Benefits Summary 2015

Transcription

Benefit Highlights Guide
2015
Contents
Enrollment.......................................................................... 2
When can I enroll? ............................................................ 2
How do I enroll? ............................................................... 2
Eligible dependents.......................................................... 3
Who can I cover? ............................................................... 3
Dependent verification ..................................................... 3
What if things change?...................................................... 3
The cost of your benefits ................................................. 4
Medical, dental and vision costs for 2015 ...................... 4
How it works ...................................................................... 5
Medical benefits summary ...........................................5-7
Opting out of medical coverage....................................... 8
Helpful terms ..................................................................... 8
Prescription drug benefits summary ............................. 9
Eligibility for the lowest-cost OHSU benefits ............. 10
Finding network providers ............................................ 11
Wellness benefits ............................................................ 12
Healthy TEAM Healthy U.............................................. 12
HealthySteps ..................................................................... 12
Weight Watchers .............................................................. 12
Tobacco cessation ............................................................ 12
Dental benefits ................................................................ 13
Vision benefits ................................................................. 14
Income protection insurance ........................................ 15
Core life insurance .......................................................... 15
Voluntary life insurance and accidental death and
dismemberment coverage ......................................... 15
Disability insurance......................................................... 15
Life and disability rates ............................................. 15-17
OHSU knows how important it is to have good, affordable
health and welfare benefits. That’s why we offer competitive
benefits that can provide protection, peace of mind and savings.
From health care to income protection and other benefits, we’ve
got you covered.
Use this overview of your benefit choices and how to enroll to
help you select the coverage that is right for you and your family.
Enrollment
When can I enroll?
New employees
As a new employee, you have 60 days from your date of hire to
enroll in benefits. Your benefits will go into effect on the 1st of
the month following the date you make your benefit elections.
If you do not make elections during those 60 days, you will be
enrolled by default for employee-only coverage in OHSU PPO
medical, Moda Health dental and VSP core vision. Default coverage will remain in effect until the end of the plan year, unless you
experience a qualifying life event such as a marriage or a birth.
(In that case, you can elect benefits relevant to the qualifying life
event.) Our benefit plan year runs from Jan. 1 through Dec. 31.
Open Enrollment
As a benefits-eligible employee, you have an opportunity
once each year to enroll in or make changes to your benefit
plans during the Open Enrollment period. Open Enrollment
is typically held in the fall. Open Enrollment for your 2015
benefits is Oct. 27 through Nov. 21, 2014, with elections
effective Jan. 1, 2015.
Note: If you make no changes during Open Enrollment, your
current benefit elections will remain in place through 2015—
with the exception of flexible spending accounts. FSA elections
do not carry over from year to year. If you want an FSA, you
must actively enroll in one during Open Enrollment.
Additional benefits ......................................................... 18
Flexible spending accounts ............................................ 18
Employee Assistance Program....................................... 19
Travel assistance............................................................... 19
You have a voice—
the Employee Benefits Council ..................................... 19
Your rights ........................................................................ 19
Health Care Reform Notice............................................ 19
Where to learn more ....................................................... 19
Contact information ....................................................... 20
2
How do I enroll?
All benefit enrollments are completed online at http://benefits.
ohsu.edu. Use your OHSU user name and password to log on to
the system.
Before logging on, have a list of your benefit choices and
changes, as well as the names, Social Security numbers,
birthdates and addresses of those you wish to designate as
beneficiaries or enroll as dependents. If you are enrolling new
dependents on your medical plan, you will be required to
provide documents verifying them as your dependent (e.g.,
marriage license, birth certificate).
https://o2.ohsu.edu/benefits | [email protected] | 503 494-7617
Eligible dependents
Who can I cover?
You can enroll yourself in the benefits listed in this guide if you
are a 0.5 FTE or greater and are working in a benefits-eligible
position. For more detailed information on employee and
dependent eligibility, visit the Benefits website at https://o2.ohsu.
edu/benefits.
If you participate in OHSU benefits, you may also enroll:
• Your spouse (opposite or same sex) or domestic partner
(opposite or same sex; registered or unregistered).
• Your child(ren) (including child(ren) of a domestic partner
or spouse) up to age 26. This applies regardless of the child’s
marital or student status.
• Your child(ren) of any age who is incapable of supporting
himself or herself due to a mental or physical disability and
who is totally dependent on you.
• Your child(ren) by adoption or court-ordered judgment who
otherwise meets these dependent eligibility requirements.
Please contact the OHSU Benefits team for additional
information.
Dependent verification
When adding a new dependent to your benefits, you will be
required to provide documents verifying your relationship to
the dependent (e.g., marriage license, birth certificate). You’ll
be provided a list of the specific document(s) required once you
enroll your dependent.
What if things change?
The benefits you choose will be effective through the end of the
calendar year. You cannot make changes to your coverage during the year, unless you have a qualifying life event, including:
• Marriage, establishment of a domestic partnership, legal separation, divorce or termination of a domestic partnership.
• Birth, legal adoption of a child or placement of a child with you for legal adoption.
• Death of your spouse/domestic partner or dependent child.
• Change in residence (only if your current coverage isn’t available in the new location or if you are offered an option that you were not
previously offered).
To make a change due to a qualifying life event, you must complete your enrollment change online within 31 days of the event, in
most cases. You have 60 days if you, your spouse/domestic partner or eligible dependent child loses coverage under Medicaid or a state
Children’s Health Insurance Program (CHIP) or becomes eligible for state-provided premium assistance.
Only certain changes to benefits are allowed during a qualifying life event. OHSU Benefits will review your request and determine
whether the change you are requesting is allowed. For a complete description of allowable benefit changes, go to https://o2.ohsu.edu/
benefits
You will be required to provide verification of your qualifying life event upon making enrollment changes.
3
The cost of your benefits
OHSU provides benefits-eligible employees with “benefit dollars” to apply toward the cost of benefits. Your benefit dollars are a set amount
of monthly funds based on your employee representation group (AFSCME, ONA or unclassified), the coverage level you select (the
number of dependents you cover on your medical plan) and whether you are a part-time or full-time employee. The funds are first applied
to the cost of the medical, vision and dental benefit options you choose to enroll in. If your benefit dollars do not cover the complete cost
of all the benefits you choose, you will pay the difference. The difference will be deducted from your pay semi-monthly (24 times a year).
Below are the benefit dollars that OHSU will contribute to your benefit selections for 2015.
Benefit dollars for 2015
OHSU’s monthly
benefit contribution
Unclassified
ONA-represented
AFSCME-represented
Full-time
(.75 – 1.0)
Part-time
(.50 – .74)
Full-time
(.70 – 1.0)
Part-time
(.50 – .69)
Full-time
(.75 – 1.0)
Part-time
(.50 – .74)
Employee only
$674.02
$505.52
$674.02
$505.52
$674.02
$505.52
Employee & spouse/
domestic partner
$971.20
$728.40
$971.20
$728.40
$971.20
$728.40
Employee & child(ren)
$796.94
$597.72
$796.94
$597.72
$796.94
$597.72
$1,073.70
$805.28
$1,073.70
$805.28
$1,073.70
$805.28
$100
$50
$50
$50
$50
$0
Employee & family
Medical opt out*
*The medical opt-out rate reflects the contribution amount employees will receive and can use for dental, life and optional coverage. Employees must
attest that they currently have equivalent health coverage in order to qualify to opt out of OHSU’s medical coverage.
Medical, dental and vision costs for 2015
The rates listed below are the monthly costs for the medical, dental and vision plans by coverage level (number of dependents) you
choose. The benefit dollars paid to you by OHSU (shown above) help you pay for these premiums, along with other benefits you select.
Monthly medical
premiums
Employee only
Employee & spouse/
domestic partner
Employee & family
OHSU PPO
$626.00
$1,000.00
$792.00
$1,054.00
Regional Medical Home
$770.00
$1,234.00
$974.00
$1,346.48
National*
$770.00
$1,234.00
$974.00
$1,346.48
Kaiser Permanente**
$943.00
$1,405.06
$1,103.32
$1,471.08
Employee only
Employee & spouse/
domestic partner
Employee & family
Moda Health
$43.10
$93.80
$104.74
$151.84
Kaiser Permanente
$87.08
$174.18
$156.76
$261.26
Willamette Dental Group
$45.40
$88.50
$80.30
$137.50
Monthly dental
premiums
*You are only eligible for the National plan if you or a covered dependent live outside Oregon and southwest Washington, or live in Klamath Falls.
**Available only to certain long-term employees (see page 7).
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Monthly vision
premiums
Employee only
Employee & spouse/
domestic partner
Employee & family
Core vision
$4.92
$9.84
$8.86
$14.27
Premium vision
$6.89
$13.78
$12.40
$19.98
Tobacco surcharge
Employees who use tobacco products or cover dependents who use tobacco are required to pay a $50 per month surcharge. You will be
asked whether you or your dependents use tobacco products when you enroll for benefits.
If you use tobacco and would like to quit, OHSU Benefits wants to provide support and resources to assist you. See page 12 for
information on tobacco cessation.
Wellness requirements surcharge
Employees who haven’t completed the wellness requirements (see page 10) for the prior year will pay a surcharge of five percent of the
medical/pharmacy premium. Wellness requirements are waived for new employees during their first year.
How it works
These two examples illustrate how benefit dollars are applied to your benefit selections and what is deducted from your pay.
Example 1—Maria
Maria is a single, full-time, unclassified employee. She’s
selected the OHSU PPO medical plan, Moda Health dental
plan and the core vision plan for 2015. Maria has completed
the wellness requirements listed on page 10 and does not
use tobacco products.
Employee-only benefit premiums (monthly)
• OHSU PPO medical (employee only): $626.00
• Moda Health dental (employee only): $43.10
• Core vision (employee only): $4.92
OHSU benefit contribution: $674.02
Maria’s cost: $0.
($626.00 + $43.10 + $4.92) - $674.02 = $0
Example 2—Alex
Alex is a married, full-time, AFSCME-represented
employee. He and his wife both smoke. He has chosen the
Regional Medical Home plan, Moda Health dental plan
and is opting out of vision coverage for himself, his wife
and three children. Alex did not complete the wellness
requirements listed on page 10.
Employee & family benefit premiums (monthly)
• Regional Medical Home medical (employee & family):
$1,346.48
• Moda Health dental (employee & family): $151.84
Tobacco surcharge: $50.00
Wellness requirements surcharge: $67.32 ($1,346.48 x 0.05)
OHSU benefit contribution: $1,073.70
Alex’s cost: $541.94 monthly
($1,346.48 + $151.84 + $50.00 + $67.32) - $1,073.70 = $541.94
Medical benefits summary
When choosing a medical plan, it is important to consider whether the primary hospitals, clinics or providers you and your family
use today will be covered. Both the OHSU PPO and Regional Medical Home plans have two networks of providers; one at a higher
coverage level and one at a lower coverage level. For more on learning about which providers are covered at which level, see page 11.
The following table summarizes medical benefits. For full plan summaries detailing coverage information, limitations and exclusions,
visit the plan websites—www.modahealth.com or www.kp.org—or https://o2.ohsu.edu/benefits. You are responsible for any
coinsurance or copays shown in this table.
5
Medical benefits summary
Key features
OHSU PPO
OHSU PPO
Network
Networks
Requirements
Community
Care Network
Non-contracted
provider
Must complete wellness requirements (see page 10).
Employees who didn’t participate in wellness programs in 2014 will
pay a 5% wellness requirements surcharge on their medical premium in 2015.
Annual calendar year deductible
Medical out-of-pocket (OOP) maximum
(includes deductible)
$250/person or $750/family
$1,600/person or
$3,250/family
Lifetime maximum
$3,500/person or
$7,000/family
$4,250/person or
$8,750/family
Unlimited
Home and doctor’s office visits
$25 copay
$40 copay
Medical home primary office visits
Specialists
40% of allowable
charges
N/A
$25 copay
$40 copay
40% of allowable
charges
No charge, not
subject to
deductible; frequency
limitations apply
No charge, not
subject to
deductible; frequency
limitations apply
40% of allowable
charges; frequency
limitations apply
20%
30%
40% of allowable
charges
Hospital services
Inpatient (per admission)
20%
30%
40% of allowable
charges
Outpatient
20%
30%
40% of allowable
charges
Preventive care
Lab and X-ray services
(in a hospital outpatient facility)
Emergency care
(waived if admitted)
$150 copay, then 20% of allowable charges
* You must see a provider from your preselected medical home for the $25 copay to apply.
** Oregon residents enrolled in the National plan may access the ODS Plus/Connexus network at the higher coverage level.
6
$500/person or
$1,500/family
Synergy/
Summit
Connexus
(ODS Plus)
Non-contracted
provider
If you select the Regional Medical Home plan,
each dependent covered under your plan will need to
choose a medical home. Each dependent can
choose a different medical home, if they desire. If you
use a medical home facility or provider for primary
care who is not part of your preselected home,
you will receive a lower benefit level.
Must complete wellness requirements (see page 10).
Employees who didn’t participate in wellness
programs in 2014 will pay a 5% wellness requirements
surcharge on their medical premium in 2015.
$400/person or $1,200/ family
$3,500/person or
$7,000/family
$500/person or
$1,500/family
$4,250/person or
$8,750/family
Unlimited
Kaiser Permanente
Network
provider only
Available only to AFSCME
represented employees
hired before 10/1/1998 and
ONA represented and
unclassified employees
hired before 1/1/1998.
All care must be received
by a participating
Kaiser Permanente
facility except for true
emergencies.
None
$1,000/person or
$2,000/family
National
Non-contracted
provider
PHCS**
Available only to employees living
outside Oregon and SW Washington
(based on ZIP code) or whose dependent(s)
reside outside Oregon and SW
Washington, or residents of Klamath Falls.
Must complete wellness requirements
(see page 10).
Employees who didn’t participate in
wellness programs in 2014 will pay a
5% wellness requirements surcharge
on their medical premium in 2015.
$500/person or $1,500/family
$3,500/person or
$7,000/family
Unlimited
$3,500/person or
$7,000/family
Unlimited
$25 copay
$40 copay
$15 copay
$25 copay
$25 copay*/
$40 copay
$40 copay
N/A
N/A
$25 copay
$40 copay
N/A
$25 copay
40% of allowable
charges
No charge, not
subject to deductible; frequency
limitations apply
40% of allowable
charges; frequency
limitations apply
No charge
No charge
40% of allowable
charges; frequency
limitations apply
20%
40% of allowable charges
No charge
20%
40% of allowable
charges
20%
$200 copay per
visit for hospital/
facility charge
20%
40% of allowable
charges
20%
20%
40% of allowable
charges
$150 copay, then 20% of allowable charges
$75 copay (waived
if admitted)
40% of allowable
charges
20%
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Opting out of medical coverage
You must enroll in medical coverage unless you have coverage under another group medical plan. When opting out, you will be
required to attest that you currently have other coverage at a comparable level.
If you choose to opt out, you will receive reduced benefit dollars, as shown on page 4.
Note: If you lose coverage under your other plan during the year, you must enroll in OHSU medical coverage within 31 days after
losing coverage.
Helpful terms
Coinsurance: A percentage of costs you pay “out of pocket” for covered expenses after
you meet the deductible.
Copay (copayment): A fee you pay “out of pocket” for certain services, such as a doctor’s
office visit or prescription drug. If you must pay a copay for a service, this means that
you will not be required to meet your deductible or pay coinsurance for that service.
Deductible: The amount you pay “out of pocket” before the health plan will start to pay
its share of covered expenses.
Extra billing (or balance billing): When a provider bills you for the difference between
the provider’s charge and the allowed amount that your insurance will cover. For
example, if the provider’s charge is $800 and your insurance’s allowed amount is $500,
the provider may bill you for the remaining $300, in addition to coinsurance you owe.
You may be subject to extra billing if you see a non-contracted provider.
Medical home: A “home base” for your medical care. Primary care providers work with specialists to coordinate your care
within a defined network of providers. Medical home plans require you to designate your medical home with the
insurance provider (Moda).
Network: Doctors, pharmacists and other health care providers who make up the plan’s preferred providers. When you use
network providers, you pay less because they have agreed to negotiated pricing. For more on finding network providers,
see page 11.
Out-of-pocket maximum: The most you pay each year out of your own pocket
for covered expenses. Once you’ve reached the out-of-pocket maximum, the
health plan pays 100 percent for covered expenses. With the OHSU plans,
you have separate out-of-pocket maximums for medical and pharmacy.
8
Prescription drug benefits summary
All OHSU medical plans provide pharmacy coverage, which is included in the cost of your medical premium. The Kaiser plan provides
coverage through Kaiser pharmacies.
The OHSU PPO, Regional Medical Home and National plans have networks of pharmacies. Most major pharmacies—except Walgreens—are in network. You can search for network pharmacies at www.modahealth.com; more detailed instructions are on page 11.
Key features
OHSU PPO, Regional Medical Home, National
Networks
NW Prescription Drug
Consortium Network
(non-OHSU pharmacies)
OHSU pharmacies
Prescription out-of-pocket
(OOP) maximum
Retail prescription drug
(30-day supply)
Value
$1,500/person or $2,500/family
$4
Select
20%, $100 max
25%, $10 min & $100 max
Preferred
30%, $100 max
35%, $10 min & $100 max
Brand
50%, $150 max
50%, $10 min & $150 max
Mail-order prescription drug
(90-day supply)
$6
Select
15%, $200 max
Preferred
25%, $200 max
Brand
50%, $300 max
Network
pharmacy only
Included in medical
OOP max
$2
Value
Kaiser Permanente
Not covered
$15 copay per
formulary
prescription
Specialty prescription drug
(30-day supply)*
Value
N/A
Select
25%, $100 max
Preferred
25%, $100 max
Brand
50%, $150 max
*Specialty medications must be accessed through the exclusive specialty pharmacy
9
Eligibility for the lowest-cost
OHSU benefits
By participating in several wellness programs, you can lower your monthly
costs on the OHSU PPO, Regional Medical Home and National plans.
Employees who haven’t completed the wellness requirements for 2014 will pay
a wellness requirements surcharge in 2015. The surcharge is five percent of the
medical/pharmacy premium.
Employees who participate in the OHSU wellness programs will not pay the
wellness surcharge during the next plan year. Note: New employees automatically
do not pay the wellness surcharge during their first year but must participate in
the OHSU wellness programs to continue not paying the surcharge in the following year.
To avoid paying the wellness surcharge during the 2016
plan year, you must complete the following requirements
by Sept. 30, 2015:
A. Join the Healthy TEAM Healthy U program and earn at
least 2,000 points.
—Or—
B. Complete two of the following programs:
1. Complete the OHSU Benefits network provider activity.
(This online activity can help you learn which providers
in your plan’s network are covered at a higher level and
which are covered at a lower level.)
2. Receive a flu vaccine by Nov. 30, 2014 at:
• An Occupational Health influenza vaccination clinic or site visit, or from an Event Manager in your work area; or
• A location of your choice. If receiving a vaccination from a provider other than Occupational Health or an Event
Manager, including an OHSU clinical provider, please create or access your ReadySet account at ohsu.readysetsecure.com and complete the seasonal flu immunization survey indicating that you received the vaccination elsewhere.
Occupational Health no longer accepts the Influenza Attestation/Declination paper form from previous years.
Please note: Vaccinations received before Aug. 1, 2014, do not count toward this year’s influenza vaccination program.
Declining the flu vaccine does not fulfill this wellness requirement. You must receive the flu vaccine to meet this
requirement. If you have questions, contact Occupational Health at 503 494-5271.
3. Earn 1,000 points in the HealthySteps program.
4. Complete the OHSU-sponsored tobacco cessation program. Start by calling 866-784-8454 or visit www.quitnow.net.
Note: This wellness program is also available to your covered dependents over age 18.
5. Complete the OHSU-sponsored weight management program with Weight Watchers. Start by calling
800-8-AT-WORK.
Employees are welcome to participate in any of the wellness activities listed above at no cost. See page 12 for more
information.
Employees not meeting these requirements will pay the five percent surcharge in 2016.
10
Finding network providers
5. Finally, narrow your search to hone in on specific
networks or providers:
Before you see a provider, find out which network he or
she is in. This will help you avoid being surprised when
you receive the bill. Your plan may offer several provider
networks or tiers:
• To see all providers in a specific network, open the
Network/networks drop-down box. Check one or more
networks. Scroll back up and click Close to shut the
drop-down box. Enter your location information and
then click Search.
• For the OHSU PPO, Regional Medical Home or National
plans, you can choose from several network tiers that
provide different levels of coverage (see pages 6-7).
• For Kaiser, you can choose only Kaiser providers (except
for emergencies).
• Similarly, to see a specific provider and his or her
associated networks, type their name in the Provider or
facility name field and click Search.
To search for providers and their networks for the OHSU
PPO, Regional Medical Home and National plans:
• To find medical homes in your area, open the Provider
type drop-down box and select Care Providers &
Doctors. Under Network/networks, select either the
Synergy or Summit network. Enter your location
information and then click Search.
1. Go to www.modahealth.com. You do not need to be a
Moda member. You may be asked to enter your state.
2. In the top right, click Find Care to search for a physician,
dentist, pharmacy or clinic.
3. Choose Search as a guest to search for providers in
networks outside your current plan, such as Synergy/
Summit. Click Go.
4. Next, select the type of provider you are seeking—
medical, dental or pharmacy.
• To find a network pharmacy, click Pharmacy. Then
be sure to choose the network for OHSU plans: NW
Prescription Drug Consortium network. Enter your
desired search criteria and then click Search.
The search results will give you both a map and an
alphabetical list.
2015 plan networks
OHSU PPO
(formerly known as 250 PPO)
National
Non-Contracted*
Non-Contracted*
Non-Contracted*
Community
Care Network (CCN)
ODS Plus/
Connexus
OHSU PPO
Synergy/
Summit Network
* Member will be balance billed for charges above Moda / PHCS’
reimbursement determination
**Oregon residents enrolled in the National plan may access the
ODS Plus/Connexus network at the higher coverage level.
<
Medical
Home
National
Network
(PHCS)**
(participants outside of
the State of Oregon and
SW-WA or in Klamath Falls,
eligibility determined
based on ZIP codes at time
of enrollment)
11
Wellness benefits
Healthy TEAM Healthy U
Healthy TEAM Healthy U can help you achieve and maintain a healthier lifestyle. This
behavior-based program, designed by OHSU faculty and staff—and refined by your
feedback—capitalizes on the power of employees working together. Numerous benefits
have been documented, including reduced blood pressure, lower body weight among
those who were overweight, improved diet and exercise behaviors, and feeling healthier.
Employees also felt less depressed, missed less work and reported being happier after
participating in HTHU.
For more information, including how to register, visit O2.ohsu.edu and search for Healthy
TEAM Healthy U.
HealthySteps
HealthySteps is an OHSU website where you can track and record your wellness activities. Being physically active, controlling your
body weight, attending health-related seminars, giving blood and other activities can all be tracked on the website. This individualinitiated employee wellness program is offered by OHSU Benefits and managed by the Division of Health Promotion and Sports
Medicine.
For more information, including how to register, visit O2.ohsu.edu and search for HealthySteps.
Weight Watchers
Benefits-eligible employees can participate in Weight Watchers at no cost. You can choose to attend a community Weight Watchers
meeting or coordinate a meeting at your worksite with your colleagues. You can also participate independently in the Weight Watchers
online program.
For more information, including how to register, visit O2.ohsu.edu and search for Weight Watchers.
Tobacco cessation
If you use tobacco and would like to quit, OHSU Benefits has support and resources to assist you. OHSU has partnered with the
American Cancer Society to provide free resources to employees and their dependents age 18 and older who want to stop using
tobacco. Resources include unlimited toll-free access to Quit Coaches, free nicotine
replacement therapy (patch or gum) mailed directly to your home and other tools to
assist you in your goal. For more information on available cessation resources, please
call the American Cancer Society’s Quit For Life program at 866-784-8454 or enroll
online at https://www.quitnow.net.
12
Dental benefits summary
Dental coverage is key to your overall health and wellness. You can enroll yourself
and your family in dental benefits with Moda Health, Kaiser Permanente
or Willamette Dental Group. For Kaiser and
Willamette Dental, you choose providers
only at those facilities. For Moda Health, you
choose providers from a network (see page 11
for instructions). You are responsible for any
coinsurance amounts shown in the chart below.
Waiting period If you previously
declined dental coverage for yourself or
a dependent, you will have a 12-month
waiting period for anything other than
preventive services on the Moda Health
dental plan.
Moda (ODS)*
Kaiser Permanente
Willamette Dental
Group
Annual deductible
$50 per person or $150 per family
None
None
Preventive and
diagnostic services
No charge, not subject
to deductible
No charge
No charge
$1,500**
None
None
Routine fillings
20% after deductible is met
No charge
No charge
Root canals
No charge
No charge
Prosthodontic care
(crowns, bridges and
dentures)
$75 copay per procedure/
unit; $25 copay
for relines and rebases
$75 copay per
procedure/unit
Orthodontia services
50% ($1,500 lifetime
maximum)
Not covered
$150 copay for preorthodontia; $1,200 copay
for comprehensive
orthodontia (no lifetime
maximum)
Key features
Annual maximum benefit
*A non‐participating dentist or dental care provider has the right to bill the difference between Moda’s maximum plan allowance and the actual charge.
This difference will be the member’s responsibility.
**Preventive services count towards the annual maximum benefit for Moda Dental.
13
Vision benefits summary
If you are enrolled in the Kaiser medical plan, your vision plan will be automatically covered
through Kaiser at no additional cost to you.
If you are enrolled in the OHSU PPO, Regional Medical Home or National plans, OHSU
offers you two vision options: a core vision plan and a premium vision plan. You can choose
either option or opt out of vision coverage.
This information is only a summary of vision coverage. For more information, visit
www.vsp.com or www.kp.org.
Key features
Providers
Exam
Core
Non-VSP
provider
VSP provider
No charge
Plan reimburses
up to $50
Lenses and frames
14
Premium
Non-VSP
provider
VSP provider
No charge
$25 copay
Plan reimburses
up to $50
$25 copay
Single vision
covered after
copay
Plan reimburses
up to $50
covered after
copay
Plan reimburses
up to $50
Lined bifocal
covered after
copay
Plan reimburses
up to $75
covered after
copay
Plan reimburses
up to $75
Lined trifocal
covered after
copay
Plan reimburses
up to $100
covered after
copay
Plan reimburses
up to $100
Lens options
35-40% off
N/A
35-40% off
N/A
Progressives
35-40% off
Plan reimburses
up to $75
covered in full
after $30 copay
Plan reimburses
up to $75
A/R coating
35-40% off
N/A
covered in full
after $30 copay
N/A
Frames
Plan reimburses
up to $150 or $80
at Costco
Plan reimburses
up to $70
Plan reimburses
up to $200 or
$110 at Costco
Plan reimburses
up to $70
Contacts
Plan reimburses
up to $140 for
elective contacts
in lieu of glasses
Plan reimburses
up to $140 for
elective contacts
and contact
lens exam in
lieu of glasses
Plan reimburses
up to $200 for
elective contacts
in lieu of
glasses
Plan reimburses
up to $185 for
elective contacts
and contact
lens exam in
lieu of glasses
Contact lens exam
Up to $60 copay
Up to $60 copay
Frequency
Exam
Every 12 months
Every 12 months
Lenses
Every 24 months
Every 12 months
Frames
Every 24 months
Every 12 months
Contacts in lieu of
glasses
Every 24 months
Every 12 months
Income protection insurance
OHSU provides eligible employees with a variety of plans to provide replacement income to you or your beneficiaries in the event of
disability, accident or death. This information is a summary of coverage only. Refer to your certificates of coverage for more detail.
The Hartford provides all life and accidental death and dismemberment insurance for OHSU employees.
Core life insurance
OHSU provides all benefits-eligible employees with a core life insurance policy in the amount of $25,000 at no cost to you.
Voluntary life insurance and accidental death and dismemberment coverage
You can also choose to purchase additional life and AD&D insurance
for yourself, your spouse/domestic partner and child(ren):
• Yourself (voluntary employee life insurance): In increments of
$25,000, up to a maximum of $975,000.
• Your spouse/domestic partner (voluntary spouse/domestic
partner life insurance): In increments of $25,000, up to a maximum
of $500,000.
Evidence of insurability For new hires and
newly benefits-eligible employees, evidence of
insurability (medical certification) is required
for life insurance policies above $300,000 for
yourself and above $50,000 for a spouse or
domestic partner.
• Dependent life insurance: For any eligible dependent, available in
the amount of $4,000 per dependent. This is separate from and in
addition to spouse/domestic partner life insurance.
AD&D coverage is different from life insurance in that it pays
benefits if you are killed or seriously injured (such as losing a limb)
in an accident. You may elect Employee AD&D insurance to cover
yourself or Family AD&D to cover all eligible members of your
household. Both policies are available in increments of $50,000, up
to $500,000. Monthly costs for voluntary life insurance and AD&D
coverage are on pages 16-17.
Disability insurance
Disability insurance is provided through The
Standard. You can buy short-term disability
and long-term disability insurance. STD is
designed to cover you during a disability that’s
shorter than 180 days. It is frequently used to
provide replacement income during maternity
leaves. LTD is designed to cover you during a
disability lasting longer than 180 days.
Current benefits-eligible employees have a
one-time opportunity during Open Enrollment
for 2015 benefits to increase life insurance
coverage without evidence of insurability. At
all other times, increases or changes to life
insurance amounts must be approved by The
Hartford before they can go into effect.
Disability costs for 2015
Percent of salary
Example of monthly premiums
for $50,000 annual salary
STD 8 day
1.290%
$53.75
STD 30 day
0.306%
$12.75
STD 90 day
0.080%
$3.33
STD 1/15 day
1.082%
$45.08
LTD 180 day
0.381%
$15.88
Disability premiums are based on your
annual compensation as of Oct. 1, 2014. This
“frozen” compensation amount and your premium will be visible in the online enrollment system. The premium does not change
throughout the calendar year, regardless of income or job changes. The “frozen” compensation amount will be updated each
October for the following calendar year. (If you are hired after Oct. 1, your compensation amount will be your annual salary as
recorded in Oracle.)
Disability payments also are based on your “frozen” compensation up to a maximum annual salary of $100,000. Premiums will be
charged to employees only up to that annual salary amount.
Continued on page 18
15
Voluntary employee life insurance costs for 2015 (monthly)
Age
<30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
$25,000
$0.43
$0.53
$0.78
$1.20
$1.95
$3.23
$4.55
$6.48
$10.35
$18.15
$22.35
$50,000
$0.85
$1.05
$1.55
$2.40
$3.90
$6.45
$9.10
$12.95
$20.70
$36.30
$44.70
$75,000
$1.28
$1.58
$2.33
$3.60
$5.85
$9.68
$13.65
$19.43
$31.05
$54.45
$67.05
$100,000
$1.70
$2.10
$3.10
$4.80
$7.80
$12.90
$18.20
$25.90
$41.40
$72.60
$89.40
$125,000
$2.13
$2.63
$3.88
$6.00
$9.75
$16.13
$22.75
$32.38
$51.75
$90.75
$111.75
$150,000
$2.55
$3.15
$4.65
$7.20
$11.70
$19.35
$27.30
$38.85
$62.10
$108.90
$134.10
$175,000
$2.98
$3.68
$5.43
$8.40
$13.65
$22.58
$31.85
$45.33
$72.45
$127.05
$156.45
$200,000
$3.40
$4.20
$6.20
$9.60
$15.60
$25.80
$36.40
$51.80
$82.80
$145.20
$178.80
$225,000
$3.83
$4.73
$6.98
$10.80
$17.55
$29.03
$40.95
$58.28
$93.15
$163.35
$201.15
$250,000
$4.25
$5.25
$7.75
$12.00
$19.50
$32.25
$45.50
$64.75
$103.50
$181.50
$223.50
$275,000
$4.68
$5.78
$8.53
$13.20
$21.45
$35.48
$50.05
$71.23
$113.85
$199.65
$245.85
$300,000
$5.10
$6.30
$9.30
$14.40
$23.40
$38.70
$54.60
$77.70
$124.20
$217.80
$268.20
$325,000
$5.53
$6.83
$10.08
$15.60
$25.35
$41.93
$59.15
$84.18
$134.55
$235.95
$290.55
$350,000
$5.95
$7.35
$10.85
$16.80
$27.30
$45.15
$63.70
$90.65
$144.90
$254.10
$312.90
$375,000
$6.38
$7.88
$11.63
$18.00
$29.25
$48.38
$68.25
$97.13
$155.25
$272.25
$335.25
$400,000
$6.80
$8.40
$12.40
$19.20
$31.20
$51.60
$72.80
$103.60
$165.60
$290.40
$357.60
$425,000
$7.23
$8.93
$13.18
$20.40
$33.15
$54.83
$77.35
$110.08
$175.95
$308.55
$379.95
$450,000
$7.65
$9.45
$13.95
$21.60
$35.10
$58.05
$81.90
$116.55
$186.30
$326.70
$402.30
$475,000
$8.08
$9.98
$14.73
$22.80
$37.05
$61.28
$86.45
$123.03
$196.65
$344.85
$424.65
$500,000
$8.50
$10.50
$15.50
$24.00
$39.00
$64.50
$91.00
$129.50
$207.00
$363.00
$447.00
$525,000
$8.93
$11.03
$16.28
$25.20
$40.95
$67.73
$95.55
$135.98
$217.35
$381.15
$469.35
$550,000
$9.35
$11.55
$17.05
$26.40
$42.90
$70.95
$100.10
$142.45
$227.70
$399.30
$491.70
$575,000
$9.78
$12.08
$17.83
$27.60
$44.85
$74.18
$104.65
$148.93
$238.05
$417.45
$514.05
$600,000
$10.20
$12.60
$18.60
$28.80
$46.80
$77.40
$109.20
$155.40
$248.40
$435.60
$536.40
$625,000
$10.63
$13.13
$19.38
$30.00
$48.75
$80.63
$113.75
$161.88
$258.75
$453.75
$558.75
$650,000
$11.05
$13.65
$20.15
$31.20
$50.70
$83.85
$118.30
$168.35
$269.10
$471.90
$581.10
$675,000
$11.48
$14.18
$20.93
$32.40
$52.65
$87.08
$122.85
$174.83
$279.45
$490.05
$603.45
$700,000
$11.90
$14.70
$21.70
$33.60
$54.60
$90.30
$127.40
$181.30
$289.80
$508.20
$625.80
$725,000
$12.33
$15.23
$22.48
$34.80
$56.55
$93.53
$131.95
$187.78
$300.15
$526.35
$648.15
$750,000
$12.75
$15.75
$23.25
$36.00
$58.50
$96.75
$136.50
$194.25
$310.50
$544.50
$670.50
$775,000
$13.18
$16.28
$24.03
$37.20
$60.45
$99.98
$141.05
$200.73
$320.85
$562.65
$692.85
$800,000
$13.60
$16.80
$24.80
$38.40
$62.40
$103.20
$145.60
$207.20
$331.20
$580.80
$715.20
$825,000
$14.03
$17.33
$25.58
$39.60
$64.35
$106.43
$150.15
$213.68
$341.55
$598.95
$737.55
$850,000
$14.45
$17.85
$26.35
$40.80
$66.30
$109.65
$154.70
$220.15
$351.90
$617.10
$759.90
$875,000
$14.88
$18.38
$27.13
$42.00
$68.25
$112.88
$159.25
$226.63
$362.25
$635.25
$782.25
$900,000
$15.30
$18.90
$27.90
$43.20
$70.20
$116.10
$163.80
$233.10
$372.60
$653.40
$804.60
$925,000
$15.73
$19.43
$28.68
$44.40
$72.15
$119.33
$168.35
$239.58
$382.95
$671.55
$826.95
$950,000
$16.15
$19.95
$29.45
$45.60
$74.10
$122.55
$172.90
$246.05
$393.30
$689.70
$849.30
$975,000
$16.58
$20.48
$30.23
$46.80
$76.05
$125.78
$177.45
$252.53
$403.65
$707.85
$871.65
Amount
16
Voluntary spouse life insurance costs for 2015 (monthly)
Age
<30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
$25,000
$0.58
$0.78
$1.18
$1.35
$2.33
$3.70
$5.25
$7.58
$13.60
$24.88
$24.88
$50,000
$1.15
$1.55
$2.35
$2.70
$4.65
$7.40
$10.50
$15.15
$27.20
$49.75
$49.75
$75,000
$1.73
$2.33
$3.53
$4.05
$6.98
$11.10
$15.75
$22.73
$40.80
$74.63
$74.63
$100,000
$2.30
$3.10
$4.70
$5.40
$9.30
$14.80
$21.00
$30.30
$54.40
$99.50
$99.50
$125,000
$2.88
$3.88
$5.88
$6.75
$11.63
$18.50
$26.25
$37.88
$68.00
$124.38
$124.38
$150,000
$3.45
$4.65
$7.05
$8.10
$13.95
$22.20
$31.50
$45.45
$81.60
$149.25
$149.25
$175,000
$4.03
$5.43
$8.23
$9.45
$16.28
$25.90
$36.75
$53.03
$95.20
$174.13
$174.13
$200,000
$4.60
$6.20
$9.40
$10.80
$18.60
$29.60
$42.00
$60.60
$108.80
$199.00
$199.00
$225,000
$5.18
$6.98
$10.58
$12.15
$20.93
$33.30
$47.25
$68.18
$122.40
$223.88
$223.88
$250,000
$5.75
$7.75
$11.75
$13.50
$23.25
$37.00
$52.50
$75.75
$136.00
$248.75
$248.75
$275,000
$6.33
$8.53
$12.93
$14.85
$25.58
$40.70
$57.75
$83.33
$149.60
$273.63
$273.63
$300,000
$6.90
$9.30
$14.10
$16.20
$27.90
$44.40
$63.00
$90.90
$163.20
$298.50
$298.50
$325,000
$7.48
$10.08
$15.28
$17.55
$30.23
$48.10
$68.25
$98.48
$176.80
$323.38
$323.38
$350,000
$8.05
$10.85
$16.45
$18.90
$32.55
$51.80
$73.50
$106.05
$190.40
$348.25
$348.25
$375,000
$8.63
$11.63
$17.63
$20.25
$34.88
$55.50
$78.75
$113.63
$204.00
$373.13
$373.13
$400,000
$9.20
$12.40
$18.80
$21.60
$37.20
$59.20
$84.00
$121.20
$217.60
$398.00
$398.00
$425,000
$9.78
$13.18
$19.98
$22.95
$39.53
$62.90
$89.25
$128.78
$231.20
$422.88
$422.88
$450,000
$10.35
$13.95
$21.15
$24.30
$41.85
$66.60
$94.50
$136.35
$244.80
$447.75
$447.75
$475,000
$10.93
$14.73
$22.33
$25.65
$44.18
$70.30
$99.75
$143.93
$258.40
$472.63
$472.63
$500,000
$11.50
$15.50
$23.50
$27.00
$46.50
$74.00
$105.00
$151.50
$272.00
$497.50
$497.50
Amount
Employee AD&D costs for
2015 (monthly)
Family AD&D costs for
2015 (monthly)
Amount
Premium
Amount
Premium
$50,000
$0.60
$50,000
$1.20
$100,000
$1.20
$100,000
$2.40
$150,000
$1.80
$150,000
$3.60
$200,000
$2.40
$200,000
$4.80
$250,000
$3.00
$250,000
$6.00
$300,000
$3.60
$300,000
$7.20
$350,000
$4.20
$350,000
$8.40
$400,000
$4.80
$400,000
$9.60
$450,000
$5.40
$450,000
$10.80
$500,000
$6.00
$500,000
$12.00
17
• Short-term disability insurance: This benefit pays 65 percent of your salary (up to an annual salary maximum of $100,000) for up to
180 days from the date of disability (some limitations apply).
You may choose an 8-day, 30-day or 90-day waiting period; longer periods mean lower premiums. The waiting period is the amount
of calendar days you will be required to wait before receiving a disability payment. It’s important to note that you also are required to
exhaust your sick time before receiving a disability payment. If you have a lot of sick time, you might consider a longer waiting period,
which will be a less expensive premium. The 180 days of coverage include your waiting period.
OHSU also offers the 1/15 short-term disability plan. This plan has two waiting periods for disability payments. If you are disabled as
the result of an accident, you will have no waiting period. If you are disabled as the result of anything but an accident, your waiting
period will be 15 days. This plan may be a good choice if you
are concerned about immediate income needs in the face of
an unexpected accident, and you have very little sick time
Pre-existing conditions These disability plans do not
accrued.
provide coverage for pre-existing conditions (including
• Long-term disability insurance: This benefit pays 65 percent
pregnancy). If you have a condition and are planning to
of your salary (up to an annual salary maximum of $100,000),
enroll in or change disability coverage for that condition,
coordinated with other income and benefits, after you have
you should consult The Standard or the Benefits team to
been disabled for 180 days (some limitations apply).
determine if that condition is likely to be covered.
Disability payments are not taxable to you upon payment.
Additional benefits
Flexible spending accounts
OHSU offers two types of flexible spending accounts that can help you save for out-of-pocket expenses. Both FSAs can be used with all
OHSU-offered medical plans. Contributions to FSAs are deducted from your paycheck semi-monthly (24 times a year). Deductions are
made pre-tax, which helps to lower your taxable income and allows you to use FSA dollars tax free on eligible expenses.
• Use the Health Care FSA for eligible health care expenses for yourself and your eligible dependents such as deductibles, copays,
coinsurance, prescription drugs, dental and vision expenses. Each year, you can contribute up to $2,500 to a Health Care FSA.
• Use the Dependent Care FSA for eligible child and elder care expenses so you (and your spouse, if married) can work or go to school.
Each year, you can contribute up to $5,000 to a Dependent Care FSA.
Visit www.benefithelpsolutions.com for a current list of eligible expenses, claims filing deadlines and other information about your
accounts.
It’s important to carefully estimate your contributions. Both FSA options feature a grace period, which allows you to incur and pay
for FSA claims until March 15 in the following calendar year using funds from your prior year’s FSA. Any unused funds in your FSA
account from the prior calendar year will be forfeited after March 15.
Household maximum Maximums for Dependent Care FSAs are per household. If you and your spouse both can enroll,
the maximum total for both of your accounts is $5,000. Contributing over the annual maximum for your household
will have tax implications.
Eligible dependents Not all dependents are eligible for FSA coverage. Domestic partners are not considered to be
eligible dependents by the IRS, but they are allowed on OHSU benefits. Because FSAs are regulated by the IRS, you
cannot use your FSA dollars toward expenses for domestic partners or children of domestic partners.
18
Employee Assistance Program
OHSU’s Employee Assistance Program services are provided by Moda Health. The EAP is available to all benefits-eligible employees
and their dependents, regardless of the medical plan you choose. The EAP provides you and eligible members of your household
with access to confidential counseling to help you address issues such as relationships, drug and alcohol abuse, financial hardship and
general stress or depression. Your EAP benefits include three free visits (no copay or other out-of-pocket cost to you) with a counselor
for you and/or your dependents. Many issues can be addressed directly with your EAP professional; in some cases, you may be referred
to other resources. The EAP is available 24 hours, seven days a week by visiting http://www.modaeap.com or calling 800-826-9231.
Travel assistance
Whether you are travelling for business or pleasure, travel assistance services are available to you through The Hartford beginning
Jan. 1, 2015. The services apply if you are more than 100 miles away from home for 90 days or less. Services include items such
as emergency medical assistance (including but not limited to medical referrals, medical evacuation and repatriation), pre-trip
information and identify theft programs. Please visit https://o2.ohsu.edu/benefits for additional information.
You have a voice—the Employee Benefits Council
The EBC is a unique and valuable group that functions on the idea of “by the people, for the people.” The council is made up of your
fellow employees to discuss important benefit topics—like what medical plans you are offered—and to make decisions on how to move
forward with your needs in mind.
OHSU believes you know yourself best and should have a voice in the benefits available to you. It’s important that you and your family
have excellent, affordable health, welfare and income-protection benefits.
The EBC represents you to make sure you have an array of health, wellness and financial components available for your total
compensation and rewards at OHSU. For more information about the EBC, visit https://o2.ohsu.edu/benefits.
Your rights
Health Care Reform Notice
OHSU believes the Kaiser Permanente medical plan is a “grandfathered health plan” under U.S. Health Care Reform legislation (Patient
Protection and Affordable Care Act, or the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan
can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan
means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example,
the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must
comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause
a plan to change from grandfathered health plan status can be directed to the plan administrator at www.kp.org. You may also contact
the U.S. Department of Health and Human Services at www.healthreform.gov.
Where to learn more
Please visit the OHSU Benefits website at https://o2.ohsu.edu/benefits or contact OHSU Benefits for additional information and full
notices on:
• Women’s Health and Cancer Rights Act
• Medicaid and the Children’s Health Insurance Program (CHIP)
• Health Insurance Portability and Accountability Act (HIPAA) of 1996
• Medicare Part D Creditable Coverage Notice
• Other additional important notices about your rights
19
Contact information
Refer to the chart below for additional contact information about your OHSU benefit options.
For individual benefits…
Contact ...
Call...
Visit...
OHSU PPO, Regional
Medical Home,
and National plans
Medical: Moda Health
Group #10001819
1-855-232-6898
www.modahealth.com
Prescription: Moda Health
Group #10001819
1-866‐939‐1660
www.modahealth.com
Vision: VSP
Group #12157430
1-800-877-7195
www.vsp.com
Kaiser Permanente HMO
(medical, prescription
and vision)
Kaiser Permanente
Group #8553
In Portland: 503-813-2000
Outside Portland:
1-800-813-2000
www.kp.org
Dental options
Moda Health
Group #10001819
Outside Portland:
1-888-217-2365
www.modahealth.com
Kaiser Permanente
Group #8553
Outside Portland:
1-800-813-2000
www.kp.org
Willamette Dental Group
Group #OR102
1-855-433-6825
www.willamettedental.com
Life insurance options
(for plans Jan. 1, 2015
and onward)
The Hartford
Group #402741
1-888-563-1124
www.thehartford.com
Life insurance options
(for plans until Jan. 1, 2015)
The Standard
Group #631050
1-800-378-2390
www.standard.com
Disability options
The Standard
Group #631050
1-800-378-2390
www.standard.com
Flexible Spending Accounts
(HFSA and/or DFSA)
BenefitHelp Solutions
Outside Portland:
1-888-398-8057
www.benefithelpsolutions.com
EAP
Moda Health
1-800-826-9231
www.modaeap.com
COBRA
BenefitHelp Solutions
1-800-556-3137
www.benefithelpsolutions.com
Leaves of absence
The Standard
1-800-378-2390
www.standard.com
For all benefits…
Contact ...
Call...
Email or visit...
General benefit questions
OHSU Benefits
503-494-7617
[email protected]
https://o2.ohsu.edu/benefits
About this guide
This guide highlights your benefits. Official plan and insurance documents govern your rights and benefits under each plan. For
more details about your benefits, including covered expenses, exclusions and limitations, please refer to the individual summary plan
descriptions (SPDs), plan document or certificate of coverage for each plan. If any discrepancy exists between this guide and the official
documents, the official documents will prevail. OHSU reserves the right to make changes at any time to the benefits, costs and other
provisions relative to benefits.
10/14 (400)

Benefits Summary 2015

Transcription

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