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Open Enrollment Guide
2016 Employee Benefits
Annual Open Enrollment
Oct. 20 – Nov. 2, 2015
1
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
CONTENTS
Announcing Benefits Open Enrollment: Oct. 20 – Nov. 2 ................................................................................................................... 3
Benefits & Wellness Fairs in October........................................................................................................................................................... 3
Enrollment Meetings Schedule ....................................................................................................................................................................... 4
Eligible Employee Group: FA ..................................................................................................................................................................... 5
Eligible Employee Groups: AC, AH, AP, CA, VF ................................................................................................................................... 5
Eligible Employee Group: FM .................................................................................................................................................................... 6
Eligible Employee Groups: CP, CS, LE, PE, PS, PT .............................................................................................................................. 6
Dental Benefits ...................................................................................................................................................................................................... 7
What the Dental Plan Covers ...................................................................................................................................................................... 8
Summary of Dental Benefits* ..................................................................................................................................................................... 8
What the Dental Plan Covers – FA, CS Groups ..................................................................................................................................... 9
Flexible Spending Accounts ...........................................................................................................................................................................10
Flexible Spending Accounts Comparison ............................................................................................................................................10
Flexible Spending Account Worksheet .................................................................................................................................................11
Life and AD&D Insurance................................................................................................................................................................................12
Supplemental Life Insurance and AD&D Coverage Options ........................................................................................................12
Increasing Supplemental Life Insurance During Open Enrollment..........................................................................................13
Monthly Costs for Supplemental Life & AD&D Insurance ...........................................................................................................14
Disability Plans....................................................................................................................................................................................................15
Clerical/Secretarial (CS) Employees May Apply for Short-Term Disability During Open Enrollment.....................15
IMPORTANT EMPLOYEE NOTICES .............................................................................................................................................................16
ACA Individual Mandate .............................................................................................................................................................................16
Special Enrollment Notice .........................................................................................................................................................................17
Newborns’ Act Disclosure ..........................................................................................................................................................................17
Children's Health Insurance Program Reauthorization ACT 2009 (CHIPRA)......................................................................18
Women's Health and Cancer Rights Act of 1998 ..............................................................................................................................19
Prescription Drug Coverage and Medicare .........................................................................................................................................20
COBRA Rights ..................................................................................................................................................................................................23
What is COBRA continuation coverage? ..............................................................................................................................................23
HIPAA NOTICE OF PRIVACY PRACTICES .............................................................................. 27
2
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Announcing Benefits Open Enrollment: Oct. 20 – Nov. 2
It’s that time of year again – time to make your 2016 benefit elections during this year’s
annual open enrollment.
During open enrollment, you have the opportunity to:
 Make changes to your medical, dental, and life insurance options
 Add or drop dependents
 Verify dependent eligibility for continued coverage in the health and dental plans
 Elect to participate in the Flexible Spending Accounts for 2016
 Elect to contribute to a Health Savings Account in 2016 if covered by the PPO/HSA Plan
Benefits & Wellness Fairs in October
Join us at our annual Employee Benefits and Wellness Fair and discover your “Passport to
Wellness. “
 October 21:
11:00-2:00pm - College of Business - Room 101 B
 October 30:
12:00-4:00pm - Student Center Ballroom
Visit with benefit vendors and ask questions about the benefit plans and your coverage.
The HR/Benefits staff will be available to answer open enrollment questions, distribute and
collect open enrollment forms.
Other activities will include complimentary massages, demo fitness classes hosted by the
Rec/IM, various health screenings, and a raffle to win prizes donated by EMU vendors.
You will also be able to get a free flu shot if you are enrolled in an EMU health plan – please
remember to bring your BCBSM card.
PLEASE NOTE: Eastern Michigan University provides employees with comprehensive,
affordable benefits, designed to meet a variety of needs. Benefit options include medical, with
pharmacy and vision coverage; dental benefits; life insurance; supplemental life insurance;
and disability coverage.. This booklet summarizes the options available to you, and contains
important annual notices related to health benefits. In the event of any discrepancies
between the information in this booklet and the official plan documents and insurance
contracts, the official plan documents and contracts supersede.
3
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Enrollment Meetings Schedule
The HR/Benefits staff will be available at the following times and locations to highlight the benefit
options for 2016, and to provide assistance with completing forms or answering other benefits-related
questions.
Date
Schedule
Thursday,
Oct. 22
Time/ Location
3 PM – 4 PM
4 PM – 5 PM
Halle Library Auditorium
Purpose
Open Enrollment Presentations
Friday,
Oct. 23
3 PM – 4 PM
Halle Library Auditorium
Open Enrollment Presentations
10 AM – 11 AM
Walk-in Help/Assistance
12 PM – 1 PM
&
1 PM – 2 PM
Open Enrollment Presentation
Monday,
Oct. 26*
2 PM – 3 PM
3 PM – 4 PM
4 PM – 5 PM
*Each session in:
HR Large Conference Room
142 McKenny Hall
Wednesday,
Oct. 28*
Thursday,
Oct. 29
Walk-in Help/Assistance
10 AM – 11 AM
Walk-in Help/Assistance
11 AM – 12 PM
Open Enrollment Presentation
12 PM – 1 PM
*Each session in:
HR Large Conference Room
142 McKenny Hall
Walk-in Help/Assistance
8:30 AM – 9:30 AM
Open Enrollment Presentation
9:30 AM – 10:30 AM
Halle Library Auditorium
Walk-in Help/Assistance
4
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
2016 Health Plan Rates*
.
BCBS PPO Option 5, PPO/HSA & HMO Employee Rates
Click this link for BCBSM Comparison Charts which are also posted on the
HR/Benefits website. Click this link for a Health and Dental Enrollment Form.
Eligible Employee Group: FA
2016 Semi-Monthly & Bi-Weekly Premiums for 24 Pay Periods
Coverage Category
Single
Two Person
Family
Family Plus
BCBS PPO Option 5
$32.10
$64.24
$77.08
$89.92
BCBS PPO w/Health
Savings Account (HSA)
$21.46
$42.87
$53.60
$64.34
BCN Health
Maintenance
Organization (HMO)
$7.17
$14.29
$17.85
$21.46
2016 Semi-Monthly Premiums for 16 Pay Periods
Coverage Category
Single
Two Person
Family
Family Plus
BCBS PPO Option 5
$48.15
$96.36
$115.62
$134.88
BCBS PPO w/Health
Savings Account (HSA)
$32.19
$64.31
$80.40
$96.50
BCN Health
Maintenance
Organization (HMO)
$10.75
$21.43
$26.78
$32.19
Eligible Employee Groups: AC, AH, AP, CA, VF
2016 Semi-Monthly & Bi-Weekly Per Pay Premiums for 24 Pay Periods
Coverage Category
Single
Two Person
Family
Family Plus
BCBS PPO Option 5
$37.15
$89.15
$111.44
$128.14
BCBS PPO w/Health
Savings Account (HSA)
$27.87
$55.67
$69.60
$83.54
BCN Health
Maintenance
Organization (HMO)
$9.31
$18.55
$23.18
$27.87
*Deductions occur the first two pay periods of each month. If a month has three pay periods, no health
care deduction is taken from the third pay period in the month.
5
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
2016 Health Plan Rates*
BCBS PPO Option 5, PPO/HSA & HMO Employee Rates
Click this link for BCBSM Comparison Charts which are also posted on the HR/Benefits
website. Click this link for a Health and Dental Enrollment Form.
Eligible Employee Group: FM
2016 Semi-Monthly & Bi-Weekly Premiums for 24 Pay Periods
Coverage Category
Single
Two Person
Family
Family Plus
BCBS PPO Option 5
$37.14
BCBS PPO w/Health
Savings Account (HSA)
$25.03
BCN Health
Maintenance
Organization (HMO)
$31.01
$89.15
$60.07
$74.43
$111.44
$75.09
$93.04
$128.14
$86.35
$106.99
Eligible Employee Groups: CP, CS, LE, PE, PS, PT
2016 Semi-Monthly & Bi-Weekly Premiums for 24 Pay Periods
Coverage Category
Single
Two Person
Family
Family Plus
BCBS PPO Option 5
$32.03
$64.10
$76.91
$89.71
BCBS PPO w/Health
Savings Account (HSA)
$21
$42
$52.50
$63
BCN Health
Maintenance
Organization (HMO)
$7
$14
$17.50
$21
*Deductions occur first two pay periods of each month. If a month has three pay periods, no health care
deduction is taken from the third pay period in the month.
6
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Dental Benefits
There are no changes to the dental benefits for 2016.
As a reminder, for the dental plan, EMU pays the entire premium for you and your enrolled
family members. The dental plan also provides a full range of preventive benefits, including
annual exams and cleanings twice per calendar year covered at 100%, with no out-ofpocket charges for you or your covered family members.
These twice a year exams make a major difference when it comes to your overall health.
Dentist are disease detectives. More than 120 signs and symptoms of non-dental diseases
can be detected through a routine oral exam. During routine checkups, dentists not only
look for cavities and gum disease, but also monitor symptoms like breath odor,
unexplained sores and tooth erosion. If certain signs are detected, dentists can urge
patients to seek medical attention to help better manage their oral health and overall
health.
It’s important to remember that just because you haven’t had a cavity in a while or haven’t
had any tooth pain recently, doesn’t necessarily mean you are in the clear. Be sure to visit
your dentist regularly to ensure your oral health and overall health are being monitored
and in good standing.
Verification of Dependent Children Age 19-24
If you have children age 19-24 enrolled in the dental plan, you must complete a Dental
Verification Form confirming that your children will be your tax dependents during the
plan year they are enrolled in the dental plan. Click this link for a Dental Verification Form
for Dependent Children
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2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
What the Dental Plan Covers
Summary of Dental Benefits*
PPO
Dentist
Premier
Dentist
Plan Pays
Play Pays
Diagnostic & Preventive
Diagnostic and Preventive Services – exams, cleanings,
100%
100%
fluoride, and space maintainers
Emergency Palliative Treatment – to temporarily relieve pain
100%
100%
Brush Biopsy – to detect oral cancer
100%
100%
Radiographs – X-rays
100%
100%
Basic Services
Minor Restorative Services – Fillings and crown repair
75%
75%
Endodontic Services – root canals
75%
75%
Periodontics Services – to treat gum disease
75%
75%
Oral Surgery Services – extractions and dental surgery
75%
75%
Major Restorative Services – crowns
75%
75%
Other Basic Services – misc. services
75%
75%
Relines and Repairs – to bridges, dentures, and implants
75%
75%
Major Services
Prosthodontic Services – bridges, implants, and dentures
50%
50%
Orthodontic Services
Orthodontic Services – braces
50%
50%
Orthodontic Age Limit - To age 70 for subscribers and spouses and to age 25 for eligible
dependent children





The annual maximum benefit payable under the plan is $1,000.
Oral exams (including evaluations by a specialist) are payable twice per calendar year.
Prophylaxes (cleanings) are payable twice per calendar year.
Fluoride treatments are payable twice per calendar year for people up to age 19.
Bitewing X-rays are payable once per calendar year and full mouth X-rays (which include
bitewing X-rays) are payable once in any five-year period.
*See page 9 for a Summary of Dental Benefits for Faculty and Clerical/Secretarial employees.
Click this link for a Health and Dental Enrollment Form.
More information about the dental benefits is posted on the HR Benefits website at this link.
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2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
What the Dental Plan Covers – FA, CS Groups
PPO
Premier
Dentist
Dentist
Plan Pays Play Pays
Summary of Dental Benefits for Faculty (FA) and
Clerical/ Secretarial (CS) Groups
Diagnostic & Preventive
Diagnostic and Preventive Services – exams, cleanings,
100%
100%
fluoride, and space maintainers
Emergency Palliative Treatment – to temporarily relieve
100%
100%
pain
Brush Biopsy – to detect oral cancer
100%
100%
Radiographs – X-rays
100%
100%
Basic Services
Minor Restorative Services – Fillings and crown repair
80%
80%
Endodontic Services – root canals
80%
80%
Periodontics Services – to treat gum disease
80%
80%
Oral Surgery Services – extractions and dental surgery
80%
80%
Major Restorative Services – crowns
80%
80%
Other Basic Services – misc. services
80%
80%
Relines and Repairs – to bridges, dentures, and implants
80%
80%
Major Services
Prosthodontic Services – bridges, implants, and dentures
50%
50%
Orthodontic Services
Orthodontic Services – braces
50%
50%
Orthodontic Age Limit - To age 70 for employee and spouses and to age 25 for
eligible dependent children





The annual maximum benefit payable under the plan is $1,000.
Oral exams (including evaluations by a specialist) are payable twice per calendar year.
Prophylaxes (cleanings) are payable twice per calendar year.
Fluoride treatments are payable twice per calendar year for people up to age 19.
Bitewing X-rays are payable once per calendar year and full mouth X-rays (which include
bitewing X-rays) are payable once in any five-year period.
Click this link for a Health and Dental Enrollment Form.
More information about the dental benefits is posted on the HR Benefits website at this link.
9
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Flexible Spending Accounts
Flexible Spending Accounts Comparison
With Flexible Spending Accounts (FSAs), you can use pre-tax dollars to pay for certain allowed
expenses. There are two different options. You may participate in one or both:
 The Health Care Reimbursement FSA is used to pay eligible out of pocket health costs for you
and your tax dependents.
 The Dependent Care FSA is used to pay eligible expenses that allow you or your spouse to
work full time, seek full-time employment or attend school full time.
Here’s how the plans work.
 Choose the amount you would like to contribute. You may use the FSA Worksheet on page 11
as a guide.
 Your contributions are taken out of your pay in equal amounts each pay period before taxes
are deducted.
 You incur eligible expenses.
 Use your FSA debit card to pay for eligible expenses. You may also pay for the expense and file
a claim for reimbursement.
 Your reimbursements are paid to you tax-free.
Note: Your FSA elections do not carry over from year-to-year. You must enroll in the plan each
year that you choose to participate. If you choose to participate in the PPO/HSA health plan option,
you cannot participate in the FSA per IRS rules. IRS regulations do not permit enrollment in an FSA
and HSA at the same time. If you are currently enrolled in the health care reimbursement FSA for
2015 and you choose the PPO/HSA for 2016, you must exhaust your health care FSA dollars before
your HSA can be opened.
FSA Plan
How Much you Can
Contribute Each Year
Health Care FSA
$200 to $2,550
Dependent Care
FSA
$200 to $5,000 ($200
to $2,500 max if you
and your spouse file
separate tax returns)
Examples of Eligible
Expenses
Health Care expenses not
covered by your medical,
dental, and vision plans,
including:
 Deductibles
 Copays
 coinsurance
Dependent day care while
you’re at work, including:
 day care
 after-school
programs
 care in your home
For a Complete List
of Eligible Expenses
Go to www.irs.gov and
review Publication
502
Go to www.irs.gov and
review Publication
503
Here is a link to the FSA Enrollment Form.
.
10
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Flexible Spending Account Worksheet
Use the worksheet below to help you decide how much to contribute to either the health
care or dependent care FSA, or both. Be conservative in your estimate because if you do
not spend the money in your account by the time allotted, you lose it. This is an IRS rule.
Generally, you must spend the money you contribute in 2016 by March 15, 2017. You will
have until March 31, 2017 to submit any required receipts,
Medical/Dental/ Vision Expenses
Annual Medical Expenses, such as:
Deductibles and co-pays
Routine physical exams
Prescriptions
Chiropractic care
Other
Annual Dental Expenses, such as:
Deductibles and co-pays
Routine check-ups
Orthodontia
Other
Annual Vision Care Expenses, such as:
Exams
Eyeglasses
Contact lenses, solutions, cleaners
Other
Total for Health FSA
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Dependent Care Reimbursement Account
Annual Dependent Care Expenses:
Payment to a dependent care facility or
individual
$
Payment to other care providers
$
Total for Dependent FSA
$
$
Please note: This is not an enrollment form.
Here is a link to the FSA Enrollment Form.
11
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Life and AD&D Insurance
Life insurance helps to provide financial protection for the unexpected. Eastern Michigan
University provides life insurance coverage to full-time employees working at least 20
hours per week. Your life insurance coverage also includes an accidental death and
dismemberment (AD&D) benefit. AD&D pays an additional benefit to your family if you die
in an accident, or it pays you if, as the result of an accident, you lose your eyesight, speech,
loss of a limb, suffer disfiguring burns or lapse into a coma.
Please note: Because Eastern Michigan University pays for your Basic Life Insurance, the
“value” of any life insurance coverage over $50,000 (based on Internal Revenue Service [IRS]
tables) will result in taxable income to you. The taxable amount is known as “imputed
income.” If applicable, “imputed income” amounts will be taxed on your bi-weekly or semimonthly paychecks.
Here is a link to more details about the Life Insurance benefits.
Supplemental Life Insurance and AD&D Coverage Options*
You may purchase supplemental life insurance for yourself and eligible family members.
For You
For Your Spouse
For Your Dependent
Children**
$10,000 to $500,000 in $10,000 increments, to a
maximum of $500,000
$15,000, $50,000 or $100,000 in coverage (coverage
amount cannot exceed employee’s coverage amount)
15 days to 6 months: $1,000;
6 months and over: $10,000 or $15,000
*Coverage is not provided for dependents in full-time military service
**Children’s Eligibility: Dependent children ages from 15 days to 19 years old, or 23 years old if a child
is a full-time student, are eligible for coverage.
.
Here is a link to the Supplemental Life Insurance Enrollment Form.
Here is a link to the Evidence of Insurability Form.
12
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Increasing Supplemental Life Insurance During Open Enrollment
If you currently have supplemental life insurance coverage:



You may increase your Supplemental Life Insurance coverage by one $10,000.
increment not to exceed $200,000. Amounts greater will require evidence of good
health.
You may increase your spouse’s coverage by one level to $50,000 or $100,000.
Amounts greater will require evidence of good health.
You may increase coverage for your children from $10,000 to $15,000. For children,
evidence of good health is not required.
If you do not currently have supplemental life insurance coverage and you elect
coverage during Open Enrollment, you will have to provide evidence of insurability for
any amounts you elect for yourself or your spouse. You must elect supplemental life
insurance for yourself before you can elect coverage for your spouse or dependent
children.
If you or a Dependent have been previously denied additional coverage:

Evidence of good health is required for any requested coverage amount.
Here is a link to the Supplemental Life Insurance Enrollment Form.
Here is a link to the Evidence of Insurability Form.
13
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Monthly Costs for
Supplemental Life & AD&D Insurance
Age
Your Monthly Cost per
$1,000 of Coverage
Spouse/ Monthly Cost per $1,000
of Coverage
Under 25
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70+
Costs for your Children
$0.047
$0.045
$0.048
$0.054
$0.065
$0.068
$0.083
$0.081
$0.100
$0.104
$0.149
$0.144
$0.230
$0.262
$0.430
$0.419
$0.613
$0.740
$1.159
$1.281
$1.877
$2.020
$0.108 (one rate covers all children enrolled for coverage)
Supplemental AD&D Rates $0.018
Use the table below to calculate your premium based on the amount of life insurance.
Example: $1,000 Supplemental Life Coverage
1. Enter the rate from the table (example age
36)
2. Enter the amount of insurance in
thousands
3. Monthly premium (1) x (2)
$0.083
$100
$8.30
Repeat the three easy steps above to determine the cost of each coverage selected.
Here is a link to the Supplemental Life Insurance Enrollment Form.
Here is a link to the Evidence of Insurability Form.
14
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Disability Plans
EMU provides both short-term and long-term disability benefits. Eligibility and benefits
provisions vary based on your employee group. Generally, the short-term disability plans
pay a portion of your pay for up to 13 weeks if you are unable to work because of a nonwork-related illness or accident. If you are unable to return to work after short-term
benefits end, you may qualify for long-term disability benefits.
Here is a link to more information on the Disability plans posted on the HR/Benefits
website.
Clerical/Secretarial (CS) Employees May Apply for Short-Term Disability During
Open Enrollment
During open enrollment, CS employees may apply for the short-term disability plan.
Evidence of insurability is required.
Here is a link to the Disability Enrollment Form.
Here is a link to the Evidence of Insurability Form.
15
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
IMPORTANT EMPLOYEE NOTICES
ACA Individual Mandate
Effective January 1, 2014 under the Patient Protection and Affordable Care Act (ACA) all
individuals and their family members are required to obtain health insurance or they may
be subject to a tax penalty.
It is important to remember that if you waive your University coverage, you are still
responsible for obtaining coverage for yourself through some other source, such as a
spouse or your parent’s plan (if you are under age 26); or you can obtain coverage via the
Health Insurance Marketplace.
Beginning with your 2014 tax filing, you will be required to report to the IRS that you have
coverage, whether through the University or some other source. For the 2015 tax year, the
University will provide you with the required form (1095-C) in time for your tax filing. The
1095-C form will confirm that you were offered the minimum level of coverage each month
and whether you elected the coverage or waived this coverage.
The Health Insurance Marketplace notice is located at this link on the HR/Benefits website,
16
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
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).
However, you must request enrollment with 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 or any longer period that applies under the plan after
the marriage, birth, adoption, or placement for adoption. To request special enrollment or
obtain information:
Contact: HR/Benefits Office
Eastern Michigan University
140 McKenny Hall
Ypsilanti, MI 48197
(734) 487-3195
Newborns’ Act Disclosure
Group health plans and health insurance issuers generally may not, under Federal law,
restrict benefits for any hospital length of stay in connection with childbirth for the mother
or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours
following a cesarean section. However, Federal law generally does not prohibit the
mother’s or newborn’s attending provider, after consulting with the mother, from
discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable).
In any case, plans and issuers may not, under Federal law, require that a provider obtain
authorization from the plan or the insurance issuer for prescribing a length of stay no in
excess of 48 hours (or 96 hours).
17
2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Children's Health Insurance Program Reauthorization ACT 2009 (CHIPRA)
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires group
health plans to permit special enrollment periods for eligible persons who experience a
qualified change in status (e.g. birth, marriage, divorce, loss of coverage). Effective April 1,
2009, the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) adds
two new special enrollment events.

You or your dependent(s) will be permitted to enroll or disenroll in Eastern
Michigan University’s medical coverage in either of the following circumstances.
o You or your dependent’s Medicaid or state Children’s Health insurance Program
(CHIP) coverage is cancelled due to a loss of eligibility. You must request to
enroll in our group health plan within sixty (60) days from the date you or your
dependent loses coverage. You must provide written notification from Medicaid
or state CHIP of the cancellation.
o You or your dependent(s) enroll in Medicaid or the state CHIP. You may cancel
coverage in our group health plan within sixty (60) days of you or your
dependent’s coverage effective date. We will need written verification of
coverage through Medicaid or state CHIP.

It is your responsibility to notify the Human Resources Benefits Office within sixty
(60) days after gaining or losing coverage in Medicaid or the state CHIP. Your
coverage will be in effect the date you lost or gained coverage in Medicaid or the
state CHIP.

For further details on Medicaid or the state CHIP (also known as MIChild), contact
the Michigan Department of Community Health.
o
The toll-free number is 1-888-988-6300
o
To apply on-line, visit https://healthcare4mi.com/michild-web/
o
Contact the Benefits Office, 140 Mc Kenny Hall, (734) 487-3195
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2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Women's Health and Cancer Rights Act of 1998
Under the Women's Health and
Cancer Rights Act of 1998 (effective October 21, 1998), employer-sponsored group health
plans offering mastectomy coverage must also provide coverage for breast reconstruction
in connection with the mastectomy. Coverage must be provided for:



Reconstruction of the breast on which the mastectomy has been performed;
Surgery and reconstruction of the other breast for symmetrical appearance; and
Prostheses and physical complications in all stages of mastectomy, including
lymphedema therapy
All of Eastern Michigan University's group health care plans (Blue Cross/Blue Shield
Community Blue PPO Plans, Traditional, and Priority Health) provide coverage for the
procedures described above, subject to the same deductibles and co-payment provisions as
other benefits under the plans. The patient, in consultation with the attending physician,
must determine the manner in which these services are performed. If you have any
questions, call your specific health care provider.
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2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Important Notice from Eastern
Michigan University About
Your Prescription Drug Coverage and Medicare
October 2015
Prescription Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has
information about your current prescription drug coverage with Eastern Michigan
University and about your options under Medicare's prescription drug coverage. This
information can help you decide whether or not you want to join a Medicare drug plan. If
you are considering joining, you should compare your current coverage, including which
drugs are covered at what cost, with the coverage and costs of the plans offering Medicare
prescription drug coverage in your area. Information about where you can get help to make
decisions about your prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and
Medicare's prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare.
You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare
Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare
drug plans provide at least a standard level of coverage set by Medicare. Some plans may
also offer more coverage for a higher monthly premium.
2. Eastern Michigan University has determined that the prescription drug coverage offered by
Blue Cross Blue Shield of Michigan is, on average for all plan participants, expected to pay
out as much as standard Medicare prescription drug coverage pays and is therefore
considered Creditable Coverage. Because your existing coverage is Creditable Coverage,
you can keep this coverage and not pay a higher premium (a penalty) if you later decide to
join a Medicare drug plan.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each
year from October 15th to December 7th.
However, if you lose your current creditable prescription drug coverage, through no fault
of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP)
to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current Eastern Michigan University
coverage will not be affected. If you do decide to join a Medicare drug plan and drop your
current Eastern Michigan University coverage, be aware that you and your dependents will
may not be able to get this coverage back until the next applicable open enrollment period.
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2016 BENEFITS OPEN ENROLLMENT
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When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with Eastern Michigan
University and don't join a Medicare drug plan within 63 continuous days after your
current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug
plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your
monthly premium may go up by at least 1% of the Medicare base beneficiary premium per
month for every month that you did not have that coverage. For example, if you go nineteen
months without creditable coverage, your premium may consistently be at least 19%
higher than the Medicare base beneficiary premium. You may have to pay this higher
premium (a penalty) as long as you have Medicare prescription drug coverage. In addition,
you may have to wait until the following October to join.
For More Information About This Notice Or Your Current Prescription Drug
Coverage...
Contact the Eastern Michigan University HR/Benefits office at (734) 487-3195. You'll get
this notice each year. You will also get it before the next period you can join a Medicare
drug plan, and if this coverage through Eastern Michigan University changes. You also may
request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug
Coverage...
More detailed information about Medicare plans that offer prescription drug coverage is in
the "Medicare & You" handbook. You'll get a copy of the handbook in the mail every year
from Medicare. You may also be contacted directly by Medicare drug plans.
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2016 BENEFITS OPEN ENROLLMENT
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For more information about Medicare prescription drug coverage:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program (see the inside back cover of your
copy of the "Medicare & You" handbook for their telephone number) for personalized help
Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug
coverage is available. For information about this extra help, visit Social Security on the web
at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the
Medicare drug plans, you may be required to provide a copy of this notice when you
join to show whether or not you have maintained creditable coverage and, therefore,
whether or not you are required to pay a higher premium (a penalty).
Contact:
Eastern Michigan University Benefits Office
Address:
140 McKenny Hall
Ypsilanti Michigan 48197
Phone Number:
(734) 487-3195
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2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
COBRA Rights
Continuation of Coverage under the
Consolidated Omnibus Budget Reconciliation Act (COBRA)
Introduction
This notice has important information about your right to COBRA continuation coverage,
which is a temporary extension of health insurance coverage under one of Eastern
Michigan University’s health plans. This notice explains COBRA continuation coverage,
when it may become available to you and your family, and what you need to do to
protect your right to get it. When you become eligible for COBRA, you may also become
eligible for other coverage options that may cost less than COBRA continuation coverage.
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 and other members of your family when group health coverage
would otherwise end. For more information about your rights and obligations under the
Plan and under federal law, you should review the health plan summaries or contact the
HR/Benefits office.
You may have other options available to you when you lose group health coverage.
For example, you may be eligible to buy an individual plan through the Health Insurance
Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower
costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may
qualify for a 30-day special enrollment period for another group health plan for which you
are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late
enrollees.
What is COBRA continuation coverage?
COBRA continuation coverage is a continuation of Plan coverage when it would otherwise
end because of a life event. This is also called a “qualifying event.” Specific qualifying
events are listed later in this notice. 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.
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If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage
under the Plan because of the following qualifying events:


Your hours of employment are reduced, or
Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose
your coverage under the Plan because of the following qualifying events:





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 of the following qualifying events:






The parent-employee dies;
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 continuation coverage available?
The Health Plan will offer COBRA continuation coverage to qualified beneficiaries after
notification that a qualifying event has occurred:



The end of employment or reduction of hours of employment;
Death of the employee; or
The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or
both).
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For 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),
the employee or person losing coverage must notify the HR/Benefits Office within
60 days after the qualifying event occurs. Notification should be made to the
HR/Benefits Office, Eastern Michigan University, 140 McKenny Hall, Ypsilanti, MI
48197 (Phone: 734-487-3195, Fax: 734-487-4389). Supporting documentation
may be required.
How is COBRA continuation coverage provided?
Once the HR/Benefits Office 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 that generally
lasts for 18 months due to employment termination or reduction of hours of work.
Certain qualifying events, or a second qualifying event during the initial period of
coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage can
be extended:
Disability extension of 18-month period of COBRA continuation coverage
If you or anyone in your family covered under the Plan is determined by Social Security
to be disabled and you notify the Plan Administrator in a timely fashion, you and your
entire family may be entitled to get up to an additional 11 months of COBRA
continuation coverage, for a 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 COBRA continuation coverage.
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2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event during the 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
the Plan is properly notified about the second qualifying event. This extension may be
available to the spouse and any dependent children getting COBRA continuation
coverage if the employee or former employee dies; becomes entitled to Medicare
benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the
dependent child stops being eligible under the Plan as a dependent child. This
extension is only available if the second qualifying event would have caused the spouse
or dependent child to lose coverage under the Plan had the first qualifying event not
occurred.
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2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015
Eastern Michigan University
HIPAA NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.
This is your Notice of Privacy Practices provided by Eastern Michigan University (EMU).
This notice refers to EMU by using the terms "us," "we," or "our." EMU must collect
information about you to provide you with health insurance. We know that information we
collect about you and your health is private. EMU is required to protect this information by
federal and state law.
This notice will tell you how we may use or disclose information about you. Not all
situations will be described. EMU is required to give you a notice of our privacy practices
for the information we collect, keep and disclose about you. We are required to follow the
terms of the notice currently in effect.
The Genetic Information Discrimination Act of 2008 (GINA) includes provisions related
to genetic information that affect HIPAA nondiscrimination rules. Genetic information is
defined as information about genetic tests of an individual or an individual’s family
members, information about the manifestation of a family member’s disease or disorder
and an individual’s request for or receipt of genetic services.
Effective May 21, 2009, GINA mandates that a group health plan cannot:




Adjust premiums or contribution amounts based on genetic information;
Request or require an individual or an individual’s family member to undergo a
genetic test;
Request, require or purchase genetic information prior to or in connection with
enrollment in the plan; or
Use genetic information for underwriting purposes Group health plans may use the
results of genetic tests for payment purposes explained below, as long as the
minimum amount of information necessary is used.
HOW EMU MAY USE AND DISCLOSE INFORMATION WITHOUT YOUR AUTHORIZATION

For Payment: We may use or disclose information to pay for the health care
services you receive. For example, EMU may receive and review health information
contained on claims to reimburse providers for services rendered or to verify
insurance enrollment and eligibility information with providers seeking to receive
payment for healthcare services provided to you or your covered dependents.
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2016 BENEFITS OPEN ENROLLMENT
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
For Health Care Operations: We may use or disclose health information for our
insurance operations or to manage our programs or activities. For example, we may
use PHI to process transactions requested by you, to review the quality of services
you receive or to audit the services for which our insurance carriers have been
contracted to perform.

Where Required by Law or for Law Enforcement: We will use and disclose
information when required by law. Examples of such releases would be for law
enforcement or national security purposes, subpoenas or other court orders,
disaster relief, review of our activities by government agencies, to avert a serious
threat to health or safety or in other kinds of emergencies.

When Required for Public Health Activities: We will disclose information when
required by federal, state or local law. Examples of such mandatory disclosures
include notifying state or local health authorities about communicable diseases, or
providing information to a coroner or medical examiner to assist in identifying a
deceased individual or to determine the cause of death.

For Health-Related Benefits or Services: We may use health information to
provide you with information about benefits available to you under your current
Insurance coverage and, in limited situations, about health-related products or
services that may be of interest to you.

When Requested as Part of a Regulatory or Legal Proceeding: If you or your
estate may disclose health information about you in response to a court or
administrative order. We may disclose Protected Health Information to any
governmental agency or regulator with whom you have filed a complaint or as part
of a regulatory agency examination.

For Government Programs: We may use and disclose information for public
benefits under other government programs. For example, we may disclose
information for the determination of benefits under Medicare.

Disclosures to Family, Friends and Others : We may disclose information to your
family or other person(s) who are involved in your medical care or payment for
your medical care. You have the right to object to the sharing of this information.

Other Uses of Health Information: For other situations, EMU will ask for your
written authorization before using or disclosing information.
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2016 BENEFITS OPEN ENROLLMENT
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To revoke an authorization, you must submit a written revocation to:
Stephanie A. Robinson
EMU HIPAA Privacy Officer
Eastern Michigan University
140 McKenny Hall
Ypsilanti, Michigan 48197
Phone: (734) 487-0085
Fax: (734) 487-4389
YOUR PRIVACY RIGHTS

Right to See and Get Copies of Your Records: In most cases, you have the right to
look at or get copies of your records. You must make the request in writing. You may
be charged a fee for the cost of copying your records.

Right to Amend Your Records: You may ask EMU to change or add missing
information to your records if you think there is a mistake. You must make the
request in writing and provide a reason for your request.

Right to Get a List of Disclosures: You may request a list of disclosures made after
April 14, 2003. You must make the request in writing. This list will not include the
times that information was disclosed for payment or health care operations or
releases required by law or for law enforcement. The list also will not include
information provided directly to you or information that was sent with your
authorization.

Right to Request Limits on Uses or Disclosures: You may request that EMU limit
how information is used or disclosed. You must make the request in writing and tell
us what information you want to limit and to whom you want the limits to apply.
EMU is not required to agree to the limitation. You can request, in writing, that the
limitation be terminated or EMU may terminate the limitation with advance notice
to you.

Right to Request Confidential Communications: You may request that we share
information with you in a certain way or in a certain place. For example, you may
ask us to send information to your work address instead of your home address. You
must make this request in writing. You do not have to explain the reason for your
request.
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2016 BENEFITS OPEN ENROLLMENT
OCT. 20 – NOV. 2, 2015

Right to Revoke Authorization: If you are asked to sign an authorization to use or
disclose information, you can cancel that authorization at any time. You must make
the request in writing. This will not affect information that has already been
disclosed under the authorization.

Right to File a Complaint: You have the right to file a complaint if you do not agree
with how EMU has used or disclosed information about you.

Right to Get a Paper Copy of this Notice: You have the right to ask for a paper
copy of this notice at any time.
COMMUNICATIONS ABOUT YOUR RIGHTS
You may contact EMU to:

Ask to look at or copy your records

Ask to limit how information about you is used or disclosed

Ask to cancel your authorization

Ask to amend your records

Ask for a list of the times EMU disclosed information about you EMU may deny your
request to look at, copy or amend your records. If EMU denies your request, it will
send you a letter that tells you why your request is being denied and how you can
ask for a review of the denial. You will also receive information about how to file a
complaint with EMU or with the U.S. Department of Health and Human Services,
Office of Civil Rights. If you wish to ask questions about this notice, exercise your
rights under this notice, communicate with us about privacy issues or file a
complaint, you can contact:
Stephanie A. Robinson
EMU HIPAA Privacy Officer
Eastern Michigan University
140 McKenny Hall
Ypsilanti, Michigan 48197
Phone: (734) 487-0085
Fax: (734) 487-4389
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2016 BENEFITS OPEN ENROLLMENT
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You may file a complaint with the federal government at:
U.S. Office of Civil Rights:
Medical Privacy, Complaint Division
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
(866) 627-7748
TTY: (866) 788-4989
Email: ocrprivacy@hhs.gov
Changes to This Notice: We reserve the right to revise this notice at any time. The revised
notice will be effective for health information we already have about you as well as any
information we may receive in the future. We are required to comply with whatever notice
is currently in effect. We will communicate any changes to this notice.
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