condition exclusion — If you have received
medical treatment (including consulting with a doctor, taking
medicine or having diagnostic work done) at any time during
the three months before the date you become covered under
this plan, you have a pre-existing condition as defined under
the terms of the LTD policy. If you suffer a disability in the
first 12 months of coverage and the disability is caused
by a pre-existing condition, no benefits will be payable for
that disability.
• When coverage ends — If you terminate employment or
cease to be a full-time employee, you will no longer be
eligible to participate in the LTD plan. Your coverage will
end as of the date you are no longer eligible to participate.
Portability options are not available under the LTD plan.
26
Brought To You By:
Flexible Spending Accounts (FSAs)
Flexible spending accounts (FSAs) help you save on taxes because you put money aside
from your paycheck — before taxes — to pay for certain types of health care and
dependent care expenses.
Tel: 1-877-WageWorks
1-877-924-3967
Fax: 1-877-353-9236 (claims)
www.wageworks.com
Full-time and part-time* employees may choose from
two flexible spending accounts (FSAs):
How flexible spending accounts (FSAs) work
• Health Care
• You contribute to the account(s) with pre-tax dollars deducted
from your paycheck. When you enroll, you specify how much
you wish to contribute each year.
• Dependent Care
Enrolling in an FSA
You must enroll each year if you want to participate in a flexible
spending account (FSA). You cannot automatically re-enroll
in an FSA from year to year by doing nothing. New hires must
enroll no later than their benefits’ effective date.
To enroll in one or both FSAs, call 1-877-WageWorks
(1-877-924-3967) or log in to the WageWorks website at
www.wageworks.com. If it’s the first time you’re visiting
the website, you’ll need to register by creating a user name
and password.
It’s easy to use these accounts:
• You pay for certain eligible expenses out of your pocket
as usual.
• Then, you submit a claim along with the appropriate
documentation to be reimbursed for those expenses from
the dollars in your account.
• Or, use your WageWorks Card to pay for eligible health care
expenses. (Be sure to save your receipts for future verification.)
Health Care FSA
You may contribute up to $2,500 to your health care FSA for
2013. These pre-tax dollars may be used for eligible expenses,
such as:
• Medical and dental plan deductibles and copayments
• Prescription medications
• Over-the-Counter (OTC) drugs. You must get a prescription
from your doctor to be reimbursed from the FSA for overthe-counter drugs. Just send the prescription in with your
claim form.
• Hearing aids
• Glasses and contacts
• Any other health care expense that is an eligible tax deduction
(except insurance premiums, nonprescription drugs and
cosmetic surgery).
Check out IRS Publication #502, available at www.irs.gov,
for a complete list of qualified health care expenses.
The total amount that you elect to contribute to a health care
FSA will be made available to you as of the first day of the plan
year. This means, if you file a claim that exceeds the amount in
your health care account, you can still be reimbursed up to the
annual amount you’ve elected.
27
Dependent Care FSA
Filing a claim for reimbursement from your FSA
This account reimburses you for qualified day care expenses
that are necessary so that you, or you and your spouse, can
work. If you are single or if you are married and filing a joint
tax return, you can contribute up to $5,000 annually into
your dependent care FSA ($2,500 if married and filing
separate federal income tax returns).
To submit a claim for your eligible dependent care and/or
health care FSA, complete a claim form, available on
Employee Resource. Attach the dated receipts along with
any other required documentation and fax or mail the form
to WageWorks.
The expenses covered on the days you are working include
charges for:
When you elect to contribute to a health care FSA, you will
receive a WageWorks Card for on-the-spot access to your
pre-tax dollars. Your WageWorks Card is similar to a VISA® debit
card. Use it to pay for eligible expenses directly at the point of
service when you incur an expense at a designated health
care merchant (doctor’s office, hospital, health care clinic,
pharmacy, etc.). However, you must keep receipts, as you may
be required to send your receipts to WageWorks for review.
• Licensed nursery schools
• Daycare centers
• Babysitting
• Disabled dependent day care (in or out of your home)
If the care is in your home, the provider cannot be one of your
dependents. On the claim form, you must provide the name,
address and taxpayer identification number of the person
performing dependent care services.
You cannot receive advance reimbursements from a dependent
care FSA. You can only be reimbursed up to the balance in
your account.
Use it or lose it
When deciding how much to contribute to your health care or
dependent care FSA for the year, be sure to estimate carefully.
Consider predictable expenses based on past experience and
upcoming events or changes. It’s important to do the math
accurately, because if you don’t use up your FSA dollars by the
end of the year, you will lose them.
Note: Eligible health care expenses can be incurred through
March 15, 2014, for reimbursement from your 2013 health
care FSA.
28
WageWorks Card = instant reimbursement
When coverage ends
You will not be eligible to receive reimbursement for expenses
incurred after your participation end date. Your participation in
the health care FSA or dependent care FSA will end:
• On the date you terminate employment or cease to be a
full-time or part-time* employee
• When you elect to stop participating — if permissible —
due to a qualifying change of status event
Health care FSA participants whose participation has ended
due to a COBRA qualifying event will be extended the
opportunity to continue their participation in the health care
FSA under COBRA.
Brought To You By:
The Retirement Plan— 401(k)
Many financial planners believe that participating in a 401(k) savings plan is the best way to
save for your future. That’s because the 401(k) plan gives you the tools you need to assist you
in building a solid financial future and retirement.
1-800-835-5092
www.401k.com
All full-time, part-time, and adjunct employees are eligible to participate in the EDMC Retirement Plan. What makes this an
even more attractive investment vehicle is that EDMC will match your contributions — dollar for dollar — up to 6% of your
annual salary on a per-pay basis.
To enroll in the EDMC Retirement Plan, log in to Fidelity NetBenefits® at www.401k.com or call the Fidelity Retirement Benefits
Line at 1-800-835-5092.
Tax-deferred savings
Transfers and rollovers
Your contributions can be deducted from your paycheck — on
a tax-deferred basis. This means that the deduction from your
paycheck is made before taxes are taken out. Instead of
paying taxes for this money now — or for EDMC’s matching
contributions and the investment earnings as you build
your retirement fund — you will pay taxes as you receive
distributions later. This is even more helpful if you expect to
be in a lower tax bracket in your retirement years.
You can roll over eligible savings from a previous employer’s
plan into this plan. You can also take your plan’s vested account
balance with you if you leave the company.
Roth 401(k) option (to be added during 2013)
Investment options
You have the flexibility to select from investment options that
range from more conservative to more aggressive, making it
easy for you to develop a well-diversified investment portfolio.
To learn more about the investment options available to you,
visit www.401k.com.
Unlike the tax-deferred 401(k), the Roth 401(k) allows you
to contribute after-tax dollars to the plan, but then withdraw
tax-free dollars from your account when you retire. The same
IRS limits that apply to tax-deferred contributions to the plan
also apply to the Roth contributions. This means that each
dollar of a Roth contribution reduces the amount that can
be contributed on a tax-deferred basis, and vice versa.
Contribution limits
The IRS determines and publishes contribution limits on an
annual basis. If you will be at least age 50 anytime during
the year, this plan will allow an additional catch-up contribution
that year.
29
Brought To You By:
Commuter Program
The commuter program is another easy and convenient way to
save on taxes while paying for predictable expenses. Full-time
and part-time* employees — who pay to get to work — can
sign up for the commuter program. You can sign up at any time
of the year. There’s no specified enrollment period, but elections
must be made by the 10th of the month for participation in the
following month. And it’s so easy to use.
Step 1: Enroll. Log in to www.wageworks.com.
Click “Sign Me Up!” if you’re new to WageWorks. Sign up by
choosing your provider and payment type.
Or, enroll by phone. Call 1-877-WageWorks (1-877-924-3967)
Monday through Friday, from 8 a.m. to 8 p.m. Eastern Time.
Step 2: That’s it. Just set it. And forget it. See how easy it is?
Your pre-tax payroll deductions will be used to pay your
commuter expenses that you defined when you enrolled.
* Part-time employees with hire dates prior to December 1, 2011 will retain
Tel: 1-877-WageWorks
1-877-924-3967
Fax: 1-877-353-9236 (claims)
www.wageworks.com
You have four options for qualified
transportation
Buy My Pass. This option is for public transportation
commuters — bus, light rail, regional rail, streetcar, trolley,
subway or ferry. When you sign up for the program, you
can choose your transit provider and pass type. The rest is
automatic. You’ll receive your transit pass or tickets in the mail
every month, in time for the month they’re valid. If you
have a SmartCard or other electronic pass, it will be
reloaded automatically.
Pay My Parking. Select your parking provider and monthly
amount when you sign up, and the program pays your expenses
automatically every month. You do nothing.
Pay Me Back. If your expenses vary from month to month,
or your provider only accepts cash, you can also send in a Pay
Me Back form for reimbursement. Just print the form from the
WageWorks website and mail or fax it with your receipts.
Commuter Card. You can elect the Commuter Card if your
parking provider accepts credit or debit cards. The Commuter
Card is a MasterCard® stored-value card, which works just like
a credit card at your parking facility.
Not all commuter fees qualify. Exclusions include transportation
costs that are not related to work, expenses for other family
members, tolls, mileage, and taxis and limousines. For more
information, please visit www.wageworks.com.
Cancel the program at any time
You can cancel your participation in the commuter program
at any time. Your cancellation will become effective on the same
schedule as signing up – cancellations must be made by the
10th of the month for cancellation the following month.
More Benefits
Visit Employee Resource to learn more about these
other valuable benefits that are available to you as an
EDMC employee:
• Tuition Assistance
• Adoption Assistance
• Paid Time Off (PTO)
• Employee Discount Programs
30
Your Wellness
Brought To You By:
EDMC’s benefit programs focus on helping you reach your best state of health and wellness.
Wellness means something different for each of us. Whether you’re already in peak condition
or if you have a chronic disease, there’s something for everyone.
Employee Assistance Program (EAP)
Job satisfaction and productivity are best achieved when you
strike a balance between personal and professional demands.
Achieving this balance can sometimes be challenging; that’s
why EDMC provides you and your household members with a
free and confidential* employee assistance program (EAP),
managed by The Wellness Corporation.
All full-time, part-time, and adjunct employees and family
members living in their household can call the EAP at any time.
You don’t have to enroll to use EAP services. This is a free
company-paid benefit with no enrollment necessary.
Someone to talk to
1-800-828-6025
www.wellnessworklife.com
Advice from an expert
The EAP program provides support, information and resources
to employees for a broad range of concerns, such as:
• Health problems
• Family, marital and relationship issues
• Dealing with stress
• Help with children
• Debt counseling
• Work or performance problems
• Personal legal consultation
• Financial assistance services
Call an EAP counselor for confidential discussions about alcohol
and drug abuse, and mental health and other emotional issues.
Each eligible employee and the adults or children living in their
household are eligible for five counseling sessions per issue/per
calendar year at no charge. The EAP is staffed by licensed
counselors who will respond quickly to your request for help
in a caring, respectful manner.
• And more
Learn more or contact the program
Visit Employee Resource or call The Wellness Corporation at
1-800-828-6025. You may also visit www.wellnessworklife.com.
EAP assistance is available 24 hours a day, including weekends
and holidays, for emergencies.
* Information you discuss with an EAP counselor remains private unless you
sign a release of information, permitting the EAP to contact a specific person.
Only in rare instances does the law require a licensed counselor to notify an
outside party. These situations occur when there is a serious threat to yourself
or others, or the abuse/neglect of a child, elder or disabled person.
31
Brought To You By:
Wellness Programs from ActiveHealth
1-866-738-6737
We’re making it easier than ever to improve your health with health-management programs through
www.aetna.com
ActiveHealth Management®. Employees and their spouses/domestic partners who enroll in an Aetna
medical plan are eligible for all of the ActiveHealth wellness programs. There’s no additional cost to participate.
These programs can help you improve the quality of care you receive and help you manage chronic health conditions
for yourself and your family.
Your Privacy is Guaranteed
All of the ActiveHealth programs are confidential, and all
health information is kept private and only shared between
ActiveHealth and your health plan administrator, Aetna.
Create your Personal Health Record
Your personal and identifiable health information is not shared
with EDMC.
The PHR gives you one place to store all of your health information.
You can update it at any time. In fact, it interacts with claims from
your medical plan that is administered by Aetna — just to make
it easy. When the plan receives a claim for, say, a preventive care
checkup or a new prescription drug, it records it in your PHR.
Find health information online
As an enrolled member, you can become totally engaged in
your health through your personalized and secure member
website at www.aetna.com. After you register, you can access
all your wellness programs and health information by clicking on
“Go to MyActiveHealth.” Here, you can also track your wellness
progress, send yourself appointment reminders, organize
meaningful information and so much more.
Here are just some of the features you’ll find:
• Health Assessment and Personal Health Record
• Drug Information
• Healthy Recipes
• Customizable Conditions Center
• Resource Center
• Health Tools and Trackers
In fact, it’s the place to get started with all of the ActiveHealth
wellness programs described here.
Ever have to try to remember what year you had a surgery or
when your child received a vaccination? Now it’s easy with
your secure, online Personal Health Record (PHR).
As an enrolled member, you can access your PHR by logging
in to www.aetna.com and clicking “Go to MyActiveHealth.”
www.aetna.com > Go to MyActiveHealth > Health Record
Engage a lifestyle coach
Looking for a better way to stick with a diet or exercise
regimen? Need to learn how to better manage your stress
levels? Want to quit smoking? Enrolled medical plan members
can take advantage, free of charge, of an Active Lifestyle Coach.
Active Lifestyle Coaching is a telephone support program with
nurses, dieticians and other trained professionals who can help
you maintain a healthy lifestyle. Help is just a phone call away
at 1-866-738-6737.
Give your baby a healthy start in life
With the ActiveHealth maternity program, you can speak
live with a nurse coach who can help you understand what
to expect at each stage of pregnancy. Your nurse can explain
prenatal tests and what the results mean, help you lower your
risk and recognize the signs of early labor, and follow a diet
that’s healthy for you and your baby. After your baby is born,
your nurse coach can follow up to see how you’re both doing.
There’s no cost to join. As an enrolled member, just call
1-866-738-6737 to sign up for the ActiveHealth maternity
program. Enroll early for a better chance at a healthy pregnancy.
32
Manage your chronic condition
Beginning on January 1:
Asthma. Diabetes. High blood pressure. Migraines. If you’re
Take Healthy Actions to Earn Healthy Rewards
living with a chronic condition, you know how much it can
You must complete the required wellness program activities
impact your life. With a little help, you can get on the right track to receive the healthy rewards. Your spouse/domestic partner,
to managing your condition without letting it manage you.
if also enrolled in the plan, is invited to participate in the
program as well. Their participation, however, is not required
ActiveHealth offers two ways to get the help you need:
for you to qualify for Healthy Rewards Pricing.
• Online coaching – You choose what you want to work on,
like eating foods that are best for your condition, building
an exercise plan or maybe just learning more about your
Engage
condition. Whatever your goal, online tools walk you
These first actions will get you started. You must complete
step-by-step through the process of creating a plan for better
these actions to qualify for the incentive.
health — privately, at your own pace. Once you are enrolled,
• Complete the Health Assessment
you can learn more about online coaching by logging in to
• Participate in a Biometric Screening
www.aetna.com and clicking “Go to MyActiveHealth.”
• Live a Tobacco-Free Lifestyle (validated through Biometric
• Nurse coach – If you’re at high risk for a chronic health
Screening)
condition, or if you’ve already been diagnosed, you can work
1.
one-on-one with a registered nurse who can help you take
control of your health and avoid future complications. Your
nurse coach can help you better understand your condition,
recognize warning signs and symptoms, help you stick to your
doctor’s treatment plan and maybe just feel better every day.
In most cases, if your claims show you have a chronic
condition, a nurse coach will call you. Or, as an enrolled
member, you can call 1-866-738-6737 to connect with a
disease management nurse directly.
www.aetna.com > Go to MyActiveHealth > OnlineCoaching
Wellness Incentive Program –
Healthy Rewards Pricing
Following a healthy lifestyle makes sense not only because
you’ll feel better, but because you could spend less on
your health care. That means more money in your pocket
for other things.
EDMC rewards healthy living and positive choices for better
health with financial incentives through our wellness incentive
program. Employees who enroll in an Aetna medical plan are
eligible. There’s no additional cost to participate. In fact,
participation pays you.
Healthy Rewards Pricing is the incentive — incentive for you
to reach for your best health. And the reward? By performing
healthy actions, you can lower the premium you pay for the
health plan you choose.
2.
Participate
After your Health Assessment is complete, you will receive
a report of your current health condition and health risks.
You’ll also get an action plan with suggestions on how you
can improve your health. These can translate into actions
that you can choose from to complete your required wellness
program activities. Choose from the following:
• Attain Biometric Screening targets
• Participate in online coaching
• Engage in telephonic lifestyle coaching
• Engage in telephonic coaching with a disease management
registered nurse if you’re at high risk for a chronic condition,
or a maternity management nurse if you’re expecting
3.
Track your progress
Log in to www.aetna.com to track your progress. The easyto-read Activity Table will tell you how close you are to achieving
your incentive reward. You’ll also find details and tips for
reaching your goals. Engage in the program early in the year
for the best chance at lowering your premiums.
www.aetna.com > Go to MyActiveHealth > Rewards Center
As an enrolled Aetna plan member, you can complete the
wellness program activities and track your progress by logging
in to www.aetna.com and clicking on “Go to MyActiveHealth.”
Your spouse/domestic partner, if also enrolled in the plan, is
invited to participate in the program as well. Their participation,
however, is not required for you to qualify for Healthy
Rewards Pricing.
33
Important Notices for Participants
Patient Protection and Affordable Care Act
Notice of Privacy Practices for Protected Health Information
Notice Regarding Grandfathered Health Plan Status
Under the Patient Protection and Affordable Care Act (referred to as the
“Health Care Reform Act”), certain health plans (called grandfathered plans)
in existence on March 23, 2010 had to be changed to reflect only some,
and not all, of the new health plan rules. Education Management LLC
(“Education Management”) believes that the Medical Feature of the Education
Management LLC Signature Benefits Plan (the “Signature Benefits Plan”)
is a grandfathered plan. That means that the Medical Feature has been
changed only in limited ways, such as eliminating lifetime limits on benefits.
If you have any questions about which new health plan rules apply to
grandfathered plans and which ones do not apply to grandfathered plans,
you may contact the plan administrator at the address or phone number
listed below. You may also contact the Employee Benefits Security
Administration (“EBSA”), U.S. Department of Labor at 1-866-444-3272
or www.dol.gov/ebsa/healthreform. The EBSA’s website has a table
summarizing which health plan rules do and do not apply to grandfathered
health plans.
This notice describes how health information about you may be used and
disclosed and how you can get access to this information. Please review
this notice carefully.
Introduction
Education Management LLC (“EDMC”) sponsors and administers a group
health, dental and vision plan, which also includes a health care flexible
spending account and employee assistance program. This Notice applies to all
of these benefits. This Notice refers to these benefits collectively as the “Plan.”
The Plan’s Duties
1. Safeguard The Privacy Of Your Protected Health Information (“PHI”). Federal
law requires that the Plan safeguard the privacy of your “protected health
information” or “PHI.” PHI includes individually identifiable information
created or received by, or on behalf of, the Plan relating to your past, present
or future physical or mental health condition, treatment for that condition,
or payment for that treatment. Information that is de-identified is not PHI
and is not subject to this Notice.
2. Notify You Of The Plan’s Privacy Policies. Federal law requires that the Plan
notify you of their legal duties and privacy policies and procedures with
respect to your PHI. This Notice is intended to satisfy that requirement.
3. Use And Disclose Your PHI Only As Described In This Notice. The Plan will
abide by the terms of this Notice as long as it remains in effect. The Plan will
use and disclose your PHI without first obtaining your written authorization
only as described in this Notice. If the Plan obtains your written authorization
for a use or disclosure not described in this Notice, you may revoke or modify
that authorization at any time by submitting the appropriate form to the
Privacy Official designated in this Notice. The Privacy Official will provide you
with a copy of the form upon request.
How The Plan Will Use And Disclose Your PHI Without Your Authorization
1. Uses And Disclosures For Treatment. The Plan may use and disclose your
PHI for “treatment.” “Treatment” includes the provision, coordination or
management of health care and related services by one or more health care
providers. For example, the Plan may assist in coordinating health care and
related benefits.
2. Uses And Disclosures For Payment. The Plan will use and disclose your PHI for
“payment.” “Payment” includes, but is not limited to, claims processing,
claims payment, payroll deductions, eligibility determinations, and claims
disputes. For example, the Plan will use your PHI to determine whether you
are entitled to benefits and, if you are, to determine your benefits.
3. Uses And Disclosures For Health Care Operations. The Plan will use and
disclose your PHI for “health care operations.” “Health care operations”
include, but are not limited to, securing or placing a contract for reinsurance
of risk relating to claims for health care; arranging for medical review, legal
services, and auditing functions; fraud and abuse detection programs;
business planning and development; investigating and resolving complaints
of privacy violations; and business management and general administrative
activities. For example, the Plan may disclose PHI as part of an investigation
into a fraudulent claim.
4. Disclosures To The Plan’s Sponsor. The sponsor of the Plan is EDMC. The Plan
will disclose your PHI to EDMC employees responsible for “plan administration
functions.” “Plan administration functions” include, but are not limited to,
claims processing, eligibility determinations, and appeals from denials of
coverage. EDMC employees are prohibited from using or disclosing your
PHI for employment-related decisions.
5. Disclosures To Business Associates. The Plan has contracted with one or
more third parties (referred to as a business associate) to use and disclose
your PHI to perform services for the Plan. The Plan will obtain each business
associate’s written agreement to safeguard your PHI.
6. Information-Sharing Among EDMC’s Health Plan. EDMC’s health plans
will share PHI with each other, and with business associates, as permitted
by state and federal law, to carry out treatment, payment or health care
operations.
Notice of Opportunity to Enroll in Connection with Extension
of Dependent Coverage to Age 26
Starting on January 1, 2011, the age limit for children to be eligible dependents
under the Signature Benefits Plan was changed to age 26 (i.e., until 26th
birthday). Dependent children whose coverage ended, or who were denied
coverage (or were not eligible for coverage), because the availability of
dependent coverage of children ended before attainment of age 26 are
eligible to enroll in the Signature Benefits Plan so long as the child does
not have coverage available through another employer-sponsored health plan.
Enrollment may be requested for such children during the annual Open
Enrollment period. Enrollment will be effective January 1. For more information,
contact the plan administrator at the address or phone number listed below.
Notice that Lifetime Limit No Longer Applies and Enrollment Opportunity
Starting on January 1, 2011, the lifetime limit on the dollar value of benefits
under the Medical Feature of the Signature Benefits Plan do not apply.
Individuals whose coverage ended by reason of reaching a lifetime limit
under the Medical Feature of the Signature Benefits Plan may again be eligible
to enroll. Individuals may request enrollment during the annual Open Enrollment
period. Enrollment will be effective January 1. For more information, contact the
plan administrator at the address or phone number listed below.
Reservation of Rights
It is important to explain that Education Management has always reserved,
and continues to reserve, the right to amend, modify or terminate the
Signature Benefits Plan (and any Feature) at any time and for any reason.
That means, for example, that the changes described in this Notice could be
changed further, that any other provision may be changed, and that the
Signature Benefits Plan could be discontinued in its entirety for any reason.
Plan Administrator
Health and Welfare Plan Committee
Education Management LLC
c/o HR One Connect
210 Sixth Avenue, 21st Floor
Pittsburgh, PA 15222
Phone Number: 1-888-HR1-EDMC
34
How The Plan Might Use Or Disclose Your PHI Without Your Authorization
Federal law generally permits the Plan to make certain uses or disclosures of PHI
without your permission. Federal law also requires the Plan to list in the Notice
each of these categories of disclosures. The listing is below.
1. Uses Or Disclosures Required By Law. The Plan may use or disclose your
PHI as required by any statute, regulation, court order or other mandate
enforceable in a court of law.
2. Disclosures For Workers’ Compensation Purposes. The Plan may disclose
your PHI as required or permitted by state or federal workers’ compensation
laws.
3. Disclosures To Family Members Or Close Friends. The Plan may disclose
your PHI to a family member or close friend who is involved in your care or
payment for your care if (a) you are present and agree to the disclosure,
or (b) you are not present or you are not capable of agreeing, and EDMC
determines that it is in your best interest to disclose the information.
4. Disclosures For Judicial And Administrative Proceedings. The Plan may
disclose your PHI in an administrative or judicial proceeding in response to a
subpoena or a request to produce documents. The Plan will disclose your
PHI in these circumstances only if the requesting party first provides written
documentation that the privacy of your PHI will be protected.
5. Disclosures For Law Enforcement Purposes. The Plan may disclose your PHI
for law enforcement purposes to a law enforcement official, such as in
response to a grand jury subpoena.
6. Incidental Uses And Disclosures. The Plan may use or disclose your PHI in a
manner which is incidental to the uses and disclosures described in this Notice.
7. Uses And Disclosures For Public Health Activities. The Plan may disclose
your PHI to a government agency responsible for preventing or controlling
disease, injury, disability, or child abuse or neglect. The Plan may disclose
your PHI to a person or entity regulated by the Food and Drug
Administration (“FDA”) if the disclosure relates to the quality or safety
of an FDA-regulated product, such as a medical device.
8. Uses And Disclosures For Health Oversight Activities. The Plan may disclose
your PHI to a government agency responsible for overseeing the health care
system or health-related government benefit programs.
9. Disclosures About Victims Of Abuse, Neglect, Or Domestic Violence.
The Plan may disclose your PHI to the responsible government agency if
(a) the Privacy Official reasonably believes that you are a victim of abuse,
neglect, or domestic violence, and (b) the Plan is required or permitted by
law to make the disclosure. The Plan will promptly inform you that such a
disclosure has been made unless the Plan’s Privacy Official determines that
informing you would not be in your best interests.
10. Uses And Disclosures To Avert A Serious Threat To Health Or Safety. The
Plan may use or disclose your PHI to reduce a risk of serious and imminent
harm to another person or to the public.
11. Disclosures To HHS. The Plan may disclose your PHI to the United States
Department of Health and Human Services (“HHS”), the government
agency responsible for overseeing the Plan’s compliance with federal
privacy law and regulations regulating the privacy of PHI.
12. Uses And Disclosures For Research. The Plan may use or disclose your
PHI for research, subject to conditions. “Research” means systemic
investigation designed to contribute to generalized knowledge.
13. Uses And Disclosures In Connection With Your Death Or Organ Donation.
The Plan may disclose your PHI to a coroner for identification purposes,
to a funeral director for funeral purposes, or to an organ procurement
organization to facilitate transplantation of one of your organs.
14. Uses And Disclosures For Specialized Government Functions. The Plan may
disclose your PHI to the appropriate federal officials for intelligence and
national security activities authorized by law or to protect the President or
other national or foreign leaders. If you are a member of the U.S. Armed
Forces or of a foreign armed forces, the Plan may use or disclose your PHI
for activities deemed necessary by the appropriate military commander.
If you were to become an inmate in a correctional facility, the Plan may
disclose your PHI to the correctional facility in certain circumstances.
If applicable State law does not permit the disclosure described above, the
Plan will comply with the stricter State law.
The Plan’s Disclosures With Your Prior Authorization
The Plan will obtain your written authorization, if and to the extent required
by state or federal law, before disclosing any of the following categories of
information:
1. Psychotherapy Notes. Psychotherapy notes are separately filed notes about
your conversations with your mental health professional during a counseling
session. Psychotherapy notes do not include summary information about
your mental health treatment. The Plan may use and disclose such notes,
without your authorization, when needed by the Plan to defend against
litigation filed by you.
2. HIV/AIDS Status, Infection Or Test Results. “HIV” means human
immunodeficiency virus. “HIV infection” means infection with HIV or any
other related virus identified as a probable causative agent of AIDS. “AIDS”
means acquired immunodeficiency syndrome.
3. Results Of Genetic Testing. “Genetic testing” means any laboratory test
of human DNA-RNA or chromosomes that is used to identify the presence
or absence of alterations in genetic material which are associated with a
predisposition for a clinically recognized disease, disorder, or syndrome.
“Genetic testing” includes only those tests which are direct measures of such
alterations. “Genetic testing” does not include chemical, blood or urine
analyses that are widely accepted and used in clinical practice and are not
used to determine genetic traits.
4. Substance Abuse Records. Substance abuse records contain information
created by a drug or alcohol abuse program about the patient’s diagnosis,
prognosis or treatment.
Your Privacy Rights As A Participant In The Plan
You may exercise the rights described below for each Plan in which you
participate. The forms referenced below can be obtained from EDMC’s
Privacy Official (the “Privacy Official”).
1. Right To Access Your PHI. You may request a review or photocopies of your
PHI on file with the Plan by submitting the appropriate form to the Privacy
Official. The Plan will provide access, or will mail the photocopies to you,
within 30 days of your request unless the PHI is not available on-site, in
which case the Plan will provide access or mail the photocopies within 60
days of your request. The Plan may extend the deadline for access or mailing
by up to 30 days. The Plan will provide you with a written explanation of any
denial of your request for access or photocopies. The Plan may charge you a
reasonable, cost-based fee for photocopies or for mailing. If there will be a
charge, the Privacy Official will first contact you to determine whether you
wish to modify or withdraw your request.
2. Right To Amend Your PHI. You may amend your PHI on file with the Plan
by submitting the appropriate request form to the Privacy Official. The Plan
will respond to your request within 60 days. The Plan may extend the
deadline by up to an additional 30 days. If the Plan denies your request
to amend, the Plan will provide a written explanation of the denial.
You would then have 30 days to submit a written statement explaining
your disagreement with the denial. Your statement of disagreement
would be included with any future disclosure of the disputed PHI.
3. Right To An Accounting Of Disclosures Of Your PHI. You may request
an accounting of the Plan’s disclosures of your PHI by submitting the
appropriate form to the Privacy Official. The Plan will provide the accounting
within 60 days of your request. The Plan may extend the deadline by up to
an additional 30 days. The accounting will exclude the following disclosures:
(a) disclosures for “treatment,” “payment,” or “health care operations,” (b)
disclosures to you or pursuant to your authorization, (c) disclosures to family
members or close friends involved in your care or in payment for your care,
(d) disclosures as part of a data use agreement, and (e) incidental disclosures.
The Plan will provide the first accounting during any 12-month period
without charge. The Plan may charge a reasonable, cost-based fee for each
additional accounting during the same 12-month period. If there will be a
charge, the Privacy Official will first contact you to determine whether you
wish to modify or withdraw your request.
4. Right To Request Additional Restrictions On The Use Or Disclosure Of Your
PHI. You may request that the Plan place restrictions on the use or disclosure
of your PHI for “treatment,” “payment,” or for “health care operations”
in addition to the restrictions required by federal law by submitting the
appropriate request form to the Privacy Official. The Plan will notify you in
writing within 30 days of your request whether or not it will agree to the
requested restriction. The Plan is not required to agree to your request.
35
5. Right To Request Communications By Alternative Means Or To An
Alternative Location. The Plan will honor your reasonable request to receive
PHI by alternative means, or at an alternative location, if you submit the
appropriate request form to the Privacy Official.
6. Right To A Paper Copy Of This Notice. You may request at any time that the
Privacy Official provide you with a paper copy of this Notice.
A Note About Personal Representatives
All of the rights described previously may be exercised by your personal
representative after the personal representative has provided proof of his or her
authority to act on your behalf. Proof of authority may be established by (a) a
power of attorney for health care purposes, or a general power of attorney,
notarized by a notary public, (b) a court order appointing the person to act as
your conservator or guardian, or (c) any other document which the Privacy
Official, in his or her sole and absolute discretion, deems appropriate.
Your Right To File A Complaint
If you believe that your privacy rights have been violated because the Plan has
used or disclosed your PHI in a manner inconsistent with this Notice, because
the Plan has not honored your rights as described in this Notice, or for any
other reason, you may file a complaint in one, or both, of the following ways:
1. Internal Complaint: Within 180 days of the date you learned of the conduct,
you can submit a complaint using the appropriate complaint form to the
Complaint Official, c/o Education Management LLC, 210 Sixth Avenue, 21st
Floor, Pittsburgh, PA 15222-2603 or call 1-888-HR1-EDMC and ask for the
HIPAA Privacy Official. You can obtain a complaint form from the Privacy Official.
2. Complaint To HHS: Within 180 days of the date you learned of the
conduct, you may submit a complaint by mail to the Secretary of the
U.S. Department of Health and Human Services, Hubert H. Humphrey
Building, 200 Independence Ave., S.W., Washington, D.C. 20201.
The Plan’s Anti-Retaliation Policy
The Plan will not retaliate against you for submitting an internal complaint, a
complaint to HHS, or for exercising your other rights as described in this Notice
or under applicable law.
Whom To Contact For More Information About The Plan’s Privacy
Policies And Procedures
If you have any questions about this Notice, or about how to exercise any
of the rights described in this Notice, you should contact the Benefits
Manager by mail c/o Education Management LLC, 210 Sixth Avenue, 21st
Floor, Pittsburgh, PA 15222-2603 or call 1-888-HR1-EDMC and ask for the
HIPAA Privacy Official.
Revisions To The Privacy Policy And To The Notice
The Plan has the right to change this Notice or the Plan’s privacy policies and
procedures at any time. If the change to the Plan’s privacy policies and
procedures would have a material impact on your rights, the Plan will notify
you of the change by promptly mailing (either electronically or by U.S. Postal
Service) a revised Notice to you which reflects the change. Any change to the
Plan’s privacy policies and procedures, or to the Notice, will apply to your PHI
created or received before the revision.
Effective Date Of This Notice: 7/1/2011
Notice of Women’s Health and Cancer Rights Act of 1998
If you have had or are going to have a mastectomy, you may be entitled to
certain benefits under the Women’s Health and Cancer Rights Act of 1998
(WHCRA).
Under the Education Management LLC medical plans, for mastectomy-related
benefits, coverage will be provided in a manner determined in consultation
with the attending physician and the patient, for:
• All stages of reconstruction of the breast on which the mastectomy was
performed;
• Surgery and reconstruction of the other breast to produce a symmetrical
appearance;
• Prostheses; and
• Treatment of physical complications of the mastectomy, including
lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance
applicable to other medical and surgical benefits provided under the plan.
Therefore, the deductibles and coinsurance associated with these benefits will
apply (see your Benefit Plan Description for more details).
More information about WHCRA can be requested by calling HR One Connect
at 1-888-471-3362 (1-888-HR1-EDMC).
36
Important Notice of Creditable Coverage and Information About
Your Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice
has information about your current prescription drug coverage with Education
Management LLC and about your options under Medicare’s prescription drug
coverage. This information can help you decide whether or not you want to join
a Medicare drug plan. If you are considering joining, you should compare your
current coverage, including which drugs are covered at what cost, with the
coverage and costs of the plans offering Medicare prescription drug coverage in
your area. Information about where you can get help to make decisions about
your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage
and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone
with Medicare. You can get this coverage if you join a Medicare Prescription
Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that
offers prescription drug coverage. All Medicare drug plans provide at least a
standard level of coverage set by Medicare. Some plans may also offer more
coverage for a higher monthly premium.
2. Education Management LLC has determined that the prescription drug
coverage offered as part of the Signature Benefits Plan is, on average
for all plan participants, expected to pay out as much as standard
Medicare prescription drug coverage pays and is therefore considered
Creditable Coverage.
Because your existing coverage is creditable coverage, you can keep this
coverage and not pay a higher premium (a penalty) if you later decide to
join a Medicare drug plan.
You can join a Medicare drug plan when you first become eligible for
Medicare and each year from October 15th through December 7th.
However, if you lose creditable prescription drug coverage, through no fault
of your own, you will also be eligible for a two (2) month Special Enrollment
Period (SEP) to join a Medicare drug plan.
If you decide to join a Medicare drug plan, your current Education Management
LLC coverage will not be affected. Education Management LLC will continue
to pay primary or secondary as it had before you enrolled in a Medicare
prescription drug plan. You may also drop the Education Management LLC
coverage, in which case Medicare will be your only payer. You can re-enroll in
the Education Management LLC plan during the annual open enrollment
period or if you have a special enrollment event.
You should also know that if you drop or lose your coverage with Education
Management LLC and don’t join a Medicare drug plan within 63 continuous
days after your current coverage ends, you may pay a higher premium
(a penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug
coverage, your monthly premium may go up by at least 1% of the Medicare
base beneficiary premium per month for every month that you did not have
that coverage.
For example, if you go nineteen months without creditable coverage, your
premium may consistently be at least 19% higher than the Medicare base
beneficiary premium. You may have to pay this higher premium (a penalty) as
long as you have Medicare prescription drug coverage. In addition, you may
have to wait until the following October to join.
For more information about your options under Medicare
prescription drug coverage
More detailed information about Medicare plans that offer prescription
drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the
handbook in the mail every year from Medicare. You may also be contacted
directly by Medicare drug plans.
For more information about Medicare prescription drug coverage:
• Visit: www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover
of your copy of the “Medicare & You” handbook for their telephone number)
for personalized help
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048
If you have limited income and resources, extra help paying for Medicare
prescription drug coverage is available. For information about this extra help,
visit Social Security on the web at www.socialsecurity.gov, or call them at
1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join
one of the Medicare drug plans, you may be required to provide a
copy of this notice when you join to show whether or not you have
maintained creditable coverage and whether or not you are required
to pay a higher premium (a penalty).
Education Management LLC will provide this notice each year before the next
Medicare drug plan enrollment period and/or if prescription drug coverage
through Education Management LLC changes. You also may request a copy.
For more information about this notice or your current prescription drug
coverage available to you under the Education Management LLC group
insurance program, contact:
Date: October 15, 2012
Name of Entity/Sender: Education Management LLC
Contact – Position/Office: HR One Connect
Address: 210 Sixth Avenue, 21st Floor
Pittsburgh, PA 15222
Phone Number: 1-888-471-3362 (1-888-HR1-EDMC)
Premium Assistance Under Medicaid and the Children’s Health
Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you are eligible for
health coverage from your employer, your State may have a premium assistance
program that can help pay for coverage. These States use funds from their
Medicaid or CHIP programs to help people who are eligible for these programs,
but also have access to health insurance through their employer. If you or your
children are not eligible for Medicaid or CHIP, you will not be eligible for these
premium assistance programs.
If you or your dependents are already enrolled in Medicaid or CHIP and you live
in a State listed below, you can contact your State Medicaid or CHIP office to
find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and
you think you or any of your dependents might be eligible for either of these
programs, you can contact your State Medicaid or CHIP office or dial
1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply.
If you qualify, you can ask the State if it has a program that might help you
pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium
assistance under Medicaid or CHIP, as well as eligible under your employer plan,
your employer must permit you to enroll in your employer plan if you are not
already enrolled. This is called a “special enrollment” opportunity, and you
must request coverage within 60 days of being determined eligible
for premium assistance. If you have questions about enrolling in your
employer plan, you can contact the Department of Labor electronically at
www.askebsa.dol.gov or by calling toll-free 1-866-444-EBSA (3272).
If you live in one of the following States, you may be eligible for
assistance paying your employer health plan premiums. The following
list of States is current as of July 31, 2012. You should contact your
State for further information on eligibility.
ALABAMA – Medicaid
Website: http://www.medicaid.alabama.gov
Phone: 1-855-692-5447
ALASKA – Medicaid
Website: http://health.hss.state.ak.us/dpa/programs/medicaid/
Phone (Outside of Anchorage): 1-888-318-8890
Phone (Anchorage): 907-269-6529
ARIZONA – CHIP
Website: http://www.azahcccs.gov/applicants
Phone (Outside of Maricopa County): 1-877-764-5437
Phone (Maricopa County): 602-417-5437
COLORADO – Medicaid
Medicaid Website: http://www.colorado.gov/
Medicaid Phone (In state): 1-800-866-3513
Medicaid Phone (Out of state): 1-800-221-3943
FLORIDA – Medicaid
Website: https://www.flmedicaidtplrecovery.com/
Phone: 1-877-357-3268
GEORGIA – Medicaid
Website: http://dch.georgia.gov/
Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP)
Phone: 1-800-869-1150
IDAHO – Medicaid and CHIP
Medicaid Website: www.accesstohealthinsurance.idaho.gov
Medicaid Phone: 1-800-926-2588
CHIP Website: www.medicaid.idaho.gov
CHIP Phone: 1-800-926-2588
INDIANA – Medicaid
Website: http://www.in.gov/fssa
Phone: 1-800-889-9949
IOWA – Medicaid
Website: www.dhs.state.ia.us/hipp/
Phone: 1-888-346-9562
KANSAS – Medicaid
Website: http://www.kdheks.gov/hcf/
Phone: 1-800-792-4884
KENTUCKY – Medicaid
Website: http://chfs.ky.gov/dms/default.htm
Phone: 1-800-635-2570
LOUISIANA – Medicaid
Website: http://www.lahipp.dhh.louisiana.gov
Phone: 1-888-695-2447
MAINE – Medicaid
Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html
Phone: 1-800-977-6740
TTY: 1-800-977-6741
MASSACHUSETTS – Medicaid and CHIP
Website: http://www.mass.gov/MassHealth
Phone: 1-800-462-1120
MINNESOTA – Medicaid
Website: http://www.dhs.state.mn.us/
Click on Health Care, then Medical Assistance
Phone: 1-800-657-3629
MISSOURI – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 573-751-2005
MONTANA – Medicaid
Website: http://medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml
Phone: 1-800-694-3084
NEBRASKA – Medicaid
Website: www.ACCESSNebraska.ne.gov
Phone: 1-800-383-4278
NEVADA – Medicaid
Medicaid Website: http://dwss.nv.gov/
NEW HAMPSHIRE – Medicaid
Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf
Phone: 603-271-5218
NEW JERSEY – Medicaid and CHIP
Medicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid
CHIP Website: http://www.njfamilycare.org/index.html
CHIP Phone: 1-800-701-0710
NEW YORK – Medicaid
Website: http://www.nyhealth.gov/health_care/medicaid/
Phone: 1-800-541-2831
NORTH CAROLINA – Medicaid
Website: http://www.ncdhhs.gov/dma
Phone: 919-855-4100
NORTH DAKOTA – Medicaid
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone: 1-800-755-2604
37
OKLAHOMA – Medicaid and CHIP
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
OREGON – Medicaid and CHIP
Website: http://www.oregonhealthykids.gov
http://www.hijossaludablesoregon.gov
Phone: 1-877-314-5678
PENNSYLVANIA – Medicaid
Website: http://www.dpw.state.pa.us/hipp
Phone: 1-800-692-7462
RHODE ISLAND – Medicaid
Website: www.ohhs.ri.gov
Phone: 401-462-5300
SOUTH CAROLINA – Medicaid
Website: http://www.scdhhs.gov
Phone: 1-888-549-0820
SOUTH DAKOTA – Medicaid
Website: http://dss.sd.gov
Phone: 1-888-828-0059
TEXAS – Medicaid
Website: https://www.gethipptexas.com/
Phone: 1-800-440-0493
UTAH – Medicaid and CHIP
Website: http://health.utah.gov/upp
Phone: 1-866-435-7414
VERMONT– Medicaid
Website: http://www.greenmountaincare.org/
Phone: 1-800-250-8427
VIRGINIA – Medicaid and CHIP
Medicaid Website: http://www.dmas.virginia.gov/rcp-HIPP.htm
CHIP Website: http://www.famis.org/
CHIP Phone: 1-866-873-2647
WASHINGTON – Medicaid
Website: http://hrsa.dshs.wa.gov/premiumpymt/Apply.shtm
Phone: 1-800-562-3022 ext. 15473
WEST VIRGINIA – Medicaid
Website: www.dhhr.wv.gov/bms/
Phone: 1-877-598-5820, HMS Third Party Liability
WISCONSIN – Medicaid
Website: http://www.badgercareplus.org/pubs/p-10095.htm
Phone: 1-800-362-3002
WYOMING – Medicaid
Website: http://health.wyo.gov/healthcarefin/equalitycare
Phone: 307-777-7531
To see if any more States have added a premium assistance program
since July 31, 2012, or for more information on special enrollment
rights, you can contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (1-866-444-3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Ext. 61565
Enroll through the HR One Connect
Employee Resource website.
You’ll find everything you need to help you decide, such as:
• Enrollment options
• Rates
• Plan comparison tools
• Communication materials
1-888-471-3362 (1-888-HR1-EDMC) / https://ess.edmc.edu
Although it is the company’s intention to continue the benefits and the individual options contained in this brochure, the Company reserves the right to
unilaterally change, modify or discontinue any benefit or individual option (in total or in part) without notice. If a plan is changed or terminated, you will be
notified. The benefit information in this brochure is not meant to be a complete representation of all the terms and conditions of the individual benefit plans,
nor is this information intended to serve as the summary plan description. All benefit coverage, terms and conditions are subject to the provisions detailed in the
respective plan documents, insurance contracts and summary plan descriptions. To the extent any difference exists between the information in this booklet and
the contracts, the differences will be resolved by the Signature Benefits Plan Document. Receipt of this brochure does not create an employment contract between
the Company and its employees. Further information can be obtained by contacting HR One Connect at 1-888-471-3362 (1-888-HR1-EDMC).
CCG EDMC-0015 (10/2012)

EDMC OE 2013 Guide_Layout 1

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