Benefits for a Healthy Life Promoting Health – Enhancing Life
Benefits for a
Healthy Life
Your American University 2010 Benefits Guide
Promoting Health – Enhancing Life
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W A S H I N G T O N , D C
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Eligible faculty and staff members of American
University receive a valuable and comprehensive package of benefit plans and programs.
This benefits guide has been prepared for your convenience as a quick reference source.
AU cares for the health and well-being of its faculty and staff—that’s why we’ve developed A healthy U, AU’s
Faculty & Staff Wellness
Program. See page 38 for more information.
Take advantage of our faculty and staff wellness program—A healthy U .
We have something to offer everyone. Look for the green apples as you read this guide and take advantage of the many ways we make it easy for you to get healthier. AhealthyU offers valuable information and activities on nutrition, fitness, relaxation, seasonal flu shots and more. Some offerings are free while others may have a modest charge. We have an onsite health and wellness coach who can create a wellness program tailored to your specific needs. See how easy it is to fit healthier habits into your life.
Visit us at american.edu/hr/wellness.html
.
A Letter from the Executive Director of Human Resources
In a recent survey of American University faculty and staff, we learned that nearly half of you would like to receive more employee benefits-related information. In large numbers, you also indicated that one of the ways you’d like to receive this information is by printed summary plan descriptions and benefits booklets. To address your sentiments, we worked hard to provide you with more readily available, easy-to-understand information about the myriad employee benefits offered to you by American University. The result of our efforts is this comprehensive benefits guide that we are pleased to roll out in conjunction with
Open Enrollment.
We understand that benefits are important to you and a valuable part of your total compensation package. Here at AU, the benefits package is typically valued at approximately 25 percent in excess of an employee’s salary. With that in mind, we continuously look for ways to maintain and improve our compensation and benefits package. For example, we regularly benchmark our benefits package with organizations with whom we compete for faculty and staff to help us gauge the value and competitiveness of our offerings. We conduct surveys of our faculty and staff to help us get a clearer sense of what you think about the benefits offered here. We also work closely with the University benefits advisory project team, comprised of our faculty and staff, to help shape our benefits package.
We encourage you to make the most of this guide, and familiarize yourself with all of the various benefits offered to you. For ease of use, the guide is color-coded and divided into three categories: Benefits Enrollment Decisions (Red), Wellness Programs and Resources
(Green), and Other Benefits, Information, and Notices (Blue). Use it as a tool during open enrollment and keep it handy as a reference throughout the year. Human Resources staff members are available to answer any of your questions and may be reached at x2591.
The University’s success depends on the contributions, engagement, and commitment of our faculty and staff. It’s the mission of our Human Resources staff to support you in your work here. To help us achieve that goal, we invite your feedback and questions about this guide and our benefits offerings.
Sincerely,
Beth Muha
Executive Director, Human Resources
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Table of Contents
Care Essentials Program New for 2010!
CareFirst Great Beginnings New for 2010!
Enhance Your Smile with Dental Coverage New Provider for 2010!
See Clearly with Vision Coverage New for 2010!
Obtain Peace of Mind with the Legal Plan New Provider for 2010!
Care for Your Animals with Pet Insurance New Plan for 2010!
You should refer to the appropriate sections of the Faculty Staff Benefits Manual or the official plan documents for more extensive information concerning your benefits plans. In the event of any conflict between this benefits guide or the appropriate descriptive sections of the benefits manual and the official plan documents, the plan documents will govern.
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Your Enrollment Options at a Glance
You may choose to enroll in the following benefits:
CovERAgE
Medical
Prescription Drug
Dental vision
Life
Personal Accident
Legal
Flexible Spending
Accounts
Long-term Care
Pet insurance group Auto and
Home insurance
PLAn oPtionS
CareFirst BlueCross BlueShield BlueChoice Open Access
Kaiser Permanente Signature Plan HMO
Express Scripts (for CareFirst participants)
Kaiser Permanente (for Kaiser Permanente participants)
Delta Dental PPO
VisionSavings Eyecare Program
MetLife Optional Life Insurance nEW in 2010
Improved mental health benefits
Delta Dental replaces CareFirst and DentaQuest
Free discount plan
Current employees can sign up for up to 4x salary/$600K without medical review
Base life: 1x salary (no more $50K cap)
MetLife Personal Accident Insurance
Hyatt Legal’s MetLaw Plan
PayFlex Medical Spending Account
PayFlex Dependent Care Spending Account
Todd Benefits Group
New plan vendor; expanded coverage
Special enrollment opportunity with limited questions to qualify
New plans Pet WellCare Protection
VPI Standard Plan
VPI Superior Plan
MetLife Group Auto and Home New plans available after January 1, 2010
Open Enrollment is your opportunity to make changes to your benefits: medical, dental, legal, flexible spending accounts, optional and personal life insurance, and long-term care insurance.
The University also provides you with an array of other benefits as a part of your total compensation at little or no cost to you:
• Basic Life and Accidental Death and Dismemberment Insurance – now covers up to one times (1x) your base salary (the $50,000 cap is removed January 1, 2010)
• Short and Long Term Disability Insurance – includes a long term disability feature to continue your 403(b) retirement contributions up to 15 percent of your pre-disability base salary.
• Educational Benefit Program – tuition for yourself, dependent children, and spouse/ same-sex domestic partner
• Defined Contribution 403b Retirement Plan with TIAA-CREF or Fidelity Investments
• Pre-Tax Parking and Pre-Tax Transit for Metro, MARC, and VRE
• Subsidized Membership in the William I Jacobs Fitness Center
• Membership in the Engraving and Printing Federal Credit Union
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Enrollment Information
You may enroll in most of the University benefits plans 1) after you are initially hired; 2) during the annual open enrollment period, or 3) at the time of a qualifying life event. If your enrollment is not completed during these times, you will have to wait until the next open enrollment to apply for or make changes to coverage. See the section “Changing Coverage
During the Year” for details. (page 9)
You may make changes to your retirement contributions, enroll in pet, home and auto insurance, and the free discount vision plan at any time.
If You Do Not Enroll . . .
During Open Enrollment— some of your existing elections will continue through the next plan year and you will not be able to make changes to your coverages until the next open enrollment period unless you have a qualifying life event. Dental and flexible spending accounts will not continue if you do not elect them. Your medical, life, legal, accident and long term care coverage will continue unless you make a change.
For New Hires— if you do not enroll within 30 days of becoming eligible, you will not have medical, dental, group legal, flexible spending account, optional life, or personal accident coverage and you will not be able to make changes to your coverage until the next open enrollment period unless you experience a qualifying life event. You will automatically be enrolled in the University-provided basic life and short term disability insurance, After one year of service, if you have not yet enrolled, you will be automatically enrolled in the AU Retirement plan and your 1% contribution will be matched by 2% from the University.
For 2010, dental and flexible spending accounts do not automatically roll over . You must elect:
• the new dental plan
• your flexible spending accounts
The legal plan will automatically continue for faculty and staff who had the benefit in 2009.
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Do you need to make changes during open enrollment? Consider these questions.
tHink About …
Do you want to change your medical plan?
Do you want dental coverage?
Will someone in your family need glasses next year?
Will someone in your family need braces next year?
Do you want to change the amount of your life insurance?
Do you want to change who you cover?
Do you want long-term care insurance (to cover out-of-pocket expenses for daily activities if you become ill or injured)?
Do you want to have a Health Care Spending
Account in 2010?
Do you want to have a Dependent Day Care
Spending Account in 2010?
Do you want to add legal coverage?
Do you want to add pet insurance coverage?
Do you want group auto or home coverage?
Do you want to take advantage of the free discount vision program?
YES no WHY …
New dental plan through Delta Dental requires you to elect it to continue dental coverage; otherwise you will not have dental coverage through Au after December 31, 2009.
Consider using VisionSavings Eyecare Program and adding a
Flexible Spending Account for medical expenses, including eye wear.
Choose the Delta Dental Plan which includes adult and child orthodontia coverage
You may elect up to 4x salary/$600K without a medical review.
Your base life insurance now is 1x salary with no $50K cap.
Enroll in long-term care with John Hancock through Todd
Benefits Group. New rates. Current employees complete a short questionnaire to qualify.
You must enroll (or re-enroll) each year.
You must enroll (or re-enroll) each year.
Enroll in Hyatt Legal’s MetLaw Plan with expanded benefits including eldercare, identity protection and real estate coverage
You must enroll to elect the benefit.
You must enroll to elect the benefit.
You must call MetLife at need number to enroll
How to Enroll
New Hires
Attend a new hire orientation to receive an overview of AU’s benefits plans. You will receive a Benefits Enrollment form. Fill out the form and submit it to HR within 30 days of your start date.
During 0pen Enrollment
From November 9 – 30, 2009, you can make your open enrollment elections online at the 2010 Open Enrollment portal under
Employment at my.american.edu.
During the Year
Go to the HR/Payroll Connection on my.american.edu portal and print a Benefits Enrollment form. Fill out the form and submit it to HR within 30 days of your qualifying life event, along with documentation to support the life event.
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Eligibility
You are eligible for the coverage described in this guide if you are a full-time faculty or staff member.
You can also enroll your eligible dependents for medical and dental coverage. Your eligible dependents include your legal spouse or same-sex domestic partner and your eligible children.
Children – Eligible children include your children, stepchildren, legally adopted children, children who have been placed with you for adoption, and children for whom you have been appointed legal guardian.
Your dependent children are eligible until age 19 (or later, as described below), provided they depend primarily on you for financial support. The age limitations for dependent children vary by plan, as described below:
PLAn
CareFirst, Delta Dental, and VisionSavings
Eyecare
Kaiser Permanente
AgE LiMitAtion
Until age 19
Until age 23 if a full-time student or on medical leave**
Any age if disabled*
Until age 25, regardless of full-time student status or on medical leave**
Any age if disabled*
MetLife Dependent Life
Insurance
From 15 days of age until age 23, regardless of full-time student status
Until 25 if a full-time student
Any age if disabled*
*Disabled children who are incapable of supporting themselves due to a mental or physical disability (provided the disability occurred before the child reached age 19)
** Please contact Human Resources for more information.
AU reserves the right to require documentation of a dependent’s eligibility at any time.
You should refer to the appropriate sections of the Faculty Staff Benefits Manual or the official plan documents for more extensive information concerning your benefits plans.
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Your Cost for Coverage
2010 RAtES
2010 Rates 2009 Rates
CareFirst & Express Scripts
Individual Under $25K
Individual Over $25K
Individual Plus One
Family kaiser Permanente
Individual Under $25K
Individual Over $25K
Individual Plus One
Family
Delta Dental
Individual
Individual Plus One
Family
Hyatt Legal’s MetLaw Plan
Individual
Family
Flexible Spending Account
Fee vision Discount Plan
All eligible family members
Pet insurance
Pet WellCare Protection
VPI Standard Plan
VPI Superior Plan optional Life insurance
Optional Life
$391.50
$391.50
$782.28
$1,134.05 varies varies varies
$340.43
$340.43
$683.14
$990.58
$21.11
$42.22
$61.20
$16.50
$16.50
$6.00
$0.00 n/a n/a n/a n/a
$365.67
$365.67
$730.66
$1,059.22
$340.43
$340.43
$683.14
$990.58 n/a n/a n/a
$15.73
$15.73
$6.00
2010 AU
Share/ Month
2010 Employee
Share/ Month
2010 Employee
Share/Bi-Weekly
$371.92
$313.20
$508.48
$737.13
$323.41
$272.34
$444.04
$643.88
$5.28
$8.44
$12.24
$0.00
$0.00
$2.75
Rates reduced 5%
Enroll up to 4x salary/$600K without medical review
$19.58
$78.30
$273.80
$396.92
$17.02
$68.09
$239.10
$346.70
$15.83
$33.78
$48.96
$16.50
$16.50
$3.25
$9.03
$36.14
$126.37
$183.19
$7.86
$31.42
$110.35
$160.02
$7.31
$15.59
$22.60
$7.62
$7.62
$1.50
Long-term Care
Based on age, plan design Group rates, individual coverage
Limited questions to qualify for AU employees
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Making Changes During the Year
You can change your medical, dental, life insurance, long-term care, and flexible spending account coverage during the year, according to IRS rules, only when you experience a qualifying life event, such as:
• Marriage, divorce, or legal separation
• Death of a spouse or dependent
• Birth or adoption of a new dependent or gaining legal custody of a new dependent
• A change in a dependent’s eligibility status
• Employment change for a spouse
• A change in your employment status or that of your spouse
• A change of your residence
You must make a coverage change due to a qualifying life event within 30 days of the event, and the election change must be consistent with the event. For example, if your dependent child no longer meets eligibility requirements (e.g., he or she reaches age 19 and is not a full-time student), you can drop coverage only for that dependent.
HIPAA Special Enrollment Notice
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your, or your dependents’, other coverage). However, you must request enrollment within 30 days after your, or your dependents’, other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact your Human Resources contact at x2591.
Stay Healthy with Medical Coverage
As a foundation for your healthy life, AU provides you with two medical plans that offer quality and value. AU offers the following plans:
• CareFirst BlueCross BlueShield Open Access Plan
• Kaiser Permanente HMO
Cost
AU contributes to the cost of your medical coverage. Your cost for medical coverage is deducted from your pay. You may choose to make pre-tax or after-tax contributions.
Insurance premiums effective January 1, 2010 are shown on page 8 of this guide.
If you have a Qualifying
Event or HIPAA Special
Enrollment and wish to change your benefits, you must submit supporting dated documentation and a benefits enrollment form within 30 days of the qualifying event to
Human Resources. Please note that the change to benefits must be consistent with the event that occurred.
Weight Watchers at Work
Stay motivated with coworkers to help you eat right and lose weight.
Meetings are held weekly on campus. Financial incentives also are available for participation. For more details go to www.
american.edu/hr/Weight-
Watchers.cfm.
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During open enrollment, you may:
• Change to a different medical plan option
• Enroll in a medical plan if you previously declined coverage
• Add or remove dependents
(i.e., change your coverage level)
• Drop coverage
If you are not currently covered under a medical plan and you do not enroll for coverage during open enrollment, or if you elect to cancel your coverage, you may not enroll until the next open enrollment except as summarized in the
Making Changes During the
Year section on page 9.
Pre-Tax Contributions
Pre-tax contributions come out of your pay before federal, Social Security, and (in most cases) state and local taxes are applied. Since your pre-tax contribution is not included as income on your W-2 earnings statement, it will reduce your taxable income. (Note: You cannot make pre-tax contributions on behalf of a domestic partner. Employees who are in a registered same-sex domestic partner relationship in the District of Columbia may be exempt from DC income tax on their medical benefit; this exemption does not apply to federal taxes.) Please contact Human Resources for more information. In addition, your pre-tax contributions for a given year will reduce your Social Security wage base for that year. This may result in a slight reduction in your Social Security benefits when you retire.
After-Tax Contributions
After-tax contributions come out of your pay after taxes are applied, and will not reduce your taxable income.
If you elect to pay for your coverage with after-tax contributions, in general you may reduce your level of coverage at any time. However, you may not increase your level of coverage during the year unless you have a qualifying life event (see the section Changing Coverage
During the Year). (You must contiune legal coverage through the calendar year.)
For example, if you elect to pay for Individual Plus One medical coverage with after-tax contributions, you may change this election to cover only yourself at any time during the year. Once you make this change, however, you may not increase to two-party or family coverage for the balance of the calendar year, unless you experience a qualifying life event.
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terms to know When Making Your Decision
blueChoice – CareFirst’s network of physicians who participate in the HMO portion of the plan (also referred to as in-network providers)
Coinsurance – The percentage amount a plan member pays for certain covered health care services and supplies after the deductible has been met (Applicable to CareFirst out-of-network)
Copay – The fixed amount a plan member pays when certain covered health care services and supplies are received (Applicable to CareFirst in-network and Kaiser)
Covered Expense – An expense for a service or supply that is covered under the applicable plan
Deductible – The initial health care expenses each year that a plan member must pay before plan benefits are paid (Applicable to CareFirst in- and out-of-network)
HMo (Health Maintenance Organization) – A health care delivery system that typically uses contracted primary care physicians to coordinate all health care for enrolled members. HMOs require each member to select a primary care physician (PCP). The PCP coordinates care and, in the Kaiser plan, makes referrals to specialists and hospitals as needed. Covered services are usually paid in full after the member pays any required copay amounts. Claim forms are generally not required (Kaiser plan and CareFirst BlueChoice
[in-network]) indemnity – A type of health plan that gives you the maximum physician choice as you may see any provider. However, your out-of-pocket expenses are higher when you see physician in an indemnity plan as they are out of the discounted HMO network (CareFirst Indemnity [out-of-network]) in-network – A network of physicians who agree to charge less to provide their services. These savings are passed on to members who have lower out-of-pocket expenses in-network (CareFirst BlueChoice [innetwork] and Kaiser) open Access – CareFirst feature that allows you to see an in-network specialist without a referral
(CareFirst)
PCP (Primary Care Physician) – Physician who coordinates your in-network care and, in the Kaiser plan, makes referrals to specialists and hospitals as needed (CareFirst in-network and Kaiser plans)
PoS (Point of Service) – A type of health plan that provides flexibility by allowing members to decide how to receive services each time services are needed. For example, a member may choose to see a network or non-network provider each time he/she needs care. The highest level of benefits is generally obtained by using in-network providers (CareFirst plan is a POS Plan with HMO Open Access network and indemnity features)
See the back of this guide for a more complete glossary of terms.
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Did you know that most medical plans offer a 24-hour nurse line for help with nonurgent medical advice?
If you’re not sure whether your cold or a child’s sore throat warrants a visit to the doctor or emergency room, call your medical plan’s nurse line.
CareFirst - FirstHelp TM
Line: 800-535-9700
Nurse
Kaiser: 703-359-7878 (DC);
800-777-7904 (outside DC) tools & Resources http://www.american.edu/ hr/Benefits.cfm
For benefit summaries, summary plan descriptions
CareFirst www.carefirst.com
Kaiser www.kp.org
Both medical plans offer many online tools, resources, and access to wellness discounts.
Check out their Web sites for more information on:
Health assessments
Health improvement tools & trackers
Wellness products and discounts (weight loss programs, sports clubs, massage therapy, and more)
Contacts:
CareFirst: 800-296-0724
(before Dec. 21, 2009)
800-628-8549
(after Dec. 21, 2009)
Kaiser: 301-468-6000
Coverage Levels
When you enroll, you will be able to elect one of the following coverage levels:
• Individual
• Individual Plus One
• Family
Choosing a Medical Plan
Choosing a medical plan can be confusing, so we provide you with this guide to help.
The information on the following pages provides an overview of the different types of coverage available under the AU medical plans. Review each plan carefully to determine which plan best fits your family’s needs.
Finding a Network Doctor
We strongly urge you to use the online provider directories for each plan. Generally, the online versions offer the most up-to-date information. However, if you would like to obtain a copy of a paper directory, please contact Human Resources at x2591.
With CareFirst, we recommend contacting the health care provider to confirm they are participating in the plan’s network and accepting new patients.
CareFirst
The CareFirst plan utilizes a local network of providers, called BlueChoice. To locate a medical provider, go to www.carefirst.com and click Find a Doctor. When you are asked to specify a plan, select CareFirst BlueChoice. You may also use this online directory to search outside of the BlueChoice network for BlueCross BlueShield participating providers by searching the Traditional/Indemnity network.
• Away from Home Plan — If you have eligible family members outside the
Washington, DC area, this plan allows them to use local participating BlueCross
BlueShield providers and receive in-network benefits. Note: You must apply for
Away from Home coverage separately. Call the Away from Home group at 888-
452-6403 for more information or to apply for coverage.
Kaiser Permanente
The Kaiser Permanente plan utilizes a local network of facilities and providers. To locate a medical provider, go to www.kp.org and select your region (Maryland/Virginia/Washington
DC). Click Locate our services, then Selecting a Physician.
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Medical Plan Options
CareFirst BlueChoice Opt-Out Plus Open Access
The CareFirst Plan is a double option plan that allows you maximum flexibility, known as a Point-of-Service plan. The two options are always available to you, if you enroll in
CareFirst. Each time you need to seek care, you have a choice as to whether your doctor is in- or out-of-network. Your choice of doctor will determine how much you pay out of pocket. With the Open Access feature, you don’t need a referral from your primary care physician (PCP) to receive most in- or out-of-network care. However, to receive maximum benefits from this plan, you should choose a BlueChoice HMO in-network PCP and have that physician direct all of your medical needs.
• CareFirst HMO —By seeing a doctor who participates in the BlueChoice HMO network of providers, you will save money out of pocket.
• Indemnity Plan —You may choose any provider and will likely pay more out of pocket.
Providers who do not participate in the BlueChoice network, but who do participate in the
Indemnity network, will accept CareFirst’s negotiated rate as payment in full and submit claims on your behalf. You would then be responsible for any applicable deductible and coinsurance.
The plan also allows you to receive care outside the CareFirst BlueChoice network from any provider; however, your out-of-pocket cost will be higher. When you access care outside the BlueChoice or Indemnity networks, you will not only be responsible for deductible and coinsurance, you may also be billed for any amounts above CareFirst’s negotiated rate. This is known as balance billing. See the example below.
Choosing a PCP with
CareFirst
You are strongly encouraged to choose a PCP when you enroll. If you are enrolling in this plan for the first time, you may select a PCP on your open enrollment form or contact CareFirst Member
Services after mid-December to make to designate your
PCP. For more information, see the Frequently Asked
Questions section of this guide.
How Your Choice of Provider Impacts Your Out-of-Pocket Cost in the CareFirst Plan
in-nEtWoRk
BlueChoice Network
$2,200 out-oF-nEtWoRk
BCBS Participating Provider Non-BCBS Provider
$2,200 $2,200 Provider’s charge (office visit, X-ray and lab)
Plan’s allowable charge (negotiated rate)
Plan pays
$800 $1,000 $1,000
$685
(100% after $15 copay and
$100 deductible)
$187.50
(75% after $750 deductible)
$187.50
(75% after $750 deductible)
You pay
Deductible*
Office visit copay
25% of allowable charge after deductible
Difference between the allowable charge and provider’s charge
(balance billing)
Your total out-of-pocket cost
$100
$15
N/A
N/A
$750
N/A
$62.50
N/A
$750
N/A
$62.50
$1,200
$115 $812.50
$2,012.50
*This example assumes that you have not satisfied the plan’s annual deductible ($100 for Individual in-network and $750 for Individual out-of-network).
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Farmers’ Market and Fresh and Local CSA
Two ways to support area farmers: visit the on-campus farmers’ market held weekly
(in season) or sign up for community supported agriculture (CSA) - sit back, and let your weekly supply of fruits and veggies come to you. CSA registration occurs annually. See page 39 for details.
Kaiser Signature HMO
Kaiser Permanente provides comprehensive prepaid health care services through a system of health care network facilities. All health care is arranged or provided by a primary care physician (PCP) of the Health Maintenance Organization (HMO) you select at the time you enroll. No benefits are provided for non-emergency services received outside the HMO network of providers.
Kaiser Permanente has 30 centers located throughout the Washington, DC metropolitan area. Some centers serve as after-hours care centers, where participants with urgent medical problems may be seen when regular medical centers are closed. With the exception of life threatening emergency treatment, participants must receive care through Kaiser centers.
Hospitalization coverage is included at area hospitals associated with Kaiser.
• You must select a PCP in order to obtain care within the network; if you do not select a PCP, one will be assigned to you.
• As needed, your PCP will refer you to specialists within the network.
• Except in emergency situations, coverage is not provided for care received outside the network.
• You pay a copay for each visit to a physician’s office.
• Use the Health Manager program at www.kp.org
to email your physician, schedule appointments, obtain prescription refills, obtain test results, and review records of earlier visits.
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Medical Benefits Summary Chart
Plan Overview
Choice of physician
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice Indemnity
Must select primary care physician from list of participating physicians.
Open Access: No referrals required To see specialist
Choose any physician. No network limitations.
No referrals required.
Annual deductible
Co-payments
$100 Individual
$200 Individual + one
$200 Family note: The in-network deductible applies to non-preventative care services. Preventative care such as annual physical and mammograms are not subject to the deductible, however co-payments still apply.
$15 Primary Care
$20 Specialty Care
$ 750 Individual
$1500 Individual + one
$1500 Family
None kAiSER PERMAnEntE
HMO
Must select a primary care physician from the list of physicians at one of Kaiser
Permanente’s medical centers.
None
$15 – For non-preventive care.
No co-payment for adult and children over 5 preventative care office visits.
No co-payment for primary care physician office visits for children under 5. (Note: specialist copayment applies for children under 5.)
None Co-insurance None 75% 1 paid by health plan
25% paid by participant
1. The amount that BCBS will pay for a given covered service is determined by the Plan Allowance for that service. The Plan Allowance for covered services is determined by the contracted rate or fee schedule that participating providers have agreed to accept for that service or the rate or fee that is established by law. Throughout this document this definition will be referred to as “plan allowance.”
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Maximum out-of-pocket expense
Claim forms
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice
$2,750 Individual
$5,500 Individual + One
$5,500 Family note: The HMO BlueChoice plan does not cover any portion of your medical bills until you first meet your annual deductible; co-payments still apply and do not count toward the deductible.
After the deductible is met for the year, you pay only the co-payment. If you reach the maximum out-of-pocket expense for the year, BCBS pays 100% of plan allowance(s) for covered expenses for the remainder of that year.
Example: With individual coverage you first pay the $100 deductible and office visit copayment for non-preventative care. Then, co-payments or other cost-sharing applies. If your outof-pocket expense totals $2,750,
BCBS pays 100% of plan allowance(s) for the remainder of the year.
No claim forms to file
Indemnity
$4,000 Individual
$8,000 Individual + One
$8,000 Family note: The indemnity plan does not cover any portion of your medical bills until you first meet your annual deductible. After the deductible is met for the year, most covered services are reimbursed by BlueCross
BlueShield (BCBS) at 75% of plan allowance and you pay 25%. Once you reach your maximum out-of-pocket expense for the year, BCBS pays 100% of plan allowance(s) for covered expenses for the remainder of that year.
Example: With individual coverage you first pay the $750 deductible. Then, BCBS pays
75% of plan allowance and you pay 25% of all covered medical bills. When your out-of-pocket expense totals $4,000, BCBS pays 100% of plan allowance(s) for the remainder of the year.
May need to file your own claims. If your physician participates with BlueCross through another plan, they are by contract required to submit your claims on your behalf as
BlueCross will reimburse them directly.
kAiSER PERMAnEntE
HMO
$1,000,000 lifetime out-ofpocket expense.
No claim forms to file
Pre-Certification Hospital certifications arranged by physicians
Responsible for arranging own hospital certifications. Financial penalty if pre-certification is not arranged.
Hospital certification arranged by the member through the plan.
See pages 61-71 for a detailed medical benefit summary chart that compares the CareFirst in- and out-of-network and Kaiser Permanente plans.
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Filing Claims
If you use a BlueChoice, BCBS, or Kaiser participating provider, you do not need to file claim forms. Show your ID card when you receive services and the provider will use the information on the card to submit your claim. You may have to file claims if you receive services from a non-network provider. Obtain claim forms online or by phone.
New CareFirst ID Cards for January 1, 2010
All CareFirst participants will receive new ID cards at the end of the calendar year. Please be sure to shred your old card and replace it with the new card to ensure that your coverage continues seamlessly. An example of the new card is to the right.
Member Name
KUA830 45 6
Group 58000
BC/BS Plan 0
789
33-DC10
C
80/580
Physic
OPEN AC opay Rider Inform
P15 S
CESS ian Name
20 ER50 VC ation
Customer Service: 80
0-628-8549
Care Essentials Program New for 2010!
CareFirst BlueCross B and does not assum lueShield provides e any financial risk or ly
Your health affects more than just the way you feel. It touches your family, your job, and your life in many ways. We know it can be difficult to make time to see your doctor, to follow up on questions, and to make sure you are on track when you have a chronic illness.
That’s why your employee benefits package now includes the Care Essentials—a health coaching and resource program for those who enroll in the CareFirst medical plan. This valuable program can make life easier and more fulfilling—all at no additional cost. (A similar program is already available to Kaiser members.)
Car eEssentials is a personalized, confidential, and voluntary program that helps people
OPEN ACCESS O
For Groups: 5800
The American U
PKG 240 niversity
PT OUT PLUS H
MO/CORE DAV
IS VISION with conditions like diabetes or asthma manage their overall health. Highly trained nurses
For groups : 5800
0034-DC40 & 58
034-DC40 & 580
00035-DC20
0035-DC20 provide one-on-one telephone support and health information. They will help you prepare questions for doctor visits, answer questions about new diagnoses and medications, and assist with other health issues.
The Care Essentials team is available to support your relationship with your physician, not replace it. They will keep your doctor informed of your progress in the program and ensure coordination of care. Your team will educate and support you as you learn to better manage your health.
Seated Massage
Relieve tension with a 15- or
30- minute seated massage.
Services provided by licensed massage therapist every other Monday.
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The Care Essentials program is provided to you by CareFirst through their partner
Healthways, Inc., a leading provider of integrated health management services that delivers personalized programs to millions of people across the country.
How
Care
Essentials Works
As part of the Care Essentials program, your services include:
A welcome mailing and follow-up phone call (caller ID will show “Your Health Plan
Nurse”); Periodic calls from the Care Essentials team to support your self-care efforts in tandem with your doctor reminders to schedule important appointments; and newsletters and educational materials; toll-free access to your support team 24 hours a day, 7 days a week.
Your Care Essentials Disease Management program is available for these conditions:
Diabetes, Asthma, Heart Failure, Coronary Artery Disease, Chronic Obstructive
Pulmonary Disease (COPD), Low Back Pain, Osteoporosis, Osteoarthritis, Hepatitis C,
Urinary Incontinence, Decubitus (Pressure) Ulcers, Atrial Fibrillation, Inflammatory Bowel,
Irritable Bowel Syndrome, Fibromyalgia, and Acid-related Disorders.
NEXT
CareFirst Great Beginnings New for 2010!
If you are enrolled in the CareFirst medical plan, the Great Beginnings program is available to you at no additional cost. Great Beginnings provides support to members during pregnancy. The program is designed to supplement the prenatal care and education you receive from your doctor. Nurse case managers strive to help you stay healthy during pregnancy.
How Great Beginnings Works
When you enroll in Great Beginnings, a nurse case manager will contact you to review your medical history and to identify any conditions that may affect your pregnancy.
During each trimester of your pregnancy, your nurse will contact you to see how you are feeling and to answer any of your questions.
You will receive information related to your condition and your baby’s development. Your
Great Beginnings nurse will tell you about community resources and support groups available to you during your pregnancy and immediately after your baby is born. He or she will also help you find a pediatrician close to your home to care for your baby.
If you experience complications during your pregnancy, your nurse will work closely with your doctor to coordinate necessary services. Your nurse will contact you often to provide the additional support and information you may need during this time and will be available to answer your questions Monday through Friday, 8:30 a.m. to 5:00 p.m.
How to Enroll in Great Beginnings
To enroll in Great Beginnings or find out more information about the program, call 888-264-8648. You will be asked to give your:
• Name
• CareFirst Membership number
• Address
• Daytime telephone number
• Due date
• Doctor’s name
• Doctor’s phone number
A Great Beginnings nurse case manager will contact you within two weeks for your initial assessment.
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What is a formulary?
A formulary is a preferred drug list of safe and effective brand name and generic drugs.
Take Your Medicine with Prescription Drug
Coverage
Our medical plans provide prescription drug coverage for a wide selection of drugs.
If you take certain medications on a regular basis, you can save money by purchasing prescriptions by mail order. With mail order prescriptions, you pay less and get convenient home delivery.
Your prescription drug coverage is a three-tier benefit structure based on a formulary.
Your copay varies, depending on whether you purchase a generic or brand name drug and whether the drug is included in your plan’s formulary.
An automatic generic substitution is made for mail order and pharmacy prescriptions. When a physician does not indicate that the prescription be “dispensed as written,” either a generic drug will be dispensed, or if the employee wishes to have the brand drug, he/she will be charged the higher tier two or three brand co-payment plus the difference between the cost of the brand-name drug and generic.
Generic
Brand Name Preferred
(Formulary)
Brand Name Non-Preferred
(Non-Formulary)
A drug that meets the same quality of standards and is an ingredient match to the brand name equivalent. Generic drugs have a lower copay.
A drug that has no generic equivalent and is included on the plan’s preferred drug list (formulary).
Both plans require a higher copay for preferred brand name drugs than for generic drugs.
A drug that is not included on the plan’s preferred drug list for which there is a therapeutic equivalent in the generic or brand name preferred tiers. Both plans require a higher copay for drugs that fall in this category.
ExPRESS SCRiPtS
(CAREFiRSt PARtiCiPAntS) kAiSER PERMAnEntE
Retail Pharmac y
Generic Drugs
Brand Name Formulary Drugs
Brand Name Non-Formulary
Drugs
Mail Order
Generic Drugs
Brand Name Formulary Drugs
Brand Name Non-Formulary
Drugs
In-Network
$10 for 1 month supply
$25 for 1 month supply
$35 for 1 month supply
$20 for 3 month supply
$50 for 3 month supply
$70 for 3 month supply
Kaiser Center Pharmacy
$10
$20
$35
$8 for 3 month supply
$18 for 3 month supply
$33 for 3 month supply
Outside Pharmacy
$20
$40
$55
Using Participating Pharmacies is Easy
If you have CareFirst medical, show your Express Scripts drug ID card to your pharmacist when you fill a prescription. important: You must present your Express Scripts, and not your CareFirst, card to have your prescriptions filled at retail pharmacies; presenting your CareFirst card will result in a denial of your claim.
Use a participating pharmacy to receive the highest level of benefits.
Find a participating pharmacy online or by phone 877-486-5984 www.express-scripts.com
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To save out-of-pocket costs and help control the community’s health care expenses, discuss with your doctor what medication is most appropriate for you based on your condition and out-of-pocket costs and ask if there is a generic or preferred brand equivalent. The majority of drugs prescribed by your doctor will already be on the formulary.
• The Express Scripts formulary is available at www.express-scripts.com
• The Kaiser formulary is available at www.kp.org
Prescription drugs are covered at 100% after your copay. Up to a 34-day supply of covered medications is provided unless the drug maker’s packaging limits the supply in some other way. The plan also covers the cost of prescriptions purchased at nonparticipating pharmacies, but you must pay for them at purchase, then file a claim to be reimbursed.
Find claim forms online.
Mail Order Prescription Program
Use the mail order program for drugs you take on an ongoing basis for conditions such as arthritis, high cholesterol, diabetes, and high blood pressure. This program is a great option to help you save on copays. You can order a 90-day supply of maintenance medication by mail. Most medications are delivered right to your doorstep . Once your order is set up, you can request refills online or by phone. Order forms are available online.
Express Scripts
To save CareFirst participants money, the University has contracted with third-party prescription drug benefit provider, Express Scripts. Present your Express Scripts card to have your prescriptions filled at retail pharmacies. The mail service prescription drug program is an integrated feature of your pharmacy coverage. Once ordered, your prescription is reviewed and dispensed by a registered pharmacist and is mailed directly to your home. Injectable and specialty drugs are available through CuraScript, the specialty care prescription program available with Express Scripts. Some drugs may require a preauthorization. Call Express Scripts customer service or go to express-scripts.
com for more information. Without prior authoization, you will pay the full price of the prescription rather than the copayment.
Kaiser
Prescriptions can be filled at a plan pharmacy located within a Kaiser facility or at a participating network/community pharmacy. Members may also choose to fill prescriptions for maintenance and other long-term medications through the mail order service offered through www.kp.org.
Why Choose a generic?
Generic drugs are an excellent value. To help control the rising cost of prescription drugs, use a generic drug whenever possible and ask your doctor if one is available when you get a new prescription. By law, the active ingredient(s) in generic and brand name drugs must meet the same standards for purity, strength and quality. Generic drugs cost less because they are created without the costly development, advertising, and sales expenses required for brand name drugs.
know Your numbers
Screening Event
Know the numbers that can have the most dramatic effect on your health: cholesterol, blood pressure, glucose, and body mass index. Additional screenings are also available. All are free and results are confidential. Events are scheduled at a variety of times and locations throughout the year.
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NEXT PREVIOUS TABLE OF CONTENTS open Enrollment Elections
To have dental coverage for 2010, you must elect
Delta Dental during Open
Enrollment. After December
31, 2009, the DentaQuest and CareFirst plans will end.
tools & Resources www.deltadentalins.com
http://www.american.edu/ hr/Benefits.cfm For benefit summary, summary plan description
Contacts
Delta Dental 800-932-0783
(8am - 8pm EST M-F)
The plan helps you pay for most necessary dental services and supplies, including diagnostic and preventive care
(such as exams, cleanings, and X-rays), basic and major restorative services (such as fillings, crowns, and dentures), and orthodontia.
Enhance Your Smile with Dental Coverage New
Provider for 2010!
Strong teeth and gums are an important part of good health. American University offers you and your eligible dependents a dental plan from Delta Dental to help pay for many of the dental expenses you and your family incur. We learned that AU faculty and staff wanted better dental coverage from the Benefits Survey run in fall 2008. Specifically, you told us to find one plan that offered a wider network of dentists for nominal cost. We are pleased to offer Delta Dental as our new PPO dental network for 2010. It provides improved benefits and a wider network of participating dentists for about the same cost or less than our prior plans.
Cost
For the first time, AU will begin contributing to the cost of your dental coverage (25% for individual and 20% for individual plus one and family coverage). Your cost for dental coverage is deducted from your pay on a pre-tax basis. Insurance premiums effective
January 1, 2010 are shown on page 8 of this guide.
Coverage Levels
When you enroll, you will be able to elect one of the following coverage levels:
• Individual
• Individual Plus One
• Family
During open enrollment, you may:
• Enroll in the new dental plan to have dental coverage in 2010 (CareFirst or
DentaQuest dental will no longer be available and you will not be automatically enrolled in Delta Dental)
• Drop coverage
• Add or remove dependents (i.e., change your coverage level)
If you are in CareFirst dental, DentaQuest dental, or are not currently covered under a dental plan, and you do not enroll for coverage during open enrollment, or if you elect to cancel your coverage, you may not enroll until a future open enrollment except as summarized in the Making Changes During the Year section on page 9.
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Dental Benefits Summary Chart
PLAn FEAtuRES
Deductible
(Waived for Diagnostic, Preventive, and Orthodontia benefits)
Individual
Family
Plan Maximum
Calendar Year Maximum (per person)
Orthodontia Lifetime Maximum (per person)
Plan Covers
Diagnostic and Preventive Services
Oral Exams
Prophylaxis (cleaning)
X-rays
Sealants
Flouride treatment
Space maintainers
Basic and Restorative Services
Fillings
Simple Extraction
Oral Surgery, Endodontics, and Denture Repair
Incisions, excisions, surgical removal of tooth
Endodontics
Denture Repair
Major Restorative, Periodontics, and Prostriodontics
Periodontal services
Dentures
Bridges, crowns, inlays and onlays
Implants
Orthodontic Services
Adults and Children
DELtA DEntAL PLAn
Delta Dental PPO sm Delta Dental Premier ® and Non-
Participating Dentists
$50
$150
$1,500
$1,000
100%, no deductible
90%, after deductible
90%, after deductible
60%, after deductible
50%, no deductible
100%, no deductible
80%, after deductible
80%, after deductible
50%, after deductible
50%, no deductible
This summary is provided for general information only. Since exclusions and dollar, frequency, and age limitations apply, you should refer to the specific plan documents for detailed information. The benefits schedule reflects amounts paid by the plan based on the allowed benefit. Delta Dental Premier and Delta Dental PPO Network dentists accept 100% of the allowed benefit as payment in full for covered services. Dentists outside the Delta
Dental PPO and Premier networks may bill you for the difference between the allowed benefit and their charges
(balance billing).
Did you know that avoiding dental visits can have lifelong or life-threatening implications?
Gum disease is often linked to complications for diabetes, heart disease, stroke, preterm birth, and other health issues.
Regular dental visits may result in the early diagnosis and treatment of chronic diseases.
The earlier these diseases are identified, the better chance for a successful outcome.
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Personal Health Assessment
Get your wellness scorecard by taking this free and confidential online health assessment. Incentives are offered for participation!
Finding a Dentist
The plan lets you select any dentist of your choice, but you save the most if you use a participating Delta Dental PPO dentist and you save moderately if you visit a Delta Dental
Premier dentist. You save the least when visiting a non-participating dentist. Although you may select any licensed dentist, if you see a dentist who is not a participating Delta Dental provider, you may be responsible for any amounts above the allowed benefit charges for services provided in your area.
You can check your benefits, review the plan, find a participating dentist, and print replacement or family member dental ID cards online at www.deltadentalins.com. If you have questions about your dental benefits, please contact Delta Dental directly or Human
Resources at x2591.
Predetermination of Dental Benefits
If your dental care will be extensive (over $300), ask your dentist to complete and submit a claim form to Delta Dental for a predetermination of benefits. Delta Dental will advise you exactly what procedures are covered, the amount that will be paid toward the treatment, and your financial responsibility.
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See Clearly with Vision Coverage
New for 2010!
The VisionSavings Eyecare Program discount plan promotes preventive care through regular eye exams and early corrective treatment. In addition to helping you see better, routine eye exams can detect a number of serious health conditions such as glaucoma, cataracts, and diabetes. Eye exams for your dependent child/ren can also recognize problems that may affect their learning.
Cost
There is no charge for the vision discount plan.
Determining Your Needs
If you are already enrolled, or enrolling, in an AU -sponsored health plan, you receive vision benefits through that plan. Depending on the extent of your vision needs, you may find that the benefits offered by your AU-sponsored medical plan are sufficient. If you are not enrolled in an AU-sponsored health plan or wish to go to a different vision provider, you may wish to use in this vision discount plan. Use this chart to assist you in determining whether VisionSavings Eyecare Program is right for you:
RoutinE ExAM EYEgLASSES,
FRAMES
AnD LEnSES
ContACt
LEnSES
CareFirst
Kaiser
VisionSavings
Eyecare
Program
(sample discounts)
$10 copay at program-designated
Vision Care
Centers (referral not required).
$25 copay at
Network Physician offices (referral from
PCP required).
Limited to one per calendar year.
100%
Discounts available at participating vision centers.
$5 off eyeglass exam
$10 off contact lens exam
Discounts available at participating vision centers.
There is an additional cost for contact lens fittings.
Discount when purchased through Kaiser
Up to 50% off lenses
(uncoated plastic)
Up to 40% off frames
Discount on initial fitting and purchase
15% off nondisposable oFFiCE viSitS
FoR MEDiCAL
ConDitionS oF tHE EYE
$15 copay
PCP;
$20 copay
Specialist
100%
Open Enrollment Elections
There is no need to elect vision coverage. The discounts are automatically available to you after
January 1, 2010. Simply give the participating vision provider/center your group number
(#923 8205) and they will automatically charge you the discounted rate. To view a list of participating providers/centers, please go to www.mybenefits.MetLife.com. You will have the option to print out a card on the mybenefits page if you wish.
Finding a Provider
This plan offers discounts on eye exams, contacts and eyewear purchased at participating providers including JC Penney Optical,
Target Optical, Sears Optical,
Pearle Vision, and LensCrafters.
AU faculty and staff with
CareFirst and Kaiser receive discounts through their medical coverage.
Contacts:
CareFirst: 800-628-8549
Kaiser: 301-468-6000
VisionSavings Eyecare
Program:
800-GET-MET8
Discount code 923 8205
Did you know that a simple vision exam can help you keep tabs on your overall health?
An annual eye exam is a simple, low-stress way to keep tabs on your vision and overall health. Some of the things that your doctor will be looking for include glaucoma, cataracts, diabetic retinopathy, and agerelated macular degeneration
(a leading cause of blindness as we grow older).
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26
Questions on Eligible Medical
Expenses?
Call PayFlex or visit their Web site at www.mypayflex.com
for information on eligible expenses. Eligible IRS Section
125 flexible spending account expenses are also listed in IRS
Publications 502 and 503, which you can obtain through your local IRS office or from the IRS Web site at www.
irs.gov. Click on Forms and
Publications and then select
Publication 502 or 503.
The dependent care flexible spending account reimburses you for eligible dependent care expenses that enable you
(and your spouse, if you are married) to work (for example, day care and elder care). If your account currently does not hold sufficient funds to cover the entire reimbursement, you receive a partial payment.
An additional check is automatically issued after contributions from your next paycheck have been added to the account.
Special rules apply to spouses who are full-time students or incapable of self-care. Contact your tax advisor for additional guidance.
Lower Your Taxes with Flexible Spending
Accounts
You can set aside money in a flexible spending account (FSA) before taxes are deducted to pay for certain health and dependent care expenses, lowering your taxable income and increasing your take-home pay. You submit itemized receipts for eligible expenses to be reimbursed with your own untaxed dollars or pay with the PayFlex debit MasterCard and retain your receipts. You may participate in one or both of the FSAs. Only expenses for services incurred during the plan year and grace period while you are actively employed are eligible for reimbursement from your accounts.
You may elect to participate in either or both the medical flexible spending account or the dependent care flexible spending account; however, money cannot be transferred between the accounts. For example, money in your medical flexible spending account may not be used to pay for dependent care expenses.
Cost
Your cost is based on the contribution amounts you elect. You pay a small monthly fee (in
2010, your share is $3.25 a month to participate).
The annual maximum amount you may elect is $6,000 for the medical care FSA and up to $5,000 for the dependent care FSA ($2,500 if you are married and filing separate tax returns).
When estimating your dependent care expenses, remember that you may not have expenses for weeks of vacation, illness, or other times your dependent receives free care.
The medical flexible spending account helps you pay for medical, dental, and vision expenses that are not covered or fully reimbursed by your other benefit plans (for example, copays, coinsurance amounts, deductibles, and amounts above benefit maximums) as well as over-the-counter, medically necessary items. You may submit reimbursement requests for health care expenses regardless of the balance in your account. You will be reimbursed for the entire amount of the eligible expenses you have paid up to your annual contribution amount—even before the full contribution has been deducted from your paychecks.
Examples of eligible medical expenses include:
• Deductibles and copays for medical, dental, vision, or prescriptions
• Other eligible medical, dental, vision, and prescription expenses not covered under a health plan
• Diabetic testing supplies
• Expenses for over-the-counter medications, only if they are used to treat personal injury or sickness (this does not include items used for general health such as vitamins or dietary supplements)
Examples of ineligible medical expenses include:
• Premiums you pay for health coverage if they are already deducted from your pay on a pre-tax basis
• Cosmetic surgery (except for covered reconstructive surgery, such as after a mastectomy)
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• Teeth bleaching or whitening
Keep in mind that a medical spending account is for eligible health care expenses for you and all of the dependents you claim on your federal tax return – not just those dependents covered under a University-sponsored medical plan.
Eligible dependent care expenses include:
• Care provided inside or outside your home
• Day care provided at a licensed facility
• Day camp
Expenses that are not dependent care eligible include:
• School tuition for dependents (except for preschool and AU’s Child Development
Center)
• Payments to a spouse or child under age 19
• Child support payments
• Personal expenses for dependents
• Overnight camp
Expenses reimbursed under this plan may not be claimed as a federal tax credit on your tax return. Consult with a financial advisor to determine which tax-saving method is better for you.
Tools & Resources http://www.american.edu/hr/Benefits.cfm For benefit summaries, summary plan descriptions www.mypayflex.com
Contacts
PayFlex: 800-284-4885 or www.mypayflex.com
open Enrollment Elections
FSA participation does not continue automatically from year to year. You must enroll (or re-enroll) if you wish to participate in 2010. During open enrollment, you may:
• Elect to contribute up to $6,000 to the medical FSA
• Elect to contribute up to $5,000 to the dependent care FSA ($2,500 if you are married and filing separate tax returns)
If you do not enroll:
• You may not participate in the dependent care FSA during 2010 except as summarized in the Making Changes During the Year section on page 9.
• You may not participate in the medical care FSA during 2010 except as summarized in the Making Changes During the Year section on page 9.
Did you know that the dependent care FSA is not just for child care expenses?
Adult day care and elder care are also considered eligible expenses as long as your adult dependent regularly spends at least eight hours each day in your home. Services can be provided at home or in a dependent care center. The cost of a convalescent home or any medical care expense is not eligible. A dependent care center must comply with all applicable state and local regulations. In addition, it must provide care for more than six persons other than persons who live there and receive a fee, payment, or grant providing services for any of those persons, even if the center is not run for profit.
iRS use-it-or-Lose-it Rule
FSAs offer sizable tax advantages to most faculty and staff. The trade-off is that these accounts are subject to strict IRS regulations, including the use-it-or-lose-it rule. According to this rule, you must forfeit any money left in your account(s) after your expenses for the year and grace period have been reimbursed. If you are unable to estimate your health care and dependent care expenses accurately, it is better to be conservative and underestimate rather than overestimate your expenses.
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NEXT PREVIOUS TABLE OF CONTENTS things to Consider
Take some time to learn about FSA plans and do your homework to find out whether these plans are right for you.
Do you pay for contacts or glasses? Dental work? Overthe counter medicines? Outof-network doctors? Then the medical care FSA might make sense for you.
Do you pay for child or senior day care expenses that enable you and your spouse to work?
Then the dependent care FSA might be right for you.
Important: Don’t forfeit your money!
2010 FSA contributions not used for expenses incurred between January 1, 2010, and December 31, 2010, plus the two and one-half month grace period until
March 15, 2011, will be forfeited.
How Do FSAs Work?
• You select the amount you want to contribute based on expenses you anticipate through March 15, 2011 (which includes the 2½ month grace period). Estimate carefully because you cannot recover money left in the account at the end of the plan year and grace period. See Frequently Asked Questions (FAQ’s) for more details on page 51.
• Your contributions are deducted before federal income or Social Security taxes are withheld.
• FSA participants receive a debit-style MasterCard (the PayFlex Card) that allows direct access to FSA funds for eligible health care and dependent care expenses. You can use the card when you make eligible health care and dependent care purchases from most merchants who accept MasterCard. Because the card deducts funds directly from your
FSA account to pay for services and supplies, it eliminates the need to file claims and wait for reimbursements. The card is offered at no additional charge to you and is not tied to or reported against your credit report.
• When you incur an eligible expense, you may use your PayFlex debit card to pay the provider right away. New participants receive a PayFlex card within a few weeks of enrollment. If you have a card from last year, please keep the card for continued use.
• Important!
You may not use your PayFlex Card to exhaust funds from your 2009 flexible spending accounts after December 31, 2009. Purchases made with your
PayFlex Card on or after January 1, 2010 will access funds from your 2010 flexible spending accounts. You must file a claim for reimbursement for claims incurred in the grace period (in this case, January 1, 2011 – March 15, 2011).
• If you paid with the PayFlex Card, be sure to keep copies of all claims and receipts for seven years, as you do with all tax records. PayFlex or the IRS may request the receipts to audit your account.
• If you prefer to file a paper claim, either mail, scan, or fax a reimbursement claim form and itemized receipts or Explanation of Benefits to PayFlex. Obtain forms online or scan and upload your information direct through mypayflex.com.
Changing Your FSA Contributions
Participating in an FSA is a plan-year commitment. During the year, you cannot change the amount you contribute, start participating, or stop making contributions unless you have a qualifying life event. Generally speaking, you cannot lower your contributions. The reasons are those listed in the “Making Changes During the Year” section of this guide. You can
Keep all your receipts with your tax records as PayFlex or the IRS may request them at any time.
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Save Money with a FSA
Here is an example of how participating in FSAs can lower your taxes and help you save money. This example highlights how your takehome pay could change by participating in the FSAs. Keep in mind that individual situations differ depending on income tax status. You are encouraged to contact your tax advisor to discuss your specific tax situation. If you decide to enroll in one or both of the plans, estimate your expenses carefully and elect to contribute only the amount you are confident that you will spend during the applicable plan year.
FSA SAvingS ExAMPLE
Taxable Income
Medical/Dependent Care FSA Contribution
Taxable Income – Adjusted
Subtract Federal and Social Security Taxes
After-tax Dollars Spent on Eligible Expenses
Spendable Income
With FSAs
$36,000
-$7,200
$28,800
-$7,387
-$0
$21,413
Without FSAs
$36,000
-$0
$36,000
-$9,234
-$7,200
$19,566
Tax Savings with FSA $1,847 N/A
The example is based on an employee who earns $36,000 per year, is married with one child, and makes a medical care FSA election for
$2,400 per year and dependent care FSA election for $4,800 per year.
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Wellness Coach
Work one on one with a wellness coach to help you reach your personal health and wellness goals. Sample topics include eating well on the run, quick nutrition for busy families, making fitness fun, mitigating chronic illnesses with healthy habits (e.g., diabetes, high cholesterol), managing your energy, and kicking the tobacco habit. Coaching is free and confidential.
No open enrollment action is required for basic life insurance. If you wish to take advantage of the special enrollment for optional life insurance, please see pages
31-33 for next steps.
Protect Your Loved Ones with Life and Accident
Insurance
Special Enrollment Opportunity for 2010!
Life insurance protects and provides security for your family or other beneficiaries in the event of your terminal illness or death while you are still actively employed at American
University. Your coverage amount will be paid to the beneficiary of your choice provided a beneficiary designation form has been submitted to Human Resources. Therefore, it is important that you evaluate your personal life insurance needs.
The University has negotiated lower rates and a special enrollment opportunity for optional life insurance for current faculty and staff. You may apply for coverage up to 4x your base salary or $600,000, whichever is lower with no medical questions !
If you wish to supplement the basic life and AD&D insurance amount, you may purchase additional voluntary coverage through the University:
• Optional Life – for you, your spouse, your dependent children
• Personal Accident – for you and your family
Basic Life and AD&D Insurance
The University offers basic life insurance in the amount of 1x your annual salary paid by the University; beginning January 1, 2010, the $50,000 salary cap will be removed.
If your death is due to a covered accident or injury, your beneficiary will receive an additional amount through accidental death and dismemberment (AD&D) coverage.
AD&D coverage is equal to your basic life insurance coverage amount. AD&D benefits are payable if you pass away, lose a limb, or have a loss of speech, hearing, or eyesight because of a covered accident (either on or off the job) and the loss occurs within one year of the covered accident. The payable amount of your AD&D benefit depends on the type of loss.
In the event of death due to an accident, your beneficiary may receive both your life and
AD&D benefits.
Cost
AU pays the entire cost of these benefits. There is no cost to you and enrollment is automatic. Your coverage begins automatically and is subject to any active at-work requirements. Please note that the premium for coverage in excess of $50,000 is imputed income. The IRS requires that the value of the premium for life insurance benefits in excess of $50,000 for federal income tax purposes be subject to taxation. The value of the premium for this benefit is considered income to you and is added to your total income for tax purposes. This added “income” is called imputed income.
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Optional Life and Personal Accident Insurance Options
Optional Life Coverage Rates for Employee, Leagal Spouse/
Same Sex Domestic Partner.
AgE
29 and under
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
RAtES CoSt
PER $1,000
$0.043
$0.050
$0.061
$0.107
$0.179
$0.321
$0.570
$0.770
$1.333
The optional life insurance complements your employer paid basic life insurance by providing additional coverage in the event of your death. The coverage amount can be 1, 2,
3, 4, or 5 times your base salary. During the special enrollment for January 1, 2010, you may elect up to 4x your base salary or $600,000 (whichever is lower) without medical review, even if you have not previously enrolled in the plan. For amounts more than that, you will need to provide a Statement of Health (see section below) that is satisfactory to the insurance company before coverage can take effect. The maximum election for employee optional life is $1,500,000 or 5 times your base salary, whichever is lower.
During Open Enrollment you may enroll or change the amount of coverage for you or your family.
If you do not make an election during this open enrollment period: Your current life and accident benefit elections will carry over to 2010. This includes optional life and personal accident insurance elections for you and your family. If your coverage is currently capped at $350,000 as you had not had an approved a Statement of Health, your cap will be raised to your true limit. For example, if you earn $100,000 and elected 4x salary but had not submitted a Statement of Health, you would have been capped at $350,000. As the guarantee issue amount has increased, in this example your coverage would automatically increase to a true 4x salary, to $400,000.
Statement of Health
The Statement of Health (also known as Evidence of Insurability [EOI] or proof of good health) is a questionnaire, to be completed by you and your physician, which provides some basic health information to the insurer. This information is used in the approval process for your request to enroll in, or increase, certain life insurance plans.
Beneficiary Designations
A primary beneficiary is defined as the person, organization, trust, or entity you name to receive any benefits if you die.
A contingent beneficiary is defined as the person, organization, trust, or entity you name to receive any benefits if the primary beneficiary is deceased.
Keep in mind that changes in your family situation (such as marriage, divorce, birth or adoption) do not automatically alter or revoke your beneficiary designation. Therefore, it is important that you review your beneficiary designation from time to time.
Updates can be made at any time by completing the beneficiary designation form available on the my.american.edu
portal.
brown bag Wellness
Workshop Series
Attend monthly lunchtime workshops on healthy living to support a healthy you!
Light lunch is provided for all who attend. RSVP requested.
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You will be required to furnish a Statement of Health for approval by the insurance company before coverage can become effective for optional life insurance for amounts of 5x salary or $601,000-$1,500,000.
To submit a Statement of Health, go to my.american.edu and download the form on the HR/Payroll Connection. Complete the form and return it to Human Resources in a confidential envelope or fax to the confidential benefits fax at 202-885-1182. MetLife will make its determination based on your medical information and may request additional medical information or tests. Once reviewed, MetLife will send a letter to your home confirming coverage. To inquire about the status of your approval, contact AU’s benefits team at x3513 directly.
How to Calculate Life/Personal Accident Insurance Costs for You and Your Legal Spouse/Same-
Sex Domestic Partner
To calculate your cost, complete the following by selecting your coverage amount and rate (based on your insurance age). If the coverage amount is not a multiple of $1,000, then it is rounded to the next higher multiple of $1,000.
ELECtED CovERAgE
AMount
Employee
Legal Spouse/ Same-Sex
Domestic Partner
$
$
LEvEL oF
CovERAgE inCREMEnt
÷ $1,000
÷ $1,000 inSuRAnCE RAtE x $ x $
MontHLY CoSt
= $
= $
Total Monthly Cost = $
Example Calculation : Claw D. Eagle is currently 36 years old and has a salary of $50,000. He is electing Optional Life Coverage of $100,000 (2 times his salary). Claw reviewed the optional insurance rates and notes his insurance rate is .061 in the table on page 31. He plugs in the information in the calculation below. Claw calculated the monthly cost of electing $100,000 of optional life insurance is $6.10 per month.
ELECtED CovERAgE
AMount
Employee (Claw D. Eagle)
LEvEL oF
CovERAgE
$ 100,000 inCREMEnt
÷ $1,000 inSuRAnCE RAtE x $.061
Total Monthly Cost
MontHLY
CoSt
= $6.10
= $6.10
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Dependent Life Coverage
You may also purchase life insurance for your eligible dependent children (see page 7 for age limits).
What is the Cost of Dependent Life Coverage?
The premium amounts correspond to the coverage you elect for dependent child coverage.
Please reference the columns below for the premium amounts.
Fitness Classes
Group exercise classes available through Jacobs
Fitness Center. Options available for members and nonmembers.
DEPEnDEnt CovERAgE ELECtion PREMiuM AMount PER MontH
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$10,000
$0.114
$0.228
$0.342
$0.456
$0.570
$0.684
$0.798
$0.912
$1.026
$1.140
Optional Personal Accident Insurance
The optional personal accident insurance complements your optional life coverage in the event of death due to accident or covered disabling injury. This coverage is in addition to your life insurance and can help replace lost income and lessen the impact of costs associated with serious injuries. The coverage amount can be 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 times your annual earnings. If the coverage amount is not a multiple of $1,000, then it is rounded to the next higher multiple of $1,000. The maximum election is $500,000. This summary is provided for general information only since exclusions and limitations apply. Statement of Health may be required as described on page 31.
oPtionAL PERSonAL
ACCiDEnt CALCuLAtion
Employee
Family
$
$
LEvEL oF
CovERAgE inSuRAnCE
RAtE x 0.015
x 0.025
inCREMEnt
÷ $1,000
÷ $1,000
Total Monthly Cost
MontHLY CoSt
= $
= $
= $
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Living Well newsletter
Catch up on the latest health and wellness news at AU and beyond.
Obtain Peace of Mind with the Legal Plan
New Provider for 2010!
Beginning January 1, 2010, faculty and staff will have an option for expanded legal coverage through Hyatt Legal’s MetLaw Plan. This plan provides a variety of services to help you protect your family, finances, and future. You have access to network attorneys who provide legal services for covered events (see chart below). The plan covers representation for many personal legal services for you and your eligible dependents
(eligible dependents are your spouse and unmarried dependent children). You may receive office consultations and/or telephone advice for virtually any personal legal matter. In other words, if you are pursuing a legal matter, as long as it is not specifically excluded, you will still receive the opportunity to discuss that matter with an attorney.
The MetLaw plan provides you with telephone and office consultations for an unlimited number of matters with the attorney of your choice. During the consultation, the attorney will review the law, discuss your rights and responsibilities, explore your options, and recommend a course of action.
Trials for covered matters are covered from beginning to end, regardless of length, when using a network attorney. MetLaw is a legal services benefit offered by Hyatt Legal Plans, a wholly-owned subsidiary of the Metropolitan Life Insurance Co.
MetLaw offers you access to the largest provider of group legal plans in the U.S. and has been in the business since 1981. The plan attorneys must meet stringent criteria before joining the network and are regularly reviewed to ensure they continue to meet plan standards.
How the Plan Works
To use the legal plan benefits after January 1, 2010, call the Client Service Center at
800-GET-MET8 . Your Social Security number is your identifier for you and your dependents. A representative will verify your eligibility, make an initial determination of coverage, give you a case number, provide you with the telephone number of a Plan
Attorney most convenient to you, and answer any questions you have about the plan. You may also use the plan by visiting the Hyatt Legal Plan Web site at www.metlife.com/mybenefits.
Covered Legal Services
Preparation of Wills, Living Wills, & Living Trusts
Purchase, sale, & refinancing primary residence
Debt collection defense & identify theft defense
Traffic ticket defense – (no Dui/DWi)
Personal Bankruptcy
Civil Litigation Defense
Uncontested adoption, guardianship, conservatorships
Protection from domestic violence
Tenant negotiations & eviction defense (tenant only)
Elder law (for issues related to your parents and Medicare, Medicaid, nursing home arrangements and more)
Preparation of Powers of Attorney, Affidavits, Demand Letters, etc.
Tax Audits & Property Tax Assessments
Juvenile Court Defense
Name change & premarital agreement
Review & preparation of personal legal documents
Consumer protections & small claims assistance
Restoration of driving privilege
Boundary-title disputes & zoning applications
School hearings
Pet Liabilities
Note: You may be responsible for certain fees (i.e., filing fees) in connection with these covered services.
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Excluded Legal Services
No services, not even a consultation, can be provided for the following: Employmentrelated matters, including company or statutory benefits; matters involving American
University, MetLife and affiliates, and plan attorneys; matters in which there is a conflict of interest between you and your spouse or dependents in which case services are excluded for the spouse & dependents; appeals and class actions; farm and business matters, including rental issues when you are the landlord; patent, trademark, and copyright matters; third party costs like fines, filing fees, or court fees; frivolous or unethical matters; matters for which an attorney-client relationship exists prior to you becoming eligible for plan benefits.
Out-of-Network Benefits
You can also access services from outside the network of attorneys. There is a separate schedule for reimbursement for these services. Once enrolled, you would be able to call
Hyatt’s Client Service Center for a fee reimbursement package for use with a non-plan attorney.
Protect Your Assets with Long-Term Care
Insurance
If you become seriously injured or ill, the costs of treatment and recovery can far exceed the amount of your life savings or retirement investments. Long-term care (LTC) coverage provides monthly payments in the event that you require assistance with activities of daily life such as bathing, dressing, and cooking. Qualifying care includes home health care, adult day care, or confinement to a long-term care facility. The duration and amount of benefits vary based on the type of care required.
You may purchase an individual long-term care policy for yourself, your spouse, and other family members (parents, parents-in-law, etc.) through the Todd Benefits Group (TBG) at a group discount. AU faculty and staff answer limited medical questions to qualify. This additional financial protection is available with premiums payable through the convenience of payroll deduction and is portable—you may take the coverage with you if you leave the University or retire. TBG will assist you in purchasing a policy that best meets your personal needs.
For further information, contact TBG directly or visit their Web site.
Cost
Your cost is based on the policy you select. Visit the TBG Web site to determine your cost.
Did you know that . . . ?
70% of people reaching age
65 will require LTC (Long
Term Care) services sometime during their lifetime*
Nearly 40% of people currently needing LTC are between the ages of 18 and
64*
The cost of waiting to purchase LTC coverage can be high
*Source: U.S. Department of
Health and Human Services tools & Resources www.toddltc.com/eagles
Design and customize your own LTC insurance program
Calculate your premium
View TBG’s interactive information site
Contacts
TBG: 888-310-TODD (8633)
Speak directly to a Benefit
Specialist who will assist you with all aspects of the program.
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Flu Shots
Seasonal flu shots are free for faculty, staff, and students during the Fall
2009 semester.
Enrollment Age Limit
Covers
Plan Rates
Maximum Annual Benefit
Allowance
Lifetime Maximum
Deductible
Coinsurance
Payment
Exclusions
Care for Your Animals with Pet Insurance
New Plan for 2010!
In the benefits survey last fall, we learned that a number of faculty and staff were interested in discounted pet insurance. In partnership with MetLife, this new plan through
Veterinary Pet Insurance (VPI) offers you an opportunity to save on your pets’ medical bills which can run into the hundreds, even thousands, of dollars. AU employees can enroll in one of two plans: VPI Standard or Superior plans: covers diagnostic tests, office visits, prescriptions, treatments, x-rays, lab fees, hospitalization and surgery as a result of conditions ranging from accidental injuries, poisonings, and illnesses (including cancer). You may also supplement coerage with CareGuard - a rider to cover routine appointments, tests, and vaccinations for dogs, cats, and birds.
With Veterinary Pet Insurance you can:
• Visit any licensed veterinarian worldwide
• Enjoy quick claims turnaround time
• Coverage is available for dogs, cats, amphibians, chameleons, geckos, gerbils and other small pets, birds, ferrets, iguanas, rabbits, snakes, opossum, turtles, goats, and
potbellied pigs.
VPI Standard
DogS AnD CAtS
VPI Superior
6 weeks to 9 years old 6 weeks to 9 years old
AviAn AnD ExotiC PEtS
Avian: 90 days old and be in owner’s possession at least 60 days; no upper age limit
Medical problems and conditions related to poisonings, accidental injury, and illness (including cancer)
Variable, based on the type and age
$7.57 - $19.13 per mo
Medical problems and conditions related to poisonings, accidental injury, and illness (including cancer)
Variable, based on the type and age $13.35 - $35.28 per mo
Variable based on type and size
Avian & Exotic: $6.65 – $15.68 per mo
$2500/incident; $9000/year
None
$4000/incident; $14,000/year
None
$2000/incident; $7000/year
None
$50 per incident
10%
Reimbursement based on claim submitted
For more details go to www.petinsurance.com (click on site map, What’s Not Covered)
$50 per incident
10%
Reimbursement based on claim submitted
For more details go to www.petinsurance.com (click on site map, What’s Not Covered)
$50 per incident
10%
Reimbursement based on claim submitted
For more details go to www.petinsurance.com (click on site map, What’s Not Covered)
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Additional Wellness Coverage
CareGuard Core wellness rider $12/mo additional
Covers: Wellness exam, vaccinations or titer, FELV/ heartworm tests, fecal test, deworming, microchip, flea and heartworm preventive, x-ray/blood screen/EKG
CareGuard Premier Coverage
Rider
$22/mo additional
Covers: all of Core Coverage above at higher reimbursement and urinalysis or ERD and dental cleaning or spay/neuter
$12/mo additional
Covers: Wellness exam, vaccinations or titer, FELV/ heartworm tests, fecal test, deworming, microchip, flea and heartworm preventive, x-ray/blood screen/EKG
$22/mo additional
Covers: all of Core Coverage above at higher reimbursement and urinalysis or ERD and dental cleaning or spay/neuter
$15.08/mo additional
Covers: physical exam/office call, parasite test/fecal exam, parasite treatment, beak trip, nail trim, win trim, CBC,
Culture, panel or titer n/a
Veterinary Pet Insurance is the nation’s oldest, largest, and #1 licensed pet medical insurance provider, with more than one million policies sold. To learn more about this important benefit and to enroll, call toll free or visit the Web site. Your premiums will be taken as payroll deductions once you enroll.
To receive the 5% discount and pay by payroll deduction, your enrollment must be effective January 1, 2010 (or later) and you must apply through MetLife’s phone or website.
To enroll or for more information, contact: 800-GET-MET8 (438-6388)
(after Nov. 16, 2009 you may enroll and receive the discount throught this web address: www.metlife.com/mybenefits)
Protect Your Car and Home New Plan Available
January 1, 2010
MetLife Auto & Home is a portable, voluntary group auto and home benefit program that provides you with access to insurance coverage for your personal insurance needs. Policies available include: auto, home, landlord’s rental dwelling, condo, mobile home, renters, recreational vehicle, boat, and personal excess liability (“umbrella”) policies. Policies can be paid by payroll deduction or debit from your checking account. The program gives you access to special group discounts.
Enrollment
As your insurance policies renew at different times during the year, you may apply for group auto and home insurance at any time by calling 1 800 GET-MET 8 (1-800-438-6388) after
January 1, 2010. An insurance consultant will provide you with free, no-obligation premium quotes. If you choose to switch policies, a consultant can help you apply for insurance while you’re on the phone. Please have your current insurance policy with you when you call.
Walking/Jogging Routes
Mapped routes with distances in and around AU are available on the Web.
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Manage Your Personal Health and Wellness
When you make smart, well-informed health care decisions, you reduce your out-of-pocket health care costs and increase your odds of living a long, active life.
• Visit your doctor for regular checkups to avoid health problems or catch illnesses early when treatment is more effective.
Æ Live an active lifestyle. No matter what your age, regular exercise is crucial for a healthy lifestyle. Regular exercise can keep your weight under control, provide protection against chronic diseases, lower your risk of depression, and increase your bone strength.
Æ Take an active role in making decisions about your health care. Work together with your doctor, ask questions, and do your homework to find out more about your condition.
Æ Exercise your funny bone. Research shows that laughter helps lower blood pressure, relieve stress, and fight colds and other illnesses.
Æ Take stock of your health. Do you want to eat better, lose weight, lower your blood pressure, and reduce your stress? Set goals and make them simple. Take advantage of A healthy U programs to meet your goals.
Æ Take advantage of online resources to learn about special programs and health care issues. o CareFirst offers wellness programs designed to improve the quality of your life. They’re easily accessible and automatically available to you if you are a
CareFirst medical plan participant. Go to carefirst.com
and select Health and
Wellness – My Care First or Options Discount Program for details.
o Kaiser Permanente offers a full menu of discounted and complimentary health and fitness related programs and resources. Visit www.kp.org. Select
Health plans and services , then Member discount programs for more information.
A healthy U
AU cares for the health and well-being of its faculty and staff—that’s why we’ve developed
A healthy U, AU’s Faculty & Staff Wellness Program.
Every day you’re faced with choices that can affect your health—and the choices aren’t always easy. At the end of the day, however, it’s up to you. Our goal is to provide you with the tools needed to make the best possible choices and to make those choices a little easier.
Check out all of the healthy opportunities available to you . . . right in your own backyard.
What is wellness?
Wellness is a state of optimal health achieved by finding a balance among the many dimensions of health as depicted here: (see graphic)
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Wellness at AU
To ensure that the unique needs of AU faculty and staff are met, the University established a Wellness Subcommittee in fall 2008. This committee reports to the Benefits
Advisory Project Team and is charged with reviewing program, policy and procedural recommendations, contributing to implementation strategies, and serving as advocates for faculty and staff health and well-being at AU. A list of current members can be found online at www.american.edu/hr/wellnesscommittee.cfm.
A healthy U Programs
Weight Watchers™ at Work
Weight Watchers™ meetings are held weekly on campus. Registration begins during the first month of each semester. Sessions last approximately 45 minutes and are led by an experienced Weight Watchers™ Team Leader. Weekly sessions include a confidential weigh-in to keep you on track and facilitated discussions to help you overcome challenges and celebrate success. To learn more about the Weight Watchers™ program, visit www.
weightwatchers.com. Financial incentives are available for participation.
More : www.american.edu/hr/weight-watchers.cfm
Farmers’ Market and Fresh and Local CSA
AU Farmers’ Market is held every Wednesday on the Friedheim Quadrangle from 11a.m. –
4p.m., February – November. Market features locally grown produce, hearth baked breads, and more.
Fresh and Local CSA (Community Supported Agriculture) Members pay in advance of the season for a weekly share of the farm’s harvest, from early June through mid-October.
Delivered shares contain a variety of seasonal foods picked that morning. A share provides most of the salad and vegetable needs for a couple or a small family for a week. Nine- and
18-week shares are available. Add-on shares are also available: flowers, eggs, and fruit.
More: www.american.edu/hr/Farmers-Market.cfm
Brown Bag Wellness Workshop Series
Attend the monthly lunchtime workshops on healthy living to support a healthy you!
Light lunch is provided for all who attend. Space limited; RSVP requested. Previous topics included getting a good night’s sleep; healthy cooking demos; and fitting fitness into your lifestyle.
More : www.american.edu/hr/workshops.cfm
Know Your Numbers Screening Events
Know the numbers that can have the most dramatic effect on your health: cholesterol, blood pressure, glucose, and body mass index. Special screenings are also available during select events on-campus (PSA or prostate specific antigen, bone density, skin cancer, and more). Most screenings are offered several times a year for your convenience. All services are free and results are confidential. You’ll even receive a Know Your Numbers journal to help you to track your results annually. Alternatively, you can see your physician for your annual physical to get your numbers.
More : www.american.edu/hr/knowyournumbers.cfm
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Personal Health Assessment
Get your wellness scorecard by taking the online health assessment (see URL below).
Questions cover topics such as nutrition, physical activity, stress, sleep, and safety, among others. On completion, you’ll receive a wellness scorecard and a personal report outlining the facets of health that need attention as well as the areas in which you are already successful. Enter your screening results for a more accurate and informative report.
Schedule an appointment with the on-site wellness coach to review your results, answer questions, or learn which A healthy U programs are right for you. Your report can be printed and taken to your physician for further discussion as needed. Take the online assessment annually for a personal year-to-year comparison. Incentives available for participation.
Service is free and results are confidential.
More : www.american.edu/hr/knowyournumbers.cfm
Wellness Coach On-Site
Work one on one with an on-site wellness coach to help you reach your personal health and wellness goals. In this innovative program, you will receive six (6) free, confidential sessions to guide you through the goal setting and achievement process. Meetings can be held in person, by phone, or email. Sessions provide accountability and greatly improve your likelihood of success in meeting your wellness goals. Sample topics include eating well on the run, quick nutrition for busy families, making fitness fun, mitigating chronic illnesses with healthy habits (e.g., diabetes, high cholesterol), managing your energy, and kicking the tobacco habit.
More : www.american.edu/hr/mywellnesscoach.cfm
Seated Massage
Relieve tension with a 15- or 30-minute seated massage. Services are provided by a licensed massage therapist every other Monday from 11:00 a.m. – 2:15 p.m. in McKinley Building room 153. Appointments must be booked in advance online. Use your American University email address to view the dates and times available on campus. Interested in booking sessions just for your office or department? Visit the Web for more information on how we can bring seated massage to you.
More : www.american.edu/hr/massage.cfm
Living Well Newsletter
Catch up on the latest health and wellness news at AU and beyond. Newsletters are sent electronically or to your home address. Past newsletters can be viewed online.
More: www.american.edu/hr/livingwell.cfm.
Discounted Gym Memberships On- and Off-Site
Low-cost memberships are available for faculty and staff at Jacobs Fitness Center, AU’s campus recreation facility. There are no initiation fees, no contracts, and no obligations. If you have Kaiser Permanente or CareFirst, you have access to discounted gym memberships at area facilities through Global Fit. Visit the Global Fit Web site and enter your zip code to find a list of participating clubs near you. Be sure to choose CareFirst or Kaiser
Permanente from the eligibility list to proceed.
More: www.american.edu/recfit/fitness and www.globalfit.com
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Fitness Classes at Jacobs Fitness Center
Group exercise classes available include yoga, kick-boxing, indoor cycling, Zumba®, and more. Options available for members and nonmembers. Faculty and staff can take advantage of exclusive small group personal training sessions. A complete schedule of classes can be viewed online.
More: www.american.edu/recfit/fitness
Flu Shots
Provided by Student Health Center. Seasonal flu shots free for faculty, staff, and students for the fall 2009 semester.
Walking/Jogging Routes
Mapped routes with distances in and around AU are available. Campus walks are ideal for walking meetings. Off campus routes will give a mid-day boost to your energy. Visit the
Web to download a map.
More: www.american.edu/hr/steps.cfm
Special Events
Various health promotion events are scheduled throughout the year. Commit to quit at the Great American Smokeout or clip on a pedometer and track your steps for the annual pedometer challenge. Events are advertised through Today@AU, the wellness Web site,
Living Well newsletters, and occasionally through campus mail. Be on the lookout for the next A healthy U Special Event.
More: www.american.edu/hr/specialevents.cfm
Faculty and Staff Assistance Program (FSAP)
The service is confidential and makes on-site personal counseling services available to faculty and staff members and their immediate families at no cost. FSAP provides assessment, short-term counseling, referral to community services, follow-up contact, and other services. (Costs that may result from referral to an outside community resource are not covered by AU, but may be covered by your health insurance or flexible spending account).
More: www.american.edu/hr/fsap.cfm
Ergonomics
A free consultative service is provided by the office of Risk Management. Learn tips for setting up your workstation or exercises you can do at your desk to relieve tension.
Schedule a workshop or consult for your office to learn the best ways to prevent workrelated injuries.
More: http://www.american.edu/finance/rmehs/ergonomics.cfm
.
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Plan For the Future with a Retirement Plan with
TIAA-CREF and Fidelity
One of the most important long-term goals to have is to plan for your retirement security.
To help you achieve your goals, eligible faculty and staff members may participate in the American University Retirement Plan, a pension benefit plan that uses tax-deferred annuities under Internal Revenue Code (IRC) Section 403(b). The Plan is comprised of the employer-matched portion (up to the first five percent of your contribution, once eligible) and the unmatched portion.
Here are some of the valuable matching contribution features offered in this benefit:
The chart below shows the amount of the University’s matching contribution, as well as the total amount that may be added to your account each year.
YouR
ContRibution
1 % of regular salary
2 % of regular salary
3 % of regular salary
4 % of regular salary
5 % of regular salary
MAtCHing
ContRibution
2 % of regular salary
4 % of regular salary
6 % of regular salary
8 % of regular salary
10 % of regular salary totAL ContRibution
3 % of regular salary
6 % of regular salary
9 % of regular salary
12 % of regular salary
15 % of regular salary
Participants who turned 50 or older by the end of the calendar year can elect to make catch-up contributions in addition to their regular contributions. The limit on catch-up contributions for 2009 is $5,500, as defined by federal tax laws.
In order to receive a matching contribution under the retirement plan, you must contribute a minimum of one percent of your salary. For every one percent you contribute, the
University will provide a two-for-one match to your pension plan account. In accordance with the table above, the University will not match contributions made by you in excess of five percent of your salary.
The following examples demonstrate the matching contribution feature of your plan:
• You elect to contribute one percent of your salary. The University will contribute an additional two percent of your salary. The total contribution to your account will be three percent.
• You elect to contribute five percent of your salary. The University will contribute an additional ten percent of your salary. The total contribution to your account will be fifteen percent.
For purposes of computing the above matching contribution, your salary does not include stipends, research grants not paid through AU, overtime, bonuses, non-taxable fringe benefits, workers’ compensation, and unemployment benefits.
Pre-tax Contributions
You may begin contributing to your pension plan account as soon as you are hired at the University with pre-tax salary contributions by completing a Retirement Election
Enrollment form (salary reduction agreement). You may change the percentage you wish to contribute as often as you would like during the course of the year, as long as the changes only apply to future salary payments.
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Eligibility for the Matching Contributions
You are eligible to receive matching contributions if you normally work 20 hours per week or more, you have attained age 24, and you have completed one year of service.
If you were hired before May 1, 2008, you must submit enrollment paperwork in order to participate in the pension plan. An employee hired before May 1, 2008, who has been notified that he/she is eligible to participate in the match but fails to return a completed
Retirement Election Enrollment form, will be considered to have waived all of his/her rights under the pension plan.
If you were hired on or after May 1, 2008, once you become eligible to receive matching contributions, you will be automatically enrolled in the pension plan with a one-percent deduction of your pre-tax salary and an employer match of two percent. The funds default into the appropriate Fidelity Freedom Fund based on your date of birth and anticipated retirement age. However, you always have the option to opt out of the plan.
You will be credited with a year of service if you work more than 1,000 hours for AU during any consecutive 12-month period starting from your date of hire. To qualify for participation in AU’s Retirement plan in advance of the waiting period, you may submit a verification of employment with 501(c)(3) or 170(b)(1)(A)(ii) organization for at least 1,000 hours during one year of service.
If you believe you are eligible to participate, but have not been notified by Human
Resources, please speak with your benefits contact in Human Resources at extension 2591.
Employer Discretionary Contributions
In certain circumstances, at the University’s discretion, it may be determined that additional contributions to the plan may be necessary or warranted. These contributions are known as employer discretionary contributions. In the event that the University decides to make such a contribution, employees will be eligible if they meet the same eligibility criteria as stated above for the employer matching contribution. However, no contribution by the employee will be required in order to receive an employer discretionary contribution. While these contributions need not be made for all employees in all circumstances, they will be made in accordance with the nondiscrimination provisions of the Internal Revenue Code.
Vesting and Distribution Provisions
All contributions to your pension plan are immediately 100 percent vested. This means that you have a non-forfeitable right to both your contribution and the University’s matching contribution. All matching contributions are made directly to your pension plan account.
While in service, you may take distributions from your account if you are at least 59-1/2 years old, a qualified reservist, or in the case of hardship (as defined by the plan). If you retire or terminate employment from AU, you are entitled to the full amount of your pension plan account.
If you have any questions, please consult the plan document on my.american.edu
under
Employment – HR/Payroll Connect – Info/Forms – Benefits – Benefits Manual (Faculty and Staff), or speak with your Human Resources by calling x2591.
No open enrollment action is required.
If you go out on LTD and you participate in the retirement plan, your contributions will continue at no additional expense to you for up to 15% of your pre-disability earnings.
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No open enrollment action is required.
Benefits are coordinated with disability benefits under other plans, such as Social Security and state disability programs.
Prepare for the Unexpected with Disability
Coverage
A disabling illness or injury can result in a devastating loss of income for your family. These plans are designed to replace a portion of your income if you are unable to work due to illness or injury. Please refer to the disability section of the Benefits Manual for more details.
Short Term Disability
Short Term disability (STD) coverage replaces a portion of your income if a nonoccupational sickness or injury forces you to stop working for a short period of time. AU automatically enrolls you in short term disability coverage at no cost to you. Coverage begins on your first day of full-time employment if you are an eligible faculty member, or after six months of employment if you are a full-time staff member.
The maximum short term disability benefit payment period is 26 weeks, after which you may be eligible for long term disability (LTD) coverage.
StD bEnEFitS
% of Weekly Base Salary Waiting Period Maximum Benefit
Period
Staff Members 100% 15 days 26 weeks
Faculty Members 100% 0 days 26 weeks
Benefits are coordinated with any Workers’ Compensation benefits. Benefits continue until the earliest of:
• The date you are no longer disabled
• The date you reach the maximum benefit period
Long Term Disability
Your participation in the Long Term Disability (LTD) plan begins on the first day of the month after you complete one year of full-time service with the University. LTD coverage replaces a portion of your monthly salary if you are unable to work due to sickness or injury after a waiting period designed to follow on after you have used your 26 weeks of short term disability benefits.
LtD bEnEFitS
Staff and Faculty Members
% of Basic Monthly
Earnings
60%
Maximum Benefit Period
Up to age 65 or your normal Social Security retirement age (24 months for mental/ nervous and substance abuse disabilities)*
*See the Faculty Staff Benefits Manual for more details.
LTD benefits are calculated using your current base annual salary prior to the date your disability begins. Only 50% of the benefit is taxable income to you, as the premiums are shared by you and the University.
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Survivor Benefit
If you die after you qualify for LTD benefits, your spouse or other eligible survivor will receive a benefit equal to three times your monthly LTD benefit (with no reduction for income from other sources).
Cost
AU pays the entire cost of STD benefits. There is no cost to you and enrollment is automatic.
Your cost for LTD coverage is deducted from your pay on an after-tax basis. The cost is shared with the University. Enrollment is required.
Continue Learning with the Educational Benefits
Program
After four months of active full-time employment, you are eligible for:
• Tuition remission for courses you or your spouse/domestic partner take at American
University or the Wesley Theological Seminary for up to eight credits per semester, to a maximum of 20 credits per academic year.
After two years of active full-time employment, your eligible dependent child(ren) may receive up to four academic years of:
• American University or Wesley Theological Seminar undergraduate or graduate tuition scholarships, including two courses in summer between academic years
• Undergraduate tuition scholarships at more than 600 colleges and universities through the Tuition Exchange network for four years
Some benefits are taxable and certain courses are not covered. Be sure to refer to the
Educational Benefits section of the Faculty-Staff Benefits Manual for detailed information about covered courses, taxes, critical deadlines and more. Call x3748 with questions about
Educational Benefits.
Save Money and Let Someone Else Drive by Using
SmartBenefits
SmartBenefits offer you a chance to receive Metro, VRE, or MARC fares on a pre-tax basis.
• You may allocate up to $230, pre-tax, on Metro, VRE, or MARC train fares.
• Order your passes online at mypayflex.com.
• You may designate, in advance, which months you wish to receive your passes.
• VRE and MARC passes will be sent to your home address. Metro funds are available for download at station kiosks each month.
• You may add or change your benefits (if you’re moving or selling your car) for the next month by going online before the 10 th of the current month to make a change to your election.
For more information, call PayFlex Customer Service at 1-800-284-4885 (Monday through
Friday, 8 a.m. to 8 p.m., EST). To register and order your card, go to mypayflex.com.
Special Events
Various health promotion events are scheduled throughout the year.
Commit to quit at the Great
American Smokeout or clip on a pedometer and track your steps for the annual pedometer challenge.
There’s so much to look forward to!
Discounted gym memberships
Low-cost memberships available for faculty and staff at Jacobs Fitness Center. No initiation fees, no contracts, and no obligations. Discounts at area health clubs also available for Kaiser
Permanente and CareFirst members via Global Fit.
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Frequently Asked Questions
Enrolling
How can I get an additional copy of the Benefits for a Healthy Life Resource
Guide?
Contact Human Resources at 202-885-2591 or download a copy from the my.american.edu portal.
Which plans does open enrollment apply to?
Open enrollment applies to medical, dental, flexible spending account plans, optional life, personal accident, spouse, same-sex domestic partner and child life insurance, long-term care, and legal at any time during the year. The pet insurance, vision discount, auto, and home plans are automatically available to you any time during the year after January 1, 2010.
You may change your retirement contributions or asset allocations at any time during the year.
What new benefits are available for 2010?
These new plans or special enrollment opportunities are available for 2010:
• Dental insurance through Delta Dental
• Increased life insurance coverage (guaranteed up to 4x salary or $600,000 whichever is lower)
• Long-term care may enroll with limited medical questions
• Pet Insurance
• Group Auto Insurance
• Group Home Insurance
What plans will not automatically roll over for 2010?
If you wish to have the following plans in 2010, you must take action as they do not automatically roll over:
• Flexible Spending Accounts
• Dental insurance through Delta Dental
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• New or increased life insurance coverage (guaranteed up to 4x salary or $600,000, whichever is lower, without medical review)
What benefits will automatically roll over?
These plans will automatically roll over unless you change your election:
• Medical
• Legal
• Current life and personal accident insurance elections
• Current long-term care elections
Why can we make changes to these plans only once a year?
The Internal Revenue Service (IRS) regulates plans that allow pre-tax contributions for benefits. The IRS permits you to make changes to your coverage only during open enrollment or when you experience certain qualifying life events (such as marriage, birth, adoption of a child, etc.).
How can I view my current benefit elections?
To view your current elections, go to my.american.edu
and click HR/Payroll Connection.
How do I make my open enrollment elections?
From November 9-30, 2009, you may make your open enrollment elections online at the
2010 Open Enrollment portal under Employment at my.american.edu.
How do I make changes to my benefits outside open enrollment?
Go to the HR/Payroll Connection on my.american.edu portal and print a Benefit
Enrollment form. Fill out the form and submit it to HR within 30 days of your qualifying life event, along with documentation to support the life event.
If I am a new hire, how do I enroll in benefits?
Attend a new hire orientation to receive an overview of AU’s benefit plans. You will receive a Benefit Enrollment form. Fill out the form and submit it to HR within 30 days of your hire date.
What if I made an election and then decide that another choice would be better?
During the open enrollment period, you can make changes to your plan. As a new hire or due to a qualifying event you can make another choice as long as you are still within 30 days of hire or event. In all cases, please call your Human Resources contact at 202-885-2591 with any questions and make changes.
Will I receive notice that my benefit elections have been received?
For open enrollment you will receive an email confirmation statement. We recommend you print a copy of your confirmation statement. For new hires and qualifying event changes, please retain a copy of your enrollment form. You may confirm the changes have been made by reviewing your pay advice on my.american.edu.
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I have dental coverage through AU. Do I have to do anything during open enrollment to keep that coverage?
Yes, you will need to elect Delta Dental PPO in order to continue dental coverage in 2010.
As we are changing from two plans to one with a new provider, we cannot automatically enroll you in the new dental plan. If you do not elect your dental with Delta Dental, your coverage will end on December 31, 2009.
I have legal coverage through AU. Do I have to do anything during open enrollment to keep that coverage?
No. Your legal coverage will be rolled over automatically to the new plan with Hyatt Legal’s
MetLaw Plan.
Legal Spouses, Same-Sex Domestic Partners, and Dependent
Children
My husband and I both work for AU. How should we cover each other and/or our dependent child/ren under the plans?
Each eligible employee or dependent can be covered only once. For example, you may elect employee and dependent coverage and your husband may elect employee-only coverage.
If you are not covering your children, you and your husband could each choose individual coverage.
Will the medical or dental plans require evidence of insurability as an enrollment requirement for legal spouses, children or same-sex domestic partners?
No. There are no evidence of insurability requirements for any individual under these plans.
What coverage is available for my same-sex domestic partner?
Your same-sex domestic partner may be covered under your medical, dental, vision, life insurance, and personal accident plans. You will need a Domestic Partnership Affidavit on file with Human Resources.
Who qualifies for coverage as a same-sex domestic partner?
A domestic partnership is defined as two individuals of the same gender who live together in a long-term relationship; share a close personal relationship and are responsible for each other’s common welfare; are each other’s sole domestic partner; are not married to anyone nor have had another domestic partner within the past year; are not eligible to marry under the District of Columbia law; and are not related by blood closer than would bar marriage in the District of Columbia.
Are children of my same-sex domestic partner eligible for coverage?
A child’s eligibility depends on the child’s relationship to the employee. A child related to the employee by blood, adoption, legal custody, or guardianship would qualify as a dependent.
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When does a same-sex domestic partner become ineligible for coverage?
A same-sex domestic partner’s eligibility under the medical, dental, or vision plan will end on the earliest of:
• the end of the month following an employee’s date of termination, or
• the end of the month in which the individual no longer satisfies the eligibility criteria for same-sex domestic partner status.
Faculty and staff must notify Human Resources immediately of any changes in eligibility status.
Medical
I’m not sure which medical plan will be the best choice for my family. Where can I get help?
We recommend reviewing this guide and taking into consideration your family’s medical needs. The Kaiser and CareFirst plans are different in that Kaiser generally costs less out of pocket than CareFirst and you see physicians in the Kaiser center. With CareFirst, you may see any doctor but how much you pay depends on whether the provider participates in the
BlueChoice network. For more details, go to www.carefirst.com and www.kaiserpermanente.
org.
How much does AU pay toward my medical premiums?
The University contributes 80% to individual coverage and 65% to individual plus one and family coverage.
Who can I enroll in the medical plan?
You can enroll yourself, one other qualified adult member (legal spouse or same-sex domestic partner) of your household, and your dependent children.
Do I need to select a primary care physician with the CareFirst BlueChoice Open
Access plan?
Selecting a BlueChoice PCP is required. You can receive care from a network or nonnetwork provider without a referral under the Open Access program.
Can I see a BlueChoice network PCP who isn’t my designated PCP?
Yes. You may visit any PCP within the BlueChoice network. However, some doctors are listed as both specialists and PCPs, in which case you will be required to pay the higher specialist copay. If you wish to change your PCP, please contact CareFirst directly.
How do I designate or change a PCP with the CareFirst BlueChoice plan?
Once your enrollment in the CareFirst BlueChoice plan has been confirmed, you will be able to either contact CareFirst member services at 800-296-0724 before December 15,
2009, or 800-628-8549 after December 15, 2009. You may change your designated PCP at any time by calling CareFirst.
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Does everyone covered under my CareFirst BlueChoice plan need to use the same designated PCP?
No. Each member can select his/her own PCP.
What is Open Access?
CareFirst’s Open Access plan allows you to see an in-network specialist without a written referral.
I have enrolled in Kaiser. Do I need to choose a PCP?
Yes, you need to choose a PCP with Kaiser. If you do not choose one, Kaiser will assign you to a PCP who will direct your care.
Dental
I have dental coverage with CareFirst/DentaQuest. Will my coverage roll over for
2010?
No, your coverage does not automatically roll over. You must elect Delta Dental in order to have dental coverage in 2010.
How do I find out if my dentist participates with Delta Dental?
Go to deltadentalins.com to see if your dentist is in the Delta Dental PPO or
Premier networks. Alternatively, you can call your dentist’s office. There are two networks for our new plan: Delta Dental PPO and Delta Dental Premier. The PPO network offers the highest benefit. You can see a dentist who does not participate with Delta Dental at all but may have to pay more out of pocket.
Do I have to choose a dentist in the PPO network with Delta Dental?
You may see any dentist with Delta Dental; however, the dentist you choose determines the level you pay out of pocket. You pay the least out of pocket if you see a dentist in the Delta
Dental PPO network; you pay a little more out of pocket if you see a dentist in the Delta
Dental Premier network; and you pay the most out of pocket for seeing a dentist who is not affiliated with Delta Dental.
Why did AU change dental plans?
In the benefits survey administered last November, AU faculty and staff told us that you want a dental plan with better coverage and a bigger network of providers. The University worked with Mercer and identified Delta Dental as the strongest dental provider in terms of offering the richest benefits coverage with the most cross-over of dentists as with the prior plans.
How much does AU contribute to the dental plan?
In our market research, we learned that we were behind the market in not contributing to your dental plan. AU is committed to providing market-competitive benefits. Beginning in
2010, the University will contribute 25% to individual plans and 20% to individual plus one and family plans.
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Vision
I have vision discounts with CareFirst/Kaiser. Why should I sign up for this vision discount plan?
This vision plan offers discounts at other vision centers including: Pearle Vision,
LensCrafters, Sears Optical, Target Optical, and JC Penny Optical. There is no charge for this discount plan and you can automatically access its benefits by giving the participating vision care provider the group ID #923 8205.
How do I enroll in the plan?
You don’t need to enroll to get the discount. Just provide group ID# 923 8205. For more information or to print a card, go to www.metlife.com/mybenefits or contact MetLife at
800-GET-MET8 (800-439-6388)
Flexible Spending Accounts
What are Flexible Spending Accounts (FSAs)?
FSAs are accounts you fund with pre-tax money withheld from your paycheck to pay for eligible health and dependent care expenses that are not reimbursed from any other source.
AU offers two accounts: the medical spending account (MSA) and the dependent care spending account (DCSA).
I currently have medical and dependent care spending accounts and want to continue my contribution in 2010. Do I need to make open enrollment elections?
Yes. If you wish to participate in medical and/or dependent care spending account in 2010, you must re-enroll during open enrollment. Medical and dependent care spending account elections do not carry over from year to year. If you do not take any action during open enrollment, your current medical and/or dependent care spending account deductions will end on December 31, 2009, and you will only be able to incur claims until March 15, 2010.
I’m not in the AU medical or dental plans. Can I enroll in the medical spending account through AU?
Yes. You are eligible to enroll in our medical spending account even if you are not in the medical or dental plans.
Can I use the medical spending account to reimburse myself for medical insurance premiums?
No. If you are enrolled in one of our health care plans, you may pay these premiums with pre-tax dollars but cannot use the medical spending account to pay your premiums.
How do the deductions come out of my paycheck?
The payroll system will calculate your deduction based on your annual election and your pay frequency. If you are paid biweekly, then your deduction will be 1/26 of your annual election. If you are paid monthly, 12 months of the year, then your deduction will be 1/12 of your annual election. If you are paid monthly, 9 months of the year, then your deduction will be 1/9 of your annual election. The deductions for these plans are made on a pre-tax basis.
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Can I have my reimbursements directly deposited to my checking or savings account?
Yes. You may have your reimbursements directly deposited into your checking or savings account. Please go to mypayflex.com
to complete a direct deposit form to add this feature.
You may elect this direct deposit option at any time; you need not wait until the beginning of a new plan year.
What happens when I terminate employment?
If you terminate employment during the year, special rules apply. Eligible expenses must be incurred on or before your date of termination, and the claim must be filed no later than 90 days from your date of termination, in order to be reimbursed. You will be reimbursed for the amount of your eligible expenses up to your full annual election for the medical spending account (please note for terminated employees this amount may exceed the amount you contributed to the plan). The rule is different for the dependent care spending account—you will be reimbursed only for the amount you contributed to that plan, which is often less than the annual election for employees terminating during the middle of a plan year.
If I receive more than I contributed to the medical spending account, am I required to “repay” this amount to AU?
No. If you receive a reimbursement for more than you contributed to the medical spending account, you will get to keep the amount you received in excess of the amount you funded.
When will I be able to access the pre-tax monies I set aside for my medical spending account?
For your medical spending account, you will have access to your total annual election on
January 1, 2010. This means that you can spend up to your full balance at any time during year, regardless of whether the money has yet been deducted from your paycheck.
When will I be able to access the pre-tax monies I set aside for my dependent care spending account?
You will have access to your dependent care spending account funds as they accrue throughout the year.
What is the PayFlex debit card?
All FSA participants receive a debit-style MasterCard that allows direct access to FSA funds for eligible health care and dependent care expenses. This means no waiting period for reimbursements. When you use your card, available funds are deducted from your FSA account to pay for services or supplies. You must retain all receipts and Explanations of
Benefits with your tax records to comply with plan and IRS rules.
How do I use the card?
You can use your card just as you would a debit card to pay for eligible health care and dependent care expenses. Once you “swipe” the card at the point of service, funds are deducted from your FSA account to pay the vendor for goods or services.
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I don’t like to use credit cards. Is this tied to my credit report?
This card is a debit card and is not tied to your credit report. There is no additional fee you must pay for this card and it is optional to use. If you do not wish to have the card, you may contact PayFlex directly to cancel the card.
Do I have to use my PayFlex Debit card?
No. Use of the card is optional. Traditional claim processing remains available and must be used for purchases from providers who do not accept MasterCard or are not designated as eligible merchants.
When will I receive my debit card?
As a new FSA participant, you can expect to receive your card at your home address in mid-
January. You will receive one card. If you already have a PayFlex debit card, you will not receive a new card. You may continue to use the card previously issued to you.
In January, may I use my PayFlex debit card to draw on my remaining 2009 FSA balance?
No. Purchases made with cards on or after January 1, 2010, will access funds from your
2010 flexible spending accounts.
How does the card know which expenses are eligible and which are not?
Each merchant or provider accepting MasterCard is assigned a merchant category code.
There are more than 500 codes and the card accepts only a few of those codes that are related to eligible expenses under medical and dependent care spending accounts. The card will deny merchant category codes that have not been programmed on the card. Although these safeguards are in place, you are fully responsible for ensuring that only eligible expenses are paid using the card. If you are having a problem using your card for eligible expenses with a specific merchant, contact PayFlex to see whether that merchant’s category code can be added to the card.
When I use the card, do I need to submit my receipt?
Not necessarily. PayFlex may request copies of your receipts to audit your account. They recommend you retain all receipts, claims forms, and Explanations of Benefits with your tax records in case they are requested by PayFlex or the IRS.
If I don’t use the card, how do I file a claim?
To receive reimbursement from your account, complete a claim form at mypayflex.com.
Follow the instructions on the Web site.
Will my transaction be denied if I don’t have enough money in my account to cover the expense?
Yes. Your transaction will be denied for any amount that is greater than your allowable balance. Your MSA balance is the amount you elect to contribute for the entire year, less any reimbursements that have already been paid. Your dependent care spending account balance is the balance in your account at the time your claim is processed (contributions made minus any reimbursements previously paid).
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What do I do if my card is lost or stolen?
Immediately call PayFlex at 800-284-4885 to deactivate your card. You may order a replacement card at no additional cost.
Can I request additional debit cards?
Yes. Additional debit cards can be obtained for your dependents by contacting PayFlex at
800-284-4885.
Life Insurance
Are there changes to the life insurance plans this year?
Beginning January 1, 2010, basic life insurance now covers 1x your base salary; the $50,000 limit has been removed. If you had not previously elected life insurance, you are eligible to enroll for up to 4x your base salary or $600,000 (whichever is lower) without medical review .
What is a special enrollment period?
Normally if you do not sign up for life insurance when you initially become eligible, you have to go through full medical review in order to be covered. The University has negotiated a special enrollment with MetLife through which you can sign up for up to
4x your base salary or $600,000 (whichever is lower) without medical review. This special enrollment period will not be repeated and will not be available next year.
My life insurance had been capped at $350,000 because I didn’t go through medical review. Will it automatically increase?
It depends. Please contact Human Resources at x3513 with questions.
What is the maximum amount of life insurance for which I can apply?
You may apply for up to 5x base salary or $1,500,000 (whichever is lower). Amounts above
4x base salary or over $600,000 are subject to medical review. Go to my.american.edu
to obtain MetLife’s Statement of Health form to initiate a medical review process.
Disability
How do I enroll in disability coverage?
You are automatically enrolled in the University’s short term disability plan. Faculty are eligible from the first day of their contract. Staff are eligible after working at the University for six months. You are eligible for long term disability after you have worked full time at
AU for one year.
How much does short term disability coverage cost? How much does long term disability coverage cost?
The University covers the cost of short term disability coverage. The cost of long term disability is based on your salary and is shared by you and the University.
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Can I drop long term disability coverage if I don’t want it?
No. Participation is mandatory.
What do I get on short term disability? What do I get on long term disability?
Faculty on short term disability continue to receive 100% of pay for up to six months. For staff, once your leave is used, you continue to receive 100% pay and benefits for the six months you are absent due to disability.
What do I get on long term disability?
Faculty and staff generally receive 60% of pay until they are no longer disabled or reach
Social Security retirement age (there are some variances based on age at time of disability and condition. See Benefits Manual for details). Only half of the 60% payment is considered taxable income. Additionally, if you participate in the retirement plan, MetLife will continue your contributions (up to 15%). You may also be eligible to continue in the health, dental, and educational benefits based on your years of service.
Tuition Remission
If I am enrolled at American University and I add or drop courses, does my tuition benefit automatically adjust?
No. You must contact Human Resources (x3748) and Student Accounts (x3541) to alert us that you have changed the number of courses in which you are enrolled.
Are educational benefits taxable?
It depends. Please see the Benefits Manual section on Educational Benefits for details.
What is the maximum benefit available to me, my spouse or same-sex domestic partner?
The maximum benefit available to you is eight credits per semester. The total credits for courses may not exceed 20 credits per academic year. If you decide to go over the maximum, you will responsible for the entire cost.
What is the maximum benefit available to my dependent child?
Dependent children are eligible for up to eight semesters of educational benefits. If they are enrolled at AU, they are also eligible for two courses during the summer months between academic years.
Are fees covered by tuition remission?
No. The educational benefits program does not cover application fees, course fees, comprehensive examination fees, matriculation fees, or other charges which exceed the standard tuition rate as define in the course catalogue of tuition and fees. There is a nonrefundable $50 administrative fee applied once you apply for tuition remission benefits.
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How do I apply for educational benefits?
For tuition remission for you or your legal spouse/same-sex domestic partner go online to my.american.edu, click on Employment, and complete the online tuition remission form.
For educational benefits for your dependent child, go to my.american.edu, HR/Payroll
Connection, Info/Forms, Benefits to print out and complete the Educational Benefits for
Dependent Children form. Send the completed form to the Benefits Operation Specialist in the Human Resources department.
I worked as a full-time staff member for five years, left AU for six months, and was recently rehired. Am I eligible for tuition benefits?
Yes. As long as you worked at AU for at least four months and have returned within three years, you and your legal spouse or same-sex domestic partner are eligible to participate in the tuition remission program without waiting. If you worked at AU for two full academic years and have returned within three years, you are eligible to participate in the educational benefit programs for dependent children without waiting.
I worked full-time for 20 years, retired, and am now working part-time at AU. Am I eligible for tuition benefits based on my prior, full-time years of service?
If you officially retired from your full-time position, you may be eligible to participate. See the Benefits Manual for details.
Are study abroad programs covered under educational benefits for dependent children?
In some cases, yes. Please contact the benefits team at x3748 for details. Generally, your child must be enrolled full-time at AU and participating in an AU study abroad program to continue to receive the AU scholarship while abroad.
Can I be granted an exception to the eligibility requirements if I only miss the deadline by two days?
No. To protect the integrity of the program, we do not waive the eligibility requirements, even for participants who miss the service requirements by a short period of time. If you miss the deadline, even by a small period of time, you may only apply for tuition remission benefits for the next semester of study.
Can I take a leave of absence and receive educational benefits for myself or my child?
In some cases, you may be eligible to be out on approved leave without pay and continue to receive educational benefits. Please contact the benefits office for details at x3748.
If I have received, or am receiving, educational benefits, and I resign from my position at the University, would I ever be required to reimburse the University for the value of my tuition benefits?
If you terminate employment, you will no longer be eligible to receive benefits, but you will not be required to reimburse the University for the benefits you have used. If you leave the University during a semester in which you or your dependents are using educational benefits, you will be responsible for a pro-rated portion of the tuition based on your last date of work.
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Retirement
If I want to make changes to my retirement plan contributions do I have to wait until open enrollment?
No. You may make contribution changes at any time during the year by filling out the
Retirement Plan Election form. If you wish to change your asset allocations, you may do so by contacting Fidelity or TIAA-CREF directly.
How can I meet with a Fidelity or TIAA-CREF representative?
Representatives from Fidelity and TIAA-CREF are at AU at least once a month. To schedule an appointment with our Fidelity representative, call 800-642-7131. To schedule an appointment with our TIAA-CREF representative, call 202-637-8939.
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Glossary
After-Tax Contributions – Employee contributions for coverage under certain benefit plans that are deducted after federal and state income taxes and Social Security (FICA) taxes are calculated and withheld.
Allowable Charge – The allowance for the service(s) rendered or the provider’s billed charge, whichever is less, based on the provider’s region.
Balance Billing – Refers to the process of a health or dental care provider charging a patient for the difference between the actual charge for services and the amount the plan will pay.
BCBS Participating Provider – Individual physicians, hospitals, and professional health care providers who have a contract with CareFirst BlueCross BlueShield and/or CareFirst
BlueChoice Inc. to provide services to its members at a discounted rate and to be paid directly for covered services.
Beneficiary – The person(s), estate, trust, entity, or organization designated to receive benefits in the event of death.
BlueChoice – CareFirst’s network of physicians who participate in the HMO portion of the plan (also referred to as in-network providers).
Brand Name Drug – A drug developed and produced exclusively by a single pharmaceutical company. The formula is protected by patent for a period of several years before a generic equivalent can be developed.
Coinsurance – The percentage amount a plan member pays for certain covered health care services and supplies after the deductible has been met (applies to CareFirst out-of-network care).
Copay – The fixed amount a plan member pays when certain covered health care services and supplies are received (applies to CareFirst in-network and Kaiser care).
Covered Expense – An expense for a service or supply that is covered under the applicable plan.
Deductible – The initial health care expenses each year that a plan member must pay before plan benefits are paid (applies to CareFirst in-network and out-of-network care).
Dependent Care Spending Account (DCSA) – An arrangement through which Flexible
Spending Account plan participants may set aside a portion of their pre-tax salaries to pay for certain eligible dependent care expenses.
Evidence of Insurability (aka Statement of Health) – A statement or proof of an employee’s physical condition or other factors affecting his/her acceptance for insurance.
American University does not require Evidence of Insurability (EOI) for our health or dental plans; for some levels of life insurance coverage EOI may be required.
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Formulary – Generally, a drug list used as a guide for determining the copay amount health plan members pay for each prescription.
Health plan members generally pay a lower amount for drugs listed on the formulary. A formulary may also be referred to as a preferred drug list.
Generic Drug – A prescription drug, which is chemically ingredient-equivalent to a brand name product, and is dispensed under its generic chemical name.
Grace Period – With regard to flexible spending accounts, the 2-1/2 month period in which claims can be incurred and charged to the prior calendar year’s account (January 1 – March 15). For example, a charge incurred on February 28, 2010, may be reimbursed with 2009 flexible spending account funds.
HMO (Health Maintenance Organization) – A health care delivery system that typically uses contracted primary care physicians to coordinate all health care for enrolled members. HMOs generally require each member to select a primary care physician (PCP). The
Kaiser PCP coordinates care and makes referrals to specialists and hospitals as needed. CareFirst PCPs are not required to write referrals to specialists under AU’s Open Access Plan; however, they are required to preauthorize hospitalizations and some prescription medications.
Covered services are usually paid in full after the member pays any required copays and deductibles.
Indemnity – A type of health plan that gives you the maximum physician choice as you may see any provider. However, your out-ofpocket expenses are higher when you see physicians in an indemnity plan than if you see physicians in the discounted HMO network.
(CareFirst Indemnity [out-of-network]).
In-network – A network of physicians who agree to charge less to provide their services. These savings are passed on to members who have lower out-of-pocket expenses in-network (CareFirst BlueChoice [in-network] and Kaiser).
Lifetime Maximum – The maximum amount the plan will pay in benefits for each member during his/her lifetime. American University’s
CareFirst plan does not have a lifetime maximum; Kaiser has a lifetime maximum of $1,000,000.
Medical Spending Account (MSA) – An arrangement through which flexible spending account plan participants may set aside a portion of their pre-tax salaries to pay for certain eligible health care expenses.
Medically Necessary – Health care service or treatment that is generally accepted in medical practice as being needed for the diagnosis or treatment of a patient’s condition and that cannot be omitted without harming the patient according to generally accepted standards of medical practice.
Network Providers – A group of doctors, hospitals, and other health care providers who have agreed to accept a negotiated fee for services rendered under a certain health care plan. The continued participation of any specific provider cannot be guaranteed as contracts may be terminated at any time.
Non-Formulary Drug – A prescription drug that is not preferred and is not included in a health care plan’s formulary. Drugs not listed on the formulary typically require a higher copay from a plan member.
Open Enrollment – The period each year (usually in November) when employees have an opportunity to elect or make changes to medical, dental, vision, and FSA elections. Elections made during open enrollment take effect the following January 1.
Out-of-Pocket Maximum – Generally, the maximum dollar amount—including deductibles, copays, and coinsurance—that a plan member pays in any calendar year toward the cost of covered medical care. Once a plan member reaches the out-of-pocket maximum, the health plan covers eligible expenses at 100% for the remainder of the calendar year.
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Plan Year – January 1 through December 31.
POS (Point of Service) – A type of health plan that provides flexibility by allowing members to decide how to receive services each time services are needed. For example, a member may choose to see a network or non-network provider each time he/she needs care. The highest level of benefits is generally obtained by using network providers. The University’s CareFirst plan is a POS plan.
Preferred Drug List – See formulary
Pre-Tax Contributions – Employee contributions for coverage under certain benefit plans that are deducted before federal and state income taxes and Social Security (FICA) taxes are calculated and withheld.
Primary Care Physician (PCP) – The physician responsible for coordinating an HMO plan member’s health care. Under CareFirst, PCPs are not required to write a referral to specialists; you may see a specialist of your choosing (the amount you pay is based on whether they are in- or out-of-network). Kaiser PCPs coordinate all care.
Qualifying Life Event – A specific change that allows an employee to make benefit election changes prior to the next open enrollment, such as the birth of a child, marriage, change of job status, and more. The IRS refers to these changes as “Qualified Family Status
Changes.” See the section on Making Changes During the Year on pages XX for more details.
Salary – Base pay, including paid vacation, paid holiday and paid sick time but excluding overtime pay, shift pay, bonuses, and other compensation.
Statement of Health – See Evidence of Insurability
Vesting – Refers to the portion of your 403(b) retirement plan account balance to which you are entitled under the plan rules. In the AU plan, you are 100% vested immediately.
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Medical Plan Comparisons
You should refer to the appropriate sections of the Faculty Staff Benefits Manual or the official plan documents for more extensive information concerning your benefits plans. In the event of any conflict between this benefits guide or the appropriate descriptive sections of the benefits manual and the official plan documents, the plan documents will govern.
Hospital Admissions
Medical, Surgical, obstetrical
Rehabilitative admission
(not related to alcohol and drug abuse treatment and rehabilitation)
Preadmission testing
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HMO: BlueChoice
100% coverage - after $100 copayment - when admitted by a
BlueChoice physician to an approved hospital only at approved locations.
Subject to deductible.
Indemnity
75% of plan allowance - after you’ve met the annual deductible.
(pre-certification is required)
Not Covered After $100 co-payment covered for up to 30 days per confinement in an acute care hospital when hospitalization is medically necessary and authorized by BlueChoice.
Subject to deductible.
100% coverage after $100 annual deductible is met - at approved locations. If testing requires a hospital stay, $100 co-payment. Subject to deductible.
75% of plan allowance - after you’ve met the annual deductible for diagnostic testing, x-rays and lab work when rendered in the outpatient department of a hospital. kAiSER PERMAnEntE
HMO
100% coverage-after $100 co-payment
100% coverage-after $100 co-payment
100% coverage. If testing requires a hospital stay, $100 co-payment applies.
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Emergency Care
in-plan area outside-plan area
Ambulance Services
Accidental injury
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice
100% coverage-after $50 copayment per visit for bona fide emergency. $50 is waived if admitted as inpatient to the hospital.
Subject to deductible.
Indemnity
75% of plan allowance of covered services - after you’ve met the annual deductible.
Same coverage as In-Plan.
100% coverage of ground ambulance to hospital for authorized emergency. Subject to deductible.
100% coverage - after $50 copayment if treated in emergency room. $50 is waived if admitted as inpatient to the hospital. Subject to deductible.
Same coverage as In-Plan.
75% of plan allowance - after you’ve met the annual deductible.
75% of plan allowance of covered services - after you’ve met the annual deductible.
kAiSER PERMAnEntE
HMO
100% coverage - after
$50 co-payment when life-threatening situation or when authorized by plan. If admitted, $50 co-payment is waived but $100 inpatient co-payment will apply.
(Urgent Care Centers are available at Kaiser facilities for urgent and non -life threatening emergencies.)
Same coverage as In-Plan.
100% coverage - when lifethreatening situation or when authorized by plan.
100% coverage - when lifethreatening situation or when authorized by plan.
(Urgent Care Centers are available at Kaiser facilities for non -life threatening emergencies.)
Maternity Care
inpatient Hospital outpatient Hospital
Physician nurse Midwife birthing Center
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice
100% Coverage - after $100 copayment at approved locations.
Subject to deductible.
100% coverage at approved locations. Subject to deductible.
100% coverage after $20 per visit co-payment. (Up to $200 copayment per pregnancy). Subject to deductible.
100% coverage after $20 per visit co-payment. (Up to $200 co-payment per pregnancy. Nurse Midwife must be associated with an approved center). Subject to deductible.
Indemnity
75% of plan allowance - after you’ve met the annual deductible.
75% of plan allowance - after you’ve met the annual deductible.
75% of plan allowance - after you’ve met the annual deductible.
75% of plan allowance - after you’ve met the annual deductible.
Benefits may not be available for
Nurse Midwife services if already billed by physician.
kAiSER PERMAnEntE
HMO
100% coverage - after $100 co-payment.
Not covered.
100% coverage through first postnatal visit.
100% covered through first postnatal visit.
100% coverage after $20 per visit co-payment. Subject to deductible.
(Up to $200 co-payment per pregnancy, at approved locations).
75% of plan allowance - after you’ve met the annual deductible.
100% coverage after $15 per visit co-payment at Kaiser affiliated centers.
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Surgery
outpatient surgery inpatient surgery
Second or multiple surgical opinion consultation
Anesthesia services organ transplant
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice Indemnity
Primary care physician: 100% coverage - after $15 per visit copayment. Subject to deductible.
Specialist: 100% coverage after
$20 per visit co-payment. Subject to deductible.
100% coverage for an approved admission after $100 co-payment.
Subject to deductible.
75% of plan allowance - after you’ve met the annual deductible.
75% of plan allowance - after you’ve met the annual deductible.
75% of plan allowance - after you’ve met the annual deductible.
Specialist: 100% coverage after
$20 per visit co-payment. Subject to deductible. Paid in full if requested by the HMO.
Inpatient: 100% coverage. Subject to deductible.
Outpatient: 100% coverage.
Subject to deductible.
100% coverage for limited services.
Subject to deductible.
75% of plan allowance - after you’ve met the annual deductible.
75% of plan allowance - after you’ve met the annual deductible for limited services. kAiSER PERMAnEntE
HMO
100% coverage after $15 copayment.
100% coverage after $100 copayment.
100% coverage after $15 per visit co-payment.
100% coverage.
100% coverage when authorized by plan for limited services.
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Inpatient Physician Visits
Medical/Surgical physician services
Specialist care inpatient consultation
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice Indemnity
100% coverage for an approved admission. Subject to deductible.
75% - after you’ve met the annual deductible.
100% coverage for an approved admission. Subject to deductible.
100% coverage for an approved admission. Subject to deductible.
75% - after you’ve met the annual deductible.
75% - after you’ve met the annual deductible.
Outpatient Physician Visits
Medical services and
Physician office visits
Well baby care 2
Routine physicals
Home physician visits
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice
Primary care physician : 100% coverage - after $15 per visit copayment.
Specialist: 100% coverage - after
$20 per visit co-payment.
Primary care physician: 100% coverage - after $15 per visit copayment.
Primary care physician: 100% coverage - after $15 per visit copayment.
Indemnity
75% of plan allowance - after you’ve met the annual deductible.
75% of plan allowance - not subject to deductible. Unlimited visits up to age 18.
Not covered.
Primary care physician: 100% coverage - after $15 per visit copayment.
Specialist: 100% coverage - after
$20 per visit co-payment. Subject to deductible.
75% of plan allowance - after you’ve met the annual deductible. kAiSER PERMAnEntE
HMO
100% coverage.
100% coverage.
100% coverage.
kAiSER PERMAnEntE
HMO
100% coverage after $15 per visit co-payment. No copayment for primary care physician office visits for children under 5. (Note: specialist co-payment applies for children under 5.)
100% coverage up for preventative services for children. No co-payment for children (under and over 5) preventative care office visits.
100% coverage for preventative services. No co-payment for adult and children (under and over 5) preventative care office visits.
100% coverage - when medically necessary. Subject to evaluation and authorization by plan.
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Durable Medical Equipment
Durable Medical
Equipment
Hearing Aids
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HMO: BlueChoice Indemnity
Covered in full; $5,000 per year maximum. Subject to deductible.
75% of plan allowance, subject to deductible.
Subject to annual deductible, then
100% of allowed benefit up to
$2,500 annual maximum per pair per 36-month period
Subject to annual deductible, then 75% of allowed benefit up to $2,500 annual maximum per pair per 36-month period kAiSER PERMAnEntE
HMO
100% coverage with certification by primary care physician.
$0 copay, 1 hearing aid per ear every 36 months to a
$1,000 benefit maximum
Nursing Care
inpatient
Private duty nurse outpatient
Private duty nurse
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HMO: BlueChoice Indemnity
100% coverage after $100 annual deductible is met when authorized by plan for an approved admission due to medical necessity.
3 Subject to deductible.
Not covered.
Not covered.
75% of plan allowance - after you’ve met the annual deductible. Limited to a maximum of two hours a day (1 visit) up to 50 visits per calendar year.
4 kAiSER PERMAnEntE
HMO
100% coverage when authorized by plan.
100% coverage when authorized by plan.
1 The amount that BCBS will pay for a given covered service is determined by the Plan Allowance for that service. The Plan Allowance for covered services is determined by the contracted rate or fee schedule that participating providers have agreed to accept for that service or the rate or fee that is established by law. Throughout this document this definition will be referred to as “plan allowance.”
2 Includes routine immunizations
3 Services must be performed by an RN or LPN
4 Services must be performed by an RN or LPN
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Diagnostic and Screening Services
Diagnostic services
Family planning/Fertility
Preventive care
Mammography
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice Indemnity
100% coverage only at approved locations. Subject to deductible.
Primary care physician: 100% coverage - after $15 per visit co-payment. Subject to annual deductible then 100% of allowed benefit to $100,000 lifetime maximum.
Specialist: 100% coverage - after
$20 per visit co-payment. Subject to annual deductible then 100% of allowed benefit to $100,000 lifetime maximum.
Prior authorization is required.
Documented one-year period of trying to become pregnant.
Diagnosis and treatment of infertility including medically necessary, non-experimental artificial insemination and In-Vitro
Fertilization (IVF).
100% coverage when authorized by plan for an approved admission due to medical necessity.
75% of plan allowance - after you’ve met the annual deductible.
Testing provided to determine that a diagnosis for infertility exists. The testing is covered at 75% of plan allowance - after you’ve met the annual deductible. No further benefits available if diagnosis is confirmed.
75% of plan allowance - after you’ve met the annual deductible. Limited to:
Ages 35-39: one preventive mammogram of both breasts in the 5 years.
Ages 40-49: one preventive mammogram of both breasts every 2 years.
Ages 50 and above: one preventive mammogram of both breasts every year. kAiSER PERMAnEntE
HMO
100% coverage
50% coverage - after $15 per visit co-payment for family planning and counseling services and physician services for the diagnosis and treatment of involuntary infertility such as artificial insemination, lab and x-rays.
In-Vitro Fertilization (IVF):
50% coverage to $100,000 benefit maximum up to three procedures per live birth
100% coverage. No copayment.
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Therapeutic Services
Radiation/ Chemotherapy
Dialysis (Physician)
Physical therapy physician-billed or physical therapist billed
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice Indemnity
100% coverage - after $20 per visit co-payment or $15 co-payment for primary care physician. Subject to deductible.
100% coverage after $20 per visit co-payment for short-term care. Subject to deductible.
(Short-term care means significant improvement is expected within
90 days).
100% coverage - after $20 per visit co-payment. Subject to deductible.
75% of plan allowance of covered services -after you’ve met the annual deductible.
75% of plan allowance - after you’ve me the annual deductible.
75% of plan allowance - after you’ve met the annual deductible. kAiSER PERMAnEntE
HMO
100% coverage.
100% coverage after $15 copayment per visit for up to 40 visits or 90 days, whichever is greater.
Speech therapy
(outpatient Physician) occupational therapy
(outpatient Physician)
100% coverage - after $20 per visit co-payment. Subject to deductible.
75% of plan allowance - after you’ve met the annual deductible.
Non-Hospital Care
Hospice care 100% coverage. No limit. Subject to deductible. Available during last 6 months of life.
Home health care 100% coverage - if service is begun within 7 days of authorized admission. Subject to deductible.
Otherwise, this benefit is provided under Indemnity option.
Extended Care Facility(ECF) 100% coverage when authorized by plan. Subject to deductible.
75% of plan allowance - after you’ve met the annual deductible. Limit of 180 days per lifetime, 60 of which may be used for inpatient hospice care.
45 lifetime reserve days are also available for inpatient or home care. Available during last 6 months of life.
75% of plan allowance - after you’ve met the annual deductible. Limited to 90 visits per confinement.
75% of plan allowance - after you’ve met the annual deductible.
100% coverage after $15 per visit co-payment for up to 40 visits or 90 days, whichever is greater.
100% coverage after$15 per visit co-payment for up to 2 months per contract year.
100% coverage. Subject to evaluation and authorization by plan. Available during last
6 months of life.
100% coverage - when medically necessary.
Subject to evaluation and authorization by plan.
100% coverage for up to 100 days. Includes bed, board and general nursing care - when authorized by HMO physician.
Transgender Care
transgender Care
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HMO: BlueChoice Indemnity
Covers pre- and post-surgical hormone therapy, surgery if performed by a qualified provider and in conformance with
HBIGDA standards. Requires preauthorization.
Surgical, hospital, and laboratory benefits subject to $75,000 lifetime max.
Covers pre- and post-surgical hormone therapy, surgery if performed by a qualified provider and in conformance with
HBIGDA standards. Requires preauthorization.
Surgical, hospital, and laboratory benefits subject to $75,000 lifetime max kAiSER PERMAnEntE
HMO
Not covered.
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Mental Health Care
outpatient Mental Health
Care
Psychological testing inpatient Mental Health
Care when billed by hospital or residential facility inpatient Mental Health
Care when billed by a physician, psychologist, or social worker
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HMO: BlueChoice Indemnity
100% coverage – after $25 per visit co-payment. Subject to deductible. Includes psychotherapy for gender identity disorders.
Primary Care Physician $15 copay per visit, subject to annual deductible, then 100% of allowed benefit
Specialist $20 copay per visit, subject to annual deductible, then
100% of allowed benefit
Coverage for psychological and neuropsychological testing is provided for outpatient services to treat mental illnesses, emotional disorders, drug abuse, or alcohol abuse including psychological and neuropsychological testing for psychological diagnostic purposes. Services include evaluation, diagnosis and treatment of acute and nonacute conditions. The benefits for neuropsychological testing are not counted toward any outpatient mental health and substance abuse visit benefit.
80% coverage after $100 copayment for short-term, acute mental health conditions. Subject to deductible. (Provided on combined basis with alcohol/ drug abuse treatment.)
100% coverage – after $25 per visit co-payment. Subject to deductible.
75% of plan allowance - after you’ve met the annual deductible for therapy rendered by psychiatrist, licensed psychologist, or licensed clinical social worker. Includes psychotherapy for gender identity disorders.
Subject to the annual deductible, then 75% of allowed benefit.
Coverage for psychological and neuropsychological testing is provided for outpatient services to treat mental illnesses, emotional disorders, drug abuse, or alcohol abuse including psychological and neuropsychological testing for psychological diagnostic purposes. Services include evaluation, diagnosis and treatment of acute and nonacute conditions. The benefits for neuropsychological testing are not counted toward any outpatient mental health and substance abuse visit benefit
75% of plan allowance - after you’ve met the annual deductible
75% of plan allowance - after you’ve met the annual deductible kAiSER PERMAnEntE
HMO
100% coverage for: $15 copayment/individual; $10 copayment/group.
Covered.
$100 co-payment/admit.
$100 co-payment/admit.
Unlimited inpatient days.
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Alcohol and Drug Abuse Treatment
outpatient Alcohol/
Substance abuse inpatient Alcohol/Substance
Abuse treatment
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice Indemnity
Physician expenses: 100% coverage – after $25 per visit copayment. Subject to deductible.
Detoxification: 80% coverage after $100 co-payment. Subject to deductible. Rehabilitation: 80% coverage after $100 co-payment.
Subject to deductible. Coverage for up to 30 days note: All detoxification and rehabilitation benefits count against the mental health day/visit maximums. note: All inpatient and outpatient substance abuse benefits count toward the $2500 annual maximum.
Physician expenses:
75% of plan allowance - after you’ve met the annual deductible. Limited to 30 visits per calendar year.
outpatient facility: 75% of plan allowance of covered services – after you’ve met the annual deductible.
Detoxification: 75% of plan allowance coverage.
Rehabilitation: 75% of plan allowance - after you’ve met the annual deductible.
note: All inpatient and outpatient substance abuse benefits count toward the
$2500 annual maximum.
kAiSER PERMAnEntE
HMO
$10 co-payment for each additional visit per contract year. $15 co-payment/ individual; $10 co-payment/ group.
$100 co-payment/admit.
Unlimited inpatient days.
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Special Care Services
Acupuncture
Chiropractic
Dental Services
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice
$20 copay; subject to in-network deductible; up to 20 visits
Covers acupuncture for pain management and anesthesia. Coverage will be provided when such treatment is rendered by a trained practitioner who is licensed or certified as such by the duly constituted authority in the area in which service is rendered and when acting within the scope of such license or certification; and if the practitioner rendering the acupuncture treatment is not an M.D., such treatment must be under the direct supervision of an M.D.
Indemnity
Subject to annual deductible, then
75% of allowed benefit; no visit limit
Covers acupuncture for pain management and anesthesia.
Coverage will be provided when such treatment is rendered by a trained practitioner who is licensed or certified as such by the duly constituted authority in the area in which service is rendered and when acting within the scope of such license or certification; and if the practitioner rendering the acupuncture treatment is not an
M.D., such treatment must be under the direct supervision of an
M.D.
$20 copay; subject to in-network deductible; up to 20 visits
Contraceptive Devices 100% covered after office visit copay.
Subject to annual deductible. Depo-
Provera, Norplant, intra-uterine devices and any medically necessary insertion, removal, or examination associated with the use of any contraceptive drug or device approved by the FDA for use as a contraceptive.
Discounted dental benefits provided for limited number of services.
Subject to annual deductible, then
75% of allowed benefit; no visit limit
Subject to annual deductible, then
75% of allowed benefit. Depo-
Provera, Norplant, intra-uterine devices and any medically necessary insertion, removal, or examination associated with the use of any contraceptive drug or device approved by the FDA for use as a contraceptive.
Not covered.
kAiSER PERMAnEntE
HMO
$15 copay, up to 20 visits
$15 copay, up to 20 visits
Covered.
Discounted dental benefits provided for limited number of services.
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Eye exams (routine)
Eyeglasses and contact lenses
Hearing Aids
Hearing Screening Exams inoculations (including travel inoculations)
CAREFiRSt bLuECRoSS bLuESHiELD
HMO: BlueChoice
Participating vision center:
100% coverage – after
$10 per visit co-payment.
Participating ophthalmologist:
100% coverage – after $25 per visit co-payment. Limited to one per calendar year.
Discounts available at participating vision centers. There is an additional cost for contact lens fittings.
Subject to annual deductible, then
100% of allowed benefit up to
$2,500 annual maximum per pair per 36-month period
100% coverage – after $20 per visit co-payment. Subject to deductible.
Primary Care Physician $15 copay per visit. Subject to annual deductible, then 100% of allowed benefit.
Specialist $20 copay per visit.
Subject to annual deductible, then
100% of allowed benefit.
Indemnity
Not covered.
Not covered.
75% of plan allowance - after you’ve met the annual deductible up to $2,500 annual maximum per pair per
36-month period
75% of plan allowance - after you’ve met the annual deductible if exam is required as result of accidental injury.
75% of plan allowance - after you’ve met the annual deductible kAiSER PERMAnEntE
HMO
100% coverage for exams after $10 per visit co-payment.
Limited to one per calendar year.
Discounts available at Kaiser centers and participating optical centers.
$0 copay, 1 hearing aid per ear every 36 months to a $1,000 benefit maximum
100% coverage after $10 per visit co-payment.
Not covered.
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COBRA Notice
Introduction
You are receiving this notice because you have recently become covered under a group health plan (the Plan). This notice contains important information about your right to
COBRA continuation coverage, which is a temporary extension of coverage under the
Plan. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.
The right to COBRA continuation coverage was created by a federal law, the Consolidated
Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator.
What is COBRA Continuation Coverage?
COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed below. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.
If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens:
Your hours of employment are reduced, or
Your employment ends for any reason other than your gross misconduct.
If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happens:
• Your spouse dies;
• Your spouse’s hours of employment are reduced;
• Your spouse’s employment ends for any reason other than his or her gross misconduct;
• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
• You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the
Plan because any of the following qualifying events happens:
• The parent-employee dies;
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• The parent-employee’s hours of employment are reduced;
• The parent-employee’s employment ends for any reason other than his or her gross misconduct;
• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
• The parents become divorced or legally separated; or
• The child stops being eligible for coverage under the plan as a “dependent child.”
When is COBRA Coverage Available?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, commencement of a proceeding in bankruptcy with respect to the employer, or the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), the employer must notify the Plan Administrator of the qualifying event.
Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to American University, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee will become a qualified beneficiary with respect to the bankruptcy. The retired employee’s spouse, surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan.
You Must Give Notice of Some Qualifying Events
For the other qualifying events ( divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice with documentation to: American University Human Resources Office, Sports Annex Center, 4400 Massachusetts Avenue, Washington, DC
20016. Please contact Human Resources at 202-885-2591 for additional information.
How is COBRA Coverage Provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child’s losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is
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NEXT PREVIOUS TABLE OF CONTENTS the end of employment or reduction of the employee’s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the employee’s hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.
Disability extension of 18-month period of continuation coverage
If you or anyone in your family covered under the Plan is determined by the Social Security
Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of
COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. You must provide this notice with documentation to: American University Human Resources
Office, Sports Annex Center, 4400 Massachusetts Avenue, Washington, DC 20016. Please contact Human Resources at 202-885-2591 for additional information.
Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A,
Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.
ARRA—How the New Law Affects COBRA
President Obama signed the American Recovery and Reinvestment Act of 2009 (ARRA) into law on February 17, 2009. ARRA includes provisions that change the way your employer administers COBRA.
Subsidized COBRA Premiums
The major change is a 65 percent COBRA subsidy for up to nine months for individuals who were involuntarily terminated from employment between September 1, 2008, and
December 31, 2009, and who were covered by an employer’s plan. If you become eligible for COBRA for reasons other than involuntary termination, such as divorce, or for gross misconduct, you are not eligible for the subsidy.
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When Does the Subsidy End?
If you pay the full COBRA premium when you are eligible for the subsidy, the Plan may either reimburse the amount of the subsidy or apply the premiums as a credit toward later months. Note that the subsidy does not extend your normal maximum COBRA coverage period of 18 months for employment termination. The subsidy ends if you become eligible for other group medical coverage or Medicare. Be sure to notify your employer immediately when this happens, since you will be subject to a penalty equal to 110 percent of any subsidy that is provided when you are not eligible.
Second Election Period
If you would otherwise qualify for the COBRA subsidy but you did not have COBRA, for whatever reason, on February 17, 2009, you will be offered a second election period of 60 days beginning after a new election notice is sent to you. If you then elect COBRA, you become eligible for the subsidy and your coverage will date back to March 1, 2009, not to your original loss of coverage date.
The subsidy is taxable income for federal income tax purposes for a tax year for those who receive the subsidy and have a modified adjusted gross income of more than $125,000
(if single) or $250,000 (if married filing jointly) for each tax year in which the subsidy is received.
The Women’s Health and Cancer Rights Act of 1998
The Women’s Health and Cancer Rights Act of 1998 provides benefits for mastectomy-related services. These services include:
• Reconstructive surgery
• Surgery to achieve symmetry between the breasts
• Prostheses
• Physical complications resulting from a mastectomy (including lymphedema)
Please refer to your medical plan summary plan description for details, or contact your plan administrator for more information.
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HIPAA Notice
AMERICAN UNIVERSITY WELFARE GROUP HEALTH BENEFIT PLAN
AMERICAN UNIVERSITY FLEXIBLE SPENDING ACCOUNT PLAN
AMERICAN UNIVERSITY FACULTY AND STAFF ASSISTANCE PROGRAM
AMERICAN UNIVERSITY FACULTY AND STAFF WELLNESS PROGRAM
JOINT NOTICE OF PRIVACY PRACTICES
As required by the privacy regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996, 42 USC
§1320d-1329d-8 (“HIPAA”).
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. Your Privacy.
American University (“university”) makes health care benefits available to American University employees, and retirees, and their families through the American University Welfare Group Health Benefit Plan, the American University Flexible Spending Account Plan, the Faculty and Staff Assistance Program, and the Faculty and Staff Wellness Program (“Health Plans”). The Health Plans provide the benefits by arrangement with Kaiser Permanente, DentaQuest, and through self-insured benefits programs administered for the university by Carefirst
Blue Cross Blue Shield (“Carefirst”), ExpressScripts, and PayFlex. The university self-administers the Faculty Staff Assistance Program
(“FSAP”) and the Faculty and Staff Wellness Program.
In the course of providing these benefits, the Health Plans create records regarding your participation in these programs. Additionally, the
Health Plans create records regarding you and the services that you receive from them. Each of the Health Plans is required by HIPAA to protect the confidentiality of any health information that identifies you (referred to in this Notice and HIPAA as “Protected Health
Information”). They also are required by HIPAA to provide you with notice of their legal duties and privacy practices concerning your
Protected Health Information.
II. Who will you receive notices from?
Where the university provides your health coverage through a health maintenance organization or through an insurance contract with a health insurance issuer, such as Kaiser Permanente and DentaQuest , you should receive notice directly from Kaiser Permanente and DentaQuest, not from the university.
With respect to those health benefits that are funded directly by the university, e.g. Carefirst, ExpressScripts, PayFlex, the Faculty and Staff
Assistance Program, and the Faculty and Staff Wellness Program (collectively referred to as “Self-Insured Plan”), the university in its capacity as a health plan is responsible for ensuring that you receive the notice of privacy practices. This document constitutes this notice. The university has contracted with professional health claims administrators, i.e. Carefirst, ExpressScripts, and PayFlex, to administer some of these programs on the university’s behalf. These third-party administrators will also follow the privacy practices described in this Notice.
This Notice only applies to your Protected Health Information that is maintained by the Self-Insured Plan. Health care providers from whom you receive services may have different policies and procedures or notices regarding the use and disclosure of your Protected Health
Information created in the provider’s office, clinic, or hospital. For information about those policies and procedures you should contact your health care provider or health care facility directly.
III. The information below is applicable only to participants in the Carefirst, ExpressScripts, PayFlex, Faculty and Staff
Assistance programs, and Faculty and Staff Wellness Program.
This Notice provides you with the following important information:
•
•
• how we may use and disclose your identifiable health information.
your privacy rights in your identifiable health information.
our obligations concerning the use and disclosure of your identifiable health information.
A. How the Self-Insured Plan May Use and Disclose Your Health Information.
Your Protected Health Information may be used and disclosed by the Self-Insured Plan in the following circumstances:
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1. For Treatment .
We may use and disclose your PHI to implement our Faculty and Staff Wellness Program. For example, the wellness coach may use or disclose PHI in order to provide services to you and may consult with wellness supervisors or other wellness team members.
2. For Payment .
The Self-Insured Plan may use or disclose your Protected Health Information to determine eligibility for benefits, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility under the Self-
Insured Plan, to coordinate benefits coverage or to reimburse third-party claims administrators. For example, the Self-Insured Plan may tell your health care provider whether you are eligible for coverage or what percentage of your bill will be paid for by the Self-Insured Plan. The
Self-Insured Plan may also use your Protected Health Information for other activities, including billing, claims management, and utilization or precertification review. The Self-Insured Plan might also share medical information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.
3. For Health Care Operations . The Self-Insured Plan may use or disclose your Protected Health Information for purposes of Self-
Insured Plan operations, including but not limited to, quality assessment and improvement, underwriting, premium rating and other insurance activities relating to the creation or renewal of insurance contracts, disease management, case management and conducting or arranging for medical review, legal services and audits. For example, the Self-Insured Plan may use information about your claims to refer you to a disease management program, project future benefit costs or to audit the accuracy of its claim processing functions.
4 . To the University as the Plan Sponsor. The Self-Insured Plan also may provide the university, in its capacity as the Plan Sponsor, with summary health information so that the university can solicit premium bids from health insurers or amend, modify, or terminate its existing arrangements with claims administrators. The Self-Insured Plan may also provide the university with information on whether you are participating in a particular health plan program.
5 . Business Associates . We may disclose personal health information to the business associates that we engage to provide services on our behalf if the information is necessary for such services. For example, we may use another company to audit the performance of our thirdparty claims administrators on our behalf. Our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract with them.
6. As required by Law. We may disclose your Protected Health Information as required by law.
7. Public Health.
We may disclose your identifiable health information to authorized public health or other public authorities for the purpose of assisting those agencies to prevent or control disease, injury, or disability.
8. Health Oversight Activities .
We may disclose your identifiable health information to a health oversight agency for activities authorized by law. Oversight activities include for example investigations, inspections, audits, surveys, licensure and disciplinary actions, civil administrative and criminal procedures or actions or other activities necessary for the government to monitor government programs, compliance with civil rights laws, and the health care system in general.
9. Lawsuits and similar proceedings . We may use and disclose your identifiable health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we first have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
10. Law Enforcement . We may release your identifiable health information if requested to do so by a law enforcement official:
• regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement;
• concerning a death we believe may have resulted from criminal conduct;
• regarding criminal conduct at our institution;
• in response to a warrant, summons, court order, subpoena or similar legal process;
• to identify or locate a suspect, material witness, fugitive or missing person;
• in an emergency, to report a crime (including the location of the victim of the crime, or the description, identity or location of the perpetrator);
• if you are an inmate or under the custody of a law enforcement official
11. Serious Threat to Health or Safety.
We may use and disclose your identifiable health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, and subject to applicable law, we will only disclose information to a person or organization able to help prevent the threat.
12. Military.
We may disclose your identifiable health information if you are a member of the U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.
13. National Security.
We may disclose your identifiable health information to federal officials for intelligence and national security
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14. Workers Compensation.
Your identifiable health information may be used or disclosed to comply with laws and regulations related to Workers’ Compensation and Occupational Safety and Health.
15. Research.
We may use and disclose your identifiable health information for research when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your identifiable health information has approved the research.
16. Other Uses .
Other uses and disclosures will be made only with your written authorization. You may revoke the authorization except to the extent Self-Insured Plan has acted in reliance on such.
B. Your Health Information Rights. You have the following rights regarding the identifiable health information that the Self-Insured
Plan maintains about you: 1
1. Confidential Communications.
You have the right to request that the Self-Insured Plan communicate with you about your health and related issues in a particular manner or at a certain location. For example, you may request that we contact you at home, rather than at work. In order to request a type of confidential communication, you must make a written request to the contact person identified in Section E below specifying the requested method of contact, or the location at which you wish to be contacted. We will accommodate reasonable requests.
2. Request Restrictions .
You have the right to request a restriction on our use or disclosure for health care operations. Additionally, you have the right to request that we limit disclosure as provided in 45 CFR §164.510. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. To request a restriction in our use or disclosures, you must make a written request to the contact person identified in below. The request must clearly describe (a) the information you wish restricted; (b) whether you want to limit the Self-Insured Plan’ use or disclosure or both; and (c) to whom you want the limits to apply.
3. Inspection and Copies.
You have the right to inspect and obtain a copy of the Protected Health Information maintained by the
Self-Insured Plan or for the Self-Insured Plan that may be used to make decisions about you. This right does not extend to psychotherapy notes. The Self-Insured Plan may deny your request to inspect or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted, as required by law.
4. Accounting of Disclosures .
You have the right to request an “accounting of disclosures.” If you request such an “accounting,” you will receive a list identifying certain disclosures that the Self-Insured Plan has made of your Protected Health Information. To obtain this list, you must make a request in writing to the person named in below.
5. Amendment . You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as this information is kept by the Self-Insured Plan. Any amendment request to Self-Insured Plan must be made in writing to the contact person named below. You must provide us with a reason to support your request. Any request that is not made in writing will be denied. Also we may deny your request if it asks us to amend information that is (a) accurate and complete; (b) not part of the
Protected Health Information kept by or for Self-Insured Plan; (c) not part of the Protected Health Information that you would be permitted to inspect and copy; or (d) not created by the Self-Insured Plan unless the individual or entity that created the information is not available to amend the information.
6. Right to Provide an Authorization for other Uses and Disclosures .
The Self-Insured Plan will obtain your authorization for uses or disclosures that are not identified in this notice. You may revoke your authorization at any time in writing. After you revoke the authorization, we will not use or disclose the information that was the subject of the authorization except when: a. We have taken action in reliance on the authorization before we received the written revocation.
b. You were required to give us your authorization as a condition of obtaining health coverage; or c. the law gives us a right to contest a claim under your policy.
7. Right to File a Complaint .
If you believe your privacy rights have been violated, you may file a complaint with the university
Self-Insured Plan or with the Secretary of Health and Human Services. To file a complaint with the Self-Insured Plan, contact the person named below. All complaints must be submitted in writing. To file a complaint with the Secretary, contact the person identified below for information.
You will not be penalized for filing a complaint.
1 The Self-Insured Plan does not have its own staff. Accordingly, some of the activities described in sections III(A)(1) and (2) above
(i.e. a limited number of the functions that are not the responsibility of the third party claims administrator) are conducted by university personnel who are designated by the university to act on behalf of the Self-Insured Plan. The university does not have access to information in the possession of the Self-Insured Plan, except as described in this Notice.
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8. Right to a Notice.
Although you are receiving this notice at the University’s web portal my.american.edu and by electronic mail at
Today@AU, you are entitled to receive a paper copy of the Self-Insured Plan’ notice of privacy practices. We reserve the right to amend our notice of privacy practices. Any revision or amendment will be effective for all of the records the Self-Insured Plan have created or maintained in the past and for any records we may create or maintain in the future. A revised notice, if any, will be sent to you by electronic mail at Today@AU and the University’s web portal my.american.edu unless you advise us in writing that you prefer to receive a paper copy.
You may also obtain a copy of the current version of the Notice at any time by visiting the University’s web portal at my.american.edu or by contacting the person listed below. Covered faculty and staff who are on leave or retired from the University will receive a paper copy of this and any revised notices.
Note – The university, in its health plan role, does not in the ordinary course of its operations have access to Protected Health Information in the records of the claims administrators, e.g. Carefirst, ExpressScripts, and PayFlex. Similarly, the university, in its health plan role, does not have access to your Protected Health Information maintained by a FSAP provider from whom you seek services. Therefore, when you are exercising the rights discussed above, we will generally ask in the first instance that you work directly with the third-party claims administrators to access those rights.
C. CONTACT information. If you have any questions or are required by this notice to submit a written request to exercise rights outlined in this notice, please contact:
For the Faculty and Staff Wellness Program:
Amy Farr
Wellness Program Manager
American University
4400 Massachusetts Avenue, N.W.
Washington, DC 20016
(202)885-3589
For all other Health Plans:
Sarah Bayne
Director of Employee Benefits & Communication
Human Resources
American University
Sports Center Annex
4400 Massachusetts Avenue, N.W. 20016
Washington, D.C. 20016-8054
(202)885-2730
If you wish to file a complaint with the Self-Insured Plan or obtain information about how to file a complaint with the Secretary of Health and Human Services about a violation of your privacy rights, please contact:
Patricia Kelshian
Executive Director, Risk and Contracts Management and HIPAA Privacy Official
Office of Finance
American University
4400 Massachusetts Avenue, N.W. 20016
Washington, D.C. 20016
(202)885-3284
This communication highlights some of your American University benefit plans. Your actual rights and benefits are governed by the official plan documents. If any discrepancy exists between this communication and the official plan documents, the plan documents will prevail. American University reserves the right to change any benefit plan without notice. Benefits are not a guarantee of employment.
©2009 Communication Partners, Inc. www.commpart.com
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American university
4400 Massachusetts Ave nW
Washington, DC 20016
Contact information
iF You HAvE QuEStionS
About…
Medical
ContACt
CareFirst BlueCross BlueShield
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PayFlex Flexible Spending Accounts and
SmartBenefits Transit
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Group Legal Plan
Human Resources - Benefits
Hyatt Legal’s MetLaw Plan
Retirement Benefits Fidelity
TIAA-CREF
Todd Benefits Group
Vision Savings Eyecare
Long-Term Care
Vision Discount
Group #923 8205
Pet Insurance
Group Auto Insurance
Group Home Insurance
General Information
Veterinary Pet Insurance (VPI)
MetLife Auto & Home
MetLife Auto & Home
Human Resources
PHonE
800-296-0724
(Before Dec 21 2009)
800-628-8549
(After Dec 21, 2009)
301-468-6000
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202-885-2591
202-885-2591
800-284-4885
202-885-3748
800-GET-MET8
800-343-0860
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888-310-TODD (8633)
800-GETMET8
800-GET-MET8
800-GET-MET8
800-GET-MET8
202-885-2591
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Employment www.american.edu/hr / benefits.cfm
