2015 BENEFITS OPEN ENROLLMENT GUIDE

Transcription

2015 BENEFITS
OPEN
ENROLLMENT
GUIDE
OCTOBER 3–17, 2014
Explore how
to be healthier,
stronger, fitter,
and more balanced.
Benefits and Health Fair
Thursday, October 16, 2014
9 a.m.–4 p.m.
Ida Noyes Hall, 1212 E. 59th St.
Visit our fair to access information and resources that
can enhance your well-being. Learn from experts
about ways to enrich your life through better nutrition,
exercise, and stress reduction.
Maroon Savings Choice Plan and Health Savings
Account Information Sessions
• 10 a.m.–11 a.m.
• 1 p.m.–2 p.m.
Ida Noyes Hall, 3rd Floor
Dear University of Chicago Colleagues,
Open Enrollment for 2015 is Friday, October 3, through Friday, October 17, 2014. Annual Open
Enrollment is the time of year when all eligible University of Chicago colleagues can re-evaluate
their benefit needs and review current plan elections to ensure they continue to meet their
needs and those of their families. Now is the time to make changes to all 2014 elections or
enroll for the first time for the 2015 calendar year. Any new elections and all changes will
become effective January 1, 2015, and continue through December 31, 2015.
In an effort to continue to offer benefit choices that fit the diverse needs of the University
population, a new medical plan will be offered for 2015, the Maroon Savings Choice, which
will include a Health Savings Account. This guidebook includes helpful information for
evaluating your benefit options, including the new medical plan. Additionally, the University
has established a helpful on-line tool called The Choice Is Yours. Using this tool, you can
answer a few questions about your medical benefit needs to find a medical plan that is right
for you based on your responses. Refer to pages 4–5 and 10–13 for more information about
the Maroon Savings Choice health plan and The Choice Is Yours web-based tool.
The University will continue to focus on providing access to high quality health care while
supporting the health and wellness of all University colleagues. Plan options are designed
to ensure choice to University colleagues while maintaining a high level of coverage and
financial protection.
Similar to last year, this guidebook includes the required 2015 Summaries of Medical Benefits
and Coverage (SBC) and a Glossary of Health Coverage and Medical Terms in the back pocket.
The SBC booklet summarizes important information about all of your medical plan options to
help you compare your choices before enrolling and understand your coverage after
enrollment. The glossary defines some of the most common medical and insurance terms.
I encourage you to please carefully review and consider the information provided in the 2015
Benefits Open Enrollment Guide. I look forward to seeing you at the University Benefits and
Health Fair on October 16, 2014, at Ida Noyes Hall. At the Benefits and Health Fair you can learn
about your benefit options and ask questions of the benefits staff and vendors.
Should you have questions on any of the plan options or need assistance related to the Open
Enrollment process, our benefit counselors are eager to assist you. Counselors can be reached
Monday through Friday from 8:30 a.m. to 4:30 p.m. by phone at 773.702.9634 or email at
[email protected].
Sincerely,
Michael F. Knitter
Assistant Vice President
Benefits and Human Resources Operations
The University of Chicago
Questions? Contact Human Resources at [email protected] | 773.702.9634 | humanresources.uchicago.edu 1
GET YOUR FLU SHOT TODAY!
Benefits
and Health Fair
9 a.m.–4 p.m.
Ida Noyes Hall
1212 East 59th Street
DO YOUR PART TO BE FLU SMART.
Please get your flu vaccination.
2 The University of Chicago 2015 Benefits Open Enrollment Guide
Campus &
Student Life
2015 BENEFITS
OPEN ENROLLMENT GUIDE
4
WHAT’S NEW FOR 2015
6 ENROLLMENT PROCESS
10
10
14
16
HEALTH & WELLNESS
Medical Plans
Dental Plans
Vision Plan
18 GROUP LIFE, PERSONAL ACCIDENT, LONG–TERM DISABILITY,
AND LONG–TERM CARE INSURANCE
18 Basic, Supplemental, and Voluntary Life Insurance
19 Personal Accident Insurance
19 Long–Term Disability Insurance
19 Long–Term Care Insurance
24 HEALTH AND DEPENDENT CARE FLEXIBLE SPENDING ACCOUNTS
AND COMMUTER BENEFITS
26 SUPPLEMENTAL RETIREMENT AND DEFERRED COMPENSATION PLANS
27 OTHER BENEFITS
29 NOTICES
32 CON TACT INFO R M AT I ON
What Do I Need to Do?
Open Enrollment is an opportunity for you to review your current health plan elections to
ensure they continue to meet your needs and those of your family.
WHAT BENEFITS REQUIRE RE-ELECTION?
If you want to participate in the health care and/or dependent
care flexible spending accounts (FSA) or the 457(b) Deferred
Compensation Plan during calendar year 2015, you must
complete new enrollment elections. Even if you participated
in these plans during calendar year 2014, your deductions will
default to $0 for 2015 unless you re-enroll. For more information,
see page 24 for flexible spending accounts and page 26 for
the 457(b) Plan.
NO CHANGES TO YOUR CURRENT ELECTIONS?
If you do not want to make any changes to your current medical,
dental, vision, supplemental life, dependent life, personal accident,
long-term disability, long-term care, commuter, or supplemental
retirement elections, you do not need to do anything. Your 2014
elections for these benefit plans will automatically continue for
calendar year 2015.
WHAT IF I WANT TO CHANGE MY CURRENT ELECTIONS OR
ENROLL FOR THE FIRST TIME?
If you want to change your elections or enroll for the first time
in the medical, dental, vision, supplemental life, dependent
life, personal accident, long-term disability, long-term care,
commuter, or supplemental retirement plans, you must access
Employee Self Service at ess.uchicago.edu/ess from any
computer beginning October 3, 2014, through October 17, 2014.
Once you have completed your changes, it is important that you
print the confirmation statement for your records. Any changes
you make during Open Enrollment will take effect on January 1,
2015. Decisions made during Open Enrollment are binding
through December 31, 2015, unless you have a qualified life event,
such as a marriage or birth of a child.
WHAT IF I EXPERIENCE A QUALIFIED LIFE EVENT IN 2015?
Dependents who become eligible during the year can be
added to your coverage within 31 days of the qualified life
event. Eligible dependents are your legal spouse, same-gender
University-registered domestic partner, civil union partner, and
children. Adopted, foster, and stepchildren are also eligible for
coverage. Documentation will be required when you add a
dependent. Contact Human Resources at 773.702.9634 within
31 days of the qualified life event to enroll.
WHAT ’S N E W
New for 2015
MAROON SAVINGS CHOICE PLAN
Effective January 1, 2015, the University will be offering the
Maroon Savings Choice Plan. This medical plan will give you
greater control and flexibility on how your health care dollars
are spent. It will also provide access to a University-funded, tax
advantaged Health Savings Account (HSA).
Highlights of the Maroon Savings Choice Plan
When you elect the Maroon Savings Choice Plan:
QQ The network will be a preferred provider organization
(PPO) administered by BlueCross BlueShield of Illinois.
This plan will offer the same broad network of physicians and
care providers currently available in the Maroon Plan.
QQ
QQ
Like all University medical plans, preventive care is covered
at 100%. This means when you receive annual physicals,
mammograms, colonoscopies, and well-child care, there is
no deductible or coinsurance.
All non-preventive care will require you to meet 100% of your
annual deductible before the plan will provide coverage.
The annual deductible forthis plan is:
•$2,000 in-network/$4,000 out-of-network for those enrolled as an individual
•$4,000 in-network/$8,000 out-of-network for those
enrolled with a spouse and/or children. The family
deductible must be satisfied before coverage begins for
any one family member (often referred to as a “true
family” deductible).
QQ
You pay the full cost of prescription drugs until your
deductible is met unless it is a preventive drug. Once
your annual deductible has been met, then the cost will be
the appropriate copay. For preventive drugs, you will only be
responsible for the copay before and after your deductible is
met. The 2015 copays will be exactly the same as the current
Maroon Plan.
Preventive
(Before and
After
Deductible)
Non-Preventive
Medications
(Participant pays 100%
until deductible is met)
Generic Retail/Mail Order
$8/$16
$8/$16 after deductible
Preferred-Brand Retail/
Mail Order
$20/$40
Non-Preferred-Brand Retail/
Mail Order
$35/$70
Remember to have the pharmacy apply all CVS Caremark network discounts prior to submitting payment.
QQ
Once you meet your annual out-of-pocket maximum, the
Maroon Savings Choice Plan will pay 100% of eligible medical
and prescription drug expenses. The out-of-pocket maximum
for this plan is:
• $3,000 in-network/$6,000 out-of-network if enrolled
as an individual
• $6,000 in-network/$12,000 out-of-network if
enrolled with a spouse and/or children
QQ
Additional plan features can be found on the Medical Plan
Comparison Chart on pages 12 and 13.
Health Savings Account
The Maroon Savings Choice Plan will include a health savings
account (HSA) administered by HSA Bank, a division of Webster
Bank, an FDIC-insured institution. For calendar year 2015, the
University will contribute $500 to the HSA for those enrolled
as individuals or $1,000 for those enrolled with a spouse and/
or children. You have the option to contribute additional funds
through pre-tax payroll deductions, but contributions are not
mandatory. For 2015 you can contribute up to an additional
$2,850 if you are enrolled as an individual or $5,650 if you
are enrolled with a spouse and/or children through payroll
deductions on a pre-tax basis. If you are age 55 or older, you
can contribute an additional $1,000 regardless of your coverage
tier. You can also contribute by check/money order or transfer/
rollover funds directly to HSA Bank.
You can use this account to pay for qualified health expenses,
including deductibles, coinsurance, dental, vision, and
prescription drug expenses. Since the HSA is a bank account
that you own, you will be issued a debit card. As the account
holder, you will be responsible for all banking fees such as
replacement of a debit card or ordering checks. You can use
your debit card or check to directly pay for your eligible outof-pocket health expenses to providers.
Any unused funds will roll over, allowing you to build tax-free
savings for future health care needs, including funds for medical
expenses during retirement years. You can also grow your
HSA savings through TD Ameritrade and Devenir self-directed
investment options (through HSA Bank’s internet banking).
There is no minimum requirement to begin investing.
Important Information to Know If You Choose to Enroll
QQ Eligibility:
•
•
•
•
IRS rules state that participants cannot be covered
in any other Traditional Health Plan, Health Care Reimbursement Account (HRA), Health Care Flexible
Spending Account (FSA), Tricare, and/or VA benefits.
You cannot be claimed as a dependent on another person’s tax return (excluding your spouse’s).
You cannot be enrolled in Medicare.
You are responsible for informing HSA Bank if you are not eligible for an HSA.
WHAT’S NEW
QQ
Health Care Flexible Spending Accounts:
•If you enroll in the HSA, you are not eligible to enroll in
•
QQ
a Health Care Flexible Spending Account (FSA) for the
2015 Plan Year; however, many of the qualified expenses
under a Health Care FSA would be reimbursable under
an HSA.
You are not eligible to participate in the 2014 Plan Year
grace period. If you are enrolled in a Health Care Flexible Spending Account for 2014, any balance not
used by December 31, 2014, will be forfeited.
Health Savings Account:
• The University will automatically open an HSA account for
•
•
•
•
•
you and deposit either $500 or $1,000. These funds will be
available on January 1, 2015.
Your HSA will operate just like a bank account. Once
your account is opened, you will be required to maintain the account, including making updates to your address
and marital status, directly with HSA Bank.
Some states (California, Alabama, and New Jersey) will
apply state taxes to contributions.
You are not required to provide proof that an HSA
distribution was used exclusively for an eligible out-ofpocket health expense; however, you will want to
maintain records showing that payments were for
qualified health care expenses in the event of an
IRS audit.
Investment accounts are not bank guaranteed or FDIC
insured and are the sole responsibility of the
account holder.
HSA Bank will provide monthly account statements, a
year-end status report, and IRS Forms 5498-SA and
1099-SA to report contributions and distributions on
your tax returns.
Additional information about the new Maroon Savings
Choice Plan can also be found online in the
“Changes for 2015” section of the Benefits website
at humanresources.uchicago.edu/benefits.
Advantages of an HSA (Health Savings Account)
• You own the account and it goes with you when you retire or leave.
• In addition to University-provided funds, you can also
contribute to the account up to certain limits.
NEW MEDICAL PLAN DECISION TOOL—
THE CHOICE IS YOURS
Need help choosing a medical plan? Answer a few simple
questions about your medical benefit needs. Then in just a few
minutes, The Choice Is Yours will suggest the medical plan that
is right for you based on your responses. Your responses are
anonymous and you can use the tool multiple times. Visit
www.decisionsupportsuite.com/uchicago to find your choices.
NEW HMO ILLINOIS VISION CARE BENEFITS
All HMO Illinois medical plan participants have access to vision
care benefits through Davis Vision. Effective January 1, 2015,
these benefits will include a $75 allowance toward the purchase
price of eyeglasses/contacts every 24 months. Plan participants
will still continue to receive coverage for one eye examination
every 12 months at no cost and discounts on the purchase of
eyeglasses and contact lenses.
Remember, these benefits are only available from a Davis Vision
network provider and are separate from the benefits offered
through the Vision Service Plan.
NEW UNIVERSITY OF CHICAGO HEALTH PLAN ID CARDS
All University of Chicago Health Plan (UCHP) participants
will receive new ID cards in mid-December for use beginning
January 1, 2015. We ask that you discard your current card when
you receive the new ID card.
NEW WOMEN’S HEALTH FRIENDS AND FAMILY PROGRAM
Effective January 1, 2015, all Maroon Plan, Maroon Savings
Choice Plan, and UCHP participants can begin receiving care
from top specialists in women’s health through the University
of Chicago’s Women’s Health Friends and Family Program. This
program will offer convenient, quality obstetric and gynecologic
care. Visits will be centrally located at the Duchossois Center for
Advanced Medicine. To get started, call 773.834.7999 or email
[email protected].
HEALTH CARE FLEXIBLE SPENDING
ACCOUNT CHANGE
As a health care flexible spending account (FSA) participant,
please keep receipts for all purchases made with your Conexis
debit card. Per IRS regulations, Conexis requires itemized
receipts to verify debit card purchases. Failure to submit proper
documentation within 90 days of the transaction date will
result in the deactivation of your Conexis debit card. Once your
card has been deactivated, you must clear all of the unresolved
card transactions to reactivate your card. Additional information
can be found on page 25.
• Your dollars can be invested and grow tax-free.
• Your funds roll over every year—no use it or lose it requirements!
• Withdrawals are tax-free when used for eligible
health care expenses.
ENRO L L M EN T
Enrollment Process
The enrollment process is the same as last year.
The Online Benefits Enrollment Center gives you the ability to
update your dependent and beneficiary data, and make benefit
choices. It is important that you print the confirmation statement
for your records.
All of your current health and welfare benefit elections can
be viewed on the Employee Self Service (ESS) web page. We
encourage you to review them to ensure they continue to meet
your needs.
Choose your medical, dental, vision, and flexible spending
account benefits carefully, as you will not be able to make
changes after October 17, 2014, unless you experience a qualified
life event. Changes made must be consistent with the type of life
event. Proof of the life event is required and must be submitted
within 31 days of the change effective date.
The benefit elections you make during this open enrollment
period will become effective January 1, 2015, and are binding
through December 31, 2015.
To begin your 2015 enrollment process, access Employee Self
Service at ess.uchicago.edu/ess from any computer beginning
October 3, 2014, through October 17, 2014.
QQ
Enter your CNet ID and password.
QQ
The first screen you will see is the personalized welcome page.
QQ
Select Benefits.
QQ
Select Current Year Coverage to review your 2014 elections.
QQ
QQ
QQ
QQ
QQ
QQ
QQ
QQ
A second message reminds you that if you plan to provide
coverage for this dependent, you will need to submit verification
of relationship to the Benefits Office by November 30, 2014.
Your new dependent is now added to your list. You can continue
entering additional dependents by selecting the
ADD DEPENDENT button.
The dependents you enter will also be included in your list of
beneficiaries. If you need to add other people to your beneficiary
list, use the Beneficiary Update option on the left menu.
You can insert as many other beneficiaries as you wish. Use the
same method as you did in adding dependents. Just select the
ADD BENEFICIARY button and complete the form.
When you have finished entering your dependents and
beneficiaries, select the Begin Election entry.
MEDICAL, DENTAL, AND VISION COVERAGE
QQ Separately select the medical, dental, and vision coverage
level you want.
QQ
QQ
QQ
Select Next Year Enrollment to begin your 2015 elections.
If you leave the enrollment system before submitting your
elections, your choices will not be saved. Remember to print
your confirmation statement for your records.
To add a dependent, select the Add Dependent button.
An Add Dependent form will appear in a separate window.
QQ
A confirmation message asks that you verify the Social Security
number, date of birth, and special status. Select Cancel if you
want to double check. If you save and these are not correct, you
will need to contact the Benefits Office for any corrections.
QQ
Provide the person’s full name.
Select a reason for this entry from those listed. If no reason
fits, simply select No Reason Given.
Select Relationship. Only individuals whose relationship is spouse,
civil union partner, same-gender domestic partner, or child will
be allowed enrollment into the medical, dental, and vision plans.
QQ
Provide the Social Security number and date of birth.
If your dependent child is a twin or triplet, enter a birth order
number (one, two, or three) in the Birth Order field.
Provide a telephone number where the person resides.
Enter disabled or veteran in the Special Status field if
applicable to your dependent.
When you have completed the information, select the
SAVE button.
QQ
QQ
Separately select the medical and dental plans that best
meet your needs.
The rates for each medical, dental, and vision plan and
coverage level are shown.
If you elect the Maroon Savings Choice medical plan and want
to contribute to your Health Savings Account, click on the link
next to it. This link will take you to the Health Savings Account
enrollment page where you will enter the annual amount you
want to contribute.
If there is a physician or medical group ID link next to
the medical plan you select, an ID number is required for
enrollment into this plan. These links will take you to the
corresponding websites for looking up the ID numbers.
If you do not wish to select a physician or group, you can
select the box to allow the carrier to make a selection
for you. You can always change this option later through
the provider.
Separately select the dependents you wish to enroll in the
medical, dental, and vision plans.
When you are finished, select SAVE.
Verification of relationship for each dependent is required. You
only have to provide this information once for enrollment into
medical, dental, or vision plans.
ENR OLLMENT
PERSONAL ACCIDENT INSURANCE
QQ Select the coverage level you want.
QQ
QQ
QQ
QQ
QQ
Select your beneficiary(ies) and benefit percentage amount.
Then select whether you want the person to be a primary or
contingent beneficiary.
If you are only selecting one primary or contingent beneficiary,
allocate 100% of the benefit to him or her.
QQ
QQ
QQ
QQ
QQ
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Any unused funds will roll over to next year.
QQ
When you are finished, select the SAVE button.
Evidence of insurability is required for a new election into
the Optional Plan. You will be contacted through US mail
by Prudential.
HEALTH AND DEPENDENT CARE FLEXIBLE
SPENDING ACCOUNTS
QQ If you enroll in the Maroon Savings Choice medical plan, you
are not allowed to enroll in the Health Care FSA.
QQ
Coverage will not become effective until evidence
of insurability is approved by Prudential.
After you have made your selection, select the
SAVE button.
QQ
Coverage will not become effective until evidence of
insurability is approved by Prudential.
Choose primary and contingent beneficiaries using the same
method as with personal accident insurance. They may be,
but do not have to be, the same designations as your personal
accident insurance selections.
You do not necessarily have to allocate the same way, but
your allocations have to add up to 100%.
VOLUNTARY SPOUSE OR SAME-GENDER DOMESTIC
PARTNER LIFE INSURANCE
QQ Select a coverage level of life insurance for your spouse,
same-gender domestic partner (registered with the
University), or civil union partner.
QQ
QQ
QQ
QQ
Evidence of insurability may be required. If required, you will
be contacted through US mail by Prudential.
VOLUNTARY DEPENDENT CHILD LIFE INSURANCE
QQ Select a coverage level of group life insurance for
your children.
QQ
If enrolled as an individual, you can contribute an annual
maximum of $2,850. If enrolled with a spouse and/or children,
you can contribute an annual maximum of $5,650.
SUPPLEMENTAL LIFE INSURANCE
QQ Select your desired coverage level based on your current
coverage election.
QQ
Enter the annual amount you want to contribute.
If you are selecting two or more primary or contingent
beneficiaries, you will need to split the 100% allocation
between them.
QQ
QQ
For calendar year 2015, the University will contribute $500 to
your account if enrolled as individuals or $1,000 if enrolled with a
spouse and/or children.
QQ
LONG–TERM DISABILITY
QQ Select the long–term disability plan that best meets
your needs.
QQ
HEALTH SAVINGS ACCOUNT
QQ Enrollment in the Maroon Savings Choice is required to
contribute to the Health Savings Account.
Evidence of insurability is required. You will be contacted
through US mail by Prudential.
insurability is approved by Prudential.
QQ
QQ
IRS regulations require re-enrollment into the FSAs each year.
If you are enrolled in a health and/or dependent care FSA during
calendar year 2014, your elections will not automatically be
continued for calendar year 2015.
Enter the annual amount you want to contribute.
For health care, you can contribute an annual minimum of
$250 and maximum of $2,500, if you are not enrolling in the
Maroon Savings Choice medical plan.
For dependent care, you can contribute any amount up to an
annual maximum of $5,000. (Highly compensated employees
can only contribute a maximum of $1,900.)
These election amounts will be available January 1, 2015,
through March 15, 2016. All claims must be submitted by June
30, 2016. Any balance not used by March 15, 2016, will be
forfeited; you cannot receive the balance.
RETIREMENT PLANS
If you would like to enroll in the Supplemental Retirement
Program (SRP) and, if eligible, the 457(b) Deferred Compensation
Plan [457(b) Plan] for 2015, you will be directed to the SRP/457(b)
online enrollment site. If you already are enrolled in the SRP,
you may change your contribution rate and your percentage
allocation between TIAA-CREF and Vanguard online during the
open enrollment period.
If you are eligible and wish to participate in the 457(b) Plan, you
must enroll online for 2015 even if you participated in the 457(b)
Plan in 2014.
COMMUTER BENEFITS
If you would like to enroll in the Commuter Benefits (Qualified
Transportation Program), you will need to contact Conexis at
877.822.9091 or visit mybenefits.conexis.com.
LONG–TERM CARE INSURANCE
If you would like to enroll in long–term care insurance, you
will need to contact Genworth at 800.416.3624 or visit
genworth.com/groupltc, and enter group id: UChicago and
code: groupltc.
ENRO L L M EN T
Enrollment Process, (continued)
ELECTRONIC SIGNATURE
Once you have selected your health and welfare benefits for
2015, ESS will request an electronic signature. You can sign the
online document by selecting the I AGREE button. By selecting
the I AGREE button, you certify that:
QQ
QQ
You authorize the University of Chicago to deduct from your
earnings the required contributions, if any, toward the cost of
the plan(s); and
You cannot change any of your elections for medical,
dental, vision, or health and/or dependent care flexible
spending accounts until the next open enrollment period,
unless you have a qualified life event. Proof of the life event
is required and must be submitted within 31 days of the life
event effective date.
Remember:
QQ
QQ
QQ
All new benefit elections will become effective January 1, 2015.
If any of your benefit elections require the completion of the
evidence of insurability (EOI) process, new benefit elections
will be effective when you have completed the EOI process
and Prudential has approved your new benefit election(s).
If you are adding dependents to your medical, dental, or
vision plans for the first time during Open Enrollment,
verification of relationship documentation must be submitted
by November 30, 2014. If documentation is not received,
coverage elections for unverified dependents will not be
effective January 1, 2015. Your next opportunity for enrollment
will be in the fall of 2015 for coverage effective January 1, 2016.
ENR OLLMENT
Confirmation Statement
Page 1 of 2
CONFIRMATION SCREEN
UNIVERSITY OF CHICAGO BENEFIT ENROLLMENT 01/01/2015 thru 12/31/2015
CONFIRMATION STATEMENT FOR EMPLOYEE ID: *****2697
XXXXXXXX
Election Entry signed: Aug
28, 2014 9:34 PM
DATE
SONIA
ALMANZA
NAME
3621
S. DAMEN
ADDRESS
1
CHICAGO,
IL 2
60609
ADDRESS
This statement is a confirmation of your benefit elections for the Jan. 1, 2015, plan year. Remember to print a copy
of this statement for your records. If you have any questions, please contact the Benefits Office by phone at (773)
702-9634 or email at [email protected].
PRE-TAX BENEFIT ELECTIONS
Pre-Tax
Dollar Amount
Plan Name
Medical
Maroon
You + Fami ly
Dental
MetLife Co-Pay
You + Fami ly
Vision
VSP Vision Cov
You + Chil d(ren)
Health Care FSA
$2,500.00
Dependent Care FSA
$5,000.00
$441.00
$66.87
$16.44
$208.33
$416.67
Total Pre-Tax Amount
$1,149.31
** Please note if you have a same-gender domestic partner, a portion of your deductions will be pre-tax
and a portion will be after-tax.
AFTER-TAX BENEFIT ELECTIONS
After-Tax
Dollar Amount
Plan Name
Personal Accident
$100,000
Yourself and Family
Long Term Disability
Base
$11.66
Group Life Insurance
$492,000.00
$16.73
Child Life Insurance
$10,000
Spouse Life Insurance
$150,000
$2.30
$1.00
$5.10
Total After-Tax Amount
$36.79
DEPENDENTS:
Our records indicate the following information for your dependents.
Please Note: If you add your same-gender domestic partner, he or she must be registered with and approved by
the University before coverage will take effect. If you have added dependents to your medical, dental, or vision plan
for the first time during Open Enrollment, verification of relationship documentation must be submitted by November
30, 2014 to finalize their enrollment. If documentation is not received, coverage elections for unverified dependents
will not be effective January 1, 2015. Your next opportunity to enroll will be in fall of 2015.
Name
SSN
Birth Date Relationship Gender Medical
Dental
Vision
JAVIER
NAMEB.1 ALMANZA
XXX-XX-XXX
...-6768
XX/XX/XXX
Apr07,1976
XXXX
Spouse
XXXX
Male
XXXX
Yes
XXXX
Yes
XXXX
No
ANGELA
NAME M.
2 ALMANZA
XXX-XX-XXX
...-9872
XX/XX/XXX
Jul23,2002
XXXX
Child
XXXX
Female
XXXX
Yes
XXXX
Yes
XXXX
Yes
XAVIER
NAMEALMANZA
3
XXX-XX-XXX
...-9925
XX/XX/XXX
Dec12,2005
XXXX
Child
XXXX
Male
XXXX
Yes
XXXX
Yes
XXXX
Yes
NAME G.
4 ALMANZA
LILIANA
XXX-XX-XXX
...-3058
XX/XX/XXX
Sep03,2008
XXXX
Child
XXXX
Female
XXXX
Yes
XXXX
Yes
XXXX
BENEFICIARIES:
Our records indicate the following information for your beneficiaries
Name
Personal Accident
Yes
Group Life
Insurance
SSN
Birth Date
JAVIER
NAMEB.1 ALMANZA
...-6768
XXXX
XXXX
Apr07,1976
XXXX
Spouse
XXXX
Primary
XXXX
100
XXXX
Primary
XXXX
100
ANGELA
NAME M.
2 ALMANZA
...-9872
XXXX
XXXX
Jul23,2002
XXXX
Child
XXXX
XXXX
XXXX
Contingent
XXXX
34
XAVIER
NAMEALMANZA
3
...-9925
XXXX
XXXX
Dec12,2005
XXXX
Child
XXXX
XXXX
XXXX
Contingent
XXXX
33
NAME G.
4 ALMANZA
LILIANA
XXXX
...-3058
Sep03,2008
Child
XXXX
XXXX
XXXX
Contingent
XXXX
XXXX
Relationship Beneficiary Percent Beneficiary Percent
XXXX
33
https://ess-test.uchicago.edu/ess/ben/igbms25.jsp?ref=99325&linkOrg=&tempid=66926&sv...
9/3/2014
Once you have verified
your elections, it is important that
you print the confirmation statements for your records.
Just select the PRINT button.
HEALT H & W E L L N E SS
Health & Wellness
Medical Plans
The University of Chicago offers two different types of medical plans: two preferred provider
organization (PPO) plans and three health maintenance organization (HMO) plans.
MEDICAL PLANS OFFERED
The University of Chicago offers five medical insurance
plans, all of which provide coverage for pre-existing conditions,
prescription drugs, mental health, and substance abuse with no
lifetime maximum. Choosing and personalizing your benefits
depends on your specific health care needs, doctor preferences,
budget, and the type of plan you prefer. Use the comparison
chart on pages 12 and 13 to determine which of the following
plans best suits your medical needs.
QQ
Maroon Plan (PPO)
QQ
Maroon Savings Choice (PPO)
QQ
University of Chicago Health Plan (HMO)
PREFERRED PROVIDER ORGANIZATION (PPO)
A PPO gives you freedom of choice and greater flexibility than an
HMO. You are not required to choose a primary care physician
and do not need a referral to see a specialist. The PPO offers a
large network of contracting doctors and hospitals to choose
from when care is needed. When a contracting network provider
is used, the care is considered “in-network,” out-of-pocket costs
will be less, and the highest level of benefits is received. If a
doctor outside the network is used, the care is considered “outof-network” and coverage is still provided, but the out-of-pocket
costs will be significantly higher. In addition, PPO members have
access to care anywhere they live, work, or travel, across the
country and around the world.
QQ
Humana Illinois Platinum HMO
With a PPO:
QQ
HMO Illinois (BlueCross BlueShield)
QQ
QQ
COST OF COVERAGE
You and the University of Chicago share the monthly cost for
medical coverage. The University pays the majority of the costs.
Your cost is based on
QQ
QQ
The plan you choose;
There is an annual deductible
You pay a percentage of the charge after you have met your
deductible for each office visit, emergency room visit, and
hospital stay.
There is a Health Savings Account (with the Maroon
Savings Choice Plan only)
The coverage level you choose (yourself only; yourself +
spouse/partner; yourself + child(ren); yourself + family)
WHICH PLAN IS RIGHT FOR YOU?
The best medical plan for you depends on a number of factors:
QQ
Your annual salary; and
QQ
QQ
Whether you are a full-time or part-time employee.
QQ
QQ
HEALTH MAINTENANCE ORGANIZATION (HMO)
QQ
An HMO is a managed care group that provides services and
supplies through its own network of doctors, hospitals, and other
health care facilities. It covers your expenses only if you go to a
health care provider within its network of providers (unless it’s a
life-threatening emergency).
QQ
When you enroll in an HMO plan, you will be required to select a
primary care physician (PCP), who manages your care using the
HMO network’s physicians and facilities. You will need approval
from your PCP before seeing a specialist.
HMOs provide health care within specific geographic areas called
service areas. An HMO’s service area may include all or part of a
particular county. To be a member of an HMO, you must live in its
service area (Illinois and Indiana). Except for emergencies, you
must use doctors in your HMO’s network and within your service
area.
With an HMO:
QQ
There is NO deductible
QQ
There are NO claims to file.
QQ
You pay a fixed copayment for each office visit, emergency
room visit, and hospital stay.
QQ
QQ
QQ
What are your anticipated medical expenses for 2015?
Do you want to participate in a Health Savings Account
or a Flexible Spending Account?
What can you afford to pay out-of-pocket (in terms of
deductibles and copayments) if you or a covered dependent
needs medical care?
Do you have other medical coverage (for example, through
your spouse’s employer)?
Do you have a doctor whom you want to keep seeing, or
would you be willing to switch to a network doctor, if
necessary, to pay less for coverage?
Do you travel often or are you away from the University of
Chicago often?
Do any of your dependents need routine medical care in an
out-of-state location?
The Choice Is Yours
Find the medical plan that is right for you by answering
a few questions about your medical needs. Visit
www.decisionsupportsuite.com/uchicago to find
your choices.
H E ALT H & WELLNESS
Monthly Medical Rates for Full-Time Employees
If your salary is: Under $45,000
$45,000 – $74,999 $75,000 – $99,999 $100,000 – $174,999 $175,000 or more
Yourself Only $117 $155
$174 $275 $290
Yourself + Spouse/Partner $210 $285 $356 $435 $450
Yourself + Child(ren) $195
$271 $320 $355 $405
Yourself + Family $266 $355 $441 $545 $565
Yourself Only $53
$69
$84 $99
$115
Yourself + Child(ren) $96 $124 $151 $179 $206
Yourself + Family $160 $206 $252 $298 $344
$110
$124 $128
$145 $218
$240 $250
Yourself + Family $126 $192 $273 $335
$350
Yourself Only $47
$76
$112 $143
$147
Yourself + Family $143 $222 $316
$395 $410
Yourself Only $41
$68 $94 $110 $118
Yourself + Spouse/Partner $97 $148
$200 $268 $278
Yourself + Child(ren) $88 $135 $190
$215 $230
Yourself + Family $123 $183 $270 $330
$340
Maroon Plan
Maroon Savings Choice Plan
UCHP
HMO Illinois
Monthly Medical Rates for Part-Time Employees
If your salary is: Under $45,000 $45,000 – $74,999 $75,000 – $99,999 $100,000 – $174,999 $175,000 or more
Maroon Plan
$261
$413
$435
Yourself + Spouse/Partner $315 $428 $534
$653 $675
Yourself + Child(ren) $293 $407 $480 $533
$608
Yourself + Family $399 $533
$662 $818 $848
Yourself Only $80
$104 $126
$149 $173
$186 $227
$269 $309
Yourself + Family $240 $309 $378 $447 $516
Yourself Only $69
$110 $165 $186 $192
Yourself + Child(ren) $138 $218
$327
$360 $375
Yourself + Family $189 $288 $410 $503 $525
Yourself Only $71
$114
$168 $215
$221
Yourself + Family $215 $333 $474 $593 $615
Yourself Only $62 $102 $141
$165 $177
Yourself + Child(ren) $132 $203 $285
$323 $345
Yourself + Family $185
$275 $405 $495 $510
UCHP
HMO Illinois
Medical Plan Comparison Chart
Your medical-related needs and considerations are unique, and so are your family’s.
That’s why the University offers you the opportunity to select the plan option that works best for you.
PLAN FEATURE
Maroon Plan
Inside BCBSIL (BlueCross
BlueShield) Network
Outside BCBSIL Network
Inside BCBSIL (BlueCross BlueShield)
Network
Limited to BCBSIL network
Choice of doctor
Limited to BCBSIL network
Any provider
Deductible
Individual — $250
Family — up to $600
Individual — $250
Family — up to $600
Additional $200 per hospital
admission
Individual — $2,000
Family — $4,000
Benefit payment percentage
You pay 20%;
Plan pays 80% of covered expenses
You pay 35% ***; Plan pays 65%
of the costs
You pay 20%;
Out-of-pocket maximum
$2,000/Individual
$4,000/Family
Health Savings Account
(University contribution)
None
Physician office visits
You pay 20%; Plan pays 80%
of covered expenses for
“non-preventive services.”
Preventive services, including
preventive office visits, are covered
at 100%.
You pay 35% ***;
Plan pays 65% of the costs
You pay 20%; Plan pays 80% of
covered expenses for “nonpreventive services.” Preventive
services including preventive office
visits, are covered at 100%.
Hospital: Inpatient
covered expenses
You pay 35%*** (after $200
deductible); Plan pays 65%
of the costs
You pay 20%;
Hospital: Outpatient
You pay 20%;
You pay 35%***; Plan pays 65%
of the costs
Preventive care/wellness
Provided in full
You pay 20%;
Provided in full
Ongoing therapy, occupational
therapy, physical therapy, and
speech therapy
20 visits maximum per condition
20 visits maximum per condition
Hearing services
Not covered
Not covered
Vision services
Contact Davis Vision at 877.393.8844.
Contact Davis Vision at 877.393.8844.
rescriptions
P
(generic/preferred brand-name/
non-preferred brand-name)
Covered under a separate prescription drug plan
administered by CVS Caremark
Retail (30-day supply): $8/$20/$35 copayment
Mail Service (90-day supply): $16/$40/$70 copayment
Covered under a separate prescription
drug plan administered by CVS
Caremark; Retail (30-day supply):
$8/$20/$35 copayment; Mail Service
(90-day supply): $16/$40/$70
copayment. You are responsible for the
full cost of non-preventive drugs until
the plan deductible has been met, after
the deductible copays apply.
Emergency room
You pay 20%;
You pay 20%***;
You pay 20%;
Mental health: Outpatient
covered expenses
You pay 35%***;
You pay 20%;
$3,000/Individual
$6,000/Family
$500/Individual
$1,000/Family
Use this chart to help you make a decision. It’s a good idea to think through how you might use the plan in the coming year. Do you
want a plan that offers you more access to providers? Are you looking for a plan with lower costs? Do you want to have one doctor to
coordinate all your care? What kind of coverage do you want? Do you want to have access to a Health Savings Account? REMEMBER:
All medical plans provide emergency care anywhere in the world. Before you enroll in a new plan, make sure the doctor you want is
accepting new patients.
University of Chicago Health Plan
HMO Illinois
Any Provider
Limited to network
Limited to network
Limited to network
Individual — $4,000
Family — $8,000
Additional $200 per
hospital admission
None
None
None
You pay 35% ***;
You pay nothing or a minimal
copayment; Plan pays 100%
$6,000/Individual
$12,000/Family
$1,500/Individual
$3,000/Family
$1,500/Individual
$3,000/Family
$1,500/Individual
$3,000/Family
None
None
None
You pay 35% ***;
You pay a $10 copayment for a PCP*
visit and $20 for a specialist visit; Plan
covers the remainder
You pay a $10 copayment for a
PCP* visit and $20 for a specialist
visit; Plan covers the remainder
You pay a $10 copayment for a
PCP* visit and $20 for a specialist
visit; Plan covers the remainder
You pay 35%*** (after
$200 deductible); Plan
pays 65% of the costs
You pay $250 copayment per
admission; Plan covers the remainder
You pay up to $300 copayment
per admission ($100 per day for
up to three days); Plan covers the
remainder
You pay $250 copayment
per admission; Plan covers
the remainder
You pay 35%***; Plan pays
65% of the costs
Provided in full
Provided in full
Provided in full
$0 copay
$0 copay
$0 copay
Limit of 60 combined treatments per
calendar year
PCP* and any consulting
physician must determine that the
member’s condition can improve
significantly within 2 months
Limit of 60 combined treatments
per calendar year; $10 copayment
per visit
Exam provided in full; no coverage for
hearing aids
Exam provided in full; no coverage
for hearing aids
$10 PCP*/$20 specialist; no
coverage for hearing aids
Contact the Plan at 773.834.0900
Contact EyeMed Vision Care at
888.289.0595
Contact Davis Vision at
877.393.8844
Retail (30-day supply): $5/$15/$30
copayment; 50% copayment for
maintenance medications after 2nd refill;
Mail service at DCAM** Pharmacy (90day supply): $10/$30/$60 copayment;
Mail service (90-day supply) with CVS
Caremark: $15/$45/$90 copayment
Retail (30-day supply):
$5/$15/$30 copayment;
Mail service (90-day supply):
$10/$30/$60 copayment
Retail (34-day supply):
$50 self-injectables
Mail service & select retail
pharmacies (90-day supply):
$50 copay for self-injectables
You pay 20%***;
$75 copayment; waived if admitted
$75 copayment; waived if
admitted
$75 copayment; waived if
admitted
You pay 35%***;
$10 copayment per visit
(waived for initial visit)
Outside BCBSIL Network
*PCP = Primary Care Physician
**DCAM = Duchossois Center for Advanced Medicine at the University of Chicago Medicine
***You are also responsible for 100% of the charges in excess of the prevailing fee schedule
Dental Plans
The University of Chicago offers two different types of dental plans: a preferred provider
organization (PPO) plan and a copay plan through MetLife.
DENTAL PLANS OVERVIEW
Regular visits to the dentist may do more than just brighten
your smile—they can be important to your overall health. Many
diseases produce oral signs and symptoms. Both of the
University of Chicago dental insurance plans provide coverage
for preventive care, basic care, major care, and orthodontia.
USING YOUR DENTAL BENEFIT IS EASY.
QQ To find a preferred provider, visit metlife.com or call
800.942.0854. Reference the “PDP Plus” network.
Choosing and personalizing your benefits depends on your
specific dental care needs, budget, and the type of plan you
prefer. Under both plans, you are free to visit any licensed dentist
you choose. The dental plans offer a large network of contracting
providers to choose from when dental care is needed.
COST OF COVERAGE
You pay the full cost for your dental coverage based on:
When a contracting network provider is used, the care is
considered “in-network,” out-of-pocket costs will be less, and
the highest level of benefits is received. If a provider outside the
network is used, the care is considered “out-of-network” and
coverage is still provided, but the out-of-pocket costs will be
significantly higher.
WHICH PLAN IS RIGHT FOR YOU?
Although the plans utilize the same provider network, your
costs associated with the plans will vary. Use the Dental Plan
Comparison Chart to determine which plan suits your dental
needs. Copay Plan approximated coinsurance amounts are
for comparison purposes. Fee schedules apply to all in-network
services.
QQ
At your appointment, tell them you have MetLife. There’s
no ID card necessary.
QQ
The plan you choose and
QQ
The coverage level you choose
The best dental plan for you depends on a number
of factors:
QQ
QQ
QQ
What are your anticipated dental expenses for 2015?
What can you afford to pay out-of-pocket (in terms of
deductibles and copayments) when dental care is needed?
Do you have other dental insurance?
Monthly MetLife Dental Rates
Copay Plan
PPO Plan
Yourself only
$25.28
$45.41
Yourself + spouse or domestic/civil union partner (without a child/children)
$41.88
$81.35
Yourself + child/children $48.43$102.15
(without a spouse or domestic/civil union partner)
Yourself + family $66.87
$161.04
(with a spouse or domestic/civil union partner
and child/children)
Dental Plan Comparison Chart
PLAN FEATURE
Choice of Dentist
COPAY PLAN
Inside MetLife Network
Limited to MetLife Network
Deductible
None
Annual Maximum
The most coverage that
the Plan will provide you
in one year. You are
responsible for all dental
costs after you reach your
annual maximum benefit.
Per individual: $5,000
Preventive Care
You pay approximately
10%; Plan pays
approximately 90%
Out of MetLife Network
Any dentist
PPO PLAN
Inside MetLife Network
Out of MetLife Network
Limited to MetLife Network
Any dentist
Per individual: $60**
Per individual: $75*
Per family: Up to $225*
Per family: Up to $3,000
You pay 30%***;
Plan pays 70%
You pay 0%;
Plan pays 100%
One visit in a six month period
You pay 0%***;
Plan pays 100%
Two visits per calendar year
Basic Care
30%; Plan pays approximately 70%
You pay 60%***;
Plan pays 40%
You pay 20%;
Plan pays 80%
You pay 20%***;
Plan pays 80%
Major Care
60%; Plan pays
approximately 40%
You pay 70%***;
Plan pays 30%
You pay 50%;
Plan pays 50%
You pay 50%***;
Plan pays 50%
Orthodontia
(Adult and Child)
You pay 60%;
Plan pays 40%
You pay 60%***;
Plan pays 40%
You pay 50%;
Plan pays 50%
You pay 50%***;
Plan pays 50%
Lifetime maximum per
individual: $1,500
Lifetime maximum per
individual: $500
Lifetime maximum per individual: $1,000
* Waived for orthodontia
** Waived for preventive care and orthodontia
*** You are also responsible for 100% of the charges in excess of the reasonable and customary charge.
Vision Plan
The University of Chicago offers a separate vision plan, through the Vision Service Plan.
VISION PLAN OVERVIEW
The University of Chicago’s separate vision plan offers
comprehensive coverage, including eye exams and discounts on
eyewear. With open access to see any eye care provider, you can
see the one who is right for you.
Eye exams are an important part of overall health care for the
entire family. The summary on the next page may help you
decide if you need or your family needs a separate vision plan.
The Vision Service Plan (VSP) offers a large network of
contracting providers to choose from when vision care is
needed. When a contracting network provider is used, the care
is considered “in-network,” out-of-pocket costs will be less, and
the highest level of benefits is received. If a provider outside the
network is used, the care is considered “out-of-network” and
coverage is still provided, but the out-of-pocket costs will be
significantly higher.
USING YOUR VSP BENEFIT IS EASY.
QQ
QQ
To find a VSP doctor or an affiliate provider, visit vsp.com or
call 800.877.7195. Reference the “choice” network to find an
“in-network” VSP doctor.
At your appointment, tell them you have VSP. There’s no ID
card necessary. If you would like a card, you can visit vsp.com
and print your personalized member vision card.
COST OF COVERAGE
You pay the full cost for this vision coverage. Your cost is based
on the coverage level you choose.
Monthly Vision Rates
Vision Service Plan
Yourself only
$7.49
Yourself + spouse or domestic/civil union partner (without a child/children)
$14.98
Yourself + child/children $16.44
(without a spouse or domestic/civil union partner)
Yourself + family $26.27
(with a spouse or domestic/civil union partner
and child/children)
Summary of Vision Benefits
Benefit
Description
Copay
Frequency
$0
Every calendar year
Your Coverage with VSP Doctors and Participating Retail Chains*
Well Vision Exam
Focuses on your eyes and overall wellness
Prescription glasses
Frame
$25
n
n
Lenses
n
n
Lens options
n
n
n
n
Contacts
(instead of glasses)
Extra savings and discounts
n
n
$150 allowance for a wide selection of frames
20% off amount over your allowance
Included in
Prescription
Glasses
Every other
calendar year
ingle vision, lined bifocal, and lined
S
trifocal lenses
Polycarbonate lenses for dependent children
Included in
Prescription
Glasses
Every calendar year
Standard progressive lenses
Premium progressive lenses
Custom progressive lenses
Average 20%–25% off other lens options
$55
$95–$105
$150–$175
Every calendar year
Contact lens exam (fitting and evaluation)
$150 allowance for contacts
Up to $60
Copay does not apply
Every calendar year
Glasses and Sunglasses
n 20% off additional glasses and sunglasses, including lens options, from any VSP doctor within 12 months of
your last Well Vision Exam
Laser Vision Correction
n Average 15% off the regular price or 5% off the promotional price; discounts only available
from contracted facilities
Your Coverage with Other Providers
Visit vsp.com for details if you plan to see a provider other than a VSP doctor.
Exam
Up to $45
Frame
Up to $70
Single Vision Lenses
Up to $30
Lined Bifocal Lenses
Up to $50
Lined Trifocal Lenses
Up to $65
Progressive Lenses
Contacts
Up to $50
Up to $105
* Coverage with a participating retail chain may be different. Visit vsp.com for details.
G ROUP L I F E , ACC IDE NT, LO NG–T E R M DISAB ILIT Y & LO NG –T E RM CARE INS U RANCE
Group Life, Personal Accident,
Long-Term Disability, and
Long-Term Care Insurance
Whether you’re just getting started or preparing for what’s next in life, someone is depending
on you. Adequate protection means your loved ones can pursue their plans and dreams, even
if something happens to you.
Life Insurance
The University of Chicago group life insurance plans provide
your family (or beneficiary) with a lump sum payment in the
event of death.
BASIC LIFE INSURANCE
All benefits-eligible employees have a life insurance coverage
amount equal to one times their annual salary to a maximum
benefit of $50,000. If you are a benefits-eligible employee,
your basic life insurance was effective on your date of hire or
benefits eligible date. Enrollment was automatic, as long as you
were actively at work on that date. The University pays the full
cost for this benefit.
VOLUNTARY SPOUSE, SAME-GENDER DOMESTIC PARTNER
(REGISTERED WITH THE UNIVERSITY), OR CIVIL UNION
PARTNER LIFE INSURANCE
The University of Chicago offers you the opportunity to purchase
life insurance protection for your spouse, same-gender domestic
partner (who is registered with the University), or civil union
partner. Enrollment is voluntary and you decide how much to
purchase.
QQ
QQ
QQ
SUPPLEMENTAL LIFE INSURANCE
additional life insurance protection for yourself. Enrollment is
voluntary and you decide how much to purchase.
If you are currently enrolled in supplemental life insurance, you
have the option of increasing your coverage by 1x your annual
base salary, up to $750,000. Evidence of insurability is not
required, unless you have previously been denied coverage under
the evidence of insurability process.
If you are not currently enrolled in supplemental life insurance,
you have the option of selecting coverage equal to a multiple
of your annual base salary (1x, 2x, 3x, 4x, 5x, 6x, 7x, or 8x), with
evidence of insurability to an overall maximum of $1,500,000
(basic and supplemental life combined).
Any coverage requiring evidence of insurability will not become
effective until approved by Prudential. You will be contacted
directly by Prudential through US mail.
You, as the employee, pay the full cost of this coverage through
after-tax payroll deductions. When you reach age 65, coverage is
only available at a reduced percentage of your elected coverage
amount.
QQ
QQ
You may elect coverage for your spouse, same-gender
domestic partner (registered with the University), or civil union
partner in $10,000 increments up to $150,000.
During the Open Enrollment period, evidence of insurability is
required for all coverage elections.
insurability is approved by Prudential. You will be contacted
directly by Prudential through US mail.
You, as the employee, pay the full cost for this coverage
through after-tax payroll deductions.
When your spouse, same-gender domestic partner, or civil
union partner reaches age 65, coverage is available at a
reduced percentage of the elected coverage amount.
VOLUNTARY DEPENDENT CHILD(REN) LIFE INSURANCE
life insurance protection for your child(ren). Enrollment is
voluntary and you decide how much to purchase.
QQ
QQ
QQ
QQ
You may elect coverage for your eligible dependent child(ren)
(up to age 26) in $2,000 increments up to $10,000.
You may cover one child or multiple children in your family.
You will only pay premium based on one level of coverage. So,
if you choose the $2,000 level of coverage, you will only pay
premium based on $2,000, yet you will have $2,000 worth of
life insurance coverage on each eligible child in your family.
There is no evidence of insurability required for children.
You, as the employee, pay the full cost for this coverage
through after-tax payroll deductions.
The monthly cost for supplemental and voluntary life insurance
is based on the coverage amounts you elect. See page 20 to
determine coverage costs.
GR O U P L IF E , ACC I DE NT, LO NG –T E RM DISAB ILIT Y & LO NG –T E RM CARE I NSUR ANCE
Personal Accident
Insurance
The University of Chicago offers personal accident insurance,
which provides a benefit that helps protect you and your family
from financial hardship if you or a covered family member
dies or suffers a serious injury in an accident. You may elect
up to $1,000,000 of personal accident insurance for you and
your dependents (to a maximum of 10 x your annual salary).
Participation is voluntary and you decide how much to purchase.
Evidence of insurability is not required.
If family coverage is selected, all eligible dependents will be
automatically covered by this voluntary personal accident
insurance benefit. If both you and your spouse, samegender University-registered domestic partner, or civil union
partner are University employees, both of you cannot choose
family coverage. You, as the employee, pay the full cost of this
coverage through after-tax payroll deductions.
The cost for personal accident insurance is based on the
coverage amounts you elect. See page 21 to determine
coverage costs.
Long-Term Disability
Insurance
The University of Chicago offers long-term disability insurance
(LTD), which provides supplemental income to allow you to
focus on your recovery when you suffer an illness, injury, or
disabling condition that prevents you from working for more
than three months. You can choose from the base plan or the
optional plan.
BASE PLAN
Under the Base Plan, you receive 60% of your monthly base
salary, up to a maximum monthly benefit of $10,000, less any
benefits you receive from other sources, such as Social Security.
Under this plan, during the first 24 months, disability is defined
as being unable to perform the material and substantial duties
of your regular occupation or having a 20% or more loss in your
monthly earnings, and being under the regular care of a doctor.
After 24 months, disability is defined as being unable to perform
the duties of any gainful occupation for which you are reasonably
fitted by education, training, or experience, and being under the
regular care of a doctor.
OPTIONAL PLAN
Under the Optional Plan, you receive 60% of your monthly base
salary, up to a maximum monthly benefit of $20,000, less any
benefits you receive from other sources, such as Social Security.
Under this plan, disability is defined as being unable to perform
the material and substantial duties of your regular occupation or
having a 20% or more loss in your monthly earnings, and being
under the regular care of a doctor. This plan also provides an
annual 5% cost of living adjustment.
Evidence of insurability is required for participation in the
Optional Plan. You will be contacted by Prudential, through US
mail. Coverage will become effective on the date approved by
Prudential.
The monthly cost for long-term disability coverage is
based on your salary and the plan you elect. See page 22
to determine coverage costs.
Long-Term Care Insurance
The University of Chicago offers long-term care (LTC) insurance
to provide support when needed due to a long-term illness,
recovery from an accident or illness, or advanced aging. LTC
support can include help getting dressed, eating, bathing, or selfadministering medication. Skilled, intermediate, and custodial care
in your home, an adult day care center, an assisted living facility,
or a nursing home can be covered. LTC insurance will provide
coverage for services when they are required for an extended
period of time and are not associated with acute care or shortterm illness.
All benefits-eligible employees actively at work are eligible to
apply. Also eligible are the employee’s spouse, same-gender
domestic partner (registered with the University), or civil union
partner and adult children between the ages of 18 and 79 years.
All applicants must maintain a permanent United States residence.
Enrollment is voluntary and you decide how much to purchase.
Evidence of insurability is required for all coverage elections.
Coverage will not become effective until evidence of insurability
is approved by Genworth. You will be contacted directly
by Genworth.
The cost for long-term care insurance is based on your age
and the coverage amounts you select. If you would like to enroll,
you will need to contact Genworth at 800.416.3624 or visit
genworth.com/groupltc and enter group id: UChicago and
code: groupltc.
Supplemental and Voluntary Life Insurance Rates
When it comes to life insurance, many families are underinsured. It can be difficult to know how much protection is needed
in the event of an unexpected death. The Prudential Easy-to-Use Life Insurance Needs Estimator can help you estimate
how much life insurance makes sense for your current situation. It’s faster and simpler than other similar tools you may
have tried. It considers income, assets, mortgage or rent, and everyday expenses such as college tuition. To get started,
visit prudential.com/EZLifeNeeds. Just answer six questions and click Continue to get an estimate of your current life
insurance needs.
How to Calculate Your Monthly Rate for Supplemental Life
Step One
Example
Take your annual salary and round it up to the next $1,000.
Sue is 38 and her annual salary is $34,482.
Sue rounds that figure up to $35,000.
Step Two
Elect the level of coverage that you want.
Sue wants to elect three times her annual salary.
Step Three
Multiply annual salary times the coverage that you elect.
3 X $35,000 = $105,000
Step Four
Divide the result in Step Three by $1,000.
$105,000 ÷ $1,000 = 105
Step Five
Multiply the result in Step Four by the applicable
105 X $0.034 = $3.57 per month
rate per $1,000.
Spouse, Same-Gender
Domestic Partner
(Registered with the University),
or Civil Union Partner
Employee
Monthly Cost
Your Age
per $1,000 of
Monthly Cost
Age
Coverage
Under 35
$0.027
Child(ren)
per $1,000 of
Monthly Factor
Age
Coverage
Under 35
All Eligible
Children
$0.034
35 – 39
$0.034
40 – 44
$0.061
40 – 44
$0.061
45 – 49
$0.103
45 – 49
$0.103
50 – 54
$0.158
50 – 54
$0.158
55 – 59
$0.293
55 – 59
$0.293
60 – 64
$0.444
60 – 64
$0.444
65 – 69*
$0.820
65 – 69*
$0.820
70 – 74*
$1.506
70 – 74*
$1.506
75 and over*
$1.506
75 and over*
$1.506
*Reduction in coverage applies.
Coverage
$0.027
35 – 39
per $2,000 of
$0.200
GR O U P L IF E , ACC I DE NT, LO NG –T E RM DISAB ILIT Y & LO NG –T E RM CARE I NSUR ANCE
Personal Accident Insurance Rates
How to Calculate Your Monthly Rate for Personal Accident Insurance
Step One
Example
Choose the amount of coverage you want.
Jane wants to know what it would cost if she chooses coverage
equal to $80,000 for herself only or for herself and family.
Step Two
Divide the amount of your total coverage
$80,000 ÷ $10,000 = 8
(your principal amount) by $10,000.
Step Three
Multiply the result by the appropriate rate:
8 x $0.14 = $1.12
n
$0.14 if you have coverage for yourself only
Jane will pay $1.12 per month for coverage for herself.
n
$0.23 if you have coverage for yourself and your family
or
This gives you your monthly contribution rate.
8 x $0.23 = $1.84
Jane will pay $1.84 per month for family coverage.
The table below shows some examples of monthly Personal Accident Insurance contribution
rates for various coverage levels:
Principal Amount Cost of Individual Coverage
Cost of Family Coverage
(Yourself Only) (Yourself and Your Family)
$50,000
$0.70
$1.15
$100,000
$1.40
$2.30
$150,000
$2.10
$3.45
$200,000
$2.80
$4.60
$250,000
$3.50
$5.75
$300,000
$4.20
$6.90
$350,000
$4.90
$8.05
$400,000
$5.60
$9.20
$450,000
$6.30
$10.35
$500,000
$7.00
$11.50
Long-Term Disability Insurance Rates
How to Calculate Your Monthly Rate
Step One
Example
Subtract the amount of coverage that the University pays
Jane Smith, a full-time employee, earns $25,840 per year. Here
($14,000 for full-time employees and $7,000 for part-time
is how she calculates her contribution rate if she is choosing the:
Base Plan: employees) from your annual salary.
$25,840 – $14,000 = $11,840
Optional Plan: $25,840 – $14,000 = $11,840
Step Two
Base Plan
Multiply the result by the appropriate factor:
$11,840 x 0.00206= $24.3904
n
n
0.00206 if you have elected coverage under the
Optional Plan
Base Plan.
$11,840 x 0.00328 = $38.8352
0.00328 if you have elected coverage under the
Optional Plan.
Step Three
Base Plan
Divide the result by 12. This gives you your monthly
$24.3904 ÷ 12 = $2.03
LTD contribution rate.
Optional Plan
$38.8352 ÷ 12 = $3.24
The table below shows some examples of monthly LTD contribution
rates for various salaries (based on full-time employment):
Annual Salary
Base Plan Optional Plan
$20,000
$1.03
$1.64
$25,000
$1.89
$3.01
$35,000
$3.60
$5.74
$50,000
$6.18
$9.84
$75,000
$10.47
$16.67
$100,000
$14.76
$23.51
FLE X IB LE S PE NDING ACCO U NTS & CO MMU TER BENEFI TS
FLEX I BL E SP E N D I NG ACCO U N TS & CO MMU T E R B E NE FITS
Health and Dependent Care
Flexible Spending Accounts
and Commuter Benefits
Flexible Spending
Accounts
The University of Chicago offers flexible spending accounts (FSA)
from which the payment for certain health and dependent care
expenses are paid with tax-free dollars.
An eligible dependent is:
QQ
QQ
A child under age 13, who is claimed as a dependent
on your income tax
A child age 13 and older, who
•Depends on you for at least half of his/her support;
• Regularly spends at least eight hours a day in your household; and
IRS regulations require re-enrollment into the FSAs each year. If
you are enrolled in a health and/or dependent care FSA during
calendar year 2014, your elections will not automatically be
continued for calendar year 2015.
HEALTH CARE FSA
The Health Care FSA offers you the opportunity to pay for
certain health care expenses for yourself and your dependents as
long as these expenses are not covered by your medical, dental,
or vision plan. Eligible health care expenses include:
To enroll you must be either single with eligible dependents
or married with a spouse who is actively employed, a full-time
student, or disabled. Non–highly compensated employees
can contribute an annual maximum of $5,000, and highly
compensated employees can only contribute a maximum of
$1,900. There is no annual minimum contribution.
QQ
Medical, dental, and vision deductibles, coinsurances, and
office visits
QQ
Prescription medication
QQ
Certain over-the-counter drug expenses
QQ
Unreimbursed vision expenses
All benefits-eligible employees not enrolled in the Maroon
Savings Choice medical plan can contribute between the
annual minimum of $250 and maximum of $2,500.
DEPENDENT CARE FSA
The Dependent Care FSA offers you the opportunity to pay for
certain eligible dependent care expenses incurred while you and
your spouse (if married) work.
An eligible dependent care expense includes:
QQ
Before- and after-school care
QQ
Extended day programs
QQ
Day care, preschool, or nursery school
QQ
Summer day camp
QQ
Elder day care
• Is physically or mentally unable to care for
himself/herself
QQ
A disabled spouse
QQ
An elderly parent
HOW THE ACCOUNTS WORK
You elect an annual contribution, which will be deducted on a
pre-tax basis from each of your paychecks in equal amounts. As
a pre-tax contribution, the amount will be deducted from your
salary before federal income tax, Social Security, and, in most
cases, state and local taxes.
Your health and/or dependent care FSA contribution elections
for 2015 must remain in effect through December 31, 2015. IRS
regulations do not allow you to increase, decrease, or stop your
contributions during a plan year unless you have a qualified life
event, such as marriage, divorce, birth, or death. And the FSA
contribution changes you make must be consistent with the
type of life event. Proof of the life event is required and must be
submitted within 31 days of the change effective date.
Qualified health and dependent care expenses incurred from
January 1, 2015, to December 31, 2015, will be eligible for
reimbursement from your FSA accounts. However, you can use
money remaining in your health care and dependent care FSAs
as of December 31, 2015, for qualified expenses incurred from
January 1, 2016, through March 15, 2016. This means you have
until March 15, 2016, to use your 2015 remaining account balance
before it is forfeited. All claims must be submitted by June 30,
2016.
Plan carefully. Any balance not used by March 15, 2016, will be
forfeited; you cannot receive the balance and you cannot carry
it over to the next year.
FLE X IB LE S PE NDING ACCO U NTS & CO MMU TER BENEFI TS
Your FSA
Reimbursement Options
YOUR HEALTH CARE FSA REIMBURSEMENT OPTIONS
As a health care FSA participant you have two reimbursement
options. You can pay for an eligible expense upfront and then
submit a written claim for reimbursement or use a Conexis debit
card to pay the expense. Supporting documentation of the
expense and payment will be required for each reimbursement
and debit card transaction. You may submit your health plan’s
Explanation of Benefits statement or an itemized receipt or bill
from the provider that includes the patient’s name, a description
of the service, and your portion of the charge. For prescriptions
you may submit the receipt from your pharmacy, including the
patient’s name, the Rx number, the name of the drug, and the
amount. Credit card receipts and cancelled checks do not meet
the requirements for acceptable documentation. Find a list of
eligible expenses at conexis.com/myfsa.
subsequent non-card (paper) claims will be used to resolve the
balance due (by reducing the amount of your reimbursement by
the amount of the balance due).
To ensure timely notification, Conexis will send all notices to you
via email. Please take time to register and log in to your account
at conexis.com/myfsa to submit or update your email address.
YOUR DEPENDENT CARE FSA REIMBURSEMENT OPTION
For reimbursement from a dependent care FSA you will need
to submit a reimbursement claim form along with appropriate
supporting documentation. All dependent care reimbursement
requests must include a completed and signed provider
certification. If you do not have provider certification, complete
the Request for Reimbursement Form and submit an itemized
statement from the dependent care provider that includes:
QQ
Start and end dates of service
QQ
Dependent’s name and date of birth
QQ
Itemization of charges
QQ
Traditional Paper Claims
When you incur an eligible medical expense, you pay for the
eligible expense up front and then file a claim with Conexis.
For reimbursement, complete, sign, and return the Request
for Reimbursement Form to Conexis. Directly with Conexis,
you can choose to have eligible health reimbursements either
direct deposited into your bank account or mailed to your home
address in the form of a check.
Debit Card Claims
The Conexis debit card allows you to pay for eligible medical,
dental, and vision expenses at the time that you incur the
expense. A debit card eliminates the need for you to pay for
eligible expenses up front and then submit a claim form for
reimbursement.
Common Purchases and Uses for the card
QQ Doctor and dentist copays
QQ
Medical plan deductibles and co-insurance
QQ
Vision exams, contact lenses, and eyeglasses
QQ
Orthodontia
Save Your Health Care FSA Receipts
While using your Conexis debit card offers convenience, please
keep receipts for all purchases made with your card. Per IRS
regulations, Conexis will require itemized receipts to verify
card purchases.
The easiest way to submit receipts and supporting
documentation is online at mybenefits.conexis.com. Simply
log in, click the Submit a Card Receipt quick link and follow the
steps to upload your documentation. You can also send by
fax to 877.881.8987 or mail to P.O. Box 650466, Dallas, Texas
75265-0466. Remember to always include a completed
Return Form.
Failure to submit proper documentation within 90 days of the
transaction date will result in the deactivation of your card.
Once your card has been deactivated, you must clear all of the
unresolved card transactions to reactivate your card. If you do
not provide acceptable documentation or repay the plan for
the ineligible transaction within the allotted time frame, any
Provider’s name, address, and tax ID or Social
Security number
Credit card receipts, canceled checks, and balance forward
statements do not meet the requirements for acceptable
documentation.
The maximum reimbursement you may receive is equal to the
current account balance in your dependent care FSA. If your
reimbursement request is more than your available balance, the
remaining amount will be placed in a pending status. The pended
amount will be paid when additional funds are posted to your
account.
Commuter Benefits
The University of Chicago offers the opportunity to save money
by using pre-tax dollars to pay for qualified work-related transit
and parking expenses. You authorize the University to deduct
an amount from your salary before federal income tax, Social
Security, and, in most cases, state and local taxes are withheld to
pay for transit and/or parking expenses. Participation is voluntary,
and enrollment is monthly rather than annual. You can enroll one
month and not the next—it’s your choice.
Eligible expenses incurred for parking and/or
transportation to and from work are:
QQ Transit expenses - train, bus, van pool
QQ
Parking expenses - Parking at or near work (other than
University lots), parking at or near transportation service sites,
Park & Ride
IRS pre-tax maximum allowable employee
contributions for 2014:
QQ Transit - $130 per month
QQ
Parking - $250 per month
These 2014 contribution limits may change for 2015. If you would
like to enroll, you will need to contact Conexis at 877.822.9091
or visit mybenefits.conexis.com. Conexis will communicate
your elections to the University to begin the appropriate payroll
deductions.
RETIREM EN T P LA N S
Retirement Plans
Invest in your financial future by taking advantage of the supplemental retirement
and deferred compensation plans.
Experts estimate that you will need at least 70% of your annual
income for each year of retirement. To build a sufficient nest
egg, it is important to save as much as you can consistently over
time. It is never too early, or too late, to save for your retirement.
You can get started right away by enrolling in the Supplemental
Retirement Program (SRP) or, if eligible, the 457(b) Deferred
Compensation Plan. Together with your personal savings and
Social Security, the SRP and 457(b) programs can provide
additional money for your retirement.
For your convenience, the University provides you an opportunity,
if eligible, to enroll in the SRP and/or the 457(b) plans online
during Open Enrollment. All salary deductions will become
effective January 1, 2015.
Supplemental Retirement
Program (SRP)
The University of Chicago offers the SRP to all employees. The
SRP is a voluntary plan that provides an opportunity to save
additional money for retirement through tax-deferred savings.
Participation in the plan is simple. You enroll only once and your
contribution rate and percentage allocation will continue year
after year unless you actively make a change. Outside of Open
Enrollment, you may change your contribution rate once each
year. You may stop your participation at any time.
Once you specify the amount you want to contribute to the plan
and the percentage you would like to invest, all contributions
are deducted automatically from each paycheck before federal
taxes. SRP contributions are subject to FICA. Your contributions
are invested in the funds of your choice and any earnings on your
contributions are not taxed until you take a distribution from the
program.
The 2014 SRP contribution limits may change for 2015. The 2014
maximum amount that you may contribute to the SRP is
as follows:
QQ
QQ
All employees may contribute a maximum of $17,500.
All employees age 50 or older may also contribute an
additional catch up of $5,500.
For more information, please refer to the Supplemental
Retirement Program Open Enrollment Guide 2015. This guide
is available online at humanresources.uchicago.edu/benefits/
retirefinancial/retireplans/srp.shtml.
If you would like to enroll in the SRP and, if eligible, in
the 457(b) plan, please visit Employee Self-Service at
ess.uchicago.edu/ess or uchicagoenrollment.com.
To continue participation in the 457(b) plan during calendar
year 2015, you must complete new enrollment elections.
457(b) Deferred
Compensation Plan
The University of Chicago offers a 457(b) Deferred Compensation
Plan to all benefits-eligible employees. The 457(b) is a voluntary
nonqualified plan of deferred compensation for employees who
already contribute the maximum permitted under the University’s
Supplemental Retirement Program. Participation in the plan
is voluntary and enrollments are only accepted for January 1
and July 1 of each year. Your enrollment does not automatically
continue from one year to the next. You must make a new
election each year. You may change your deferral rate only once
each year. You may stop your participation at any time during
the year.
Once you specify the amount you want to contribute to the plan
and select the investment funds that will be used to measure
the investment experience of your account, all contributions
are automatically deducted from each paycheck before federal
income taxes. Your contributions and any earnings on your
contributions are not taxed until you take a distribution from
the plan.
The following 2014 457(b) plan may change for 2015:
QQ
QQ
To be eligible to participate in this plan, your “benefit base
salary” on October 15, 2014, must be equal to or exceed
$204,750.
All eligible employees may contribute a maximum of $17,500.
All current 2014 participants must re-enroll into the plan to
have deductions continue for calendar year 2015.
For the definition of “benefit base salary” and additional eligibility
requirements, please refer to the 457(b) Deferred Compensation
Plan Guide 2015. This guide is available online at humanresources.
uchicago.edu/benefits/retirefinancial/retireplans/457b.shtml.
OT HER BENEFI TS
Other Benefits
Your employment with the University of Chicago provides you with access to a variety of
added benefits that are associated with working for one of the world’s top universities. For
more information on all of these benefits, please visit humanresources.uchicago.edu.
ADOPTION ASSISTANCE PROGRAM
The University of Chicago offers financial assistance to
employees who seek to become parents through the legal
adoption process. This financial support can help defray
expenses related to the medical, legal, and administrative costs
associated with adopting a child. Benefits-eligible employees are
eligible for up to $5,000 per adoption (and $10,000 per lifetime)
for qualified adoption expenses.
Ninety days prior to placement/adoption of an eligible child, a
Notice of Intent to Adopt must be submitted. Within 90 days
following the placement/adoption of an eligible child, a copy of
itemized bills, receipts/cancelled checks for each expense, and
paperwork that demonstrates that a legal adoption has been
finalized must be submitted along with the Adoption Assistance
Program application. If approved, a lump sum reimbursement
check will be forwarded to the employee for actual costs
incurred, up to $5,000 per adoption. Additional information can
be found at humanresources.uchicago.edu/benefits/adoption.
BUSINESS TRAVEL ACCIDENT INSURANCE
The University of Chicago provides benefits-eligible employees
business travel accident insurance, as a benefit in the event
of your death or serious injury in an accident while traveling on
University business away from University premises.
Enrollment is automatic and coverage begins on your first day
of work. Coverage begins automatically when you leave your
home or office to start a business trip. It does not cover
your commute to and from work. Amount of coverage is
generally five times your annual salary to a maximum
of $500,000. The University pays the full cost for this benefit.
Additional information can be found at
rmia.uchicago.edu/page/international-travel-insurance.
CHILD CARE PROGRAM
The University of Chicago’s Child Development Center, managed
by Bright Horizons, provides child care for children ages 6 weeks
to 5 years old of faculty members, other academic appointees,
and staff. This center is designed to meet the child care and
educational needs of young children, while maximizing learning
and ensuring safety. The Bright Horizons experience encourages
children to be confident, successful, and lifelong learners. In
each classroom, teachers provide a stimulating environment for
learning and development.
The Great Places for Babies program is designed to provide a
warm, welcoming environment where infants can thrive and
grow from a bundle of joy to a bundle of curiosity. The Growing
World of Toddlers curriculum uses hands-on exploration and
social interaction to help toddlers learn about the world in a
safe and engaging environment. The Preschool program builds
upon established foundations for learning while focusing on
the children’s newly emerging and advanced use of language,
mathematical reasoning, and scientific thought. Tuition varies
by schedule and individual classrooms. Additional information,
including Enrollment Interest Forms and an FAQ can be found
on the University of Chicago Child Development Center website
at child-care-preschool.brighthorizons.com/IL/Chicago/
uchicagodrexel/Parent-Resources.
EDUCATIONAL ASSISTANCE PLAN
The University of Chicago Educational Assistance Plan gives
you and your dependent children several educational assistance
options depending on your position and, in some instances, your
years of consecutive employment in an eligible position at the
University. Benefits for staff employees include tuition assistance
for classes at the University for themselves and tuition assistance
for their dependent children at the University and the Laboratory
Schools. Benefits for faculty and other academic appointees
includes tuition assistance for their dependents at the University
and the Laboratory Schools. Additional information can be
found at humanresources.uchicago.edu/benefits/tuition.
OTHE R BEN EF I TS
ELDER CARE CONSULTATION PROGRAM
The University offers a referral service through our provider
Perspectives Ltd. to provide assistance in evaluating your elder
care needs and making appropriate arrangements. The referral
service is available at no charge to you, but you are responsible
for the elder care services you choose. You may call Perspectives
Ltd. at 800.456.6327 to speak with a trained counselor about
your elder care needs. The counselor can provide you with
information related to the following:
QQ
Day/nursing/respite/hospice care
QQ
Home health/homemaker
QQ
Nutrition/housing services
QQ
Transportation/recreation
QQ
Retirement facilities and planning
QQ
Leisure time pursuits
QQ
Volunteer opportunities
QQ
Adult education options
QQ
Travel and tour options
FACILITIES
As one of the largest academic research libraries in the United
States, the University of Chicago Library is a highly valued
partner in research and special collections. University of Chicago
faculty and staff can use their UChicago Cards to borrow books
and other materials, such as journals and reserve items. View
the University of Chicago Library borrowing policies for faculty
and staff. Additional information can be found at
lib.uchicago.edu/e/using/access/ucusers.html.
Faculty and staff are invited to take advantage of the campus
health facilities at the Ratner Athletics Center and Henry
Crown Field House before and after work, as well as during
lunch time. Payroll deduction is available for University
of Chicago employees who purchase a one-year membership.
athletics.uchicago.edu/facilities/memberships.
Faculty and staff are also invited to apply for membership with
the Quadrangle Club. The Quadrangle Club offers fine dining
and catering services, guest rooms for overnight stays, and
top-rate tennis facilities conveniently located in the heart of
the University of Chicago campus. The Quadrangle Club
provides a unique venue for events and receptions, as well as
a comfortable spot for dining, socializing, and conversation.
Additional information can be found at quadclub.uchicago.edu.
FINANCIAL
There are two financial institutions centrally located on campus:
Citibank and Maroon Financial Credit Union. Additional
information can be found for Citibank at citi.com and for
Maroon Financial at maroonfinancial.org.
Residential Properties provides services to faculty and staff
seeking assistance in renting or purchasing a residence.
The Employer-Assisted Housing Program, offered through
Residential Properties, offers financial assistance opportunities
to homebuyers. Additional information can be found at
rp.uchicago.edu.
GETTING AROUND—TRANSPORTATION
The University of Chicago offers several local transportation
options for faculty and staff. CTA routes #170, #171, and #172
serve the campus and surrounding neighborhoods. Staff and
faculty may show their UChicago Cards to ride the CTA routes
free of charge. UChicaGO shuttles and evening buses,
operated by the University around campus, are also available
to faculty and staff. The University of Chicago also provides
a comprehensive nighttime shuttle service to the entire campus
community on a fixed schedule along highly used routes.
safety-security.uchicago.edu/services/travel_options.
SAFETY AND SECURITY
The University of Chicago Police Department provides a safety
escort program. If you are concerned about your safety as you
walk in their patrol area, you can request a safety escort. The
first available patrol officer will be sent to escort you to your
destination. Additional information can be found at
safety-security.uchicago.edu/services/umbrella_coverage.
STAFF AND FACULTY ASSISTANCE PROGRAM
The University of Chicago’s Staff and Faculty Assistance
Program (SFAP) is a confidential service offered through
Perspectives Ltd. This program provides support, counseling,
referrals, and resources for all life issues. Confidentiality is an
important aspect of these services. Information you discuss with
Perspectives Ltd. will not be shared by them, except as may be
required by federal and state laws.
Use of SFAP is free; the University of Chicago pays the full cost
of this program. Please note, if you or a family member needs
referral services or a treatment program, all costs incurred by
the referral service or treatment program are your responsibility.
Perspectives Ltd. is available 24 hours 7 days a week and can be
accessed three ways:
QQ
QQ
QQ
Over the phone at 800.456.6327.
In person, by appointment only. To schedule an appointment,
call 800.456.6327.
Online at perspectivesltd.com. Log in with user name: UNI500
and password: perspectives.
NOTI CES
Notices
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, using funds from their Medicaid or CHIP programs. If
you or your children are not eligible for Medicaid or CHIP, you
will not be eligible for these premium assistance programs, but
you may be able to buy individual insurance coverage through
the Health Insurance Marketplace. For more information, visit
healthcare.gov.
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; dial 1-877-KIDS NOW or visit
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.
If 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,
contact the Department of Labor electronically at
askebsa.dol.gov or by calling 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 January 31, 2014. Contact
your state for more information on eligibility.
COLORADO – Medicaid
Medicaid Website: colorado.gov
Medicaid Phone (In state): 1.800.866.3513
Medicaid Phone (Out of state): 1.800.221.3943
FLORIDA – Medicaid
Website: flmedicaidtplrecovery.com
Phone: 1.877.357.3268
GEORGIA – Medicaid
Website: dch.georgia.gov
Click on Programs, then Medicaid, then Health Insurance Premium
Payment (HIPP)
Phone: 1.800.869.1150
IDAHO – Medicaid
Medicaid Website: healthandwelfare.idaho.gov/Medical/Medicaid/
PremiumAssistance/tabid/1510/Default.aspx
Medicaid Phone: 1.800.926.2588
INDIANA – Medicaid
Website: in.gov/fssa
Phone: 1.800.889.9949
IOWA – Medicaid
Website: dhs.state.ia.us/hipp
Phone: 1.888.346.9562
KANSAS – Medicaid
Website: kdheks.gov/hcf
Phone: 1.800.792.4884
KENTUCKY – Medicaid
Website: chfs.ky.gov/dms/default.htm
Phone: 1.800.635.2570
LOUISIANA – Medicaid
Website: lahipp.dhh.louisiana.gov
Phone: 1.888.695.2447
MAINE – Medicaid
Website: maine.gov/dhhs/ofi/public-assistance/index.html
Phone: 1.800.977.6740
TTY 1.800.977.6741
MASSACHUSETTS – Medicaid and CHIP
Website: mass.gov/MassHealth
Phone: 1.800.462.1120
MINNESOTA – Medicaid
Website: dhs.state.mn.us
Click on Health Care, then Medical Assistance
Phone: 1.800.657.3629
ALABAMA – Medicaid
Website: medicaid.alabama.gov
Phone: 1.855.692.5447
MISSOURI – Medicaid
Website: dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 573.751.2005
ALASKA – Medicaid
Website: health.hss.state.ak.us/dpa/programs/medicaid
Phone (Outside of Anchorage): 1.888.318.8890
Phone (Anchorage): 907.269.6529
MONTANA – Medicaid
Website: medicaidprovider.hhs.mt.gov/clientpages/clientindex.shtml
Phone: 1.800.694.3084
ARIZONA – CHIP
Website: azahcccs.gov/applicants
Phone (Outside of Maricopa County): 1.877.764.5437
Phone (Maricopa County): 602.417.5437
NEBRASKA – Medicaid
Website: ACCESSNebraska.ne.gov
Phone: 1.800.383.4278
NOT I C ES
NEVADA – Medicaid
Medicaid Website: dwss.nv.gov
WASHINGTON – Medicaid
Website: hca.wa.gov/medicaid/premiumpymt/pages/index.aspx
Phone: 1.800.562.3022 ext. 15473
NEW HAMPSHIRE – Medicaid
Website: dhhs.nh.gov/oii/documents/hippapp.pdf
Phone: 603.271.5218
WEST VIRGINIA – Medicaid
Website: dhhr.wv.gov/bms
Phone: 1.877.598.5820, HMS Third Party Liability
NEW JERSEY – Medicaid and CHIP
Medicaid Website:
state.nj.us/humanservices/dmahs/clients/medicaid
Medicaid Phone: 609.631.2392
CHIP Website: njfamilycare.org/index.html
CHIP Phone: 1.800.701.0710
WISCONSIN – Medicaid
Website: badgercareplus.org/pubs/p-10095.htm
Phone: 1.800.362.3002
NEW YORK – Medicaid
Website: nyhealth.gov/health_care/medicaid
Phone: 1.800.541.2831
To see if any more states have added a premium assistance program
since January 31, 2014, or for more information on special enrollment
rights, you can contact either:
NORTH CAROLINA – Medicaid
Website: ncdhhs.gov/dma
Phone: 919.855.4100
NORTH DAKOTA – Medicaid
Website: nd.gov/dhs/services/medicalserv/medicaid
Phone: 1.800.755.2604
OKLAHOMA – Medicaid
Website: insureoklahoma.org
Phone: 1.888.365.3742
OREGON – Medicaid
Website: oregonhealthykids.gov
hijossaludablesoregon.gov
Phone: 1.800.699.9075
PENNSYLVANIA – Medicaid
Website: dpw.state.pa.us/hipp
Phone: 1.800.692.7462
RHODE ISLAND – Medicaid
Website: ohhs.ri.gov
Phone: 401.462.5300
SOUTH CAROLINA – Medicaid
Website: scdhhs.gov
Phone: 1.888.549.0820
SOUTH DAKOTA – Medicaid
Website: dss.sd.gov
Phone: 1.888.828.0059
TEXAS – Medicaid
Website: gethipptexas.com
Phone: 1.800.440.0493
UTAH – Medicaid and CHIP
Website: health.utah.gov/upp
Phone: 1.866.435.7414
VERMONT – Medicaid
Website: greenmountaincare.org
Phone: 1.800.250.8427
VIRGINIA – Medicaid and CHIP
Medicaid Website: dmas.virginia.gov/rcp-HIPP.htm
CHIP Website: famis.org
CHIP Phone: 1.866.873.2647
WYOMING – Medicaid
Website: health.wyo.gov/healthcarefin/equalitycare
Phone: 307.777.7531
US Department of Labor
Employee Benefits Security Administration
dol.gov/ebsa
1.866.444.EBSA (3272)
US Department of Health and Human Services
Centers for Medicare & Medicaid Services
cms.hhs.gov
1.877.267.2323, menu Option 4, Ext. 61565
Women’s Health and
Cancer Rights Act Notice
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). For individuals receiving
mastectomy-related benefits, coverage will be provided in a
manner determined in consultation with the attending physician
and the patient, for:
QQ
QQ
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;
QQ
Prostheses; and
QQ
Treatment of physical complications of the mastectomy.
These benefits will be provided subject to the same deductible
and coinsurance applicable to other medical and surgical benefits
provided under the plan. The amounts are shown on the chart on
pages 12–13.
If you have questions or would like more information,
please contact your medical plan provider. See page 32
for contact information.
NOTI CES
Medicare Part D
When Will You Pay a Higher Premium (Penalty) to Join a
Medicare Drug Plan?
Important Notice from the University of Chicago about
Your Prescription Drug Coverage and Medicare
You should also know that if you drop or lose your current
coverage with the University of Chicago 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.
Please read this notice carefully and keep it where you can find it.
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.The University of Chicago has determined that the
prescription drug coverage offered by your University of
Chicago medical plans 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.
When Can You Join a Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible
for Medicare and each year from October 15 through December 7.
However, if you lose your current 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.
What Happens to Your Current Coverage If You Decide to
Join a Medicare Drug Plan?
If you decide to join a Medicare drug plan your current University of
Chicago prescription drug coverage will be affected.
QQ
QQ
If you decide to KEEP your University of Chicago prescription
drug coverage and enroll in a Medicare prescription drug plan,
your University of Chicago coverage generally will be your
primary coverage. You may be required to pay a Medicare
Part D premium in addition to your University of Chicago
medical plan contributions.
If you do decide to join a Medicare drug plan and DROP your
current University of Chicago prescription drug coverage—
by dropping your medical plan, be aware that you and your
dependents may not be able to get this coverage back.
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 19 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 November to join.
For More Information about This Notice or Your Current
Prescription Drug Coverage
Contact the Benefits Office at 773.702.9634 for further information.
NOTE: You’ll get this notice each year. You will also get it before the
next period you can join a Medicare drug plan and if this coverage
through the University of Chicago changes. You also may request a
copy of this notice at any time.
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:
QQ Visit medicare.gov.
QQ
QQ
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
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, therefore,
whether or not you are required to pay a higher premium (a
penalty).
Contact Information
PLAN
Additional Resource
Telephone
Number
Website
Maroon Plan
BlueCross BlueShield of Illinois
CVS Caremark
24/7 Nurseline
Davis Vision
866.390.7772
866.873.8632
800.299.0274
877.393.8844
bcbsil.com
caremark.com
bcbsil.com
bcbsil.com
Maroon Savings Choice
CVS Caremark
24/7 Nurse Line
HSA Bank
Davis Vision
866.390.7772
866.873.8632
800.299.0274
800.357.6246
877.393.8844
bcbsil.com
caremark.com
bcbsil.com
hsabank.com
bcbsil.com
773.834.0900
uchp.uchicago.edu
Humana Health Care Plans
EyeMed Vision Care
Nurse Line
800.448.6262
888.289.0595
800.622.9529
humana.com
HMO Illinois
Davis Vision
800.892.2803
877.393.8844
bcbsil.com
Dental Plans (Copay and PPO)
MetLife
800.942.0854
metlife.com/mybenefits
Vision Service Plan (VSP)
VSP
800.877.7195
vsp.com
Long-Term Disability Insurance
Benefits Office
773.702.9634
humanresources.uchicago.edu
Group Life Insurance
(Basic, Supplemental, and Dependent)
Benefits Office
773.702.9634
Personal Accident Insurance
Benefits Office
773.702.9634
Flexible Spending Accounts
Conexis
877.822.9091
conexis.com/myfsa
Retirement Plans (SRP, CRP, ERIP, and
SEPP)
TIAA-CREF
800.842.2776
tiaa-cref.org
Vanguard
800.523.1188
vanguard.com
Benefits Office
773.702.9634
TIAA-CREF
800.842.2776
tiaa-cref.org
Vanguard
800.523.1188
vanguard.com
Benefits Office
773.702.9634
Educational Assistance Program
Benefits Office
773.702.9634
Qualified Transportation Program
Conexis
877.822.9091
mybenefits.conexis.com
Child Care Resource and Referral Service
Perspectives
800.456.6327
perspectivesltd.com
Staff and Faculty Assistance Program
Perspectives
800.456.6327
perspectivesltd.com
Elder Care Consultation and
Referral Service
Perspectives
800.456.6327
perspectivesltd.com
Long-Term Care
Genworth
800.416.3624
genworth.com/groupltc
Group ID: UChicago
Code: groupltc
457(b) Deferred Compensation Plan
If you have any questions after reading this 2015 Benefits Open Enrollment Guide, please visit
humanresources.uchicago.edu or call the Benefits Office at 773.702.9634. In addition, you can
call the resources above or visit their websites.
IMPORTANT DATES
OCTOBER 3–17, 2014
Enroll for your benefits online at ess.uchicago.edu/ess.
OCTOBER 16, 2014
• Benefits and Health Fair
• Maroon Savings Choice Plan and Health Savings Account Information Sessions
JANUARY 1, 2015
Your new benefit elections become effective on this date.

2015 BENEFITS OPEN ENROLLMENT GUIDE

Transcription

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