Human Resources, St. Norbert College, De Pere, WI 54115, (920) 403-3211 2016 ST. NORBERT COLLEGE HOURLY NONCASH COMPENSATION St. Norbert College (hereinafter referred to as Employer) is proud of the noncash compensation it makes available to eligible employees. Health Insurance Administrator United Medical Resources (www.umr.com) Eligibility .75 FTE with 1st of the month following employment as effective date. Domestic Partner Coverage Same sex domestic partners are eligible for coverage (need declaration from residing county court) Plan Monthly Rates Single Employee + 1 Family Spouse/Domestic Partner Surcharge PPO – Preferred Provider HDHP (Health Savings Account - HSA Plan) $105 $209 $311 $79 $160 $237 $75 per month Plan Year January 1st – December 31st Lifetime Max Unlimited Deductible In-Network Out-of-Network Embedded Deductible $750 (Single); $1,500 (EE+1); $2,250 (Family) $1,001 (Single); $2,002 (EE+1); $3,303 (Family) Non-Embedded Deductible $2,000 (Single); $4,000 (Family) $4,000 (Single); $8,000 (Family) Coinsurance In-Network Out-of-Network 80% 60% 90% 70% Includes deductible and medical &Rx copays $1,500 (Single); $3,000 (EE+1); $4,500 (Family) $3,000 (Single); $6,000 (EE+1); $9,000 (Family) Includes Deductible $4,000 (Single); $8,000 (Family) $8,000 (Single); $16,000 (Family) N/A $500 (Single); $750 (Family) $20 Copay; then Deductible, 80% Coinsurance $20 Copay; then Deductible, 60% Coinsurance Deductible, 90% Coinsurance Deductible, 70% Coinsurance Out-of-Pocket Max In-Network Out-of-Network H.S.A. Annual Employer Contribution Office Visits/Instacare In-Network Out-of-Network Routine/Preventive In-Network Out-of-Network Inpatient Hospital In-Network Out-of-Network Outpatient Hospital In-Network Out-of-Network 100% 100% 100% Deductible, 70% Coinsurance Deductible, 80% Coinsurance Deductible, 60% Coinsurance Deductible, 90% Coinsurance Deductible, 70% Coinsurance Deductible, 80% Coinsurance Deductible, 60% Coinsurance Deductible, 90% Coinsurance Deductible, 70% Coinsurance Urgent Care In-Network Out-of-Network $50 Copay; then Deductible, 100% Coinsurance $50 Copay; then Deductible, 100% Coinsurance Deductible, 90% Coinsurance Deductible, 70% Coinsurance Emergency Room In-Network Out-of-Network $100 Copay; then Deductible, 100% Coinsurance Same as In-Network Benefit Deductible, 90% Coinsurance Same as In-Network Benefit Ambulance Services In-Network Out-of-Network Deductible, 100% Coinsurance Same as In-Network Benefit Deductible, 90% Coinsurance Retail Prescriptions Generic Brand/Formulary Non-Formulary 25% ($10 Minimum, $50 Maximum) Rx copays will double for Maintenance Medications if you continue to use retail after 2 consecutive fills. Cost will increase to 50% ($20 min/$100 max) Deductible, 90% Coinsurance Deductible, 90% Coinsurance Mail Order Prescriptions Generic Brand $30 Copay $90 Copay Generic Preventive HDHP Drugs are covered at 100% (Mail Order Only). Contraceptive Coverage No coverage, but members legal right to access coverage is accommodated through UMR HSA Plan Notice (In-Network) No individual family member's deductible is considered satisfied until the full family deductible has been met. However, no individual family member can exceed $6,650 in out-of-pocket expenses per year. The out-of-pocket limit for all family members combined remains at $8,000. PPO Network - United Health Care Choice Plus Network (www.uhc.com/find_a_physician.htm) Dental Insurance Plan Administrator Delta Dental (www.deltadentalwi.com) Eligibility .75 FTE with 1st of the month following employment as effective date. Monthly Rates - Single = $26.45 - 1 + 1 = $52.87 - Family = $101.69 Coverage 100% - Diagnostic and Preventive Services 80% - Basic Services 50% - Major Services such as Crowns, Inlays, Onlays, Bridges, Dentures, and Implants Annual Max $1,000 per person annual maximum ($1,000 lifetime maximum for orthodontic services) Dentist List Freedom to choose any dentist but can receive discounts if you choose one of Delta Dental’s Premier or PPO Dentists Flexible Spending Account Plan Description Allow employees to set aside, or “bank,” pretax portions of their wages to be used to pay for a variety of medical and dependent care expenses (i.e., deductible, co pays, Rx, Glasses, dental, childcare). Eligibility .75 FTE with 1st date of employment as effective date. Medical Maximum of $2,550 may be set aside for medical expenses. If participating in the HDHP plan, may contribute to Limited Flexible Spending Account plan. Dependent Maximum of $5,000 may be set aside for dependent care expenses. *Note Enrollment in either plan is optional. *Note The plan year is January 1 through December 31 of each year and coincides with the plan year for health insurance. *Note $500 Rollover provision into next plan year with medical plan. Anything more than that not used by employee is forfeited. Short-Term Disability Eligibility .75 FTE with 1st of the month following employment as effective date. Coverage 67% of employee’s basic monthly salary. *Note Employer provides this insurance at no cost to the Employee. *Note After a 7-day elimination period, provides income protection during a period of total disability (through the 90th day of disability) resulting from illness or injury which renders Employee incapable of performing his or her normal occupation. Long-Term Disability Eligibility .75 FTE with 1st of the month following employment as effective date. Coverage 67% of employee’s basic monthly salary. *Note Employer provides this insurance at no cost to the Employee. *Note Provides income protection during a long term period of disability resulting from illness or injury which renders Employee incapable of performing his or her normal occupation or later gainful occupation for which he or she reasonably fits. *Note Disability insurance payments begin on the 91st day of a disability. Staff Parental Leave Eligibility .75 FTE and after 1 year of continuous service. Coverage Staff Member may take up to 6 weeks of leave. Leave must be taken in consecutive weeks and must be started and completed within the 1st twelve weeks of the birth or adoption. The first week is a waiting period which the staff member can take as unpaid or substitute vacation or PTO. The remaining weeks will be paid at 67%. *Note The goal of this policy is to provide non-birthing staff members with paid time off that allows them to accommodate their professional and personal familial obligations as a child is added to the staff member’s family. Term Life Insurance / Accidental Death and Dismemberment Insurance Eligibility .75 FTE with 1st of the month following employment as effective date. Coverage Two times the Employee’s annual salary at no cost to the Employee. *Note An accidental death and dismemberment rider is included with this policy. *Note Reduction rules apply beginning at age 65. Optional Life Insurance Eligibility .75 FTE with 1st of the month following employment as effective date. Coverage Employee can purchase an additional 1 times their annual salary in coverage. Monthly Rate Variable rate depending on age group. Optional Accidental Death and Dismemberment Insurance Eligibility .75 FTE with 1st of the month following employment as effective date. Coverage Available to Employees in multiples of $10,000 up to a maximum of $250,000, with the limitation that employees may not select a principal sum that is larger than an amount equal to 10 times their annual salary. Monthly Rate Individual Coverage = $.50 for every $10,000 up to $250,000 Family Coverage = $.70 for every $10,000 up to $250,000 *Note A family plan is available that allows for the coverage of spouses and dependents as well as employees. Retirement Plan Administrator Teachers Insurance Annuity Association (TIAA) and College Retirement Equities Fund (CREF) Eligibility Employees may choose to participate in the TIAA-CREF plan immediately upon employment. Participation in the plan is completely elective. TIAA A nonprofit legal reserve, life insurance, and annuity company founded in 1918 and incorporated in New York State. CREF A separate nonprofit corporation, companion to TIAA, established in 1952 to provide variable annuities based on common stocks and other equity securities. TIAA-CREF Together they constitute a defined contribution retirement plan in which both the Employer and Employee participate. Defined Contributions Contributions are based on regular earnings only, and both Employer and Employee contributions are sent to TIAACREF after each pay period. Contribution levels are as follows and can be made as pre-tax or post-tax: Employee St. Norbert College 2% 5% 3% 6% 4% 7% 5% 9% *Note Employer contribution will begin when the Employee begins participation in the plan. *Note The intended purpose of the funds is to provide retirement income and death benefits for participants and their families. Group Supplemental Retirement Annuities Deductions May not exceed the limitations of sections 403 (b) and 415 of the Internal Revenue Code *Note Employer allows Employees to participate in supplemental retirement annuity programs designed for those who want to set aside tax-deferred funds. *Note This plan has a “hardship” or “loan” provision. Group Long-term Care Insurance Eligibility .75 FTE with 1st of the month following employment as effective date. *Note Voluntary plan that provides guarantee issue to employees 65 and under. Benefit can also be used by spouses, immediate family members, and some extended family member classes. *Note Insurance that helps pay a daily benefit for home care, assisted living facility, and nursing home facility expenses. Can help protect personal assets such as retirement or pension plans. This plan is portable. Tuition Waiver Eligibility Effective after one year of full-time employment (must be .75 FTE or greater). *Note Employer offers tuition waivers to full-time Employee, his or her spouse, and his or her dependent children in accordance with current College policy. Tuition Exchange Eligibility Effective after 3 years of full-time employment (must be .75 FTE or greater). *Note Employer offers tuition exchange to full-time Employee’s dependent children in accordance with current College policy. Educational Assistance for Master’s Programs Eligibility A Participant is eligible to receive benefits under the Plan if he/she has completed one year of full time service (.75 or Greater FTE) prior to the first day of classes for the applicable academic term. In order for the Participant to receive benefits under the Plan, the employee must be employed for the complete duration of the academic term. *Note In any Plan Year during which an employee is a Participant in the Plan, the College may (contingent on the availability of financial resources) reimburse up to a maximum of $500 in tuition expenses in each academic term for an educational course. The Participant must secure a grade of “B” or better or its equivalent in the educational course to receive reimbursement. Expenses must be validated by receipts and a copy of the final grade must be presented. The maximum annual reimbursement per Participant will be $2,000. CatholicLink Tuition Discount Eligibility .75 FTE or greater full time employees *Note St. Norbert College, Notre Dame Academy, and the Green Bay Area Catholic Education have partnered together to provide a discount program for dependents of employees working at those organizations with the goal of providing exceptional faith-based educational experiences for students. Faculty and staff at any of these organizations will be eligible to receive at least a 50 percent discount on tuition for each of their dependents to attend any of the three organizations – regardless of which of the three employs them. *Note This program applies only to undergraduate programs at St. Norbert College, 9 – 12th grades at Notre Dame Academy, and K-8th grades at Green Bay Area Catholic Schools. Personal Time Off (PTO) Eligibility .75 FTE with 1st date of employment as effective date. *Note Employees will receive 6 days of PTO starting 8/16 each year to be used only as time off, with no carry over; new hires will have a prorated amount based on hire date. *Note PTO may be used as time off for illness or injury as well as scheduled for personal business. *Note Employees will be awarded PTO hours based on the number of hours worked if between .75 and 1.00 FTE. Vacation Less than 4 years service 12 days/year or 3.70 hours/pay period 4 but less than 8 15 days/year or 4.62 hours/pay period 8 but less than 11 18 days/year or 5.54 hours/pay period 11 but less than 15 21 days/year or 6.47 hours/pay period 15+ years 25 days/year or 7.70 hours/pay period *Note Employees will be able to accrue up to 125% of the annual vacation amount. *Note Employees will accrue vacation based on the FTE. Accrual above is based on 1.00 FTE. Holidays -New Year’s Day -Good Friday -Memorial Day *Note -Labor Day -Thanksgiving Day -Day after Thanksgiving -Independence Day -Christmas Day There are also two days paid as holidays that vary from year to year but occur during the Christmas/New Year holiday season Funeral Leave Immediate Up to 5 days for immediate family (parent, step-parent, spouse, child or step-child, brother/sister, parent-in-law, brother/sister-in-law, children-in-law). Extended Up to 2 days for extended family (grandparent, aunt, uncle, cousin, niece/nephew, grandparent-in-law, grandchild) up to 2 days. Jury Duty and Military Leave *Note Employees shall receive the difference between their normal pay and remuneration for jury duty or military leave pay if they earn less than their normal daily rate while performing these services. *Note A copy of any jury duty pay shall be forwarded to the College and the College shall pay the employee through the normal payroll process. *Note St. Norbert College supports public policy and regulations to leaves for military service and complies with all state and federal regulations regarding leave, pay and reinstatement rights. Worker’s Compensation *Note Should you lose work time or incur medical expenses because of a work-related accident, you will be compensated by this insurance program according to Wisconsin law. Family & Medical Leave Eligibility After you have worked for the college for 12 months and meet certain other criteria. *Note Authorized absences may be for up to 12 weeks in a calendar year. *Note FMLA is an unpaid leave that does allow substitution of any paid time an employee has accrued. Miscellaneous Additional Benefits Direct Deposit Use any bank or financial institution (mandatory). Parking Free in specified lots with proper automobile identification. Sports Center Free us of facilities with authorized ID. Athletic Events Free or reduced admission price for most events upon presentation of authorized ID. Spouses/Dep Children Eligible for an authorized ID entitling them to free use of the Schuldes Sports Center and its facilities, free or reduced admittance to most athletic events, and use of the Miriam B. and James J. Mulva Library. For Further Information Contact: Jesse Albers Manager of HRIS, Compensation, & Benefits (920) 403-3982 E-mail: jesse.albers@snc.edu St. Norbert College 100 Grant Street De Pere, WI 54115-2099 St. Norbert College is committed to the highest moral and ethical standards and to the spirit as well as the letter of law, in all its employment policies and practices. It adheres to all policies of nondiscrimination on the basis of age, race, religion, creed, color, handicap, marital status, sex, sexual orientation, national origin, ancestry, arrest record, veteran’s status, non job-related arrest record or conviction as defined by current Federal and State statutes, as well as in its admissions practices, educational programs and activities, as required by Title IX of the 1972 Education Amendments and code of Federal Regulations. The College insists on a good faith effort on the part of all its employees in the area of equal employment. EMPLOYEE RIGHTS AND RESPONSIBILITIES UNDER THE FAMILY AND MEDICAL LEAVE ACT Basic Leave Entitlement Use of Leave FMLA requires covered employers to provide up to 12 weeks of unpaid, jobprotected leave to eligible employees for the following reasons: • For incapacity due to pregnancy, prenatal medical care or child birth; • To care for the employee’s child after birth, or placement for adoption or foster care; • To care for the employee’s spouse, son or daughter, or parent, who has a serious health condition; or • For a serious health condition that makes the employee unable to perform the employee’s job. An employee does not need to use this leave entitlement in one block. Leave can be taken intermittently or on a reduced leave schedule when medically necessary. Employees must make reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt the employer’s operations. Leave due to qualifying exigencies may also be taken on an intermittent basis. Military Family Leave Entitlements Eligible employees with a spouse, son, daughter, or parent on active duty or call to active duty status in the National Guard or Reserves in support of a contingency operation may use their 12-week leave entitlement to address certain qualifying exigencies. Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings. FMLA also includes a special leave entitlement that permits eligible employees to take up to 26 weeks of leave to care for a covered service member during a single 12-month period. A covered service member is a current member of the Armed Forces, including a member of the National Guard or Reserves, who has a serious injury or illness incurred in the line of duty on active duty that may render the service member medically unfit to perform his or her duties for which the service member is undergoing medical treatment, recuperation, or therapy; or is in outpatient status; or is on the temporary disability retired list. Substitution of Paid Leave for Unpaid Leave Employees may choose or employers may require use of accrued paid leave while taking FMLA leave. In order to use paid leave for FMLA leave, employees must comply with the employer’s normal paid leave policies. Employee Responsibilities Employees must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable. When 30 days notice is not possible, the employee must provide notice as soon as practicable and generally must comply with an employer’s normal call-in procedures. Employees must provide sufficient information for the employer to determine if the leave may qualify for FMLA protection and the anticipated timing and duration of the leave. Sufficient information may include that the employee is unable to perform job functions; the family member is unable to perform daily activities, the need for hospitalization or continuing treatment by a health care provider, or circumstances supporting the need for military family leave. Employees also must inform the employer if the requested leave is for a reason for which FMLA leave was previously taken or certified. Employees also may be required to provide a certification and periodic recertification supporting the need for leave. Employer Responsibilities Benefits and Protections During FMLA leave, the employer must maintain the employee’s health coverage under any “group health plan” on the same terms as if the employee had continued to work. Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms. Use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of an employee’s leave. Eligibility Requirements Employees are eligible if they have worked for a covered employer for at least one year, for 1,250 hours over the previous 12 months, and if at least 50 employees are employed by the employer within 75 miles. Definition of Serious Health Condition A serious health condition is an illness, injury, impairment, or physical or mental condition that involves either an overnight stay in a medical care facility, or continuing treatment by a health care provider for a condition that either prevents the employee from performing the functions of the employee’s job, or prevents the qualified family member from participating in school or other daily activities. Subject to certain conditions, the continuing treatment requirement may be met by a period of incapacity of more than 3 consecutive calendar days combined with at least two visits to a health care provider or one visit and a regimen of continuing treatment, or incapacity due to pregnancy, or incapacity due to a chronic condition. Other conditions may meet the definition of continuing treatment. Covered employers must inform employees requesting leave whether they are eligible under FMLA. If they are, the notice must specify any additional information required as well as the employees’ rights and responsibilities. If they are not eligible, the employer must provide a reason for the ineligibility. Covered employers must inform employees if leave will be designated as FMLA-protected and the amount of leave counted against the employee’s leave entitlement. If the employer determines that the leave is not FMLAprotected, the employer must notify the employee. Unlawful Acts by Employers FMLA makes it unlawful for any employer to: • Interfere with, restrain, or deny the exercise of any right provided under FMLA; • Discharge or discriminate against any person for opposing any practice made unlawful by FMLA or for involvement in any proceeding under or relating to FMLA. Enforcement An employee may file a complaint with the U.S. Department of Labor or may bring a private lawsuit against an employer. FMLA does not affect any Federal or State law prohibiting discrimination, or supersede any State or local law or collective bargaining agreement which provides greater family or medical leave rights. FMLA section 109 (29 U.S.C. § 2619) requires FMLA covered employers to post the text of this notice. Regulations 29 C.F.R. § 825.300(a) may require additional disclosures. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ For additional information: 1-866-4US-WAGE (1-866-487-9243) TTY: 1-877-889-5627 WWW.WAGEHOUR.DOL.GOV WHD Publication 1420 Revised January 2009 U.S. Department of Labor | Employment Standards Administration | Wage and Hour Division PLEASE READ CAREFULLY We truly welcome your application with St. Norbert College. You are applying for a position whose acceptance will place you in a category of recognized professionals. In pursuit of that excellence we require, as a condition of employment, that all applicants consent to and authorize a pre-employment and/or continued employment verification of their background, including information submitted on their application or resume. DISCLOSURE This document serves solely as a clear and conspicuous written disclosure as required by the Federal Fair Credit Reporting Act set forth in Section 604 (b) to the applicant that a social security number trace, motor vehicle verification, education, previous employment, credit and a criminal background verification. In addition, investigative consumer reports gathered from personal interviews with former employers and other past or current associates of mine to gather information regarding my work performance, character, general reputation and personal characteristics may be obtained for the purpose of this employment application. By the signature below, the Applicant acknowledges that AccuSource, Inc. has made this disclosure. APPLICANT AUTHORIZATION AND CONSENT FOR RELEASE OF INFORMATION This release and authorization acknowledges that St. Norbert College may now, or any time while I am employed/training, conduct a verification of my education, previous employment/work history, credit history, contact personal references, motor vehicle records, conduct drug testing and to receive any criminal history information pertaining to me which may be in the files of any Federal, State, or Local criminal justice agency, and to verify any other information deemed necessary to fulfill the job requirements. The results of this verification process will be used to determine employment/training eligibility under St. Norbert College employment/training policies. In the event that information from the report is utilized in whole or in part in making an adverse action decision with regard to your potential employment/training, before making the adverse decision, we will provide you with a copy of the consumer report and a description in writing of your rights under the law. I authorize AccuSource, Inc. at 1240 E. Ontario Avenue, Suite 102-140, Corona, California 92881, 951-734-8882, customerservice@accusource-online.com, www.accusource-online.com, and any of its agents, to disclose orally and in writing the results of this verification process to the designated authorized representative St. Norbert College. Contact AccuSource, Inc., if you want to receive a copy of our Information Security Policy. I have read and understand this disclosure, and I authorize the background verification. I authorize persons, schools, current and former employers, and other organizations and Agencies to provide AccuSource, Inc. with all information that may be requested. I agree that any copy of this document is as valid as the original. According to the Federal Fair Credit Reporting Act, I am entitled to know if employment/training was denied based on information obtained by my prospective employer/training program and to receive a disclosure of the public record information and of the nature and scope of the investigative report. CONFIDENTIAL INFORMATION FOR POSITIVE IDENTIFICATION PURPOSES ONLY Applicant Last Name First Name Middle Name List Other Names Used Date of Birth (For Identification only) Social Security Number Drivers License Number State Drivers License Issued Last Name on Drivers License Current Address City/State/Zip Dates Previous Address City/State/Zip Dates Previous Address City/State/Zip Dates RELEASE MUST BE SIGNED Applicant’s Signature Today’s Date Please provide me with a copy of my credit report (California, Oklahoma, Minnesota residents only) Please provide me with a copy of my investigative consumer report (California, New Jersey and New York residents only)