2016 Open Enrollment and
Benefits Guide
English
2016 Inscripción Abierta y
Guía de Beneficios
Español
Welcome!
This guide provides information about your benefits with
The Claremont Colleges… at the click of a mouse!
Use this guide as your go-to source when you are first
enrolling for your benefits, when changing your benefits
at Open Enrollment, or throughout the year as a benefits
resource.
Click one of the links below to get started.
Your 2016 Open Enrollment Guide
Your Benefits Guide
2016 Open Enrollment Guide | Open Enrollment Is Active — You MUST Enroll
It’s Decision Time!
Open Enrollment for your 2016 benefits is
November 2 through November 20, 2016 at
5:00 p.m. PST.
This is YOUR opportunity to review your current benefit elections and make any
necessary changes. Review this guide for information about:
●● What’s new for 2016
You Must Take Action!
Open Enrollment is an active enrollment
for 2016. Active enrollment means that you
must elect or decline benefits during Open
Enrollment. If you do not actively enroll in the
●● How to enroll
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
2016 Plan Rates
Your Benefits at a Glance
desired benefit, you will not be covered under
●● A high-level overview of your benefits
the plan in 2016.
●● Important required federal notices.
Questions? Who to Contact for benefits administration assistance.
For more information about any of The
Claremont Colleges plans, click the “Benefits
Guide” link on any page to go to the more
detailed Benefits Guide. This guide will
be accessible on The Claremont Colleges
intranet all year.
Who to Contact
Forms
Notices
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Benefits Guide
2016 Open Enrollment Guide | Open Enrollment Is Active — You MUST Enroll
2016 Benefit Changes and Reminders
Find out what you need to know about the 2016 plan year before
enrolling for or changing your benefits this year. Keep in mind, you
must elect or decline benefits during Open Enrollment. If you do not
actively enroll in the desired benefit, you will not be covered under
the plan in 2016.
2016 Benefit Changes and Reminders
Two Things You Can Do to Lower Medical
Expenses in 2016
What to Do During Open Enrollment
●● Practice preventive care. Get your annual
2016 Plan Rates
physical each year and other recommended
Your 2016 Benefit Changes
exams and tests based on your age and
The following changes are being made to your benefits, effective January 1, 2016.
Anthem Lumenos HDHP Deductible
The out-of-network deductibles for the Anthem Lumenos HDHP are changing
for 2016. Your out-of-network deductible amounts are $2,500 per individual and
$5,000 per family.
For more details about this plan, visit Medical Benefits at a Glance.
Your Benefits at a Glance
gender. You and your doctor can evaluate
your health status and identify health risks
that could turn into bigger problems down
the road. All of our medical plans cover
recommended preventive medical care for
FREE when you use in-network providers.
Find an Anthem or Kaiser in-network
provider today to get started.
●● Save on prescription drugs. Choose generic
drugs—they use the same active ingredient
as their brand-name counterparts, and in
most cases are available for a much lower
cost. And, consider the mail-order program.
You can receive up to three months-worth
of medication for the price of two, AND
have your prescription delivered right to
your mailbox. View your prescription drug
costs here.
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Who to Contact
Forms
Notices
Benefits Guide
2016 Open Enrollment Guide | Open Enrollment Is Active — You MUST Enroll
New Life Insurance Vendor
Life Insurance coverage will now be administered by The Standard. Here’s what
you need to know about the change:
●● Benefit amounts: The Standard is providing the same benefit amounts.
●● Coverage rates: The rates for any voluntary coverage you elect through The
Standard are lower than those provided through our current vendor, Anthem
Blue Cross.
●● Beneficiary designations: You will not need to resubmit your beneficiary
designations. However, Open Enrollment is a good opportunity to review your
designations and make any desired updates.
●● Evidence of Insurability: If you wish to enroll in coverage with The Standard
for the first time, or increase your current coverage amounts, you will need to
complete Evidence of Insurability (EOI), also known as “proof of good health.”
For more information about this benefit, see the Life Insurance section of this
guide. You can also find The Standard’s contact information in Who to Contact.
Save Money on Everyday Expenses
Flexible Spending Accounts (FSAs) help you
harness your saving power by reducing your
taxable income and helping you save money
2016 Benefit Changes and Reminders
while paying for eligible everyday expenses.
What to Do During Open Enrollment
Not only does the Health Care FSA cover
2016 Plan Rates
medical expenses, like your deductible,
coinsurance and prescriptions, it covers much
Your Benefits at a Glance
more! Have glasses? Need a dental crown?
Go to the chiropractor on a regular basis?
Wear a hearing aid? All these expenses—and
more—are eligible for reimbursement under
the Health Care FSA.
And the Dependent Care FSA covers more
than just your baby sitter. It also covers
summer day camps for your kids, your
2016 Rates
housekeeper (if he or she also cares for your
For most plans, the amount you pay for coverage will increase slightly for
2016. The plan rates for the Anthem HMO plan will be decreasing. See the 2016
rate sheet provided on your school’s enrollment page or view the 2016 Open
Enrollment Brochure.
child or dependents in addition to performing
household services), and elder care for a tax
dependent, just to name a few.
You’re already spending your hard-earned
money on these common out-of-pocket
Remember to Make Your 2016 FSA Elections
Per IRS regulations, you are required to actively enroll in the Health Care, Limited
Scope, or Dependent Care Flexible Spending Accounts (FSAs) each year. This
means that if you are currently enrolled in an FSA, your 2016 elections will not
roll over to 2016. Be sure to enroll for your 2016 FSAs before the enrollment
deadline!
expenses. Why not pay for these expenses
on a pre-tax basis? Learn more about these
money-saving plans—click here.
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Who to Contact
Forms
Notices
Benefits Guide
2016 Open Enrollment Guide | Open Enrollment Is Active — You MUST Enroll
Health Care Reform in 2016
As you know, the Affordable Care Act (ACA, also known as “health care reform”)
was passed in 2010. This law extended medical coverage access to nearly
everyone in the U.S. and eliminated restrictions on key benefits. The ACA also
includes the individual mandate, which requires nearly all Americans to have
medical coverage or pay a penalty (when they file their annual tax returns).
2016 Benefit Changes and Reminders
Plan for the Future with Long-Term Care
If you are eligible for coverage through The Claremont Colleges, this is likely
your best option to meet the individual mandate. The plans offered through
The Claremont Colleges are comprehensive and affordable compared to other
options that might be available to you.
(LTC)
What to Do During Open Enrollment
According to Medicare, about 70% of
2016 Plan Rates
However, if you are not eligible for coverage through The Claremont Colleges,
visit www.GetInsured.com/Mercer, a personalized service that can link you to
a variety of quality medical plan options. You can also visit California’s health
insurance marketplace online at www.CoveredCA.com. The health insurance
marketplace opens for enrollment beginning November 1, 2015 for coverage
effective in 2016.
point. Are you and your loved ones prepared?
individuals aged 65 or over will need some
Your Benefits at a Glance
form of long-term care services at some
The Claremont Colleges offers a voluntary
Long-Term Care benefit to employees and
their spouses or domestic partners.
●● What does it cover? In addition to
conventional nursing home coverage, the
policy covers other types of care services,
including those received in your own home.
●● How much does it cost? The younger you
are when you purchase coverage, the lower
your cost will be since your age and the
plan you select determine your monthly
premium rate for the coverage.
Be prepared for anything. Enroll for
Long-Term Care coverage.
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Forms
Notices
Benefits Guide
2016 Open Enrollment Guide | Open Enrollment Is Active — You MUST Enroll
Coming Soon: ACA Reporting in 2016
Starting in January, the IRS will require employers with 50 or more employees
to provide an annual statement describing the coverage offered to eligible
employees. This statement is called Form 1095-C and includes information about:
●● You and The Claremont Colleges.
●● Which months during the year you were eligible for coverage.
●● The cost of the cheapest monthly premium you could have paid under the
available plans.
In addition, if you are enrolled for medical coverage, you will receive a Form
1095-B from your insurance carrier. This form will include information about your
specific coverage, your coverage period, and who from your family was covered.
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
2016 Plan Rates
Your Benefits at a Glance
If you are eligible for coverage from The Claremont Colleges, a copy of Form
1095-C from The Claremont Colleges will be mailed to your home address in
January 2016.
What it means for you: You will need these forms for your tax returns to verify
that you and your dependents have health insurance that meets the ACA’s
minimum coverage requirements. If you do not have health care coverage for
any part of 2016, you may have to pay a tax penalty. The check boxes in Part IV
of Form 1095-B will help you calculate the penalty that applies, if any. Be sure to
share these forms with your tax advisor.
Who to Contact
Forms
Notices
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Benefits Guide
2016 Open Enrollment Guide | Open Enrollment Is Active — You MUST Enroll
What to Do During Open Enrollment
Open Enrollment for your 2016 Claremont Colleges benefits is November 2 –
November 20, 2015. Keep in mind, if you do not actively enroll in your desired
benefits during the Open Enrollment period, you will not be covered under the
plan in 2016.
To complete enrollment:
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
1. Review the changes for 2016 so you understand how these changes impact
your 2016 benefits.
2. Review your current benefit choices. Ask yourself, does this coverage meet
my expected needs? If not, what should I change?
3. Log on to Ultipro using the link through your school’s website by
November 20 to enroll for new plans or make changes to your current
coverage. See How to Enroll for more information.
How to Enroll
CUC, RSABG, CMC, HMC, Pitzer,
and Scripps
KGI and CGU
Pomona
2016 Plan Rates
Your Benefits at a Glance
Outside of the regular Open Enrollment period, you can only change your
benefits if you experience a qualified life event. Qualified life events include:
●● Marriage, divorce or legal separation
●● Birth or adoption
●● A dependent that becomes ineligible for coverage
●● Death of your dependent
●● Loss/gain of coverage elsewhere for employee or spouse/domestic partner
●● Change in work status for you or your spouse/domestic partner
Contact Benefits Administration for more information about what qualifies as a life event,
including exceptions. See Who to Contact for CUC Benefits Administration.
Who to Contact
The Claremont Colleges’s Health and Welfare Plans are governed by Internal Revenue Code
Section 125. Federal law prohibits any change in your health plan elections during the plan year
unless you or your dependent(s) experience a qualifying life event.
Forms
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Notices
2016 Open Enrollment Guide | Open Enrollment Is Active — You MUST Enroll
How to Enroll
Click the links below to navigate to enrollment instructions for:
For faculty and staff of CUC, RSABG, CMC, HMC, Pitzer and Scripps
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
How to Enroll
CUC, RSABG, CMC, HMC, Pitzer,
and Scripps
For faculty and staff of KGI and CGU
KGI and CGU
Pomona
2016 Plan Rates
Your Benefits at a Glance
For faculty and staff of Pomona
Who to Contact
Forms
Notices
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How to Enroll
For faculty and staff of CUC, RSABG, CMC, HMC, Pitzer
and Scripps
To enroll for new coverage or make changes to your current benefits coverage,
follow these steps to complete the online enrollment process:
1. Log on to Ultipro using the link through your school’s website.
2. Enter your login information.
–– If you need your login information, contact your Human Resources
Representative.
3. Once logged on, click “Myself” and then “Open Enrollment.”
–– You can also view the “Quick Tour” video for instructions on how to make
your elections.
4. Follow the instructions that appear on your screen to make changes, enroll
or cancel your health benefit elections. Please be sure to click Submit to
complete your enrollment or change.
2016 Plan Year
Benefits elected during Open Enrollment
will be effective January 1, 2016 through
December 31, 2016.
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
How to Enroll
CUC, RSABG, CMC, HMC, Pitzer,
and Scripps
KGI and CGU
Pomona
2016 Plan Rates
Your Benefits at a Glance
5. You may print a Confirmation Statement confirming your elections for your
records.
If you do not have access to Ultipro, please contact your Human Resources
Office or Benefits Administration for a Benefit Election Worksheet to submit
your elections. Changes you make to your current health benefit elections during
Open Enrollment will be effective January 1, 2016.
Who to Contact
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How to Enroll
For faculty and staff of KGI AND CGU
To make changes or elections for the 2016 plan year, follow the instructions
below:
1. Log in to https://portal.adp.com.
2016 Plan Year
2. Select User Login.
–– Input your user name and password.
(If you do not have a user name and password, select First Time Users
Register Here to obtain your user name and password. You will be asked to
enter a registration code. Enter code cgu1-91711 (CGU) or cgukgi-91711 (KGI).)
Benefits elected during Open Enrollment
3. Select the Benefits Tab and click Review/Change Benefits.
–– All employees must update their college-provided life insurance beneficiary
located in the Benefits Tab, Review/Change Beneficiaries.
4. At the Welcome page, you will be guided through the Open Enrollment portal
where you can change existing coverage and/or elect coverage for you and
your dependents.
will be effective January 1, 2016 through
December 31, 2016.
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
How to Enroll
CUC, RSABG, CMC, HMC, Pitzer,
and Scripps
KGI and CGU
Pomona
2016 Plan Rates
Your Benefits at a Glance
5. Once you’ve completed your enrollment, you will be able to print a benefit
summary of your 2016 elections and coverage for your records.
6. 2016 Open Enrollment elections must be made by 5:00 p.m. PST on
November 20, 2015.
Who to Contact
Forms
Notices
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How to Enroll
For faculty and staff of Pomona
To enroll for new coverage or make changes to your current benefits coverage,
follow these steps to complete the online enrollment process:
1. Log on to the Portal at my.pomona.edu.
2016 Plan Year
2. Select “My HR Info” from the right hand side of the screen under Human
Resources/Payroll.
Benefits elected during Open Enrollment
–– If this is your first time logging into the HR/Payroll system you will need to
complete the new user authentication process. Instructions can be found on
the portal by selecting the “documentation” link located directly under the
“My HR Info” link.
3. Once logged on, click “Myself” and then “Open Enrollment” You can also view
the “Quick Tour” video for instructions on how to make your elections.
4. Follow the instructions that appear on your screen to make changes, enroll or
cancel your health benefit elections. Please be sure to click Finish to complete
your enrollment or change.
will be effective January 1, 2016 through
December 31, 2016.
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
How to Enroll
CUC, RSABG, CMC, HMC, Pitzer,
and Scripps
KGI and CGU
Pomona
2016 Plan Rates
Your Benefits at a Glance
5. You may request a Confirmation Statement confirming your elections for your
records.
If you do not have Internet access, or need assistance with enrolling, please
contact your Human Resources Office or Benefits Administration. Changes you
make to your current health benefit elections during Open Enrollment will be
effective January 1, 2016.
Who to Contact
Forms
Notices
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2016 Plan Rates
To review your monthly plan rates for benefits, click your school’s logo below:
At No Cost to You…
The Claremont Colleges pays 100% of the cost
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
of coverage for:
2016 Plan Rates
●● Core vision coverage (employee-only)
Your Benefits at a Glance
●● Basic Life Insurance
●● Long-term disability*
●● Employee Assistance Program (EAP).
All benefit premium deductions for health, dental, vision, health savings account
(HSA) and flexible spending accounts (FSA) coverage are taken on a pre-tax
basis unless otherwise requested. Benefit deductions are taken in the current
month of coverage.
* RSABG employees pay 50% of the cost for
long-term disability insurance.
Who to Contact
Forms
Notices
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Your Benefits at a Glance
Benefits are an important part of your overall compensation. Click the type of
benefit you want to learn more about:
●● Employer-Paid Benefit Coverage
●● Benefits You Can Enroll in During Open Enrollment
●● Voluntary Benefits You Can Enroll in at Any Time
●● Wellness Resources
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
2016 Plan Rates
Your Benefits at a Glance
Employer-Paid Benefit Coverage
Benefits You Can Enroll in During
Open Enrollment
Voluntary Benefits You Can Enroll
in at Any Time
Wellness Resources
Who to Contact
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Employer-Paid Benefit Coverage
For more information, click the benefit name in the table below.
Benefit
Options
Vision Core Plan
●● Employee coverage
Basic Life Insurance
●● Employee coverage
Long-Term Disability
●● Group Long-Term Disability (LTD)
Who Pays
The Claremont Colleges pays 100% of the cost
of coverage.
The Claremont Colleges pays 100% of the cost
of coverage.
The Claremont Colleges pays 100% of the cost
of coverage.
If you are on the Rancho Santa Ana Botanic
Garden’s staff, you must elect this benefit if you
want coverage. Additionally, The Claremont
Colleges pays 50% of the cost of coverage, and
you pay the remaining cost.
Employee Assistance
Program (EAP)
ARP
●● Employee Assistance Program
●● Academic Retirement Plan
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
2016 Plan Rates
Your Benefits at a Glance
Employer-Paid Benefit Coverage
Benefits You Can Enroll in During
Open Enrollment
Group LTD coverage is available to faculty and
staff working 30 or more hours per week.
Voluntary Benefits You Can Enroll
in at Any Time
The Claremont Colleges pays 100% of the cost
of coverage.
Wellness Resources
Employer contributions are subject to the
satisfication of eligibility requirements.
Who to Contact
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Benefits You Can Enroll in During Open Enrollment
(November 2–November 20, 2015)
For more information, click the benefit name in the table below.
(Note: Benefits-eligible temporary employees are only eligible for medical coverage.)
Benefit
Options
●● Kaiser Permanente HMO
Medical
●● Anthem Blue Cross HMO
●● Anthem Lumenos HDHP
Health Savings Accounts
(HSAs)
●● Mellon Health Savings Account
(You must be enrolled in the Anthem
Lumenos HDHP or another high deductible
health plan to be eligible for the HSA.)
●● MetLife DHMO
Dental
●● MetLife DPPO
●● Anthem Core Plan
Vision
●● Anthem Buy-Up Plan
Who Pays
2016 Benefit Changes and Reminders
You pay a portion of the cost of coverage.
Premiums are deducted from your paycheck on
a pre-tax basis. See your 2016 Open Enrollment
Brochure or your school’s enrollment website
for more details.
What to Do During Open Enrollment
You can choose to contribute funds from your
paycheck to your HSA on a pre-tax basis. The
Claremont Colleges will also make a one-time
contribution to your account, depending on
your coverage level and eligibility status.
You pay a portion of the cost of coverage.
Premiums are deducted from your paycheck on
a pre-tax basis. See your 2016 Open Enrollment
Brochure or your school’s enrollment website
for more details.
2016 Plan Rates
Your Benefits at a Glance
Employer-Paid Benefit Coverage
Benefits You Can Enroll in During
Open Enrollment
Voluntary Benefits You Can Enroll
in at Any Time
Wellness Resources
The Claremont Colleges pays the full cost of
employee-only coverage for the Anthem Core
Plan. You pay a portion of the cost of coverage
for Anthem Core Plan coverage for your
dependents and the Anthem Buy-Up Plan.
Premiums are deducted from your paycheck on
a pre-tax basis.
Flexible Spending Accounts ●● Health Care FSA
(FSAs)
●● Dependent Care FSA
●● Limited Scope Health FSA
See your 2016 Open Enrollment Brochure or
your school’s enrollment website for more
details.
Contributions are deducted from your paycheck
on a pre-tax basis.
Who to Contact
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Voluntary Coverage You Can Enroll in at Any Time
Benefit
Options
Supplemental Life
Insurance
●● Employee coverage
●● Spouse or domestic partner coverage
●● Child(ren) coverage
Accidental Death &
Dismemberment (AD&D)
Insurance Plan
●● Employee coverage
●● Family coverage
Retirement Plans
●● Academic Retirement Plan
Long Term Care Insurance
●● Optional Long Term Care Insurance
Long-Term Disability
(Rancho Santa Ana Botanic
Gardens staff)
●● Tax Deferred Annuity Plan (TDA)
●● Group Long-Term Disability (LTD)
Who Pays
You pay the full cost of coverage. Premiums are
deducted from your paycheck on an after-tax
basis. See your 2016 Open Enrollment Brochure
or your school’s enrollment website for more
details.
You pay the full cost of coverage. Premiums are
deducted from your paycheck on an after-tax
basis. See your 2016 Open Enrollment Brochure
or your school’s enrollment website for more
details.
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
2016 Plan Rates
Your Benefits at a Glance
Contributions are deducted from your paycheck
on a before-tax basis.
Employer-Paid Benefit Coverage
You pay the full cost of coverage. You are billed
directly by Genworth. Costs are determined by
your age and the plan you select when you first
enroll.
Voluntary Benefits You Can Enroll
in at Any Time
For staff working at RSABG, The Claremont
Colleges pays 50% of the cost of coverage,
and you pay the remaining cost on an after-tax
basis.
Benefits You Can Enroll in During
Open Enrollment
Wellness Resources
Group LTD coverage is available to faculty and
staff working 30 or more hours per week.
See Forms and Notices for necessary documentation, including an Evidence of
Insurability form.
Who to Contact
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Wellness Resources
If you enroll in a medical plan with The Claremont Colleges, you will also have
access to wellness resources through your plan provider, including programs that
can help you:
●● Quit smoking
Ready for More Wellness?
●● Get more exercise
●● Improve your diet with nutritional counseling
●● Lose weight
For more detailed information about these
and other wellness programs available, see
the Wellness Program section of the Benefits
In addition, disease management programs offer support, tools and information
to help manage certain chronic conditions like:
●● Asthma
Guide.
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
2016 Plan Rates
Your Benefits at a Glance
Employer-Paid Benefit Coverage
Benefits You Can Enroll in During
Open Enrollment
●● Congestive heart failure
Voluntary Benefits You Can Enroll
in at Any Time
●● Diabetes
Wellness Resources
●● Hypertension (high blood pressure)
Go online to the Anthem or Kaiser Permanente websites to learn more about the
programs they offer.
Who to Contact
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Who to Contact
CUC Benefits Administration
If you have questions about your benefits or for additional information on new enrollment,
changes or cancellation of your benefits, contact CUC Benefits Administration.
Contact
Phone
Email
Carol Saldivar
Director Benefits Administration
909-607-3195
carol_saldivar@cuc.claremont.edu
Monica Villanueva
Lead Benefits Representative/
Systems Specialist
909-607-3684
monica_villanueva@cuc.claremont.edu
Anna Huerta
Benefits Representative
909-607-9494
anna_huerta@cuc.claremont.edu
Claudia Garcia
Benefits Representative
909-607-9493
claudia_garcia@cuc.claremont.edu
Alicia Silva
Benefits Representative
909-621-8049
alicia_silva@cuc.claremont.edu
Tony Romero
Retirement Analyst
909-621-8805
tony_romero@cuc.claremont.edu
Loo Hsing,
Senior Benefits Analyst
909-607-3780
loo_hsing@cuc.claremont.edu
Lissette Martinez
Workers’ Compensation &
Disability Administrator
909-621-8847
lissette_martinez@cuc.claremont.edu
Arcy Serrano
VDI & Return to Work
Coordinator
909-607-7946
araceli.serrano@cuc.claremont.edu
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
2016 Plan Rates
Your Benefits at a Glance
Who to Contact
Benefits Administration Offices
Plan Providers
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Plan Providers
You may also contact the providers directly with specific benefit coverage questions.
Provider or Department
Phone
Website Address
Anthem Blue Cross HMO
(CaliforniaCare)
800-227-3771
www.anthem.com/ca
Anthem Lumenos HDHP
866-207-9878
www.anthem.com/ca
Kaiser Permanente
800-464-4000
www.kp.org
What to Do During Open Enrollment
Benefit Wallet HSA
877-472-4200
https://mybenefitwallet.com/
2016 Plan Rates
MetLife Dental
800-942-0854
www.metlife.com
Anthem Vision
866-723-0515
www.anthem.com
PayFlex FSA Administration
888-678-8242
www.PayFlexDirect.com
United Behavioral Health—
Employee Assistance Program
800-234-5465
www.liveandworkwell.com/default.asp?
ProgramPIN=claremontcolleges
The Standard Life Insurance
Medical underwriting:
800-843-7979
Life claims: 800-628-8600
www.standard.com
Zurich Voluntary AD&D
866-841-4771
www.zurichna.com
Genworth—Long-Term Care
(Policies issued on or after
1/1/2012)
800-416-3624
http://genworth.com/groupltc
Username: Claremont
Password: groupltc
2016 Benefit Changes and Reminders
Your Benefits at a Glance
Who to Contact
Benefits Administration Offices
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Plan Providers
Forms
Notices
Benefits Guide
2016 Open Enrollment Guide | Open Enrollment Is Active — You MUST Enroll
Plan Providers (Continued)
Provider or Department
Phone
Website Address
TIAA-CREF
800-842-2776
www.tiaa-cref.org
Medicare
800-MEDICARE (800-633-4227) www.medicare.gov
Health Insurance Counseling & Advocacy
Program
2016 Benefit Changes and Reminders
●● Los Angeles County (Center for Health
213-383-4519
www.chcsbc.org
●● Orange County (Council on Aging)
714-560-0424
www.coaoc.org
909-256-8369
www.hicapsbc.org
Assist America (In conjunction with
Business Travel Accident policy through
AC Newman)
609-986-1234
www.assistamerica.com
Worldwide Travel Assistance through AIG
877-832-3523
assistance@aig.com
Group Name: Claremont University Consortium
Policy #: GLB 0009148392
Care Rights)
●● San Bernardino County (HICAP of San
What to Do During Open Enrollment
2016 Plan Rates
Your Benefits at a Glance
Bernardino County)
Who to Contact
Benefits Administration Offices
Plan Providers
Forms
Notices
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Benefits Guide
2016 Open Enrollment Guide | Open Enrollment Is Active — You MUST Enroll
Forms
Use the links below to open the corresponding form:
Form
What It Means for You
The Standard Evidence of Insurability (EOI) Form:
Print Form
Online Form
To confirm you are generally in good health when electing or
increasing life insurance with The Standard
Domestic Partner Affidavit
To verify unmarried domestic partner relationship
PayFlex FSA and LPFSA Claim Form
To file a claim for reimbursement from your FSA
2016 Plan Rates
Long-Term Disability (EOI) Form
To confirm you are generally in good health when electing
long-term disability coverage (for RSABG only)
Your Benefits at a Glance
Life Insurance Beneficiary Change Form
AD&D Insurance Beneficiary Change Form
To change and verify your elected beneficiaries for Life and AD&D
insurance. You must log in to your account to establish or change
your beneficiaries
Benefits Election Form
To elect benefits during the year if you experience a qualified
life event
MetLife Dental Claim Reimbursement Form
To file a claim for reimbursement from MetLife for dental service
received from an out-of-network provider
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
Who to Contact
Forms
Notices
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Benefits Guide
2016 Open Enrollment Guide | Open Enrollment Is Active — You MUST Enroll
Notices
Federal laws require that The Claremont Colleges provides you with certain
notices that inform you about your rights regarding eligibility, enrollment and
coverage of health care plans. The following sections explain these rules; please
read them carefully. Click the notice in the table below for more information;
these notices are also available in the benefits guide.
Notice
What it Means for You
●● Life Event Changes Information Sheet
Describes qualified life events that allow you to make changes
to your benefits outside the Open Enrollment period
●● Special Enrollment Rights
●● Women’s Health and Cancer Rights Act of 1998
●● Newborns’ and Mothers’ Health Protection Act
●● Consolidated Omnibus Budget Reconciliation Act (COBRA)
●● Medicaid and the Children’s Health Insurance Program (CHIP)
Notice
●● Health Insurance Portability and Accountability Act (HIPAA)
●● Your Prescription Drug Coverage and Medicare
●● Physician Designation Form
Describes when you can enroll for coverage when you have
previously declined coverage
2016 Benefit Changes and Reminders
What to Do During Open Enrollment
2016 Plan Rates
Your Benefits at a Glance
Provides information regarding a woman’s rights after a
mastectomy
Describes protections for mothers and their newborn
children relating to the length of their hospital stays following
childbirth
Provides details about how COBRA can provide ongoing
health benefits after coverage ends under certain conditions
A list of states that have premium assistance programs to
help you pay for medical coverage if you are unable to afford
health care coverage premiums
Describes your rights to health privacy
Explains that prescription drug coverage through The
Claremont Colleges is as good as, or better than, Medicare
prescription drug coverage
Provides information regarding the selection of a primary care
physician as required by HMO plans
●● Summary Annual Reports
●● Summary of Benefits and Coverage
–– Kaiser Permanente HMO
–– Anthem Blue Cross HMO
–– Anthem Lumenos HDHP
–– Anthem Blue Card Lumenos HDHP (for out-of-area participants)
Annual reports of The Claremont Colleges benefits
Summarizes important information about your health
coverage options in a standard format to help you compare
each option
Who to Contact
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Notices
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Benefits Guide
2016 Benefits Guide
Your Benefits Guide
Your benefits are an important part of your overall compensation. The Claremont
Colleges is pleased to offer a comprehensive array of benefits to protect your
health, your family and your way of life, including:
●● Health care coverage, including medical, dental and vision benefits
●● Financial protection for you and your family, including disability, life and
accident insurance coverage
Check It Out!
This interactive guide will not only help
you find information easily, but it’s
●● Retirement savings opportunities
environmentally friendly.
●● Work-life resources through the Employee Assistance Program
●● Other voluntary benefits include Flexible Spending Accounts (FSAs), Health
Savings Accounts (HSAs) and other financial benefits.
This guide provides general benefit plan and enrollment information only. For specific details,
conditions and exclusions, please refer to the official summary plan descriptions (SPDs). If there
is a discrepancy between this guide and an official SPD or Collective Bargaining Agreement, the
official document will govern.
Your Benefits
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
Forms
Notices
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2016 Benefits Guide
Your Benefits
The following benefit programs are available to you. Click the benefit plan below
for more information.
●● Medical Benefits
●● FSAs
–– Kaiser Permanente HMO
–– Health Care FSA
–– Anthem Blue Cross HMO
–– Limited Scope Health FSA
–– Anthem Lumenos HDHP
• Benefit Wallet Health Savings
Account
–– Dependent Care FSA
●● Long-Term Disability
–– Basic Coverage
●● Dental Benefits
●● Life Insurance
–– MetLife DHMO
–– Basic Life Insurance
–– MetLife DPPO
–– Supplemental Life Insurance
●● Vision Benefits
●● Accidental Death & Dismemberment
–– Anthem Core Plan
Insurance (AD&D)
–– Anthem Buy-Up Plan
●● Employee Assistance Program
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
●● Long-Term Care
Long-Term Disability
●● Retirement Plan
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
Forms
Notices
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2016 Benefits Guide
Your Medical Benefits
The Claremont Colleges offers three medical plans for you to choose from. Click
the plan name for more detail:
●● Kaiser Permanente HMO
Your Benefits
●● Anthem Blue Cross (CaliforniaCare) HMO
Your Medical Benefits
●● Anthem Lumenos HDHP
Your Dental Benefits
Kaiser Permanente HMO and Anthem Blue Cross
(CaliforniaCare) HMO Plans
Your Vision Benefits
Employee Assistance Program
The HMO plans offer affordable health care for you and your family through a
network of health care providers. When you enroll in an HMO plan, you (and
each enrolled family member) will be asked to select a primary care physician
(PCP) from the network. The PCP you choose will help you manage all aspects
of your health care. You have the right to designate any primary care provider
who participates in the plan’s network and who is available to accept you or your
family members.
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Plan Features:
Long-Term Care
1. You must select and use a primary care physician (PCP) from the HMO
network to coordinate your care.
Who’s Eligible
Enrolling for Benefits
2. HMOs do not have deductibles or coinsurance. Instead, you pay a copay when
you visit your PCP or a specialist whom you have been referred to by your
PCP.
2016 Plan Rates
Wellness Resources
3. If you use doctors, hospitals, labs, pharmacies or other health care facilities
outside the HMO, you are responsible for paying the full cost (except in an
emergency).
Retirement Plan
4. There are no claim forms to file.
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Open Enrollment Guide
2016 Benefits Guide
Kaiser Permanente HMO and Anthem Blue Cross
(CaliforniaCare) HMO Plans (Continued)
Here’s what you need to know about receiving care from the HMO plans:
Kaiser Permanente HMO
Your Benefits
You have the option of going to any Kaiser Permanente facility to receive your
care. Care received from a non-Kaiser facility will not be covered (except for
emergency care).
There’s an App for That
Apple smartphone. You can:
Your Dental Benefits
How to Find a Kaiser Permanente Provider
●● Find a local doctor, network, or facility and
Your Vision Benefits
Your Medical Benefits
Download the KP Mobile App for Android or
make an appointment
1. Go to www.kp.org/newmember
Employee Assistance Program
●● View, refill, and check the status of a
2. Click on “Find a Doctor”
Flexible Spending Accounts
prescription
3. Select “California-Southern”
4. Enter the name of your physician and your location
Life Insurance Benefit
●● Check your latest test results
Evidence of Insurability
●● Email your doctor.
Long-Term Disability
Once you have selected a Primary Care Physician (PCP) you can use Kaiser
Permanente’s My Doctor portal at www.kp.org/mydoctor to email your doctor
and access health care tools.
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
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Kaiser Permanente HMO and Anthem Blue Cross
(CaliforniaCare) HMO Plans (Continued)
Anthem Blue Cross (CaliforniaCare) HMO
You must receive all of your non-emergency care from doctors and hospitals
in the Anthem Blue Cross (CaliforniaCare) HMO network, and the care must be
under your PCP’s direction or the plan will not pay benefits. Women may go
directly to a gynecologist in their PCP’s medical group or practice association
without a referral from their PCP. Care received from an out-of-network provider
will not be covered (except for emergency care).
How to Find an In-Network Anthem Provider
1. Go to anthem.com/ca.
There’s an App for That
You can also download Anthem’s mobile
app to search for an in-network provider.
Download the Anthem Blue Cross app for
Android or Apple smartphone.
3. Under “Search by selecting a plan/network,” go to “Select a state.” You can
enter the name of your state or select it from the drop-down list.
4. Under “Select a plan/network,” you can enter the name of your plan/network
under the “Medical (Employer Sponsored)” heading, or select it from the
drop-down list then choose “Select and Continue.”
–– The HMO plan name is “Blue Cross HMO (CA Care)-large group.”
5. Using the drop-down boxes, select what type of doctor and the location you’re
looking for, then select “Search”.
6. For more info about a provider (like skills and training), just select that name in
the directory.
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
30-mile Requirement
2. Under “Useful Tools” on the right, select “Find a Doctor.”
Your Benefits
If you are enrolled in the Anthem Blue Cross
HMO (CaliforniaCare) plan, you must elect
a primary care physician or medical group
within 30 miles of where you live or work in
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
order to receive care.
Accidental Death & Dismemberment
(AD&D) Insurance
If you attempt to elect a doctor who is outside
Long-Term Care
of these limits then the plan may prevent you
from electing that doctor, even if he or she is
accepting new patients, or the medical group
may disenroll you from their medical group
facility. To find out whether your primary care
physician meets this requirement, contact
Anthem customer service.
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
Forms
Notices
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Anthem Lumenos HDHP
With the Anthem Lumenos High Deductible Health Plan (HDHP), you have the
flexibility to choose any doctor or facility and receive benefits. However, if you
go to Anthem Lumenos HDHP network doctors and facilities, you will pay less
because Anthem Lumenos HDHP network providers have agreed to charge
lower, negotiated rates.
Plan Features:
Your Benefits
Need More Detail?
Your Medical Benefits
Click here to review A Guide to the Anthem
1. Flexibility to go to in-network and out-of-network providers
2. Lower out-of-pocket expenses when you see in-network providers
3. 100% coverage for preventive care with in-network providers
4. Coinsurance for most services once you meet the plan’s deductible
A Note About Reasonable And Customary Charges
When you use in-network providers, the coinsurance percentage is lower
due to negotiated rates. If you use out-of-network providers, the coinsurance
percentage is higher and is based on Reasonable and Customary charges. You
must also pay any amount over the R&C limit.
5. Out-of-pocket maximum(s) to help protect you from the expense of a possible
catastrophic illness or injury
6. A tax-advantaged Health Savings Account (HSA) for those individuals who
are not enrolled in Medicare Parts A and/or B. Go to Health Savings Account
(HSA) for more information about this unique savings account.
Your Dental Benefits
Lumenos HDHP. This guide has more detail
about how the Anthem Lumenos HDHP
Your Vision Benefits
works, and how to make the most of the
Employee Assistance Program
tax-advantaged Health Savings Account
(HSA).
Flexible Spending Accounts
Life Insurance Benefit
Think About Participating in the Limited
Evidence of Insurability
Scope Health Care FSA/Health Savings
Account (HSA)
Long-Term Disability
If you enroll in the Anthem Lumenos HDHP
Accidental Death & Dismemberment
(AD&D) Insurance
and open a Health Savings Account (HSA), a
Long-Term Care
Limited Scope Health FSA is available to you.
Who’s Eligible
The Limited Scope Health FSA allows you to
pay for eligible dental and vision expenses
Enrolling for Benefits
(i.e., deductibles, copays, coinsurance).
2016 Plan Rates
You can also use the Limited Scope Health
FSA to pay for medical expenses and
Wellness Resources
prescription drugs AFTER you’ve met your
Retirement Plan
plan’s deductible. Click here for more details
about how a Limited Scope Health FSA works
together with an HSA.
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Anthem Lumenos HDHP (continued)
How to Find an In-Network Anthem Provider
1. Go to anthem.com/ca.
2. Under “Useful Tools” on the right, select “Find a Doctor.”
3. Under “Search by selecting a plan/network,” go to “Select a state.” You can
enter the name of your state or select it from the drop-down list.
4. Under “Select a plan/network,” you can enter the name of your plan/network
under the “Medical (Employer Sponsored)” heading, or select it from the
drop-down list then choose “Select and Continue.”
–– The Anthem Lumenos HDHP name is “Blue Cross PPO (Prudent Buyer)—
large group.”
5. Using the drop-down boxes, select what type of doctor and the location you’re
looking for, then select “Search”.
There’s an App for That
You can also download Anthem’s mobile
app to search for an in-network provider.
Download the Anthem Blue Cross app for
Android or Apple smartphone.
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
6. For more info about a provider (like skills and training), just select that name in
the directory.
Long-Term Disability
You can also download Anthem’s mobile app to search for an in-network
provider. Download the Anthem Blue Cross app for Android or Apple
smartphone.
Long-Term Care
Accidental Death & Dismemberment
(AD&D) Insurance
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
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Notices
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How the Anthem Lumenos HDHP Works
How does an HDHP work? Let us tell you.
OUT-OF-POCKET MAXIMUM
1. Your annual out-of-pocket maximum for in-network usage
caps your expenses, like the roof of a house. Once you reach the
annual out-of-pocket maximum for in-network usage, the plan
pays 100% of your costs for the rest of the year. Please note:
your out-of-pocket expenses could exceed your maximums
when using out-of-network providers and facilities.
2. Comprehensive coverage with coinsurance paid by you and
the medical plan. Once you meet the deductible, the plan pays
a percentage of the cost and you pay the rest. You can pay for
your portion with the tax-free money you contribute to your
HSA.
COINSURANCE
3. Your contribution to your deductible. The first floor of this
house represents the first expenses you will pay for your health
care. You can use the tax-free money that you contribute to
your HSA to cover this amount.
4. Preventive care is the plan’s foundation, covered at 100% by
the medical plan. This is the point from which you grow your
most valuable health knowledge and healthy habits. Most
appropriate preventive care received in-network is free to you
and your family.
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
ANNUAL DEDUCTIBLE
Don’t Forget to Open Your HSA!
If you enroll in the Anthem Lumenos HDHP and you are
not enrolled in Medicare Parts A and/or B, you have the
option to enroll in a Health Savings Account (HSA) with
Benefit Wallet. An HSA is a special account that lets you
pay eligible expenses—like deductibles, coinsurance
PREVENTIVE CARE—FREE
and prescription drugs—with tax-free dollars. An HSA
can be offered only with a medical plan that meets the
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
IRS high deductible health plan requirements—like the
Anthem Lumenos HDHP.
Go to the Health Savings Account (HSA) section to
learn more about the HSA and how it works.
Who to Contact
Forms
Notices
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Health Savings Account (HSA)
If you choose to enroll in the Anthem Lumenos HDHP, you may
be eligible to enroll in a Health Savings Account (HSA). An HSA
is a personal savings account created from pre-tax employee
contributions to be used for qualified medical expenses. Federal
regulations limit HSAs for plans with a high deductible, like the
Anthem Lumenos HDHP.
HSA Basics
Funding
●● The maximum annual contribution is $3,350 per
individual*
An HSA can also be used as an investment tool. Your account
balance can roll over from year to year. And, the HSA is completely
portable—you can take it with you if you change jobs or retire.
You can then use this tax-free money to pay for eligible medical
expenses for you or your dependents (excluding domestic
partners).
●● The maximum annual contribution is $6,750 per
family*
●● If you are 55 years of age or older, there is a
catch-up contribution option in the amount of
$1,000
* These amounts include any employer contributions. Only
When you enroll in an HSA, you will receive a welcome kit from the
HSA administrator, Benefit Wallet, with more information about
using your HSA.
Learn more about the HSA in A Guide to the Anthem Lumenos
HDHP. For information about the fees and rate schedule for your
HSA account, please visit Benefit Wallet online at
www.mybenefitwallet.com, or call 877-472-4200.
You can contribute to your HSA directly from your
salary on a pre-tax basis if you select Benefit Wallet
as your HSA provider. You can also contribute to
another financial institution’s HSA using post-tax
dollars up to the IRS limit:
non-highly compensated participants (employees who had
an annual compensation of less than $120,000 in 2015) who
are not enrolled in Medicare A and/or B are eligible for the
employer contribution.
Qualified
Expenses
FSA
Participation
The money that you put into the HSA can be used
to pay for qualified medical expenses, including the
Lumenos HDHP’s deductible or coinsurance, and
other out-of-pocket health care expenses like dentist
visits and eye exams. Additionally, the money that
you roll over can be used for future eligible expenses,
including long-term care. There may be restrictions
on who the plan will cover, for more details see
A Guide to the Anthem Lumenos HDHP.
If you enroll in an HSA, you will only be eligible
for the Limited Scope FSA, due to IRS regulations.
Limited-scope FSA reimbursements are for nonmedical related expenses that you choose not to
use your HSA to reimburse, such as dental or vision
copays or coinsurance payments. Refer to Limited
Scope Reimbursements for more information.
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
Forms
Notices
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Medical Benefits at a Glance
The chart below provides an overview of the most commonly used benefits.
Benefit
Kaiser HMO
Anthem Blue Cross
(CaliforniaCare) HMO
Anthem Lumenos HDHP
Kaiser Permanente
Network
Anthem Blue Cross
Providers
Employee Only
N/A
N/A
$450*
Family
N/A
N/A
$900*
Employee HSA
contribution maximum
(including the employer
contribution)
N/A
N/A
$2,900 (employee only)/$5,850 (family)
Employee HSA catch-up
contribution (ages 55 and
over)
N/A
In-Network
Out-of-Network
Your Benefits
HSA Contributions
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
N/A
Flexible Spending Accounts
$1,000
Life Insurance Benefit
Evidence of Insurability
Calendar-year deductible
Employee Only
None
None
$1,500
$2,500
Family
None
None
$3,000**
$5,000**
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Out-of-pocket maximum (per calendar year); some benefits do not apply toward the out-of-pocket maximum
Employee Only
$1,500
$1,500
$3,000
$6,000
Family
$3,000
$3,000 (two party)/
$4,500 (family)
$6,000
$12,000
Lifetime Maximum
Unlimited
Unlimited
Inpatient Hospital
$200 copay per
admission
$300 copay per
admission
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Pre-Admission Testing
Plan pays 100%
Plan pays 100%
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Long-Term Care
Who’s Eligible
Unlimited
Enrolling for Benefits
Inpatient Services
Drugs, Medicine, Casts,
Dressings, Special Duty
Nursing (when prescribed
and medically necessary)
Plan pays 100%
Plan pays 100%
*For employees who earned less than $120,000 in 2015, when opened through Mellon Bank.
**Includes insured employee & one or more members of the employee’s family.
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Medical Benefits at a Glance (Continued)
Benefit
Kaiser HMO
Anthem Blue Cross
(CaliforniaCare) HMO
Anthem Lumenos HDHP
Kaiser Permanente
Network
Anthem Blue Cross
Providers
In-Network
Out-of-Network
X-ray, Laboratory
Plan pays 100%
Plan pays 100%
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Cost of Administering
Blood Transfusions
Plan pays 100%
Plan pays 100%
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Whole Blood Plasma
No charge if replaced
Plan pays 100%
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Hospice Care
Plan pays 100%
Plan pays 100%
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Skilled Nursing Facility
Plan pays 100% (limit 100
days per calendar year)
Plan pays 100% (limit 100
days per calendar year)
Plan pays 80% after
deductible (limit 100 days
per calendar year)
Plan pays 60% after
deductible (limit 100 days
per calendar year)
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Outpatient Services
Office Visits
You pay a $20 copay
(PCP), or
You pay a $25 copay
(PCP), or
You pay a $30 copay
(specialist)
You pay a $40 copay
(specialist)
X-rays, Laboratory Tests
Plan pays 100%
Plan pays 100%
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Routine Exams
Plan pays 100%
Plan pays 100%
Plan pays 100%
Plan pays 60% after
deductible
Routine Immunization
Plan pays 100%
Plan pays 100%
Plan pays 100%
Plan pays 60% after
deductible
Preventive Care
Plan pays 100%
Plan pays 100%
Plan pays 100%
Plan pays 60% after
deductible
Outpatient Surgery (at a
Plan facility)
You pay a $30 copay
You pay a $100 copay
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
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Medical Benefits at a Glance (Continued)
Benefit
Kaiser HMO
Anthem Blue Cross
(CaliforniaCare) HMO
Kaiser Permanente
Network
Anthem Blue Cross
Providers
In-Network
Out-of-Network
You pay a $25 copay per
visit ($40 for specialist);
limited to a 60-day period
of care after an illness or
injury; additional visits
available when approved
by your medical group
Plan pays 80% after
deductible (maximum
24 visits for both
in-network and
out-of-network providers)
Plan pays 60% after
deductible (maximum
24 visits for both
in-network and
out-of-network providers)
Plan pays 80% after
deductible (limited to
12 visits per calendar
year)
Short-Term Rehabilitation You pay a $20 copay per
(physical, occupational, or visit; benefits are limited
speech therapy)
to medically necessary
therapy authorized by a
Plan physician.
Chiropractic Care
Not covered
$25 per visit, short
term (referral from PCP
required)
Acupuncture
Not covered
You pay a $25 copay per
visit
Anthem Lumenos HDHP
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Plan pays 60% after
deductible (limited to
12 visits per calendar
year)
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Cardiac/Pulmonary
Rehabilitation
You pay a $20 copay per
visit
You pay a $40 copay per
visit
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Home Health Care
Plan pays 100% (limited
to 100 2-hour visits per
calendar year)
You pay a $25 copay per
visit (limited to 100 visits
per calendar year)
Plan pays 80% after
deductible (limited to 100
visits)
Plan pays 60% after
deductible (limited to
100 visits)
Emergency Room
Services and Supplies
You pay a $100 copay;
waived if admitted
You pay a $150 copay;
waived if admitted
Plan pays 80% after
deductible
Plan pays 80% after
deductible
Who’s Eligible
Ambulance
You pay a $50 copay per
trip
Plan pays 100%
Plan pays 80% after
deductible
Plan pays 80% after
deductible
Enrolling for Benefits
Office Visits (for mother)
Plan pays 100%
You pay a $25 copay
per visit
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Wellness Resources
Hospital (for mother)
You pay a $200 copay per You pay a $300 copay per Plan pays 80% after
admission
admission
deductible
Plan pays 60% after
deductible
Retirement Plan
Office Visits (for baby)
Plan pays 100% for well
baby visits
Plan pays 60% after
deductible
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Emergency Services
Long-Term Care
Maternity Care
2016 Plan Rates
You pay a $25 copay
per visit
Plan pays 80% after
deductible
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Medical Benefits at a Glance (Continued)
Benefit
Kaiser HMO
Anthem Blue Cross
(CaliforniaCare) HMO
Anthem Lumenos HDHP
Kaiser Permanente
Network
Anthem Blue Cross
Providers
In-Network
Out-of-Network
Elective Interrupted
Pregnancy
You pay a $30 copay
You pay a $150 copay
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Your Medical Benefits
Tubal Ligation
You pay a $30 copay
Plan pays 100%
Plan pays 100%
Plan pays 60% after
deductible
Your Dental Benefits
Vasectomy
You pay a $30 copay
Plan pays 100%
Plan pays 100%
Plan pays 60% after
deductible
Your Vision Benefits
You pay a $25 copay
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Outpatient Family Planning
Your Benefits
Counseling & Consultation Plan pays 100%
Employee Assistance Program
Flexible Spending Accounts
Medical Equipment
Durable Medical
Equipment (DME)
Plan pays 80%; in
accordance with DME
formulary and prescribed
by a Kaiser physician
Plan pays 100%
Inpatient Care
You pay $200 per
admission
You pay $300 per
admission
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Outpatient Care
You pay a $20 copay per
visit/individual therapy
You pay a $25 copay per
visit
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
Mental Health
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
You pay a $10 copay per
visit/group therapy
Enrolling for Benefits
2016 Plan Rates
Substance Abuse
Inpatient Care
You pay a $200 copay per You pay a $300 copay per Plan pays 80% after
admission
admission
deductible
Outpatient Care
You pay a $20 copay per
visit for individual therapy
You pay a $25 copay per
visit
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Wellness Resources
Plan pays 60% after
deductible
Retirement Plan
You pay a $5 copay per
visit for group therapy
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Medical Benefits at a Glance (Continued)
Benefit
Kaiser HMO
Anthem Blue Cross
(CaliforniaCare) HMO
Kaiser Permanente
Network
Anthem Blue Cross
Providers
Anthem Lumenos HDHP
In-Network
Out-of-Network
Prescription Drugs—Preventive
Preventive
Your Benefits
N/A
N/A
Plan pays 100%
Prescription Drugs—Retail (up to a 30-day supply)
Generic
You pay a $10 copay
You pay a $10 copay
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Brand Formulary
You pay a $25 copay
You pay a $30 copay
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Brand Non-formulary
You pay a $25 copay*
You pay a $50 copay
Plan pays 80% after
deductible
Plan pays 60% after
deductible
Prescription Drugs—Mail Order
Mail-Order Supply
Up to a 100-day supply
Up to a 60-day supply
Up to a 90-day supply
Generic
You pay a $20 copay
You pay a $10 copay
Plan pays 80% after
deductible
Brand Formulary
You pay a $50 copay
You pay a $60 copay
Plan pays 80% after
deductible
Brand Non-formulary
You pay a $50 copay*
You pay a $100 copay
Plan pays 80% after
deductible
Plan pays 100%
Plan pays 100%
Plan pays 100%
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
Not covered
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Vision Care
Who’s Eligible
Preventive Eye Exams
* On exception and if approved by a plan physician
Plan pays 60% after
deductible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
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Your Dental Benefits
Dental coverage is key to your overall health. Eligible
employees are offered a choice of two dental plans:
●● MetLife DHMO
●● MetLife DPPO
Quick Guide to Dental Services:
●● Preventive services include: semi-annual
check-ups (including X-rays), cleanings and
Use In-Network Providers
To search for providers who participate in your dental plan’s network, follow the
steps below:
fluoride treatments (for children)
●● Basic services include: diagnostic X-rays,
fillings and extractions
1. Go to www.metlife.com.
2. Click “Find a Dentist” located on the right side of the home page.
3. Select Dental PPO or Managed Dental Plan (Dental DMO), depending on your
choice of plan.
4. Enter the ZIP code of the city in which you want to find a dentist. Click “Go.”
●● For DHMO coverage, you will be directed to the Find a Dentist Advanced
Search page where you will input the plan name using the drop down menu.
Select Met3757. You can also modify the mile radius option in the Location box
to narrow down or broaden your search. Click “Search.”
●● For the DPPO plan, you will be directed to a list of dentists within a 30 mile
radius of the ZIP code you entered. You can modify your search by using the
“Modify Your Search” options at the top of the
“Find a Dentist” page.
●● Major services include: bridges, crowns
and dentures
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Alternatively, you can call 800-942-0854.
Who to Contact
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MetLife DHMO
The MetLife DHMO plan works much like a medical HMO plan. When you enroll
in a DHMO plan, you (and each enrolled family member) will be asked to select a
primary care dentist (PCD) from the network.
Plan Features:
Your Benefits
1. You must select and use a PCD from the MetLife network to coordinate your
care, including referrals to specialists within the network.
Your Medical Benefits
Your Dental Benefits
2. There are no deductibles or annual dental maximum.
3. Preventive and basic services are covered at 100% with the exception of
prophylaxis cleaning, sealants and space maintainers.
Your Vision Benefits
Employee Assistance Program
4. General services such as fillings and simple extractions are subject to copays.
Flexible Spending Accounts
5. Major dental services, such as crowns, inlays and dentures, require a copay.
Life Insurance Benefit
6. If you use a dentist outside the DHMO network, you are responsible for paying
the full cost (except in an emergency).
Evidence of Insurability
To view the Metlife DHMO copayment schedule, click here.
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Disability
Long-Term Care
How the Plans Compare
Who’s Eligible
MetLife DHMO
MetLife DPPO
Plan Rates
Less expensive
More expensive
Providers
You must visit a dentist within
the network
You can visit any dentist
Deductible
No deductible
You pay a deductible first
before the plan begins to pay
benefits
Preventive Services
Costs for Dental
Services
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Most preventive services covered 100%
You pay a copay
You pay coinsurance after you
meet the deductible
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MetLife DPPO
With the MetLife DPPO Plan, you have the flexibility to choose any dentist and
receive some benefits. However, if you go to a MetLife network dentist, you will pay
less because MetLife dentists have agreed to charge lower, negotiated rates.
Plan Features:
1. You can choose any dentist, but will pay less if you choose a MetLife dentist.
2. You pay the first $50 in eligible expenses per person ($150 maximum per
family) each year, then the plan pays benefits (out-of-network deductibles are
$75 per person or $225 per family).
3. Preventive services are covered at 100% and aren’t subject to the deductible
(covered 90% for out-of-network services).
4. Basic services are covered at 80%, and major services are covered at 50%,
after you’ve met the deductible.
5. The MetLife DPPO Plan covers up to $2,000 of eligible dental expenses
per covered family member each calendar year. Diagnostic and preventive
benefits are not counted toward the annual maximum.
6. The MetLife DPPO Plan has a lifetime maximum of $2,000 per covered family
member for orthodontia services.
Coverage levels are different when using an out-of-network provider. See
Dental Benefits at a Glance for more details.
How the Dental DPPO Works
See any PPO
network provider
See a provider
outside the PPO
network
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Pay a deductible and
any applicable
coinsurance, and you
will pay less because
rates are negotiated
Flexibility of
choosing any dentist,
but you will pay a
higher deductible;
the rates are not
negotiated, so you
may be charged more
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
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Dental Benefits at a Glance
The chart below provides an overview of the most commonly used dental benefits.
Benefit
MetLife DHMO
MetLife DPPO
In-Network
In-Network
Out-of-Network
Calendar-Year Deductible*
None
Individual: $50/Family: $150
Individual: $75/Family: $225
Calendar-Year Maximum
Benefit*
Unlimited
Plan pays up to $2,000 per
person/year
Plan pays up to $2,000 per
person/year
Routine Examination: Cleaning
(once every 6 months), Fluoride
Treatment (including bitewing
X-rays)
You pay $0
Plan pays 100%; deductible does
not apply
Plan pays 90%; deductible does
not apply
Office Visits
You pay $0
Plan pays 80% after deductible
Plan pays 80% after deductible
Fillings: Amalgam Composite/
Resin
You pay $0 to a $240 copay
(depending on number of
surfaces)
Plan pays 80% after deductible
Plan pays 80% after deductible
Simple Extractions
You pay a $5 copay
Plan pays 80% after deductible
Plan pays 80% after deductible
Long-Term Disability
Copays as listed in the schedule
of covered services and copays
Plan pays 50% after deductible
Plan pays 50% after deductible
Accidental Death & Dismemberment
(AD&D) Insurance
Preventive/Diagnostic*
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
General Services (Restorative)
You pay a $1,695 copay
Dependent Children (to age 19)
You pay a $1,695 copay
Treatment Plan and Records
You pay a $250 copay
Retention
$250 copay
Life Insurance Benefit
Long-Term Care
Orthodontia
Adults
Flexible Spending Accounts
Evidence of Insurability
Major Services
Caps, Crowns, Dentures
Your Benefits
Who’s Eligible
Plan pays 50% up to $2,000 lifetime maximum benefit; deductible
does not apply
* Calendar-year deductible maximum benefit is not applicable to preventive or diagnostic services.
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
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Vision Benefits
Eligible employees are automatically enrolled in the core vision coverage through
Anthem at no cost. This plan includes coverage for eye exams and eyeglasses
or contact lenses. You receive a higher level of coverage when you use network
providers; however, you can use this claim form to file claims with Anthem if you
visit a provider outside Anthem’s network. Anthem uses a network of nationwide
providers, including national retailers like Target and LensCrafters.
Find the right Anthem eye doctor for you at
www.anthem.com/ca.
Increased coverage is available for purchase through the Buy-Up Plan.
Your Benefits
Your Medical Benefits
Your Dental Benefits
Vision Benefits at a Glance
Your Vision Benefits
The chart below provides an overview of the most commonly used vision benefits.
Employee Assistance Program
Benefit
Core Plan
Buy-Up Plan
In-Network
In-Network
Out-of-Network
Plan pays 100% after a $10 copay
Plan pays up to $79
Plan pays up to a $130 allowance; you
receive a 20% discount on amounts
over allowance
Plan pays up to $100
Plan pays 100% after a $15 copay
Plan pays up to $36
Plan pays up to $60
Plan pays up to $79
Eye Exam (Once every 12 months)
Plan pays 100% after a $10 copay
Frames (Once every 12 months)
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
You receive a 35% discount
You pay $50
You pay $70
You pay $105
Contact Lenses (Once every 12 months, in lieu of glasses)
You receive a 15% discount
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Lenses (Once every 12 months)
Single Vision
Lined Bifocal
Lined Trifocal
Flexible Spending Accounts
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Plan pays up to a $130 allowance; you
receive a 15% discount on doctor’s
professional fees. Materials are paid at
usual & customary rates
Plan pays up to $115
Wellness Resources
Retirement Plan
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Employee Assistance Program (EAP)
Confidential advice and counseling are available at no cost to you through the
Employee Assistance Program (EAP). When you contact the EAP you can speak
confidentially to a counselor or other professional who can help with issues,
such as:
●● Parenting issues
●● Self-improvement
Did You Know?
●● Loss or grieving issues
●● Mental health issues
●● Relationship problems
●● Financial concerns
Colleges!
●● Substance abuse issues
●● Legal-referral assistance
Employees and their legal spouse, domestic partner and eligible dependents
receive up to 5 counseling sessions with a licensed/certified therapist by phone
or in person per family member, per issue, each calendar year. Call
800-234-5465 or log on to www.liveandworkwell.com (use access code:
claremontcolleges) to get started.
You can also receive support for everyday tasks through the EAP’s WorkLife
Services. Get referrals and consultations for such concerns as child and elder
care, household care and services, and personal services (such as shopping,
translators, or even dog walkers). Read this WorkLife Services flyer for more
information.
Access to the EAP is available 24/7 year-round. All records, including medical
information, referrals and evaluations, are kept strictly confidential in accordance
with federal and state laws.
More information is available in the EAP Brochure.
The EAP is 100% paid by The Claremont
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
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Flexible Spending Accounts (FSAs)
FSAs help you make your money go further by letting you set aside before-tax
dollars to pay for certain out-of-pocket eligible expenses and dependent care
costs. Here’s how they work:
●● You make contributions from your pay on a pre-tax basis. Contributions and
Your Benefits
eligible reimbursed expenses aren’t subject to federal income tax, Social
Security tax, and, in most cases, state income tax.
Your Medical Benefits
●● The tax savings help offset the cost of eligible health care and dependent care
Your Dental Benefits
expenses.
Your Vision Benefits
●● You are not taxed on reimbursements from your FSAs.
Employee Assistance Program
The Claremont Colleges offers three types of FSAs:
Flexible Spending Accounts
●● Health Care FSA—To pay for eligible medical, dental, and vision expenses
Life Insurance Benefit
●● Limited Scope Health Care FSA—To pay for eligible dental and vision expenses
Evidence of Insurability
if you participate in an HSA or are enrolled in Medicare Parts A and/or B
Long-Term Disability
●● Dependent Care FSA—To pay for eligible child and elder care expenses
Accidental Death & Dismemberment
(AD&D) Insurance
Making FSA Contributions
Long-Term Care
The annual amount you contribute to your FSA is deducted from your paychecks
in equal installments, on a pre-tax basis, from January through December 31, 2016,
and credited to your FSA account(s).
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Incurring Claims
Wellness Resources
You can incur claims for eligible expenses from January 1, 2016 through
March 15, 2017. You will have until June 30, 2017 to submit claims for
reimbursement.
Retirement Plan
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Health Care FSA
You can use the funds in your Health Care FSA to pay for eligible expenses like
deductibles, copays and coinsurance for you and your eligible dependents. You
can contribute a minimum of $300 and a maximum of $2,550 per plan year,
before tax. You don’t have to have medical, dental or vision coverage through The
Claremont Colleges to enroll in the Health Care FSA.
Your Benefits
Eligible/Ineligible expenses
Your Medical Benefits
Here are a few common examples of
Limited Scope Health Care FSA
expenses you can reimburse from your
If you participate in an HSA or if you are enrolled in Medicare Parts A and/or
B, you can participate in a Health Care FSA called a Limited Scope Health Care
FSA. You can contribute a minimum of $300 and a maximum of $2,550 for
eligible expenses.
This FSA offers limited-scope reimbursements for eligible non-medical
expenses, such as dental and vision plan deductibles, copays and coinsurance.
Additionally, once you’ve met your medical plan’s deductible, you can use the
Limited Scope Health Care FSA to cover medical expenses and prescription
drug costs.
Keep in mind that you cannot use a Limited Scope Health Care FSA for any
of the expenses that are not eligible for reimbursement from a regular Health
Care FSA.
The Limited Scope Health Care FSA is a great option if you want to save the
money in your HSA for future health care expenses (because HSA funds roll
over each year). To learn more about how a Limited Scope Health Care FSA
works with an HSA, check out this brochure.
Your Dental Benefits
Health Care FSA:
●● Ambulance services
Your Vision Benefits
●● Artificial teeth/limbs
Employee Assistance Program
●● Copays
●● Chiropractic care
Flexible Spending Accounts
●● Contact lenses
Life Insurance Benefit
●● Crutches
●● Deductibles and coinsurance
Evidence of Insurability
●● Hearing aids
Long-Term Disability
●● Insulin
●● Laser eye surgery
Accidental Death & Dismemberment
(AD&D) Insurance
●● Stop-smoking programs
Long-Term Care
●● Long-term care expenses
Who’s Eligible
Below are some examples of ineligible
Enrolling for Benefits
expenses:
●● Cosmetic surgery (if not medically
2016 Plan Rates
necessary)
●● Teeth bleaching
Wellness Resources
●● Health insurance premiums
Retirement Plan
●● Over-the-counter medications
For a full list of eligible and ineligible
expenses, go to www.PayFlexDirect.com.
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Dependent Care FSA
The Dependent Care FSA may be used to pay for expenses that allow you (or
your spouse, if married) to work. In any calendar year, you can contribute, before
tax, a minimum of $300 and a maximum of $5,000 ($2,500 if married and filing
separately). The limit applies to all contributions made by you and your spouse to
any dependent care spending accounts through The Claremont Colleges and any
other employer combined.
Your Benefits
Eligible Dependents
An eligible dependent is a person who shares
Eligible/Ineligible expenses
the same primary place of residence with you
Here are some examples of eligible expenses you can reimburse from your
Dependent Care FSA:
●● At-home child and elder day care
for more than six months each year and is:
●● Your child under age 13 whom you can
Employee Assistance Program
Flexible Spending Accounts
income tax return;
●● Care at certain child and elder day care centers
●● Charges from certain child and elder day care providers
●● Pre-school and nursery schools
●● Your spouse who is mentally or physically
Life Insurance Benefit
disabled; or
Evidence of Insurability
●● Your dependent who is mentally or
Long-Term Disability
physically disabled and whom you can
Accidental Death & Dismemberment
(AD&D) Insurance
claim on your federal income tax return.
●● Summer day camp
Long-Term Care
In most cases, your domestic partner and
Below are some examples of ineligible expenses:
children of your domestic partner are not
●● Tuition
considered eligible dependents for purposes
●● Child or elder day care provided by someone living in your home
Your Dental Benefits
Your Vision Benefits
claim as a dependent on your federal
●● Before- or after-school care
Your Medical Benefits
Who’s Eligible
Enrolling for Benefits
of your Dependent Care FSA.
2016 Plan Rates
●● Overnight camp
Wellness Resources
Retirement Plan
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FSA Reimbursements
Health Care FSA and Limited Scope Health Care FSA Reimbursements
If you enroll in the Health Care FSA or the Limited Scope Health Care FSA, you
will receive a debit card you can use for eligible health care expenses. Even if
you use the debit card, be sure to save all receipts in the event the administrator
needs to verify eligibility.
If you do not use your debit card to pay for expenses, you may submit a claim
for any eligible expenses. Both reimbursement options require that you submit
your receipts for eligible expenses to the FSA administrator. Reimbursements
are generally paid through direct deposit or check by a third party administrator.
You do not pay federal income, state income or Social Security taxes on FSA
expenses.
Don’t Forget: If You Do Not “Use It” You Will
“Lose It”!
Your Medical Benefits
When estimating your annual expenses,
Your Dental Benefits
consider only those that you are reasonably
certain you will incur. Any amount left in your
FSA after March 15, 2017 is forfeited. This is
called the “use it or lose it” rule.
Your account will be left open for claims until
Dependent Care FSA Reimbursements
To be reimbursed, you must save your receipts and submit a claim for any eligible
expenses. The Dependent Care FSA does not issue debit cards. Reimbursements
are generally paid through direct deposit or check by a third party administrator.
You do not pay federal income, state income or Social Security taxes on FSA
expenses. You can only be reimbursed from contributions you have made to
your account.
The reimbursement claim form can be found here.
Your Benefits
June 30 of the following calendar year. All
FSA claims must be submitted within 90 days
of termination or unpaid leave of absence.
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
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Life Insurance
All benefits eligible employees receive Basic Life Insurance. You also have
the option to purchase additional coverage for yourself and your eligible
dependents.
Basic Life Insurance
Keep In Mind…
Basic Life Insurance is fully paid by The Claremont Colleges. Coverage is
automatic—you don’t have to enroll in it. However, you do need to select a
beneficiary. The beneficiary or beneficiaries receive your benefit amount in the
event of your death.
The amount of the benefit is equal to one times your basic annual earnings
(rounded to the next $1,000). The minimum coverage amount is $20,000, and
the maximum coverage amount is $50,000.
You may choose to purchase additional insurance coverage for yourself through
The Standard on a after-tax basis. This coverage would be in addition to the
basic benefit provided by The Claremont Colleges. You can also purchase
supplemental coverage for your eligible dependents, subject to Evidence of
Insurability (see following page).
Coverage for supplemental life insurance is available in the following amounts:
Eligible Member
Coverage Amount
Employee
1–4 times your basic annual earnings (rounded to
the nearest $1,000), to a maximum of $1 million
Spouse
$10,000 increments, to a maximum of $250,000 or
50% of your combined Basic and Supplemental Life
Insurance coverage
$1,000
Child(ren) (6 months and older)
$5,000
your 65th birthday, your life insurance
coverage amount decreases. Your premiums
will be based on the reduced coverage
amount. The Standard pays a percentage of
your benefit amount as follows:
●● Age 65 to 70 = 65%
●● Age 70 to 75 = 50%
Supplemental Life Insurance
Child(ren) (birth—6 months)
Beginning on the first of the year following
●● Age 75+ = 30%.
Conversion Privilege
Conversion options are available should you
leave The Claremont Colleges. Contact
CUC Benefits Administration for details.
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
Forms
Notices
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Open Enrollment Guide
2016 Benefits Guide
Evidence of Insurability (EOI)
When you purchase Supplemental Life Insurance through The Standard for
yourself, your spouse or your dependents, you may need to provide Evidence of
Insurability (EOI).
If you purchase Supplemental Employee Life Insurance, Spouse Life Insurance, or
Child Life Insurance when you are first eligible (within 30 days of your hire date),
you do not need to provide Evidence of Insurability (EOI) unless you purchase
coverage above a certain amount:
●● For yourself: Amounts above four times your annual earnings or $355,000
●● For your spouse: Amounts above $30,000
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
After this 30-day period, you will be required to provide EOI if you choose to
enroll in or increase your coverage amount at any time throughout the year.
Flexible Spending Accounts
Life Insurance Benefit
An EOI form is available on the Forms page.
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
Forms
Notices
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Long-Term Disability Coverage
You are automatically enrolled for Long-Term Disability Insurance on your first
day of employment if you work 30 hours or more per week.
After you have been disabled for 180 days, you may apply for long-term
disability coverage which could pay 66⅔% of your covered monthly salary, up to
a maximum benefit of $15,000 per month.
Voluntary Disability for California
Your Benefits
Employees
Your Medical Benefits
If you live in California, you’re eligible to
Your Dental Benefits
receive disability benefits through the
Voluntary Disability Plan (VDI). You’re eligible
for VDI after missing 5 continuous days of
work due to non-work-related illness or
injury, pregnancy, or childbirth. VDI replaces
approximately 55% of your base weekly
earnings, to a maximum of $1,067 per week.
For additional information on eligibility or
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
on how to file a claim please contact
Long-Term Disability
benefits@cuc.claremont.edu.
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Did You Know?
The long-term disability premium is 100%
paid for by The Claremont Colleges. If you
are an RSABG employee, you pay 50% of
the cost of LTD coverage, and coverage is
voluntary for these employees.
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
Forms
Notices
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Accidental Death & Dismemberment (AD&D)
Insurance Plan
The Claremont Colleges also offers employees voluntary coverage to protect you
and your family in the event of an accident-related death or dismemberment. You
can choose individual or family coverage (according to IRS regulations). You pay
the full cost for this coverage.
Accidental Death & Dismemberment (AD&D) Insurance is available in the
following amounts:
Your Benefits
Conversion Privilege
Your Medical Benefits
Conversion options are available should you
Your Dental Benefits
leave The Claremont Colleges. Contact
CUC Benefits Administration for details.
Type of Coverage
Coverage Amount
Employee
$25,000 increments, up to $500,000, but not exceeding
10x your annual salary* if the selection is over $250,000
Your Vision Benefits
Employee Assistance Program
●● If only a spouse/domestic partner is covered, the
Spouse
Flexible Spending Accounts
spouse’s coverage amount is 100% of the employee’s
coverage amount
Life Insurance Benefit
●● If a spouse/domestic partner and child(ren) are covered,
the spouse’s coverage amount is 80% of the employee’s
coverage amount
Evidence of Insurability
amount is 30% of the employee’s coverage amount
Accidental Death & Dismemberment
(AD&D) Insurance
the children’s coverage amount is 20% of the employee’s
coverage amount
Long-Term Care
Long-Term Disability
●● If only children are covered, the children’s coverage
Children
●● If a spouse/domestic partner and child(ren) are covered,
Who’s Eligible
* If you attempt to elect coverage that is more than 10x your annual salary, your coverage
amount will automatically be lowered to 10x your annual salary.
Enrolling for Benefits
2016 Plan Rates
At age 70, for you and your insured dependents, the principal sum will be
reduced based on your previous principal sum according to the following
schedule:
Age at Date of Loss
Loss Percent of Principal Sum
70–74
65%
75–79
45%
80–84
30%
85 & Over
15%
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Forms
Notices
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2016 Benefits Guide
Long-Term Care Insurance
The Claremont Colleges sponsors a Group Long-Term Care Insurance Plan
for active employees and their eligible family members. Genworth is the
administrator of the Group Long-Term Care Insurance Plan.
Long-term care insurance provides enrollees with access to personal assistance
from care coordinators who are knowledgeable in the field of long term care.
In addition to conventional nursing home coverage, the policy covers services
received in your own home; other types of care facilities may be covered.
You will have guaranteed acceptance into the plan regardless of your current
health status if you are a newly-hired eligible employee or newly-eligible
employee age 18–69, and you apply within 60 days of first becoming eligible for
this benefit.
Your age and the plan you select when you first enroll determine your monthly
premium rate for the coverage. The younger you are when you become insured,
the lower your cost will be. Active faculty and staff and their spouses or qualified
domestic partners pay premiums through direct billing or automatic bank
withdrawal.
More Information
Go to www.genworth.com/groupltc
(code: groupltc) for more information about
the long-term care coverage available
through Genworth.
Your Benefits
Your Medical Benefits
Your Dental Benefits
Your Vision Benefits
Employee Assistance Program
Flexible Spending Accounts
Life Insurance Benefit
Evidence of Insurability
Long-Term Disability
Accidental Death & Dismemberment
(AD&D) Insurance
Long-Term Care
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
Forms
Notices
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Who’s Eligible for Benefits
The Claremont Colleges offers benefits to full-time, part-time and temporary
employees who meet eligibility requirements. You can also enroll your spouse or
domestic partner and your eligible child(ren) for coverage.
Your Benefits
Employee Type
Effective Date
Close of Eligibility
All Benefits-Eligible Employees
First day of the month after date of hire;
or date of hire when date of hire is the first
day of the month. Enrollments received
in Benefits Administration prior to initial
eligibility date become effective on the initial
eligibility date, not sooner.
31 days from eligibility date.
First of the month following 30 days after
the 12-month measurement period in which
the temporary employee works at least 30
hours per week as defined by the Affordable
Health Care Act. Temporary employees hired
before January 1, 2016, and who have been
granted benefits will be grandfathered.
2
Interim Employees
(Except Temporary Employees)
Temporary Employees
Student Employees
1, 2
1
Who’s Eligible
Close of eligibility for new faculty with a July 1 date
If You Are NOT Eligible for
Health Benefits
of hire is 60 days after date of hire. The effective date
for all benefits other than Basic Group Life Insurance
GetInsured
may be August 1.
Covered California
Applications received in Benefits Administration prior
to the close of eligibility date become effective on
Eligible Dependents
the initial effective date. Applications received after
close of eligibility date cannot be accepted. Affected
Enrolling for Benefits
employees are required to reapply at a subsequent
open enrollment period.
2016 Plan Rates
Wellness Resources
First of the month following 60 days after
the 12 month measurement period in which
the student works at least 30 hours per week
as defined by the Affordable Health Care
Act.
Retirement Plan
For more detailed eligibility information, see the Statement of Benefit Eligibility
for Centrally Administered Employee Benefits Programs.
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Forms
Notices
Open Enrollment Guide
2016 Benefits Guide
If You Are NOT Eligible for Health Benefits
The Affordable Care Act’s individual mandate requires you to have medical
coverage in 2016. If you are not eligible for health benefits through The Claremont
Colleges, there are several resources you can use to find comprehensive coverage,
including the public insurance marketplaces. You cannot be denied coverage
through these public insurance marketplaces, and you may be eligible for tax
credits that lower the cost of health insurance.
Contact GetInsured
Call 877-917-7957 or visit
GetInsured
www.GetInsured.com/Mercer for
GetInsured is a personalized service that can link you to a variety of quality
medical plan options available through the public insurance marketplaces.
Through GetInsured, you can compare health insurance plans and find one that
best meets your needs and budget. You can find out if you are eligible for tax
credits that will lower your coverage costs, and you can enroll in a plan that
specifically meets your unique medical needs. Every plan includes great benefits
like preventive doctor visits, prescriptions, birth control and emergency care.
With GetInsured, a licensed agent can help you navigate your insurance options,
determine if you are eligible for tax credits, and help you get enrolled so that
your coverage can begin by January 1, 2016.
personalized service.
Your Benefits
Who’s Eligible
If You Are NOT Eligible for
Health Benefits
GetInsured
Covered California
Open Enrollment Through the Public
Marketplaces
Open Enrollment through the public
insurance marketplaces, including Covered
California, begins November 1, 2015. The
deadline to enroll in coverage beginning
January 1, 2016 is December 15, 2015.
Eligible Dependents
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Covered California
The state of California provides a public insurance marketplace, Covered
California, for California residents needing health care coverage. Visit
www.CoveredCA.com to explore a variety of comprehensive insurance plans
that you can enroll in for coverage starting January 1, 2016.
Who to Contact
Forms
Notices
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Eligible Dependents
When you enroll, you can enroll your eligible dependents in the same coverage
you are selecting for yourself, including medical, dental and vision coverage, as
well as supplemental life and accident insurance.
Your eligible dependents include:
To Enroll Your Dependents for Coverage…
●● Your spouse
You will need:
●● Your domestic partner
●● Your children (including the children of your domestic partner) who are:
–– Up to age 26
–– Any age who are mentally or physically disabled and meet certain
requirements.
●● the dependent(s) name(s),
●● relationship to employee,
●● marriage/birth certification or other form
Your Benefits
Who’s Eligible
If You Are NOT Eligible for
Health Benefits
GetInsured
Covered California
of documentation proving life event,
Eligible Dependents
●● dependent Social Security number, and
Enrolling for Benefits
●● date of birth.
2016 Plan Rates
Wellness Resources
Retirement Plan
Domestic Partner Coverage
The IRS does not recognize domestic partners as legal dependents for purposes
of tax reporting. For this reason, The Claremont Colleges must report the value
(employer subsidy) of medical benefits. Employee contributions for domestic
partner benefits are made after tax. For California-registered domestic partners
or married domestic partners, deductions are made on a pre-tax basis for state
withholding. The employer contributions of health and/or dental benefits must be
included in the employee’s taxable income for federal and state withholding for
any state other than California for registered and married domestic partners.
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Who to Contact
Forms
Notices
Open Enrollment Guide
2016 Benefits Guide
Enrolling for Benefits
To enroll for benefits when you are first eligible or when you have a qualified life
event during the year, contact Benefits Administration. See Who to Contact for
CUC Benefits Administration.
When to Enroll
Enrolling During Open Enrollment?
See How to Enroll in the 2016 Open
When You Are First Eligible
Enrollment Guide for enrollment instructions.
When you are first eligible for benefits coverage, you have 31 days from your
eligibility date to enroll in health benefits. If you do not enroll during the first
31 days after your eligibility date, you will only be enrolled in coverage that’s
automatically provided to you (i.e., core vision, Employee Assistance Program,
basic life, long-term disability, and the Academic Retirement Plan).
When a Qualified Life Event Occurs
After your initial eligibility enrollment period, you may change your benefits
during Open Enrollment or when you experience a qualified life event. Qualified
life events include:
Your Benefits
Who’s Eligible
Enrolling for Benefits
When to Enroll
When Coverage Begins
2016 Plan Rates
Benefits elected when you are first eligible
Wellness Resources
will be effective on the 1st of the month
following hire or, if you are hired on the
Retirement Plan
1st of the month, benefits will be effective
immediately.
●● Marriage, divorce, or legal separation
●● Birth or adoption
●● A dependent that becomes ineligible for coverage
●● Death of your spouse or one of your children
●● Change in work status of your spouse/domestic partner
●● Employee enrolling in Medicare Part B
If you experience a qualified life event, you may change your coverage within
30 days of the event. Necessary documentation will be required. Contact
Benefits Administration for more information about what qualifies as a life event,
including exceptions. See Who to Contact for CUC Benefits Administration.
Who to Contact
Forms
Notices
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2016 Plan Rates
To review your monthly plan rates for benefits, click your school’s logo below:
At No Cost to You…
The Claremont Colleges pays 100% of the cost
Your Benefits
Who’s Eligible
of coverage for:
Enrolling for Benefits
●● Core vision coverage (employee-only)
2016 Plan Rates
●● Basic Life Insurance
Wellness Resources
●● Long-term disability*
Retirement Plan
●● Employee Assistance Program (EAP).
All benefit premium deductions for health, dental, vision, health savings account
(HSA) and flexible spending accounts (FSA) coverage are taken on a pre-tax
basis unless otherwise requested. Benefit deductions are taken in the current
month of coverage.
* RSABG employees pay 50% of the cost for
Long-term disability insurance.
Who to Contact
Forms
Notices
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Wellness Resources
The Claremont Colleges recognizes that wellness is an important component
of helping you create and maintain a healthy lifestyle. The wellness programs
offered by Anthem Blue Cross HMO (CaliforniaCare)/Anthem Lumenos and
Kaiser Permanente provide tools and information that can help you make
important healthy lifestyle choices. These programs enhance your core benefits
by offering savings on alternative health and wellness products
and services.
Your Benefits
Who’s Eligible
Enrolling for Benefits
All employees are eligible to participate in the wellness programs offered by
their respective health plans. Whether you are looking for help to quit smoking,
creating an exercise plan, or need some nutritional guidance, these programs
offer you the tools to help you get there. See Wellness Offerings from Your Plan
Provider for a list of the tools and programs available from our medical plan
carriers.
2016 Plan Rates
Wellness Resources
Retirement Plan
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Wellness Offerings from Your Plan Provider
Your plan providers offer a number of health and wellness services that are covered
for free under your medical plan:
Anthem Blue Cross HMO and Lumenos HDHP
●● Free preventive care (in-network only for Lumenos HDHP members)
●● Free immunizations like the annual flu shot and pneumonia vaccine
●● 24/7 Nurseline provides an on-call nurse that you can call at any time, day or night
●● Future Moms is a no-cost resource to expecting mothers who want to access advice
Your Benefits
Start Today!
To access these helpful tools from Anthem visit
Who’s Eligible
Enrolling for Benefits
www.anthem.com/ca to get started.
nurses and specialists, wellness info, and health screenings
2016 Plan Rates
●● Condition Care provides on-hand advice nurses and other resources to members
Wellness Resources
affected by chronic and long-term health problems including asthma, diabetes, and
heart failure.
Retirement Plan
●● LiveHealth Online (LHO) gives you quick and easy 24/7 access to doctors, including
private video chats. LHO consultations are covered by your regular copay.
●● MyHealth Record is a feature of Anthem’s website that stores your medical and
immunization records all in one place.
●● 360°Health offers an online library of health-related information and tools to help
members with anything from managing a condition to organizing health records
●● Discounts on eye care and eye care vendors for services like Premier LASIK
●● Discounts on health programs and fitness clubs, such as Weight Watchers and
Gold’s Gym
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Kaiser Permanente HMO
●● Free preventive care
●● Free immunizations like the annual flu shot and pneumonia vaccine
●● Healthy Lifestyle Programs cover:
–– Health Assessment
–– Maternity and pregnancy
–– Pain management
–– Weight loss
–– Nutrition
–– Smoking cessation
–– Depression and stress management
–– Insomnia
–– Diabetes management
–– Chronic condition management
Start Today!
To access these helpful tools from Kaiser,
visit www.kp.org or call Member Services at
800-464-4000.
Your Benefits
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
●● Wellness Coaching encourages members to focus on health and wellness
Retirement Plan
improvement initiatives
●● ChooseHealthy is a website that offers discounts on fitness and health club
membership rates and other health-improving resources such as health and fitness
books, videos and personalized exercise and nutrition plans
●● Discounts on alternative care services for acupuncture or massage therapy
Who to Contact
Forms
Notices
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Retirement Plan
Academic Retirement Plan (ARP)
The Academic Retirement Plan (ARP) is the primary retirement plan for The
Claremont Colleges. All faculty and staff (excluding students) are eligible to
participate in the ARP through voluntary elective deferrals upon date of
hire. Eligibility for employer contributions is dependent upon job classification,
satisfying a service requirement, and attainment of age 21. Check with your
Human Resources Office for information on your institution’s ARP eligibility
requirements for employer contributions. Different retirement plan options apply
for employees of Rancho Santa Ana Botanic Garden.
Your Benefits
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
How to Enroll
Retirement Plan
Eligible employees can enroll online through www.tiaa-cref.org/
theclaremontcolleges or by completing and returning a paper enrollment form
to the CUC Benefits Office. If an enrollment form is not completed within 30
days of your eligibility date for employer contributions, contributions made on
the employee’s behalf will be made by default to the appropriate Vanguard
Target Retirement Fund for his/her age as described in the enrollment materials
provided by the Human Resources Office.
Contributions
Employer contributions are made as a percentage of eligible compensation.
Employee voluntary elective deferrals can be made on a pre-tax or Roth aftertax basis. Employer and employee contributions are remitted to your TIAA-CREF
account after every pay period.
Vesting
Contributions are vested 100% immediately upon participation in the ARP.
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Distributions
You are able to take a distribution from the Academic Retirement Plan if you
meet one of the following criteria:
●● Termination of employment for employer or employee contributions
●● Reaching age 59½ for employee elective deferrals
Your Benefits
●● Meeting minimum loan requirements and/or qualifying under Internal Revenue
Who’s Eligible
Service (IRS) Safe Harbor Hardship Withdrawal Guidelines for employee
elective deferrals
Enrolling for Benefits
2016 Plan Rates
●● Death of the employee
For more information on the Academic Retirement Plan, click here.
Wellness Resources
Retirement Plan
Who to Contact
Forms
Notices
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Who to Contact
CUC Benefits Administration
If you have questions about your benefits or for additional information on new enrollment,
changes or cancellation of your benefits, contact CUC Benefits Administration.
Contact
Phone
Email
Carol Saldivar
Director Benefits Administration
909-607-3195
carol_saldivar@cuc.claremont.edu
Monica Villanueva
Lead Benefits Representative/
Systems Specialist
909-607-3684
monica_villanueva@cuc.claremont.edu
Anna Huerta
Benefits Representative
909-607-9494
anna_huerta@cuc.claremont.edu
Claudia Garcia
Benefits Representative
909-607-9493
claudia_garcia@cuc.claremont.edu
Alicia Silva
Benefits Representative
909-621-8049
alicia_silva@cuc.claremont.edu
Tony Romero
Retirement Analyst
909-621-8805
tony_romero@cuc.claremont.edu
Loo Hsing,
Senior Benefits Analyst
909-607-3780
loo_hsing@cuc.claremont.edu
Lissette Martinez
Workers’ Compensation &
Disability Administrator
909-621-8847
lissette_martinez@cuc.claremont.edu
Arcy Serrano
VDI & Return to Work
Coordinator
909-607-7946
araceli.serrano@cuc.claremont.edu
Your Benefits
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
Who to Contact
Benefits Administration Offices
Plan Providers
Forms
Notices
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Plan Providers
You may also contact the providers directly with specific benefit coverage questions.
Provider or Department
Phone
Website Address
Anthem Blue Cross HMO
(CaliforniaCare)
800-227-3771
www.anthem.com/ca
Anthem Lumenos HDHP
866-207-9878
www.anthem.com/ca
Kaiser Permanente
800-464-4000
www.kp.org
Who’s Eligible
Benefit Wallet HSA
877-472-4200
https://mybenefitwallet.com/
Enrolling for Benefits
MetLife Dental
800-942-0854
www.metlife.com
Anthem Vision
866-723-0515
www.anthem.com
PayFlex FSA Administration
888-678-8242
www.PayFlexDirect.com
Wellness Resources
United Behavioral Health—
Employee Assistance Program
800-234-5465
www.liveandworkwell.com/default.asp?
ProgramPIN=claremontcolleges
Retirement Plan
The Standard Life Insurance
Medical underwriting:
800-843-7979
Life claims: 800-628-8600
www.standard.com
Zurich Voluntary AD&D
866-841-4771
www.zurichna.com
Genworth—Long-Term Care
(Policies issued on or after
1/1/2012)
800-416-3624
http://genworth.com/groupltc
Username: Claremont
Password: groupltc
Your Benefits
2016 Plan Rates
Who to Contact
Benefits Administration Offices
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Forms
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Plan Providers (Continued)
Provider or Department
Phone
Website Address
TIAA-CREF
800-842-2776
www.tiaa-cref.org
Medicare
800-MEDICARE (800-633-4227) www.medicare.gov
Health Insurance Counseling & Advocacy
Program
Your Benefits
●● Los Angeles County (Center for Health
213-383-4519
www.chcsbc.org
●● Orange County (Council on Aging)
714-560-0424
www.coaoc.org
909-256-8369
www.hicapsbc.org
Assist America (In conjunction with
Business Travel Accident policy through
AC Newman)
609-986-1234
www.assistamerica.com
Worldwide Travel Assistance through AIG
877-832-3523
Care Rights)
●● San Bernardino County (HICAP of San
Bernardino County)
Who’s Eligible
Enrolling for Benefits
2016 Plan Rates
Wellness Resources
Retirement Plan
assistance@aig.com
Group Name: Claremont University Consortium
Policy #: GLB 0009148392
Who to Contact
Benefits Administration Offices
Plan Providers
Forms
Notices
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Forms
Use the links below to open the corresponding form:
Form
What It Means for You
The Standard Evidence of Insurability (EOI) Form:
Print Form
Online Form
To confirm you are generally in good health when electing or
increasing life insurance with The Standard
Domestic Partner Affidavit
To verify unmarried domestic partner relationship
PayFlex FSA and LPFSA Claim Form
To file a claim for reimbursement from your FSA
Enrolling for Benefits
Long-Term Disability (EOI) Form
To confirm you are generally in good health when electing
long-term disability coverage (for RSABG only)
2016 Plan Rates
Life Insurance Beneficiary Change Form
AD&D Insurance Beneficiary Change Form
To change and verify your elected beneficiaries for Life and AD&D
insurance. You must log in to your account to establish or change
your beneficiaries
Benefits Election Form
To elect benefits during the year if you experience a qualified
life event
MetLife Dental Claim Reimbursement Form
To file a claim for reimbursement from MetLife for dental service
received from an out-of-network provider
Your Benefits
Who’s Eligible
Wellness Resources
Retirement Plan
Who to Contact
Forms
Notices
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Notices
Federal laws require that The Claremont Colleges provides you with certain
notices that inform you about your rights regarding eligibility, enrollment and
coverage of health care plans. The following sections explain these rules; please
read them carefully. Click the notice in the table below for more information.
Notice
●● The Affordable Care Act (ACA) and Health Insurance
Marketplaces
●● Life Event Changes Information Sheet
What it Means for You
Who’s Eligible
Describes the Patient Protection and Affordable Care Act
(often referred to as the “Affordable Care Act” or “health care
reform law”)
Enrolling for Benefits
Describes qualified life events that allow you to make changes
to your benefits outside the Open Enrollment period
●● Special Enrollment Rights
●● Women’s Health and Cancer Rights Act of 1998
●● Newborns’ and Mothers’ Health Protection Act
●● Consolidated Omnibus Budget Reconciliation Act (COBRA)
●● Medicaid and the Children’s Health Insurance Program (CHIP)
Notice
●● Health Insurance Portability and Accountability Act (HIPAA)
●● Your Prescription Drug Coverage and Medicare
●● Physician Designation Form
Your Benefits
Describes when you can enroll for coverage when you have
previously declined coverage
2016 Plan Rates
Wellness Resources
Retirement Plan
Provides information regarding a woman’s rights after a
mastectomy
Describes protections for mothers and their newborn
children relating to the length of their hospital stays following
childbirth
Provides details about how COBRA can provide ongoing
health benefits after coverage ends under certain conditions
A list of states that have premium assistance programs to
help you pay for medical coverage if you are unable to afford
health care coverage premiums
Describes your rights to health privacy
Explains that prescription drug coverage through The
Claremont Colleges is as good as, or better than, Medicare
prescription drug coverage
Provides information regarding the selection of a primary care
physician as required by HMO plans
●● Summary Annual Reports
●● Summary of Benefits and Coverage
–– Kaiser Permanente HMO
–– Anthem Blue Cross HMO
–– Anthem Lumenos HDHP
–– Anthem Blue Card Lumenos HDHP (for out-of-area participants)
Annual reports of The Claremont Colleges benefits
Summarizes important information about your health
coverage options in a standard format to help you compare
each option
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Special Enrollment Rights
Special enrollment events allow you and your eligible dependents
to enroll for health coverage outside the Open Enrollment period
under certain circumstances if you lose eligibility for other
coverage, become eligible for state premium assistance under
Medicaid or the State Children’s Health Insurance Program (CHIP),
or acquire newly eligible dependents. This is required under the
Health Insurance Portability and Accountability Act (HIPAA).
If you decline enrollment in The Claremont Colleges medical plan
coverage for you or your dependents (including your spouse/
domestic partner) because of other health insurance coverage,
you or your dependents may be able to enroll in a Claremont
Colleges medical plan without waiting for the next Open
Enrollment period if you:
1. Lose other coverage. You must request enrollment within 30
days after the loss of other coverage.
2. Gain a new dependent as a result of marriage, birth, adoption
or placement for adoption. You must request enrollment within
30 days after the marriage, birth, adoption or placement for
adoption.
Women’s Health and Cancer Rights
Act of 1998
The act requires that all group health plans providing medical
and surgical benefits with respect to a mastectomy must provide
coverage for all of the following:
●● Reconstruction of the breast on which a mastectomy has been
performed
●● Surgery and reconstruction of the other breast to produce a
symmetrical appearance
●● Prostheses
●● Treatment of physical complications of all stages of mastectomy,
including lymphedemas
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This coverage will be provided in consultation with the attending
physician and the patient, and will be subject to the same
annual deductibles and coinsurance provisions, which apply for
the mastectomy. For deductibles and coinsurance information
applicable to the plan in which you enroll, please refer to the plan
descriptions.
3. Lose Medicaid or Children’s Health Insurance Program (CHIP)
coverage because you are no longer eligible. You must request
enrollment within 60 days after the loss of such coverage.
In addition, you may enroll in a Claremont Colleges medical plan if
you become eligible for a state premium assistance program under
Medicaid or CHIP. You must request enrollment within 60 days after
you gain such coverage.
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Newborns’ and Mothers’ Health
Protection Act
Consolidated Omnibus Budget
Reconciliation Act (COBRA)
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 issuer
for prescribing a length of stay not in excess of 48 hours (or
96 hours).
If you are an employee with medical, dental or vision coverage
through The Claremont Colleges, you have the right to choose
continuation coverage if you lose your group health coverage
due to reduction in your hours of employment or the termination
of your employment for reasons other than gross misconduct.
Your eligible dependents may also have the right to elect and pay
for continuation of coverage for a temporary period in certain
circumstances where coverage under the plan would otherwise
end, such as divorce, or dependent children who no longer meet
eligibility requirements.
Important Note: This brief summary of the right you and your
dependents have to continue insurance is not intended as the
official notice of your rights required by federal and state law.
We’ve included this brief summary to inform you that you have
these rights. You will receive a separate, detailed explanation of
your right to continue health insurance coverage when applicable.
Specific information is also available from Benefits Administration
at 909-621-8151.
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You can also call 800-MEDICARE (800-633-4227). TTY users
should call 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 800-772-1213 (TTY 800-325-0778).
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Premium Assistance Under Medicaid and the
Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and
you’re eligible for health coverage from your employer, your state
may have a premium assistance program that can help pay for
coverage, using funds from their Medicaid or CHIP programs.
If you or your children aren’t eligible for Medicaid or CHIP, you
won’t be eligible for these premium assistance programs, but you
may be able to buy individual insurance coverage through the
Health Insurance Marketplace. For more information, visit
www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or
CHIP and you live in a state listed below, you can contact your
state Medicaid or CHIP office to find out if premium assistance is
available.
If you or your dependents are NOT currently enrolled in Medicaid
or CHIP, and you think you or any of your dependents might be
eligible for either of these programs, you can contact your
state Medicaid or CHIP office or dial 1-877-KIDS NOW or
www.insurekidsnow.gov to find out how to apply. If you qualify,
ask your state if it has a program that might help you pay the
premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance
under Medicaid or CHIP, as well as eligible under your employer
plan, your employer must permit you to enroll in your employer
plan if you aren’t already enrolled. This is called a “special
enrollment” opportunity, and you must request coverage within
60 days of being determined eligible for premium assistance. If
you have questions about enrolling in your employer plan, you can
contact the Department of Labor at www.askebsa.dol.gov or call
866-444-EBSA (3272).
You may be eligible for assistance paying your employer health
plan premiums—contact the State of California for further
information on eligibility:
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Website:
http://www.dhcs.ca.gov/services/Pages/TPLRD_CAU_cont.aspx
Health Insurance Portability and
Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act of 1996
(HIPAA) limits the circumstances under which coverage may be
excluded for medical conditions present before you enroll. Under
the law, a preexisting condition exclusion generally may not be
imposed for more than 12 months (18 months for a late enrollee).
The 12-month (or 18-month) exclusion period must be reduced by
prior health coverage as long as there was no break in coverage
equal to or exceeding 63 days. In other words, you will be given
credit, based on your prior coverage, toward satisfying any
applicable preexisting condition exclusion imposed by the plan.
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Your Prescription Drug Coverage and
Medicare
The key purpose of this notice is to advise you that the
prescription drug coverage you have under the Claremont
University Consortium Health and Welfare Plan is expected to
pay out, on average, at least as much as the standard Medicare
prescription drug coverage will pay in 2016. (This is known as
“creditable coverage.”) Please read this notice carefully and keep
it where you can find it.
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