Guide for UPlan
Benefits Enrollment
• Current Employees –
make Open Enrollment changes for 2014
• New Employees – enroll in UPlan benefits for 2014
Employee Benef its
GENERAL
GENEral ENROLLMENT
ENrollmENT INFORMATION
INformaTIoN
Using Employee Self-Service
to enroll in UPlan
Benefit Programs
http://hrss.umn.edu
With Self-Service, you can log in, make some selections, save your
work, and come back to complete it at another time.
Open Enrollment: The last elections you submit before the deadline
will be your choices for the plan year. Your deadline is December 2.
New Employee: You can submit your choices only one time. Your
deadline is 60
30 days from date of employment or benefit eligibility.
It may take up to three business days to process your enrollment. You
will receive an email when it is done. Log in to view your Benefits
Summary at that time or any time during the year.
Three important tips
1. Scroll Down. There is often more information than will fit on a
screen. Be sure to scroll down to see all of your choices.
2. Wait - PROCESSING. It may take a while to process information
as you make your benefits selections. When you see the word
“PROCESSING” flashing in the upper right corner of your screen,
wait. Do not click another selection until the page refreshes.
Need help?
Internet ID and Password:
Crookston: 218-281-8000
Duluth: 218-726-8847
Morris: 320-589-6391
Twin Cities and anywhere in the
state: 612-301-4357 (1-HELP) or
email help@umn.edu
Benefits Enrollment not available
(down for maintenance):
Mon-Sat: 4 a.m. - 6 a.m.
Sun: 4 a.m. - 1 p.m.
Three ways to log out:
• Return to the “Internet Login
Successful” screen and use the
“LOGOUT” button.
• Close ALL application windows.
• From any browser window, go to
www.umn.edu/logout.
3. Final Submit Button. After you make your selections, you will
see a “Submit Benefits Choices” page. Be sure to click “Submit” at
the bottom of this page to send your information to Employee
Benefits. You will see the “Submit Confirmation” page when you
have successfully completed your enrollment.
To submit your choices online
1. Go to the Employee Self-Service website: http://hrss.umn.edu.
2. Select “Benefits Enrollment.”
3. Log in using your Internet ID and password.
4. Select “Benefits Enrollment.”
5. Select the open benefit event.
Open Enrollment: Use the Open Enrollment page as a base page to
begin entering each of your selections.
New Employee: Use the Benefit Enrollment page as a base page to
begin entering each of your selections.
Information needed for enrollment: To add dependents, you need
the birth date and, if required, a primary care clinic number. Your
same-sex domestic partner must be registered to complete enrollment online. If your spouse/same-sex domestic partner is age 45 or
older, his/her Social Security number is required. If changing plans,
check whether you need a primary care clinic number.
Table of Contents
General Enrollment Information..................................................................................... Page 2
Open Enrollment
What you can do during Open Enrollment.................................................................. Page 4
Computer Assistance.................................................................................................. Page 4
Employee Health & Benefits Fair................................................................................ Page 6
New Employee
Employee Eligibility Guidelines...................................................................................
Effective Date of Your Benefits....................................................................................
Waiting Period Medical Coverage...............................................................................
Definition of UPlan Medical and Dental Plan Eligibility...............................................
Dependent Eligibility Verification.................................................................................
Overview of Retirement Plans.................................................................................... Page 7
Page 8
Page 8
Page 10
Page 10
Page 11
General Benefits Information
Definition of Eligible Dependents................................................................................ Page 12
Family Status Change................................................................................................. Page 16
Medicare Eligible......................................................................................................... Page 17
Medical Plan Options......................................................................................................
Medical Plan Descriptions........................................................................................... Pharmacy Benefits...................................................................................................... Zones and Base Plan.................................................................................................. Plan Availability........................................................................................................... Plan Comparison........................................................................................................ UPlan Wellness Achievement Rates per Pay Period..................................................
UPlan Standard Rates per Pay Period.......................................................................
Walk-in Clinics............................................................................................................. Consult A Doctor 24/7................................................................................................ Travel Program...........................................................................................................
FrontierMEDEX (Emergency Medical Assistance)......................................................
Wellness...................................................................................................................... Wellness Points Chart.................................................................................................
Medication Therapy Management............................................................................... Page 18
Page 20
Page 21
Page 22
Page 23
Page 24
Page 28
Page 29 Page 30
Page 31
Page 32
Page 32
Page 33
Page 36
Page 38
Notice about your Prescription Drug............................................................................. Page 39
Coverage and Medicare
Dental Plan Options........................................................................................................ Dental Plan Descriptions............................................................................................. Plan Availability........................................................................................................... Plan Comparison........................................................................................................ Rate Contributions per Pay Period............................................................................. Page 41
Page 42
Page 43
Page 44
Page 46
Flexible Spending Accounts.......................................................................................... Page 47
Health Care................................................................................................................. Page 49
Dependent Daycare.................................................................................................... Page 50
Life Insurance.................................................................................................................. Page 54
Rates........................................................................................................................... Page 57
Short-term Disability....................................................................................................... Page 58
Rates........................................................................................................................... Page 58
Long-term Disability........................................................................................................ Page 59
Rates........................................................................................................................... Page 59
Notice about the Early Retiree Reinsurance Program................................................. Page 60
General enrollmenT InformaTIon
What the Guide contains
This Guide includes information for two groups of employees:
• Employees making changes in their UPlan benefits coverage
during 2013 Open Enrollment for January 1, 2014, effective
date.
• New employees eligible for UPlan benefits coverage during the
2014 calendar year.
Some information in the Guide is specific to your group, and some is
general information that applies to all eligible employees. Read the
information for your group and the general benefits information to
learn what you need to do to successfully enroll in your benefits.
Open Enrollment: Information and guidelines for employees
making benefits changes during Open Enrollment are on pages 4-6.
New Employees: Information and guidelines for new employees
electing benefits coverage for the 2014 calendar year are on pages
7-11.
General Benefits Information: This section includes information
that applies to both groups. The plan comparison charts, biweekly
rates, plan descriptions, plan availability, and dependent eligibility
are the same for both groups of employees. This section starts on
page 12.
How to Enroll: Each group has different guidelines for electing
coverage. These will be pointed out in the description section for
each benefit option under “How to enroll.” An example of the
different guidelines is that new employees can elect certain amounts
of life insurance without evidence of good health within their first 30
60
days of employment while current employees must provide health
history information for underwriting even during Open Enrollment.
Plan provider directories
Benefits Enrollment
Plan provider directories are available in electronic and print formats.
We recommend checking that the medical or dental clinic you want
to use is in the network directory before you make your final plan
election. Your department’s benefit contact person has provider directories you can review. Or you can access directories on the Employee
Benefits website where you will find links to the plans’ websites and
search tools.
Page 2
General Enrollment Information
Open Enrollment dates
Enroll online
November 1 through December 2
Enroll online in Employee Self-Service: http://hrss.umn.edu.
Where to go for answers
The Employee Benefits Service Center staff is available to help you with
your benefits questions and enrollment. The Benefits Service Center’s
phone number is 612-624-8647 or 1-800-756-2363:
The Benefits Service Center’s email address is benefits@umn.edu.
The Employee Benefits website is at www.umn.edu/ohr/benefits.
Regular office hours are from 8 a.m. to 4:30 p.m. Monday through
Friday. Telephone language interpretation services are available through
Employee Benefits. Employee Benefits is located in the Donhowe
Building at 319 15th Ave SE on the East Bank campus in Minneapolis.
Customer Service Center
For questions you have about your benefit options:
Medica: 952-992-1814 or 1-877-252-5558 HealthPartners Dental: 952-883-5000 or 1-800-883-2177
Delta Dental: 651-406-5916 or 1-800-448-3815
Prime Therapeutics
Pharmacy Program: 800-727-6181
Fairview Specialty Pharmacy: 612-672-5289 or 1-877-509-5115
Plan group numbers
The group numbers for the plan options are provided below in case you
need to call the plan’s customer service center before you receive your
member ID card in the mail.
Medical Plans
Medica Twin Cities Elect/Essential:
53858
Medica Duluth Elect/Essential: 53860
Medica Choice Regional:
53862
Medica Choice National: 83864
Medica ACO Plan:
Fairview & North Memorial Vantage Plan: Inspiration Health by Health East: Park Nicollet First: Ridgeview Connect: 80438
80439
80440
80441
Insights by Medica: 53864
Medica HSA Single Options PPO Network: 83866
Medica HSA Family Options PPO Network: 83867
Dental Plans
Delta Dental PPO: HealthPartners Dental: Delta Dental Premier: HealthPartners Dental Choice: University Choice (Delta Dental): Benefits Enrollment
6100
16000
6090
16000
6113
Page 3
Open Enrollment
What you can do during
Open Enrollment
Open Enrollment is the one time each year when the University
announces benefit plan changes and biweekly contribution rates for
the next calendar year.
You may choose different medical and dental plans. If you do not
have medical or dental coverage, you can add it, or if you no longer
need it, you can cancel coverage.
You can add or cancel dependents on your coverage. If adding dependents, review the Definition of UPlan Medical and Dental Program
Eligibility on page 10 and the Definition of Eligible Dependents on
page 12. You can also add Child Life coverage without evidence of
good health.
You can add up to $200 of short-term disability without evidence of
insurability if you have an existing amount of short-term disability.
You can add or increase the amount of long-term disability if you are
a civil service or labor represented employee.
Open Enrollment is also when you need to enroll in or re-enroll in
the flexible spending accounts for participation in the 2014 calendar
year.
Open Enrollment dates:
November 1 - December 2
Online enrollment is available in Employee Self-Service from Friday,
November 1, through Monday, December 2. You must be sure to
enroll online before the deadline. We encourage you to submit your
choices as soon as possible.
If your newly eligible benefits are effective by November 1, complete
your initial benefits enrollment soon because it needs to be processed
before you can go online to do Open Enrollment elections.
Please remember the deadline for Open Enrollment. To have your
changes effective January 1, 2014, you must complete your online
enrollment before the self-service site is closed on Monday, December 2.
An Open Enrollment presentation is available on the Employee
Benefits website at www.umn.edu/ohr/benefits/openenroll.
Computer assistance
You will need to use a computer to make your benefit changes online
for Open Enrollment. If you do not have one available to you at work
or home there are some options:
• Computers will be available at the Employee Health & Benefits
Fairs in Minneapolis, St. Paul, and Duluth.
• Computers may be available at your local library.
• Computer lab sessions will be available in 315 Donhowe
on the Minneapolis campus at these dates and times:
Benefits Enrollment
November 25, 26, 27, and December 2 — 8 a.m. to 4:30 p.m.
Page 4
Open Enrollment
Member ID cards
You will receive new member ID cards at your home address from your
Medica medical plan whether or not you change options. HealthPartners and Delta Dental will send new dental member ID cards only if
you change options. Prime Therapeutics will send a member ID card if
you are electing medical coverage for the first time.
Medical plan options
You can enroll in a different medical plan. You can add eligible dependents to your medical coverage. You have the choice to add or cancel
medical coverage.
If you want to change your primary care clinic, you must do that directly with the medical plan as a clinic change cannot be made online. It is
also a good idea to check with your medical plan each year to confirm
that your clinic still participates in your plan option.
Dental plan options
You can enroll in a different dental plan or add eligible dependents to
your dental coverage. You have the choice to add or cancel dental coverage. It is also a good idea to check with your dental plan each year to
confirm that your dentist still participates in your plan option.
Flexible spending
accounts
You can enroll or re-enroll in a pre-tax Dependent Daycare or Health
Care Flexible Spending Account (FSA). Deposits are made into these
accounts on a calendar year basis; however, you may file claims for
expenses incurred from January 1, 2014, to March 15, 2015, against the
2014 deposits. Refer to the Flexible Spending Accounts section in the
guide for information on these accounts, especially the definition of
qualified health expenses under the health care FSA.
Long-term disability
As a civil service or labor represented staff employee, you can add or
increase long-term disability without evidence of good health; however,
this amount is subject to pre-existing conditions.
Short-term disability
You can increase your existing amount of short-term disability coverage
by up to $200 without evidence of insurability. The total amount can
replace up to 66-2/3 percent of your salary but not more than $5,000
per month. This year you will make your election using a paper application that is available at www.umn.edu/ohr/benefits.
Optional benefits
Employee and spouse/same-sex domestic partner life coverage is NOT
part of Open Enrollment, but is included in the guide for your convenience. If you want to add or increase the amount of life insurance
coverage, you will need to complete health history questions for underwriting. Follow the directions for enrollment found in the applicable
section of this guide.
Additional life
insurance
Benefits Enrollment
Page 5
Open Enrollment
When your coverage
goes into effect
Your Open Enrollment elections for medical, dental, flexible spending
accounts, and short-term and long-term disability amd child life insurance become effective on January 1, 2014. If you are on a leave of
absence on January 1, 2014, coverage may be delayed until you return
to work. Please contact Employee Benefits for more information.
Optional coverages requiring evidence of insurability will become
effective based upon the underwriting approval date of the insurance
carrier.
Employee Health
& Benefits Fair
The annual Employee Health & Benefits Fair, sponsored by Employee
Benefits and Boynton Health Service, will be held at the U of M
campuses this fall. The schedule is:
October 31 Ballroom, Kirby Student
Center, Duluth
10 a.m. to 2:30 p.m.
November 7 Bede Ballroom, Sargeant
Student Center, Crookston
12 to 2 p.m.
November 11 Oyate Hall, UMM Student Center,
Morris
11 a.m. to 1 p.m.
November 12 North Star Ballroom,
Student Center, St. Paul
10 a.m. to 3:30 p.m.
November 13 Great Hall, Coffman Memorial
Union, Minneapolis
10 a.m. to 3:30 p.m.
At the Employee Health & Benefits fair, you can talk to the medical and
dental plan administrators and pharmacy benefit manager about your
plan options and visit with representatives from your life, disability,
and retirement plans, along with a number of University departments.
The fair is also the place to participate in health promotion activities,
including flu shots at some fair locations.
Benefits Enrollment
Page 6
neW emPloyee — benefITs enrollmenT
employee eligibility
guidelines
You are eligible for UPlan benefits if:
• you are a new hire, or
• your appointment increased to 50-74 percent time, or
• your appointment increased to 75-100 percent time
AND all of the following apply to your appointment:
• eligible classification
• 50 percent time or greater
• three months or longer
basic benefits
You qualify for benefits provided by the University of Minnesota
because you are either a new employee or in a newly benefits-eligible
position. This guide highlights your benefits and rates and is designed
to help you complete the online enrollment process.
The basic benefits offered to you are employee medical and dental
coverage and employee basic life insurance. If you have an appointment
that is 75 percent time or greater, the University will contribute toward
the cost of your rates. If your appointment is 50 percent to 74 percent
time, you will pay the full cost of the rates.
You need to elect your medical and dental plan options within the first
60
30 days of employment or benefits eligibility. If for any reason you
elect to change to another plan within this 30
60-day period, the new
plan will be retroactive to your initial date of active coverage.
optional benefits
enroll to have
coverage
Waive benefits or
do not enroll
Benefits Enrollment
The optional benefits available to you include: medical and dental
coverage for eligible dependents; additional life insurance for you,
your spouse/registered same-sex domestic partner, and dependent
children; disability insurance; and the flexible spending accounts.
Certain amounts of life and disability coverage can be obtained
without underwriting if you apply within your first 60
30 days of
eligibility.
You must make your benefits elections online in Employee SelfService for yourself, your spouse/registered same-sex domestic partner and dependent children within your first 60
30 days of employment
or benefits eligibility. Employee Benefits will contact you by email
after they have prepared the Employee Self-Service site for you to
enroll.
Since you are not required to choose a medical or dental plan,
you can elect to waive or not have benefits. This is also true for
the optional benefits. However, if you do not enroll during the 6030
day window you will not have an opportunity to elect medical and/
or dental coverage for yourself and your dependents until the next
available open enrollment period.
Page 7
New Employee — Benefits Enrollment
New employee
effective date
Example:
Date of employment: February 12
Effective date of basic benefits: March 1
Example:
Date of employment: May 1
Effective date of basic benefits: June 1
If you are newly hired, your basic employee medical, dental, and
life insurance coverage will become effective on the first day of the
month following your first day of employment.
You can determine the effective date of your basic benefits by using
the chart below.
2014 Monthly Effective Date Chart
Employed during Coverage effective date
January 2014February 1, 2014
February 2014March 1, 2014
March 2014April 1, 2014
April 2014May 1, 2014
May 2014
June 1, 2014
June 2014
July 1, 2014
July 2014August 1, 2014
August 2014September 1, 2014
September 2014October 1, 2014
October 2014November 1, 2014
November 2014
December 1, 2014
December 2014
January 1, 2015
January 2015February 1, 2015
Waiting period
medical coverage
Newly eligible employee
effective date
Example:
Date of eligibility change: February 3
Effective date of basic benefits: March 1
Example:
Date of eligibility change: May 1
Effective date of basic benefits: May 1
Benefits Enrollment
You may purchase medical coverage for the waiting period from your
first day of employment until your active coverage begins. You may
elect a medical plan, other than Medica HSA, for this coverage. You
need to enroll within 30 days of your first day of employment and
pay the full cost of the coverage for the full waiting period. Please
contact the Employee Benefits Service Center at 612-624-8647 or
800-756-2363 to request an enrollment form and the rate for waiting
period medical coverage. You may elect a different plan and coverage
level when you enroll online for your active coverage.
If you are a current employee who becomes newly eligible for
coverage as a result of an appointment change, your basic employee
medical, dental, and life insurance coverage will become effective on
the first day of the month following the date of the eligible change.
If your newly eligible appointment begins on the first of the month,
then your coverage becomes effective on that day.
You can use the “Coverage effective date” column above to determine
the effective date of your basic benefits.
• If you are not actively at work due either to your or your depenPage 8
New Employee — Benefits Enrollment
When you are actively at work
affects coverage start date
dent’s health status or medical disability on the date that your coverage is scheduled to begin, medical and dental coverage will still take
effect. (However, life and disability coverage will be delayed until you
return to work.)
• If you are not actively at work on the initial effective date of coverage
due to a reason other than hospitalization or medical disability for
yourself or your dependent, then medical and dental coverage will
be delayed until the first day of the pay period coinciding with or
following your return to work.
• Medical and dental coverage for your dependents, additional life,
disability insurance coverage, and the flexible spending accounts will
go into effect on the same date as your basic coverage if you enroll
on a timely basis and you are actively at work. Otherwise, the effective
date may be delayed. Optional coverage requiring evidence of good
health will go into effect on the first day of the pay period coinciding
with or following approval by the insurance company, provided that
you are actively at work.
If you have any questions on determining your effective date of coverage, please call the Employee Benefits Service Center at 612-624-8647
or 800-756-2363.
If you have an
academic appointment
If you work for the University only during the academic year, generally
on a 9- or 10-month appointment, your coverage will continue during
the summer months that you are not scheduled to work provided that
you return to work at the beginning of the new academic year. To pay
for your contribution toward coverage during the non-work period,
rate amounts will be deducted in arrears from your paycheck when
you return to work.
Note: If you do not return to work for the following academic year,
your benefits terminate on the last day of the pay period in which you
last worked.
Rates paid on
a pre-tax basis
The rates you pay for your medical or dental coverage for you and
your dependents are automatically deducted from your paycheck on
a pre-tax basis. The pre-tax payment saves you money because your
contributions for medical and dental coverage are subtracted from
your salary before federal, state, and Social Security taxes are withheld.
As a result, your taxable salary and your taxes are reduced.
Because you pay less in taxes, your take-home pay may be greater. Since
pre-tax benefits reduce the salary on which Social Security benefits
are calculated, you may have a slight reduction in your Social Security
benefits if your annual salary is less than the Social Security base.
Benefits Enrollment
Page 9
New Employee — Benefits Enrollment
Rates paid on
an after-tax basis
Definition of UPlan Medical
and Dental Program
eligibility
Rates for life and disability insurance are paid only on an after-tax
basis. Effective January 1, 2014, you will no longer have the choice to
pay your share of medical and dental rates on an after-tax basis.
The University of Minnesota develops eligibility criteria for its employees and their dependents (subject to collective bargaining agreements and compensation plans) that may change during a Plan Year.
You are eligible to participate in the University of Minnesota UPlan
Medical and Dental Program (the Plan) if you are working at the University with an appointment in an eligible classification of at least 50
percent time and lasting at least three months in duration.
The University contributes a significant portion of the cost of medical
and dental benefits if you have an appointment of 75 percent time
or greater. If your appointment is at least 50 percent to 74 percent
time, you are eligible to participate in the Plan but must pay full cost
of coverage. There is no University contribution at this level of
employment.
In no event can you receive coverage as both an employee and as a
dependent of another Plan member. For example, you may not have
coverage for yourself as an employee and be a dependent on the
coverage of a spouse/registered same-sex domestic partner or a parent
who has family coverage as a University of Minnesota employee.
In no event can you include a dependent on the Plan who is ineligible for coverage. You will be subject to disciplinary action if you
provide false, incorrect, or fraudulent information on your enrollment, including enrollment of dependents. The Plan reserves the
right to request documentation to verify eligibility of your enrolled
dependents.
Dependent eligibility
verification
The University has a responsibility to ensure UPlan resources are
well managed and to apply the dependent eligibility rules fairly and
equally. For both these reasons, you will be asked to verify eligibility
of your dependents if they are added to your UPlan coverage during
Open Enrollment, when you are a new employee, or when you acquire a new dependent.
You will need to verify the eligibility of these dependents by providing documentation such as a tax form, birth or marriage certificate,
same-sex domestic partner registration information, or a birth or
adoption certificate.
Please respond to the verification request from Employee Benefits
promptly to ensure coverage for your dependents.
Benefits Enrollment
Page 10
New Employee — Benefits Enrollment
Overview of
retirement plans
The University provides basic retirement plans for both faculty and
staff. Your required contributions are taken on a pre-tax basis. For more
detailed information about the retirement plan available to you, refer to
the Employee Benefits website at www.umn.edu/ohr/benefits/
retiresave/index.html.
Civil Service and
Labor Represented
staff
Civil service and non-faculty labor represented staff are covered by
Minnesota State Retirement System (MSRS). Participation is mandatory
and begins from the first day of employment. There is no waiting
period. Retirement deductions are a percentage of total salary and
are paid into the Retirement Fund. This money is credited to your
individual MSRS account and is tax sheltered from both federal
and state income tax. The employer contribution is not credited to
individual accounts. It is used to help pay the monthly annuities and
benefits received from the Retirement Fund. Rates are subject to change
by the Legislature.
Faculty and Professional
& Administrative staff
Faculty and Professional & Administrative staff who hold a 67 percent
time or greater appointment for not less than nine months in duration
are eligible (with some exceptions) to participate in the Faculty
Retirement Plan. For some Professional & Administrative staff,
participation begins after a waiting period based on appointment
type, years of service, and salary. You are immediately covered by the
Academic Disability Program, which provides medical leave benefits
and long-term disability insurance.
Voluntary retirement plans
The University also offers two voluntary retirement savings plans – the
Optional Retirement Plan and the Section 457 Deferred Compensation
Plan. All faculty and staff who are paid on a continuous basis may participate. No minimum appointment is required.
You can contribute, in each calendar year, the amount allowed under
the federal limits. Contributions may be invested in any of more than
200 no-load investment options offered by leading insurance and
mutual fund companies.
You pay no federal or state income taxes on the money you put into
the plans or on any investment gains until you withdraw funds. And
because your contributions are tax-deferred, you reduce your taxable
income and pay less in taxes on your take-home pay.
You can increase or decrease your contributions during the year. You
may also stop contributions and restart them at a future date.
Refer to the Employee Benefits website to learn more about the
voluntary retirement savings plans and to request an enrollment kit for
either plan. Allow about four weeks for your Optional Retirement Plan
enrollment and up to eight weeks for your Section 457 Plan enrollment
to be completed. Applications received after November 28 may apply to
the next calendar year.
Benefits Enrollment
Page 11
General Benefits Information
Definition of eligible
dependents
Relationship
to Employee
Spouse
The chart specifies the criteria for coverage along with whether the dependent
is considered qualified for favorable tax treatment under the Plan.
Criteria for Coverage
Is Dependent
Qualified for Tax
Favored Treatment(1)
Must be legally married.
Qualified
Your spouse must not be working full-time for an employer and receiving cash or
credits 1) in place of medical coverage or 2) in exchange for medical coverage with a
deductible of $750 or greater.
Same-Sex
Domestic Partner
Dependent
Child
Your registered same-sex domestic partner must not be working full-time for an
employer and receiving cash or credits 1) in place of medical coverage or 2) in
exchange for medical coverage with a deductible of $750 or greater.
Usually non-qualified.
Refer to same-sex
domestic partner
information in the
Definition of Eligible
Children
Dependent child — birth through age 25 (up to the 26th birthday)
Qualified
Must be registered as same-sex domestic partner.
An eligible child can include your unmarried or married biological child, legally
adopted child or child placed for the purposes of adoption, foster child, stepchild, or
any other child state or federal law requires be treated as a dependent.
Note: The spouse of your eligible married dependent child is not eligible for
coverage.
Dependent child of registered same-sex domestic partner — birth through age
25 (up to the 26th birthday)
Usually
non-qualified
An eligible child can include your same-sex domestic partner’s unmarried or married
biological child, legally adopted child or child placed for the purposes of adoption,
foster child, stepchild, or any other child state or federal law requires be treated as a
dependent.
Note: The spouse of your same-sex domestic partner’s eligible married dependent
child is not eligible for coverage.
Disabled child— age 26 or above (no maximum) if physically or mentally disabled and either:
Qualified
• lives with you and does not provide over 50% of his/her own support, or
• does not live with you but is at least 50% dependent on you
Dependent
Grandchild
Benefits Enrollment
A grandchild is eligible for coverage if he/she is placed in your legal custody; or if
the grandchild is legally adopted or placed with you for the purpose of adoption. The
grandchild must be dependent upon you for more than one-half of his/her support,
and you must claim the grandchild as a dependent on your tax return.
Qualified
Your unmarried grandchild is also eligible for coverage if (1) he/she is in your legal
custody and dependent upon you for principal support and maintenance, but is a
qualified tax dependent of another person or (2) your unmarried grandchild is the
dependent child of your unmarried dependent child, and even though the grandchild
may be dependent upon you for principal support and maintenance, he/she would
not be eligible to be your tax dependent under tax regulations. In these instances,
the contributions made by the University to your grandchild’s coverage as well as
your contributions are considered taxable income on your tax returns.
Usually
non-qualified
(1) “Tax Favored Treatment” refers to how dependent coverage is treated for tax purposes.
Page 12
General Benefits Information
Notes about eligible
dependent children
An eligible child, unmarried or married, can include your own biological child, legally adopted child or child placed for the purposes
of adoption, foster child, stepchild, and any other child state or
federal law requires be treated as a dependent. Eligible child can also
include the unmarried or married child of your registered same-sex
domestic partner, although that coverage is generally not available
on a tax favored status.
For a child who is being adopted, the date of placement means the
date you assume and retain the legal obligation for total or partial
support of the child in anticipation of your adoption of the child. A
child’s adoption placement terminates upon the termination of the
legal obligation of total or partial support.
To be considered a dependent child, a foster child must be placed by
the court in your custody.
To be considered a dependent child, a stepchild must be the child
of your spouse/same-sex domestic partner by a previous marriage/
partnership
Note: The spouse of your eligible married dependent child is not
eligible for coverage.
The child of your same-sex domestic partner can be considered a
dependent child if your same-sex domestic partner is registered with
the University and the child satisfies all other requirements to be an
eligible child. This applies to both the children of your registered
same-sex domestic partner from your current partnership or his/her
previous marriage/partnership.
If both you and your spouse/registered same-sex domestic partner
work for the University of Minnesota, then either of you, but not
both, may cover your eligible dependent children/grandchildren.
This also applies to two divorced or unmarried employees who share
legal responsibility for their dependent children or grandchildren.
Notes about dependent
grandchildren
Your unmarried grandchild is eligible for coverage if he/she is your
tax dependent; if the grandchild is placed in your legal custody; or if
the grandchild is legally adopted or placed with you for the purpose
of adoption. The grandchild must be dependent upon you for more
than one-half of his/her support, and you must claim the grandchild
as a dependent on your tax return. In these instances, the contributions made by the University and your pre-tax contributions are not
considered taxable income on your tax returns.
Your unmarried grandchild is also eligible for coverage if (1) he/she
is in your legal custody and dependent upon you for principal support and maintenance, but is a qualified tax dependent of another
person or (2) your unmarried grandchild is the dependent child of
your unmarried dependent child, and even though the grandchild
Benefits Enrollment
Page 13
General Benefits Information
may be dependent upon you for principal support and maintenance,
he/she would not be eligible to be your tax dependent under tax regulations. In these instances, the contributions made by the University to
your grandchild’s coverage as well as your contributions are considered
taxable income on your tax returns.
Notes about eligibility of
spouse/registered samesex domestic partner
If both you and your spouse/registered same-sex domestic partner work
for the University of Minnesota, then either of you has the option of
adding the other as a dependent to his/her family coverage. The spouse/
registered same-sex domestic partner added to the family coverage must
waive employee coverage.
If your spouse or registered same-sex domestic partner works full-time
for an employer and receives cash or credits (1) in place of medical
coverage, or (2) in exchange for a medical coverage with a deductible of
$750 or greater, then he/she is not considered to be an eligible dependent under the Plan.
Same-sex domestic partner registration criteria:
1. Engaged in a committed relationship and intend to remain together
indefinitely;
2. Are the same sex and for this reason are unable to marry each other
under Minnesota law;
3. Are at least 18 years of age and have the capacity to enter into a
contract;
4. Are jointly responsible to each other for the necessities of life; and
5. Are not related by blood closer than permitted under Minnesota
marriage laws.
Contact the Employee Benefits Service Center at 612-624-8647 or
1-800-756-2363 for the forms to register your same-sex
domestic partner.
Notes about the taxability
of coverage for your
registered same-sex
domestic partner and the
child/children of
registered same-sex
domestic partner
Under IRS rules, the value of the medical and dental benefits provided
by the University to your registered same-sex domestic partner and the
child/children of your registered same-sex domestic partner is generally
considered taxable income to you as the employee. The only exception
to the taxability of these benefits is if your registered same-sex domestic
partner and his or her children meet the following IRS definition of a
dependent. A registered same-sex domestic partner and his/her children
can meet the definition of a dependent for the purposes of family
coverage if the following conditions are met:
1. They lived with you for the entire year as a member of your household.
Benefits Enrollment
Page 14
General Benefits Information
2. They were U.S. citizens or resident aliens of the U.S. or residents
of Canada or Mexico for part of the calendar year in which your
tax year began.
3. They did not file a joint tax return.
4. You provided over half of their support for the calendar year.
5. They are not a dependent child for tax purposes of any other
individual.
If your registered same-sex domestic partner and children meet all of
the above requirements, you will need to complete a Certification of
Dependent Status form. Information and the form can be found on
the website at www.umn.edu/ohr/benefits/domesticpartner/
index.html or by contacting the Employee Benefits Service Center.
Note: Most same-sex domestic partner expenses are not eligible to be
reimbursed through the HSA, per IRS regulations.
Coverage of disabled
children of any age
Your dependent child of any age is eligible for coverage and tax
favored status if he/she is incapable of self-sustaining employment
by reason of mental retardation, mental illness, mental disorder, or
physical disability, and is chiefly dependent upon you for his/her
support and maintenance (meaning you provide for more than onehalf of the child’s support).
A dependent child must be certified by the UPlan Medical Plan
Administrator to be disabled prior to age 26, based on proof that the
child meets the above requirements.
If for any reason, you drop coverage for a disabled dependent prior
to age 26, then wish to cover the child again, coverage must be added
prior to the child turning age 26, and his/her disabled status recertified by the Plan Administrator.
Once your disabled child has reached age 26, the child must be continuously covered under the Plan in order to maintain eligibility.
A disabled dependent child who is 26 years of age or older and unmarried at the time of your initial eligibility for coverage in the Plan
may be enrolled for coverage if:
• you (the employee) enroll for coverage during your initial eligibility period, and;
• the UPlan Medical Plan Administrator certifies that the dependent meets the above requirements. Proof of disability status
must be provided within 31 days of your initial date of eligibility
and enrollment in the Plan. The disabled dependent shall be eligible for coverage as long as he/she continues to be disabled and
dependent, unless coverage otherwise terminates under the Plan.
Benefits Enrollment
Page 15
General Benefits Information
A dependent child who is considered to be disabled by the UPlan
Medical Plan Administrator will be eligible for tax favored coverage
under the Plan, regardless of age. The disabled child of a registered
same-sex domestic partner will not be eligible for tax favored coverage.
Children covered by
Child Support Order
Children of the employee who are required to be covered by reason
of a Qualified Medical Child Support Order are eligible, as required
by federal and state law, to assure that children who do not live with
both of their biological parents have adequate medical coverage. This
provision does not apply to children of the spouse/registered same-sex
domestic partner who are not also children of the employee.
Not eligible
For purposes of coverage under the Plan, your parents, grandparents,
in-laws, brothers, sisters, aunts, uncles, cousins and other extended
family members, non-registered same-sex domestic partners and their
children, and unmarried opposite-sex domestic partners and common-law spouses are not eligible dependents.
Family status change
To make changes in your medical, dental, optional life coverage, or
flexible spending accounts after you are first eligible or outside of the
annual open enrollment period, you must have a change in family
status. The coverage change must be consistent with the family status
change. A request for change in your coverage due to a family status
change must be made within 30 days of the date of change. If you fail
to apply for a change in coverage within 30 days of the family status
change, you will not be able to make a change until the next available
open enrollment period.
Family status changes include:
• Change in legal marital status, including marriage, divorce, or
annulment
• Registration of your same-sex domestic partnership or termination
of same-sex domestic partnership
• Death of your spouse/registered same-sex domestic partner or last
eligible dependent child
• Birth or adoption of your eligible dependent child
• Change in last dependent child’s eligibility because of age
• Commencement or termination of employment for you, spouse/
registered same-sex domestic partner, or dependent
• Change in your or your spouse/registered same-sex domestic
partner’s employment status from part time to full time or from
full time to part time
Benefits Enrollment
Page 16
General Benefits Information
• Change in the place of residence or worksite for you, spouse/
registered same-sex domestic partner, or dependent to a location
outside of the current plan’s service area and the current plan is not
available
Call the Employee Benefits Service Center if you have more specific
questions about changes in your coverage.
Transition of Care
If you are in the middle of treatment for a serious medical condition,
you may need special assistance to change to a new medical plan. Transition of care allows for a short-term continuation with your current
provider before you begin receiving care from a provider in your new
medical plan’s network.
A current course of treatment is defined as having received consultation
or treatment from a provider for a specific condition within 90 days
prior to your effective date with Medica. The care coordinators at
Medica will work with your medical providers and assist you with
completing the form and other steps for short-term continuation with
your current provider.
Medicare eligible?
Let your medical plan know
If you or a covered family member have Medicare Part A or B, please
be sure to contact your medical plan to let the plan know. You must
provide information about Medicare participation so your files can be
updated and your claims processed correctly.
If you are age 65 or older and actively working (or your dependent is age
65 or older), enrollment in Medicare Part B should be delayed until you
are no longer working. Contact the Employee Benefits Service Center if
you need additional information.
For employees who are actively at work, their medical plan must pay first
(primary) on all claims. Your medical plan carrier will then submit any
remaining charges to Medicare for possible payment. Also, please request
that your health care provider submit any claims to your medical plan —
not to Medicare.
If you or any of your dependents have Medicare Parts A or B due to age
or disability, please contact your medical plan to let them know.
Benefits Enrollment
Page 17
meDICal: Plan oPTIons
basic benefit
Your medical plan options provide regular medical care and pharmacy benefits for the diagnosis and treatment of most illnesses and
injuries in a number of formats, ranging from limited network plans
to open access and tiered network plans to a high deductible health
plan. The plan options include a wide range of providers at different
rates, deductibles, and copayments.
The medical plans do not have a pre-existing condition clause. This
means that you and your eligible dependents have coverage for any
medical condition, including pregnancy, as soon as your coverage
becomes effective.
The plan options cover in-network preventive care at no cost to you
and provide physician and hospital care on a worldwide basis, subject
to copays. The UPlan medical options have out-of-network coverage
available at 70 percent coinsurance after a $600 deductible and subject
to an overall in- and out-of-network maximum.
The options that are available to you differ by geographic location or
zone. Each zone has a base plan that offers the lowest rates and copayments. You may choose a medical plan that is available where you
live or work. For example, if you live in the Greater Minnesota zone but
work in the Duluth area zone, you can choose a plan in either zone.
Coverage available
rates
How to enroll
You elect coverage from one of four rate tiers: Employee only; Employee and spouse/same-sex domestic partner; Employee and child/children; and Employee and both spouse/same-sex domestic partner and
child/children. You may also waive or elect not to have coverage.
The University of Minnesota pays 87 percent of the cost of employeeonly coverage (employee pays 13 percent) and 80.5 percent of the
cost of each tier of family coverage (employee pays 19.5 percent) for
the base plan for your geographic zone. For other plans, your rate will
include the additional cost of that plan.
Open Enrollment: Enroll or make your change online in Employee
Self-Service from November 1 through December 2. If you cancel
coverage, the plan you terminate will send a Certificate of Creditable
Coverage to verify that you cancelled coverage.
New Employee: Make your election online in Employee Self-Service
within the first 60
30 days of employment or benefits eligibility.
The medical plan in which you enroll will send a member ID card to
your home.
Contact your new clinic
Benefits Enrollment
If the clinic you chose under your medical option is new to you, you
may want your new physician to have your records. Have your current
clinic send a copy of your records to your new clinic by your effective
date of coverage.
Page 18
Medical: Plan Descriptions
Medica Elect/Essential
Medica: 952-992-1814
1-877-252-5558
TTY Toll Free: 800-855-2880
Web: www.medica.com/uofm
Medica Elect/Essential, the base plan for Duluth and the Twin Cities
area, is a combination of two networks, each of which includes major
care systems. Each care system includes a comprehensive network of
physicians, specialists and other types of care providers, clinics, and hospitals. You have low biweekly rates and reasonable out-of-pocket costs
with the base plan. The out-of-network benefit and in-network travel
benefit give you additional flexibility in selecting a provider.
You will need to select a primary care clinic (PCC) when you enroll in
this plan. Family members may select their own primary care clinics.
You and your family members can choose separate primary care clinics
from care systems in either the Elect or Essential networks. Clinics can be
changed monthly. When you contact Medica’s member services by the
20th of the month, the change goes into effect the first of the following
month.
Your PCC will work with you to coordinate your care including, when
appropriate, referral to specialists. Each care system establishes its own
access procedures for seeing specialists. Some require a referral from
your primary care clinic; others allow you to directly access a specialist
affiliated with your care system. You must follow your care system’s
access procedures to receive the highest level of benefits. To be referred
to an out-of-network provider and obtain the highest level of benefits,
you also need Medica’s approval.
Medica Choice Regional
Medica Choice Regional is the base plan for Greater Minnesota including Crookston, Morris, and Rochester. It is an open access plan that
uses the statewide Medica Choice network. You have low biweekly rates
and reasonable out-of-pocket costs with the base plan. The out-of-network benefit and in-network travel benefit give you additional flexibility in selecting a provider.
You have access to any provider who is part of the network, and you do
not need to select a primary care clinic when you enroll. You can see
any specialist within the plan network without getting a referral from
your primary care doctor.
Medica ACO Plan
Medica ACO Plan is available to you if you live in the 11-county, Twin
Cities metro area. In an ACO, Medica and the network of primary care
and specialty providers work together to deliver coordinated health
care and support to the member. You will have benefits that are slightly
higher and biweekly rates that are slightly lower than the base plan.
Your ACO options include Fairview & North Memorial Vantage Plan
with Medica (including Boynton and UMP); Inspiration Health by
HealthEast with Medica; Park Nicollet First with Medica; and Ridgeview
Connect with Medica. You need to select one ACO for your entire
family. ACO enrollments are for a full year, so mid-year changes cannot
be made. You don’t need a referral to see any primary care provider or
specialist within the network. The out-of-network benefits and in-network travel benefit give you additional flexibility.
Benefits Enrollment
Page 19
Medical: Plan Descriptions
Insights by Medica
Insights by Medica is available in the Twin Cities metro area, Duluth,
Morris, and some areas in Greater Minnesota. Insights is an open access,
tiered network plan in which health care providers are analyzed on cost,
efficiency, and quality measures and then ranked into three tiers. Copayment amounts on services differ for each tier.
You have access to any provider in the network, in any tier, without a
referral, and you do not need to select a primary care clinic when you
enroll. If you obtain services from network providers that are in a lower
tier you will have greater overall value and lower copayments.
Medica Choice National
Medica Choice National is an open access plan with a statewide
network of over 13,000 physicians and more than 200 hospitals. You
also have national coverage access to more than 600,000 physicians
and health care providers through United Healthcare Options PPO network when traveling or working outside the service area.
You have access to any network provider without a referral, and you
do not need to select a primary care clinic when you enroll. The out-ofnetwork benefit gives you additional flexibility in selecting a provider.
Medica HSA
Due to federal law, if you have
any other medical coverage,
including any part of Medicare,
you are not eligible to enroll in
Medica HSA.
However, if you are age 65 or
older and delay taking Social
Security benefits and Medicare
Part A, you remain eligible for
Medica HSA.
Medica HSA is a high deductible plan that allows you to make decisions
about how you spend your health care dollars. This plan also uses the
Medica Choice statewide network and the United Healthcare Options
PPO national network with the same provider access described in
Medica Choice National.
The University will contribute $750 to your HSA for employee-only
coverage and $1,500 for family coverage that is contributed over the
26 pay periods in 2014 for coverage effective January 1, 2014. When
enrolling mid-year, the HSA amount will be prorated monthly; however, the deductible amount is not prorated. The amount you receive
depends on when coverage becomes effective and is contributed over
the number of pay periods remaining in the year. While the HSA
amount is tax-sheltered from federal and state taxes in most states
(including Minnesota), for federal reporting the amount the University contributes to your HSA will be shown on your pay statement.
Enrollment in Medica HSA means that you are not eligible to participate fully in a health care Flexible Spending Account. You may
only use the pre-tax FSA plan to cover out-of-pocket costs for eligible
dental and vision expenses.
You will have a special debit card to spend HSA dollars for pharmacy
or medical expenses. You pay the doctor or pharmacy until the annual deductible is met, and you can be reimbursed from the health
savings account as funds are available. After the deductible is satisfied, Medica pays 90 percent.
You own the HSA contributions and can decide whether to use them
for current expenses or save them for future expenses when you retire.
You can also make your own pre-tax contributions to the HSA and
invest them in options from Wells Fargo. If you leave the University,
the account balances are portable.
Benefits Enrollment
Page 20
Medical: Pharmacy Benefits
Pharmacy benefits
provided through
Prime Therapeutics and
Fairview Specialty Pharmacy
Specialty medications
include most drug products
that you inject yourself,
plus certain oral drugs that
can be a challenge to
manage.
Prime Therapeutics is the pharmacy benefits manager for all UPlan
medical options. Fairview Specialty Pharmacy is the exclusive provider
of most specialty medications. You are automatically enrolled in the
pharmacy program when you elect a medical plan.
The UPlan and the pharmacy benefits manager have a strong emphasis on the use of generic drugs to help control the cost of prescription
drugs. The drug formulary through Prime provides safe, effective, highquality, cost-effective medications to ensure the best medical results
while also reducing the overall costs for providing prescription benefits. Fairview will provide a high level of support with specialty medications to help you achieve the best outcomes and quality of life.
The copayment is $0 for Certain Preventive Medications specified in
the Affordable Care Act and Contraceptives in the Generic Plus Category. Medica HSA covers these medications at 100%.
The copayment is $10 for a 30-day supply of Generic Plus (Tier 1)
drugs, which covers all generic drugs and certain preferred brand drugs
for which there is no generic therapeutic equivalent.
The copayment is $30 for a 30-day supply of all other Brand Formulary
(Tier 2) drugs listed on the formulary.
The copayment is $75 for a 30-day supply of Non-Formulary (Tier 3)
drugs, which includes all covered brand name drugs not listed on the
formulary.
For Medica HSA, prescriptions can be covered first under the account,
but the annual deductible also applies until it is met. After that the
medical plan pays 90 percent of pharmacy expenses in the HSA.
Prime Therapeutics:
1-800-727-6181
www.myprime.com/MyPrime/umn
Fairview Specialty Pharmacy:
612-672-5289
1-877-509-5115
www.fairviewspecialtyrx.org/uplan
For more information
Benefits Enrollment
Prime Therapeutics has a broad Minnesota and national retail pharmacy network that includes popular pharmacy chains, clinic and hospital pharmacies, independent pharmacies, and a home delivery mail
service pharmacy. Fairview Specialty Pharmacy provides home delivery
or pick-up service of specialty drugs at Fairview clinic/hospital retail
pharmacies and at Essentia Health and St. Luke’s in Duluth.
The prescription drug member ID card from Prime Therapeutics can
also be used for Fairview Specialty Pharmacy. You must show your
member ID card when obtaining new or refilled prescriptions. Your
member card includes your unique ID number, and your pharmacist
will need to enter the new prescription processing information from
your card into their system.
For questions or to locate a participating pharmacy or obtain specific
plan information, contact Prime Therapeutics’ 24-hour Member
Customer Service at 1-800-727-6181. For questions or prescription
orders, Fairview Specialty Pharmacy’s 24-hour customer service representatives and pharmacists are available at 612-672-5289 or 1-877509-5115.
Page 21
Medical: Zones and Base Plan
Zone: Twin Cities metropolitan
area and northern/southern
surrounding counties
Base Plan: Medica Elect/Essential
Zone: Duluth area
Zone: Greater Minnesota
Base Plan: Medica Elect/Essential
Base Plan: Medica Choice Regional
Base Plan by Zone:
Twin Cities: Medica Elect /Essential
Duluth area: Medica Elect/Essential
Greater MN: Medica Choice Regional
See above
• Duluth area
Carlton County: Zip Codes
– 55707, 55726, 55749,
55756, 55757, 55767, 55780,
55783, 55787, 55797, 55798
Benefits Enrollment
Medica ACO
Insights by Medica
Plan
Tiers I, II, and III
ACOs are available
in specific locations
in the Twin Cities
metro area. Refer
to the provider
directories to determine if one is available where you live.
•Twin Cities
metropolitan area
• Duluth
• Morris/West Central MN
Medica
Choice
National
Statewide
and nationwide
Medica
HSA
Statewide
and nationwide
Page 22
Medical: Plan Availability
County
Medica
Medica
Insights Elect/
ACO by Essential
Medica
Aitkin •
Anoka •
•
•
Becker Beltrami Benton Big Stone •
Blue Earth • *
Brown • * •
Carlton • **
•
Carver •
•
•
Cass Chippewa •
Chisago •
•
•
Clay Clearwater Cook Cottonwood Crow Wing Dakota •
•
•
Dodge • *
Douglas Faribault •
Fillmore Freeborn Goodhue •
Grant Hennepin •
•
•
Houston Hubbard Isanti •
•
•
Itasca •
Jackson Kanabec • Kandiyohi Kittson Koochiching Lac Qui Parle •
Lake •
• ** Lake of the Woods Le Sueur • Lincoln •
Lyon Mahnomen Marshall * Essential not available
** Partial coverage
Benefits Enrollment
Medica Choice/
Medica
HSA
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•**
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
County
Medica
Medica
Insights Elect/
ACO by Essential
Medica
Martin McLeod •
•
Meeker • * •
Mille Lacs • Morrison Mower Murray Nicollet • * Nobles Norman Olmsted Otter Tail Pennington Pine Pipestone Polk Pope •
Ramsey •
•
•
Red Lake Redwood Renville • * •
Rice • •
Rock Roseau Scott •
•
•
Sherburne •
•
•
Sibley • St. Louis • •
Stearns • •
Steele • * Stevens •
Swift •
Todd •
Traverse Wabasha Wadena Waseca • *
Washington •
•
•
Watonwan • * Wilkin Winona Wright •
•
•
Yellow Medicine
•
Medica Choice/
Medica
HSA
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Refer to the map to verify your zone based on where you live or work.
For Medica ACO Plan, you must live in one of the 11 available counties.
Page 23
Medical: Plan Comparison
Medica ACO
Base Plan
Plan
Medica Elect/Essential Medica Choice Regional Twin Cities only
Insights
by Medica
Tiers I, II, and III
Medica
Choice
National
Medica
HSA
Deductibles
$100 per person/
$200 per family
$100 per person/
$200 per family
$200 per person/
$400 per family
$200 per person/
$400 per family
Out-of-network
deductible
$600
$600
$600
$600
HSA Account**
None
None
None
Ground and air
ambulance to
nearest facility
80%
80%
80%
In-network and
Out-of-network
$100 copay, waived
if admitted
$100 copay, waived
if admitted
$25 copay
$20 copay
In-network
deductible*
None
Total in-network
and out-of-network:
Employee only:
$1,500
Family: $3,000
UPlan account
contribution
can be used
to offset
deductibles:
Employee only:
$750
Family: $1,500
Emergency Care
80%
$100 copay, waived $100 copay, waived
if admitted
if admitted
90% after
deductible
90% after
deductible
Urgent Care
In-network and
Out-of-network
I. $25 copay
II. $40 copay
III. $65 copay
$40 copay
90% after
deductible
Network Hospital
General
100% coverage
after deductible
100% coverage
after deductible
100% coverage
after deductible
100% coverage
after deductible
90% after
deductible
Mental Health/
Substance Abuse
100% coverage
after deductible
100% coverage
after deductible
100% coverage
after deductible
100% coverage
after deductible
90% after
deductible
* In-network deductible applies to expenses without a copay, primarily in- and out-patient hospital, and lab/x-ray.
** Refer to page 27 for current employee limits.
Benefits Enrollment
Page 24
Medical: Plan Comparison
Base Plan
edica Elect/Essential
M
Medica Choice Regional
Medica ACO
Plan
Twin Cities only
Insights
by Medica
Tiers I, II, and III
Medica
Choice
National
Medica
HSA
Network Health
Care Services
Preventive care*
100% coverage
100% coverage
100% coverage
Eye and hearing
exam (routine)
100% coverage
100% coverage
100% coverage
$20 Primary/
$30 Specialty copay
I. $25 Primary/
$35 Specialty copay
II.$40 Primary/
$50 Specialty copay
III.$65 Primary/
$75 Specialty copay
Physician**
$25 Primary/
$35 Specialty copay
All Walk-In/
Convenience Clinics***
Lab/X-Ray
$15 copay
100% coverage
$40 Primary/
$50 Specialty copay
100% coverage
100% coverage
90% after
deductible
$15 copay
$20 copay
$20 copay
90% after
deductible
100% coverage
after deductible
100% coverage
after deductible
100% coverage
after deductible
100% coverage
after deductible
90% after
deductible
$50 copay
$40 copay
$50 copay
$50 copay
90% after
deductible
100% coverage
after deductible
$100% coverage
after deductible
100% coverage
after deductible
Outpatient mental
health/substance
abuse
$25 copay
$20 copay
$25 copay
$40 copay
90% after
deductible
Chiropractic care
$25 copay
$20 copay
$25 copay
$40 copay
90% after
deductible
Physical, speech,
occupational therapy
$25 copay
$20 copay
$25 copay
$40 copay
90% after
deductible
Home health care
$25 copay
$20 copay
$25 copay
$40 copay
90% after
deductible
Prosthetics,
Durable Medical
Equipment
80% coverage,
including hearing
aids
80% coverage,
including hearing
aids
80% coverage,
including hearing
aids
80% coverage,
including hearing
aids
90% after
deductible
Outpatient MRI
and CT scan
Outpatient/
surgery
*
100% coverage
100% coverage
` after deductible
90% after
deductible
Preventive care includes routine physical, hearing and eye exams; well child care; prenatal care; immunizations; and allergy injections.
** Primary Care includes Family Medicine, Internal Medicine, Obstetrics/Gynecology, and Pediatrics.
*** Gopher Quick Clinic in the Twin Cities, QuickCare in Duluth, and other walk-in/convenience care clinics; also applies to Consult A Doctor.
Benefits Enrollment
Page 25
Medical: Plan Comparison
Base Plan
Medica ACO
Medica Elect/Essential Plan
Medica Choice Regional Twin Cities only
Insights
by Medica
Tiers I, II, and III
Medica
Choice
National
Medica
HSA
Pharmacy Program through Prime Therapeutics and Fairview Specialty Pharmacy
The pharmacy program is automatically provided to members in all UPlan medical options.
Prescription
Drugs
30-day supply
(including insulin);
network pharmacies
only
30-day supply
(including insulin);
network pharmacies
only
30-day supply
30-day supply
(including insulin);
(including insulin);
network pharmacies network pharmacies
only
only
30-day supply
(including insulin);
network pharmacies
only
Certain Preventive
Medications specified
in the Affordable
Care Act and
Contraceptives in the
Generic Plus Category
$0 copay
$0 copay
$0 copay
$0 copay
100%
Generic Plus (Tier 1)
drugs (includes all
generic drugs and
some low-cost brand
drugs if there is no
generic drug in a given
therapeutic class)
$10 copay
$10 copay
$10 copay
$10 copay
Prescriptions are
covered in the HSA
and at 90%
in medical plan
after deductible
Formulary brand
name (Tier 2) drugs
(includes all other
formulary brand
drugs)
$30 copay
$30 copay
$30 copay
$30 copay
Prescriptions are
covered in the HSA
and at 90% in medical
plan, after deductible
Non-formulary (Tier
3) (includes covered
brand drugs not listed
on formulary)
$75 copay
$75 copay
$75 copay
$75 copay
Prescriptions are
covered in the HSA
and at 90% in medical
plan, after deductible
Purchase of brand
drug when chemically
equivalent generic is
available
Pay the generic
copay and
difference in cost*
between the brand
drug and the
generic drug
Pay the generic
copay and
difference in cost*
between the brand
drug and the
generic drug
Pay the generic
copay and
difference in cost*
between the brand
drug and
the generic drug
Drugs purchased
by mail order
3-month supply
available
for two copays
3-month supply
available
for two copays
3-month supply
available
for two copays
3-month supply
available
for two copays
90-day supply
available at discount
Annual out-ofpocket maximum
(Rx only)
$750 per person
$1,500 per family
$750 per person
$1,500 per family
$750 per person
$1,500 per family
$750 per person
$1,500 per family
No separate out-ofpocket maximum for
prescriptions
Pay the generic
Prescriptions are
copay and
covered in the HSA
difference in cost* and at 90% in medical
between the brand
plan, after deductible
drug and
the generic drug
* The difference in cost does not apply toward the annual out-of-pocket maximum.
** When in the coinsurance level, pay 10 percent coinsurance based on generic price in addition to difference in cost between the
brand drug and the generic drug.
Benefits Enrollment
Page 26
Medical: Plan Comparison
Base Plan
Medica Elect/Essential
Medica Choice Regional
Medica ACO
Plan
Twin Cities only
Insights
by Medica
Tiers I, II, and III
Medica
Choice
National
Medica
HSA
Out-of-Network
Care
$600 deductible
per person,
$1,200 per family,
70% coinsurance
up to annual out-ofpocket
maximum
$600 deductible
per person,
$1,200 per family,
70% coinsurance
up to annual out-ofpocket
maximum
$600 deductible
per person,
$1,200 per family,
70% coinsurance
up to annual out-ofpocket
maximum
$600 deductible
per person,
$1,200 per family,
70% coinsurance
up to annual out-ofpocket
maximum
Out-of-Network
Emergency
Care
Covered as
in-network
emergency benefit
Covered as
in-network
emergency benefit
Covered as
in-network
emergency benefit
Covered as
in-network
emergency benefit
Covered as
in-network
emergency benefit
National
Coverage
Available through
emergency or
out-of-network
benefit only
Available through
emergency or
out-of-network
benefit only
Available through
emergency or
out-of-network
benefit only
Available in-network
through United
Healthcare
Options PPO
network
Available in-network
through United
Healthcare
Options PPO
network
Travel Benefit
Providing
In-Network
Coverage
For students and
other travelers
if services are
provided by United
Healthcare Options
PPO providers
For students and
other travelers
if services are
provided by United
Healthcare Options
PPO providers
For students and
other travelers
if services are
provided by United
Healthcare Options
PPO providers
For out-of-area
residents, students,
and other travelers if
services are provided
by United Healthcare
Options PPO
providers
For out-of-area
residents, students,
and other travelers if
services are provided
by United Healthcare
Options PPO
providers
Annual
Out-of-Pocket
Maximum
$2,500 per person
$4,000 per family
$2,500 per person
$4,000 per family
$2,500 per person
$4,000 per family
$2,500 per person
$4,000 per family
$3,000 per person/
$6,000 per family
(Note: Out-of-pocket
maximums include
the deductible)
Unlimited
Unlimited
Unlimited
Unlimited
70% after
deductible
Total annual
in-network
and out-ofnetwork
Lifetime
Maximum
HSA
Benefits Enrollment
Unlimited
Employee Contributions
Employee-only amount
Catch-up amount – Age 55 or over
$2,550
$1,000
Family coverage amount (any level)
Catch-up amount – Age 55 or over
$5,050
$1,000
Page 27
Medical: 2014 UPlan Wellness Achievement Rates per Pay Period
These are your rates if you achieved the required number of points to reduce your 2014 premiums by $300 or $400 based
upon your tier of medical coverage.
Work 75% to 100% time, pay “Employee contribution” per pay period. Work 50% to 74% time, pay “Total cost” per pay period.
Employee-only coverage
Total cost
Base Plan:
Medica Elect/Essential: Twin Cities and Duluth Medica Choice Regional: Greater Minnesota
$281.24
$281.24
$256.22
$256.22
$25.02
$25.02
Medica ACO Plan: Twin Cities only
Insights by Medica
Medica Choice National
Medica HSA
$271.50
$303.26
$310.26
$281.55
$247.74
$256.22
$256.22
$256.22
$23.76
$47.04
$54.04
$25.33
Employee and child/children coverage
Total cost
Base Plan:
Medica Elect/Essential: Twin Cities and Duluth Medica Choice Regional: Greater Minnesota
$487.47
$487.47
$403.95
$403.95
$83.52
$83.52
Medica ACO Plan: Twin Cities only
Insights by Medica
Medica Choice National
Medica HSA
$469.72
$523.35
$536.80
$488.39
$389.66
$403.95
$403.95
$403.95
$80.06
$119.40
$132.85
$84.44
Employee and spouse/same-sex domestic partner coverage
Total cost
Base Plan:
Medica Elect/Essential: Twin Cities and Duluth Medica Choice Regional: Greater Minnesota
$732.61
$732.61
$615.76
$615.76
$116.85
$116.85
Medica ACO Plan: Twin Cities only
Insights by Medica
Medica Choice National
Medica HSA
$706.16
$787.66
$804.76
$733.69
$591.74
$620.87
$618.04
$615.75
$114.42
$166.79
$186.72
$117.94
Employee and spouse/same-sex domestic partner
and child/children coverage Total cost
Base Plan:
Medica Elect/Essential: Twin Cities and Duluth Medica Choice Regional: Greater Minnesota
$732.61
$732.61
$594.96
$594.96
$137.65
$137.65
Medica ACO Plan: Twin Cities only
Insights by Medica
Medica Choice National
Medica HSA
$706.16
$787.66
$804.76
$733.69
$571.29
$592.17
$586.20
$594.89
$134.87
$195.49
$218.56
$138.80
Benefits Enrollment
Less U contribution
Less U contribution
Less U contribution
Less U contribution
Employee contribution
Employee contribution
Employee contribution
Employee contribution
Page 28
Medical: 2014 UPlan Standard Rates per Pay Period
These are your rates if you did not participate in or earn the required number of wellness points for 2014.
Work 75% to 100% time, pay “Employee contribution” per pay period. Work 50% to 74% time, pay “Total cost” per pay period.
Employee-only coverage
Total cost
Base Plan:
Medica Elect/Essential: Twin Cities and Duluth Medica Choice Regional: Greater Minnesota
$281.24
$281.24
$244.68
$244.68
$36.56
$36.56
Medica ACO Plan: Twin Cities only
Insights by Medica
Medica Choice National
Medica HSA
$271.50
$303.26
$310.26
$281.55
$236.20
$244.68
$244.68
$244.68
$35.30
$58.58
$65.58
$36.87
Employee and child/children coverage
Total cost
Base Plan:
Medica Elect/Essential: Twin Cities and Duluth Medica Choice Regional: Greater Minnesota
$487.47
$487.47
$392.41
$392.41
$95.06
$95.06
Medica ACO Plan: Twin Cities only
Insights by Medica
Medica Choice National
Medica HSA
$469.72
$523.35
$536.80
$488.39
$378.12
$392.41
$392.41
$392.41
$91.60
$130.94
$144.39
$95.98
Employee and spouse/same-sex domestic partner coverage
Total cost
Base Plan:
Medica Elect/Essential: Twin Cities and Duluth Medica Choice Regional: Greater Minnesota
$732.61
$732.61
$600.38
$600.38
$132.23
$132.23
Medica ACO Plan: Twin Cities only
Insights by Medica
Medica Choice National
Medica HSA
$706.16
$787.66
$804.76
$733.69
$576.36
$605.49
$602.66
$600.37
$129.80
$182.17
$202.10
$133.32
Employee and spouse/same-sex domestic partner
and child/children coverage Total cost
Base Plan:
Medica Elect/Essential: Twin Cities and Duluth Medica Choice Regional: Greater Minnesota
$732.61
$732.61
$579.58
$579.58
$153.03
$153.03
Medica ACO Plan: Twin Cities only
Insights by Medica
Medica Choice National
Medica HSA
$706.16
$787.66
$804.76
$733.69
$555.91
$576.79
$570.82
$579.51
$150.25
$210.87
$233.94
$154.18
Benefits Enrollment
Less U contribution
Less U contribution
Less U contribution
Less U contribution
Employee contribution
Employee contribution
Employee contribution
Employee contribution
Page 29
Medical: Walk-in Clinics
Walk-in clinics
When you want fast and affordable medical care for certain common
ailments that have specific treatments, you can access the Gopher
Quick Clinic walk-in clinics on the Twin Cities campus and QuickCare on the Duluth campus. These clinics, along with other convenience care clinics, such as MinuteClinic locations in the Twin Cities
and Target Clinic, are in-network providers for all UPlan Medical
Program options.
The walk-in clinics do not require appointments or referrals, and the
visits generally take about 15 minutes. You will have a $15 to $20
copayment per visit for treatments and screenings depending on your
medical plan selection. There is no copayment for immunizations.
In Medica HSA, the cost of the visit is applied to the deductible, or if
funds are available, it may be paid out of the account balance.
The clinics are staffed by board-certified physician assistants or nurse
practitioners who are trained to diagnose, treat, and provide prescriptions when needed. If necessary, they will refer you to your regular
health care provider.
Gopher Quick Clinic on
Twin Cities campus
The Gopher Quick Clinic offers health care services to faculty, staff,
and their dependents who are enrolled in a UPlan medical plan.
Gopher Quick Clinic is open from 9 a.m. to 5 p.m., Monday through
Friday, at its Minneapolis location:
• On the third floor (entry level) in Boynton Health Service, 410
Church Street SE, on the East Bank
Gopher Quick Clinic is open from 9 a.m. to 5 p.m., Monday through
Friday, at Boynton’s St. Paul Clinic location:
• On the first floor, 109 Coffey Hall, across from the St. Paul
Student Center
The clinic opens at 9:30 a.m. on Thursday. It is closed from 12:45 to
1:45 p.m., Monday through Friday.
For more information about Gopher Quick Clinic, refer to the website at www.bhs.umn.edu.
QuickCare on
Duluth campus
QuickCare offers health care services for UMD faculty, staff, and their
dependents who are enrolled in a UPlan medical plan.
Located in 107 Kirby Student Center on the UMD campus, QuickCare
is open from 8 a.m. to 2:30 p.m., Monday through Friday, during the
academic school year. QuickCare will be closed on employee holidays.
For more information about QuickCare, refer to the website at
www.d.umn.edu/quickcare/.
Benefits Enrollment
Page 30
Consult A DoctorTM 24/7
Get care from a doctor for a variety of conditions using Consult A
Doctor. Connect with a licensed physician to receive medical care and
advice and, when necessary, obtain prescriptions. This convenient
option gives you 24/7 access to care for non-emergency medical concerns (e.g., allergies, cold/flu, ear and sinus infections) anytime you
need it — without having to leave your home or office.
Consult a Doctor 24/7 is available to all UPlan members in any of the
Medica plan options. You can activate your account by calling a care
coordinator at 1-855-993-7633 or you can visit www.medica.com/
consultadoctor and click on Activate Account.
You will have a copay of $15 for all Medica plan options, except if you
are with Medica HSA in which case the cost of the visit is applied to the
deductible or covered at 90 percent if the deductible has been met.
Your benefits
• On-demand physician care — Call or email a doctor 24/7
• Request prescription medication — Obtain
prescription medication and timely prescription refills
• Care for your family — Instant, affordable access to care for Medica
members of all ages
• Nationwide medical expertise — All doctors are U.S.-based, statelicensed, and available in all 50 states
•
5 easy ways to connect
By phone at
1-855-993-7633
Online at
www.medica.com/consultadoctor
When you log into the Consult A Doctor 24/7 website, you also
gain access to the My Personal Health Manager member portal that
includes health tools such as a symptom checker, health library,
and personal health record.
1. Talk to an on-call doctor in as little as two minutes to get answers
to informational medical questions and receive treatment recommendations.
2. Request a priority consultation and the doctor will call you back
in 30 minutes to three hours for a comprehensive phone appointment for possible diagnosis and treatment plan, including a prescription when appropriate.
3. Schedule an appointment, Monday through Friday, at a time that is
convenient for you to talk to a doctor for a comprehensive diagnostic consultation, including a prescription when appropriate.
4. Email a doctor about medical issues using a secure messaging system and get a response within two to four hours for a comprehensive appointment to discuss treatment recommendations.
5. Set up a video consultation, similar to a face-to-face appointment,
for a comprehensive consultation, including a prescription when
appropriate.
Benefits Enrollment
Page 31
Medical: Travel Program
Travel program provides
in-network coverage
When you are traveling or your dependent is a student attending
college outside of the plan’s service area, you may still receive innetwork benefits for medical services if you use a provider in the
designated networks from Medica. To be eligible for this benefit, your
permanent residence must be in the plan’s service area.
Medica offers a travel program for members in Medica Elect/Essential,
Medica ACO Plan, Medica Choice Regional, and Insights by Medica.
This benefit will make it possible for you or your covered dependents
to access the UnitedHealthcare Options PPO network only when
traveling outside of Medica’s service area and receive in-network
benefits. However, chiropractic and transplants are not part of the travel
program. Your out-of-network/emergency benefit will apply for these
services.
To locate a UnitedHealthcare Options PPO network provider, you
may visit www.medica.com/uofm and click on the link for “Travel
Program” to access the travel network. Or you may call the customer
service phone number listed on the back of your Medica member ID
card.
Note: The ability to travel outside of the Medica service area is already
included in the Medica Choice National and Medica HSA plan options.
Medica Choice National and Medica HSA also allow a member to live
outside of the service area.
FrontierMEDEX
Emergency Medical
Evacuation and Travel
Assistance
You also have a benefit with FrontierMEDEX that gives you access
to a comprehensive program providing you with 24/7 emergency
medical, security, and travel assistance—including emergency medical
evacuation and repatriation—when you are outside your home country
or 100 ormore miles from your home.
FrontierMEDEX’s highly trained coordinators can assist you and
monitor your care 24 hours a day, 365 days a year, if you have a
medical emergency or need travel assistance. FrontierMEDEX will work
closely with your UPlan claims administrator to coordinate emergency
medical assistance services or hospitalization with your UPlan benefits.
There is no additional cost for this benefit through your medical plan.
More information is available on the FrontierMEDEX website at www.
frontiermedex.com. The toll-free and collect-call telephone numbers
are printed on your ID card. If you need additional FrontierMEDEX
cards, contact the Employee Benefits Service Center.
Benefits Enrollment
Page 32
Wellness
Wellness
The Wellness Program designs and delivers programs to support
wellness at work and in the home. As UPlan members, you and your
family are invited to take advantage of opportunities to maintain or
improve your health.
Wellness
For this program year, when you participate in the Wellness Program,
you can earn wellness points. The points earned between October 1,
2013, and August 31, 2014, are used in 2015 to reduce the cost of what
you pay for UPlan Medical Program coverage. Your rate contribution
can be reduced by $300 or $400 in 2015 when you earn the minimum
number of points required for your level of coverage.
Connecting with Wellness
Employee Benefits Phone Center: 612-624-8647 or 800-756-2363
well@umn.edu
www.wellness.umn.edu
StayWell: 866-341-1170
Medica: www.medica.com/uofm
Healthy Pregnancy program
888-992-3875
Tobacco Cessation program
800-934-4824
OptumHealthSM 24/7 NurseLineSM:
See the toll-free phone number
listed on the back of the UPlan
Medical Program ID card
• When you elect the Employee-only or Employee plus child/children
level and earn 300 points between October 1, 2013, and August 31,
2014, your total rate contribution will be reduced by $300 in 2015.
• When you elect the Employee plus spouse/same-sex domestic
partner or Employee plus spouse/same-sex domestic partner and
child/children level of coverage and earn 400 points between
October 1, 2013, and August 31, 2014, your total rate contribution
will be reduced by $400 in 2015.
You must earn the minimum of 300 points, and 100 of the 400 points
for the applicable family levels can be earned by your spouse/same-sex
domestic partner if he or she chooses. The deadline to earn wellness
points for health improvement is August 31, 2014.
Learn more about the program and then review the Wellness Points
Chart on the following pages to develop a plan to earn the total points
you need to achieve.
• If you are newly eligible for UPlan medical plan coverage effective
June 1, 2014, or earlier, you can earn the required number of
wellness points for 2015 by completing the wellness assessment
and successfully completing additional activities and health
improvement programs no later than August 31, 2014.
• If you are newly eligible for UPlan medical plan coverage effective
July 1 or August 1, 2014, you need to enroll for your benefits by
August 31, 2014, and take the wellness assessment by September
12, 2014, to earn the points to reduce your employee contribution
for 2015. You do not need to earn additional wellness points.
Wellness Points return
October 1, 2013 —
What’s new?
• If you are newly eligible for UPlan medical plan coverage effective
September 1, 2014, or later, you can begin to earn wellness points
for the following year starting on October 1, 2014.
As your points accumulate, track your progress online. Go to www.
wellness.umn.edu, then log in to StayWell Online, the website that
hosts the assessment and MyPoints Bank.
You will receive the $300 or $400 reduction in the cost of your 2015
coverage with the UPlan Medical Program over the 26 pay periods.
Benefits Enrollment
Page 33
Wellness
Fit Choices
Eligibility
Medica:
www.medica.com
952-992-1814
877-252-5558
Enrollment
When you exercise at least eight times a month at a participating fitness
center, up to $20 per month of your membership dues can be returned
to you. Exercise eight times a month for six months between October 1,
2013, and July 31, 2014, and earn 75 wellness points. Exercise 12 times
a month for six months in that same period and earn 125 wellness
points.
To be eligible to participate in the Fit Choices program you must be
enrolled in a Medica medical plan, be age 18 years or older, and join
or belong to a participating health club or fitness center. The network
of participating fitness facilities features hundreds of major and independently owned recreational and fitness centers. Also included are
the University recreational and fitness centers located on the Twin
Cities, Duluth, and Morris campuses. The full list of participating
fitness centers and health clubs can be found on the Medica website.
Enrollment in the Fit Choices program occurs at your fitness facility. If
you change medical plans, even though you may be currently participating in the program, you will need to re-enroll in the program. When
registering, remember to bring your Medica medical plan ID card.
Visits to the fitness centers are recorded by the participating facilities.
Once your regular workouts are underway, you can expect to receive
your membership dues reimbursement within about 60 days. Depending on your fitness center’s policy, your reward will be reflected as a reduction in monthly dues or will be directly deposited into your checking or savings account.
Group Strength Express
(Twin Cities campus)
Heart Rate Express
(Twin Cities campus)
Weight Watchers®
on Campus
Benefits Enrollment
An eight-week program through the UMTC Recreation and Wellness
Center that aims to increase muscular strength and endurance under
the instruction of a Certified Personal Trainer. Attend 13 of the 16
classes and complete the pre- and post-class fitness assessments, and
receive a full reimbursement of the $199 class cost, plus 50 wellness
points through Wellness My Way. Limit: once per lifetime.
An eight-week program through the UMTC Recreation and Wellness
Center that aims to improve cardiovascular fitness through cycling and/
or running/jogging under the instruction of a Certified Personal Trainer.
Attend 13 of the 16 classes and complete the pre- and post-class fitness
assessments, and receive a full reimbursement of the $199 class cost,
plus 50 wellness points through Wellness My Way. Limit: once
per lifetime.
A motivational support program for weight loss and maintenance in
a group setting. Attend 14 meetings over a four-month period by
August 31, 2014, and be reimbursed for four months of dues (totaling
$159.80), in addition to earning 150 wellness points. You can be
reimbursed three times within one calendar year for up to a lifetime
total of six reimbursements.
Page 34
WELLNESS
Create Your Weight
(Twin Cities campus)
A behavior modification program offered through the University of
Minnesota Medical Center Fairview that includes a measurement of
your rate of metabolism. Attend nine out of the 11 classes by August
31, 2014, and be fully reimbursed for the $235 program fee (limit
once per calendar year), in addition to earning 150 wellness points.
Mindfulness in Motion
(Twin Cities and
Duluth campuses)
An eight-week, research-based program offered by the Center for
Spirituality and Healing that gives participants tools to reduce daily
stress. Weekly sessions emphasize bodily relaxation and mindful
awareness of cognitive habits. Attend at least seven of the eight weekly, hour-long classes, and be reimbursed for the $200 program fee, in
addition to earning 50 wellness points through Wellness My Way.
Mindfulness-Based Stress
Reduction
An eight-week program offered by the Center for Spirituality and
Healing that guides participants in mindfulness and meditation practices, group discussions, and gentle stretching and yoga to promote
balance, focus, and reduced stress. Attend at least six of the eight
classes and the day-long retreat and be reimbursed $200 of the $375
enrollment fee, in addition to earning 50 wellness points through
Wellness My Way.
OptumHealth 24/7
Nurseline
When you want help making decisions about your health or the
health of a family member, consider a call to the nurse line. The
nurse line offers immediate access to experienced registered nurses
who can answer your health questions and provide support, 24 hours
a day, 365 days a year. The phone number for the nurse line and the
web address for the “live” nurse chat are on your medical ID card.
OptumHealth Treatment
Decision Support
OptumHealth Treatment Decision Support (TDS) Service, provides
one-on-one consultations that can ease the stress of sorting through
information when faced with a new diagnosis for a medical condition, including back pain, knee and hip replacement, benign prostate
disease, prostate cancer, breast cancer, certain uterine conditions, and
angina. TDS helps give you the answers and resources you need to
choose appropriate treatment. Connect with a TDS nurse by calling
the 24/7 Nurse Line at the phone number on your medical ID card.
Interested in becoming a
Wellness Advocate?
Wellness Advocates work within their departments and colleges/units
to increase the commitment to wellness among faculty and staff and
support the efforts of the Wellness Program. Contact the Wellness
Program to learn more.
Questions:
Email: well@umn.edu
Telephone: 612-624-8647
Fax: 612-626-0808
Benefits Enrollment
Page 35
Wellness Points
Wellness
Wellness activity
25
50 1
Points
75
25
100
50
October 1, 2013, through March 31, 2014.
Biometric health screenings2 125
75
150
100
Complete by August 31, 2014.
$
200
125
25
150
25
25
50
50
50
Bicycle Commuter program
200
75
75
75
100
100
100 Complete by August 31, 2014.
Face-to-face
health coaching
$
125
125
125
25
150
25
150
Enroll by May 31, 2014. Complete by August 31, 2014.
150
50
50
Fit Choices
200
200
200
75
75
100
100 Enroll by February 1, 2014. Complete by July 31, 2014.
150
150
50
25
25
125
125
25
200
50
200
50
75
100
75
25
75
100
50
100
125
150
START HERE
Wellness assessment
Annual flu shot pledge
$
$
NEW POINT LEVEL
Healthy Pregnancy program
Medication Therapy Management
NEW
125
75
125
Complete by August 31, 2014.
Complete by August 31, 2014.
Complete by August 31, 2014.
NextSteps® Health Coaching
• Coaching for medical condition management*
• Coaching
$ for lifestyle change**
200
125 ** 150
200
Non-tobacco user pledge
200
25
50 Complete by August 31, 2014.
25
25
50
75
50
100 Enroll by June 30, 2014. Complete by August 31, 2014.
75
75
25
100
125
100
50
150 Complete by August 31, 2014.
125
125
75
25
25
200
200
125
75
150
200
150
100
50
50
75
150
100
100
200
125
125
150
150
Online
Healthy Living programs
$
$
Specialty
Therapy Management
Step It Up!® walking program
Tobacco Cessation program
$
150
100
150
* 200
2014 Deadlines for enrollment and completion
Weight Management
$
Wellness My Way
$
NEW
200
200
25
50
75
100
Complete by August 31, 2014.
Enroll by June 30, 2014. Complete by August 31, 2014.
Enroll by May 31, 2014. Complete by August 31, 2014.
Weight Watchers® at Work can be completed 3 times
annually; 6 times per lifetime. Create Your Weight can
be completed just one time annually. Enroll by May 31,
2014. Complete by August 31, 2014.
Complete by August 31, 2014.
1
Although it may be possible to complete an activity more than one time between October 1, 2013, and August 31, 2014, the point value associated with each of the programs above
is the maximum number of points that can be earned for the completion of that specific activity.
In lieu of biometric health screening data obtained through on-campus health screenings,
UPlan members can request their health care provider to submit screening results using
125
150
the Health Care Provider Biometric Health Screening Form which can be accessed at: www1.umn.edu/ohr/wellness/assess/biohealthscreenings.
2
200
Benefits Enrollment
Page 36
Wellness Points
Description
20-minute online questionnaire to assess current health status. Access online at: www.wellness.umn.edu. Provided by: StayWell Online.3
A brief health screening to determine cholesterol, blood pressure, glucose, and BMI. Providers: Personal physician; UMTC
Boynton Health Service; UMD QuickCare Clinic.
Flu vaccine available at campus flu vaccination clinic, physician’s office, UMTC Boynton Health Service, UMD Quick Care, or retail
convenience clinic. Access online at: www.wellness.umn.edu. Self-report vaccination occurred within previous 12 months.
Bike to work 50 days; track trips using RFID technology. Provider: University Parking and Transportation Services.
On-campus, in person. Minimum visits: 3. UMTC: Health coaching available for nutrition, physical activity, or nicotine use. Provider:
Boynton Health Service. UMD Health and Wellness Center and UMM: Health coaching available to achieve overall wellness.
Exercise at least 8 times per month at a participating fitness center for 6 months to earn 75 points or 12 times per month for
6 months to earn 125 points. Must be completed between October 1, 2013, and July 31, 2014. Provider: Medica.
Telephone-based assistance and support during pregnancy and following childbirth. Minimum calls: 3; at least 1 call after birth
of baby. Provider: Medica. Enroll by May 31, 2014.
Face-to-face consultations with a MTM Pharmacist for UPlan members taking 4 or more covered prescriptions.
Minimum visits: 3. Provider: MTM Pharmacy Network. Enroll by May 31, 2014.
Telephone-based coaching for management of high-risk asthma, chronic obstructive pulmonary disease, coronary artery disease,
diabetes, or heart failure; or lifestyle change such as stress or weight management, nutrition, physical activity, or smoking.
Minimum calls: 3. Provider: StayWell. Enroll by May 31, 2014.
Access online at: www.wellness.umn.edu. Self-report tobacco-free for minimum of 6 previous months.
Six-week, self-paced, online programs for behavioral change. Provider: StayWell Online. Access online at: www.wellness.umn.edu.
Telephone consultations with specialty pharmacy nurse for UPlan members taking specialty medication. Minimum calls: 3.
Provider: Fairview Specialty Pharmacy. Enroll by May 31, 2014.
Receive a free pedometer and walk or exercise for six weeks. Provider: StayWell Online. Access online at: www.wellness.umn.edu.
Telephone-based guidance and support to end nicotine dependence. Minimum calls: 3. Provider: Medica.
On-campus weight management:
• Weight Watchers® at Work. Minimum attendance: 14 meetings.
• Create Your Weight (UMTC only). Minimum attendance: 9 classes.
• Registration fees returned when attendance requirements are met.
A self-directed approach to reach a personal wellness goal. Options include a race or athletic event, in-home exercise, Universitysponsored programs, alternative weight management programs, team sports, fitness classes, and personal training sessions.
Details at www.wellness.umn.edu.
3
StayWell Health Management, LLC. Staywell, NextSteps and StayWell Online, and Step It Up! are registered trademarks of StayWell Health Management, LLC. StayWell Online is a
product of StayWell Health Management, the independent, third-party administrator of the Wellness Points Bank. StayWell Health Management, 3000 Ames Crossing Road, Suite 100,
St. Paul, MN 55121-2520, www.staywellhealthmanagement.com.
You can earn...
400 •• Employee-only
Employee plus 300
150
125
100
child/children
ELLNESS
W
400 Enrollment
Benefits
75
P OI TS
N
50
75
ELLNESS
W
300
P OI TS
N
= $300
ANNUAL
PREMIUM
REDUCTION
• Employee plus spouse/SSDP
• Employee plus spouse/SSDP and child/children
• Spouse/SSDP can contribute up to 100 points
400
= $400
ANNUAL150
PREMIUM
125
100
REDUCTION
50
ELLNESS
W
400
P OI TS
N
75
Page
75 37
300
ELLNESS
W
300
P OI TS
N
Medication Therapy Management
Making the best use of
your medication
Do you want to be more involved in your medication therapy decisions? A program called Medication Therapy Management (MTM) allows you to do just that, and it could result in improved health for you.
MTM eligibility
You are eligible for the MTM program if you take four or more UPlancovered prescriptions and prescription over-the-counter medications for
chronic conditions or you are referred by your physician to the program. The UPlan pays the full cost of MTM services so there is no copay
or other cost for the consultations with the pharmacist.
What to expect
The purpose of MTM is to be sure that your medications are appropriate, effective, safe, and convenient. MTM is set up as a private, face-toface meeting between you and a specially trained pharmacist. An initial
visit may be 30 to 45 minutes. All your prescription, over-the-counter,
and herbal medications will be reviewed by the pharmacist who will
ask you questions about your medical history and conditions and use
of medications in the past so that he or she can assess and identify any
problems with your current medications. By doing this the MTM pharmacist can identify, resolve, and prevent medication-related problems.
With your permission, the pharmacist will contact your primary care
provider with an assessment and recommendations and then work
closely with your provider to optimize your health care and resolve any
medication-related problems.
MTM pharmacists
Pharmacists must meet credentialing standards developed by the
UPlan. Specifically, all of the pharmacists received education on the
delivery of MTM during their degree program, or they completed an
additional, approved continuing education course on how to provide
medication therapy management services.
The Medication Therapy Management website includes the network of
MTM pharmacists who are based out of clinics and community pharmacies at all five campuses and other major locations. You can choose
an MTM pharmacist who is not part of your medical plan and primary
care clinic or your regular pharmacy.
Wellness Points for MTM
Participants
Benefits Enrollment
If you participate in the MTM program, you are eligible to earn 100
Wellness Points for meeting with an MTM pharmacist three times or
more between the program dates of October 1, 2013, to August 31,
2014. You must have your first visit with a MTM pharmacist by
May 21, 2014.
Page 38
Important Notice from the UPlan Medical Program
Important Notice from the
UPlan Medical Program for
Employees, Early Retirees,
Disabled, and
COBRA Participants and
Dependents Concerning Your
Prescription Drug Coverage and
Medicare
READ THIS ENTIRE NOTICE
CAREFULLY and keep it
where you can find it.
If you or a covered dependent has Medicare Part A and/or B (or will
be eligible within the next 12 months) you’ll want to read this notice about your current Prescription Drug Coverage and Medicare. If
not, you can disregard this notice.
NOTE: The Centers for Medicare and Medicaid Services (CMS) regulations require us to send this notification to all individuals with prescription drug coverage who are eligible for Medicare. We’re including
this information in our Guide for UPlan Benefits Enrollment because
we don’t know if you are entitled to Medicare or not. Medicare entitlement includes individuals who qualify for Medicare because of a
disability or end-stage renal disease (ESRD), as well as individuals who
are over age 65.
This notice has information about your current prescription drug
coverage with the University of Minnesota’s UPlan Medical Program
for employees, early retirees, disabled, and COBRA participants (and
dependents) and the prescription drug coverage available for people
with Medicare. It also explains the options you have under Medicare
prescription drug coverage and can help you decide whether or not you
want to enroll. At the end of this notice is information about where
you can get help to make decisions about your prescription drug coverage.
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare through Medicare prescription drug plans and Medicare Advantage Plans that offer prescription drug coverage. All Medicare
prescription drug plans provide at least a standard level of coverage
set by Medicare. Some plans may also offer more coverage for a higher
monthly premium. The five plans in the University of Minnesota
Retiree Medical Program for Over 65 Retirees will automatically enroll
you in the Medicare prescription drug benefit and will include coverage
that is at least as good as the Medicare prescription drug benefit.
2. The University of Minnesota has determined that the prescription
drug coverage offered by the UPlan Employee Medical Program is, on
average for all plan participants, expected to pay out as much as the
standard Medicare prescription drug coverage will pay and is considered Creditable Coverage.
If you have a spouse or dependent on a Medicare plan, separate
communications will be sent to them regarding their coverage.
Because your existing UPlan Employee Medical coverage is on average at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay extra if you later decide
to enroll in the Medicare prescription drug program.
If you decide to enroll in a Medicare prescription drug plan and drop
your UPlan Employee Medical Program prescription drug coverage, be
aware that you cannot get this coverage back.
Benefits Enrollment
Page 39
Important Notice from the UPlan Medical Program
You can enroll in a Medicare prescription drug plan when you first
become eligible for Medicare and each year from October 15 through
December 7. When you leave employer coverage you may be eligible for
a Special Enrollment Period to sign up for a Medicare prescription drug
plan.
You should also know that if you drop or lose your coverage with your
UPlan Employee Medical Program and don’t enroll in Medicare prescription
drug coverage after your current coverage ends, you may pay more
(a penalty) to enroll in Medicare prescription drug coverage later.
For more information about
this notice or your current
prescription drug coverage
For more information
about your options
under the Medicare
prescription drug coverage
Remember: Keep this notice. If
you enroll in one of the new plans
approved by Medicare which offer
prescription drug coverage, you may
be required to provide a copy of
this notice when you join to show
that you are not required to pay a
higher premium amount.
Date:October 2013
Sender: University of Minnesota Employee Benefits
Department
Contact:Employee Benefits Service Center
Address: 319 15th Avenue SE, Minneapolis, MN 55455-0103
Phone: 612-624-8647 or
1-800-756-2363
Benefits Enrollment
If you go 63 days or longer without prescription drug coverage that’s at
least as good as Medicare’s prescription drug coverage, your monthly
premium will go up at least one percent per month for every month
that you did not have that coverage. For example, if you go 19 months
without coverage, your premium will always be at least 19 percent higher
than what many other people pay. You’ll have to pay this higher premium as
long as you have Medicare prescription drug coverage. In addition, you may
have to wait until the following November to enroll. However, if you
lose your current creditable prescription drug coverage, through no fault
of your own, you will also be eligible for a two month Special Enrollment Period to join a Medicare drug plan.
Contact the University of Minnesota Employee Benefits Service Center
by calling 612-624-8647 or 1-800-756-2363.
NOTE: You will receive this notice annually and at other times in the
future such as before the next period you can enroll in Medicare
prescription drug coverage, and if this coverage through the UPlan
Employee Medical Program changes. You also may request a copy.
More detailed information about Medicare plans that offer prescription
drug coverage is available in the “Medicare & You” handbook, which
you receive in the mail from Medicare. You may also be contacted
directly by Medicare prescription drug plans. When you are approaching
age 65, you will also receive information about the University of
Minnesota Retiree Medical Program for Over 65 Retirees.
For more information about Medicare prescription drug plans:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see your copy
of the Medicare & You handbook for their telephone number) for
personalized help
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048
For people with limited income and resources, extra help paying for a
Medicare prescription drug plan is available. Information about this
extra help is available from the Social Security Administration (SSA).
For more information about this extra help, visit SSA online at
www.socialsecurity.gov, or call them at 1-800-772-1213
(TTY 1-800-325-0778).
Page 40
DenTal: Plan oPTIons
basic benefit
All of the dental plans available to you provide comprehensive
coverage for most conditions requiring dental diagnosis and treatment
including many preventive and restorative services such as: periodic
examinations, x-rays, cleanings, fillings, restorative crowns, root canals,
extractions, bridgework, and orthodontic treatment for children.
There are some differences in the coverage of specific services and in
your out-of-pocket costs. You should carefully review the benefits
provided by the plans available in your area to help you determine
which plan best meets your needs.
One difference in the plan options is how the benefits for fillings are
determined. Delta Dental Premier, HealthPartners Dental Choice, and
University Choice pay benefits based on composite (white) fillings
throughout the mouth. Delta Dental PPO and HealthPartners Dental
pay benefits based on composite fillings in the front of the mouth and
on amalgam (silver) fillings in the back of the mouth.
As you consider the dental plans, you may want to check which networks
your dentist is in and enroll accordingly. Since some dental plan networks are available in parts of the state, you may have a different set of
options than someone living in another county. You can choose any
plan that is available in the county where you live or work.
Coverage available
You elect coverage from one of these four rate tiers: Employee only;
Employee and spouse/same-sex domestic partner; Employee and child/
children; and Employee and both spouse/same-sex domestic partner
and child/children. You may also waive or elect not to have coverage.
rates
The University of Minnesota pays 88 percent of the cost of employeeonly coverage (employee pays 12 percent) and 52 percent of the cost
of each tier of family coverage (employee pays 48 percent) for the base
plan for your geographic zone.
base plans
How to enroll
Delta Dental PPO is the base plan for employees in the Twin Cities and
Duluth zone. Delta Dental Premier is the base plan for employees in
the Greater Minnesota zone.
Open Enrollment: Enroll or make your change online in Employee
Self-Service from November 1 through December 2.
New Employee: Make your election online in Employee Self-Service
within the first 60
30 days of employment or benefits eligibility.
The dental plan in which you enroll will send a member ID card to
your home.
Benefits Enrollment
Page 41
Dental: Plan Descriptions
You do not need to select a primary dental clinic when you enroll. To
learn more about specific benefits for the dental plans, review the Plan
Comparison on the following pages.
For more information on
Delta Dental Premier,
Delta Dental PPO,
and University Choice:
Customer Service: 651-406-5916
Toll free: 800-448-3815
w
ww.deltadentalmn.org/uofm
Delta Dental PPO is an affordable, network-only plan. Under this plan
you must go to a dentist participating in the Delta Dental PPO network to receive benefits. With the exception of out-of-area emergencies,
benefits will be denied if you do not see a Delta Dental PPO dentist.
The Delta Dental PPO network includes more than 1,800 participating
dentists and specialists in 73 Minnesota counties and border communities. With a Delta Dental PPO dentist your out-of-pocket costs may be
reduced.
Delta Dental Premier is a flexible plan that offers access to the broad
Delta Dental Premier network as well as the more cost-effective Delta
Dental PPO network. Out-of-network benefits are also available. The
Delta Dental Premier network is Minnesota’s largest dental network with
more than 3,100 participating dentists and specialists in 87 Minnesota
counties and border communities. Seeing a dentist in either of the Delta
Dental networks will help you make the most of your benefits and can
result in out-of-pocket cost savings.
University Choice is administered by Delta Dental and offers
freedom to see any provider of your choice. There may be a payment
difference between the allowed reimbursement and what the
dentist charges for a particular service, which could result in greater
out-of-pocket costs for you since the dentist may bill you for the
balance. Seeing a dentist who participates in the Delta Dental PPO
or Delta Dental Premier networks may result in lower out-of-pocket
costs, in addition to waiving the $50 deductible under this program.
For information on UPlan
HealthPartners Dental and
UPlan HealthPartners
Dental Choice:
UPlan HealthPartners Dental is an affordable, network-only plan.
Under this plan you must go to a dentist participating in the network
to receive benefits, except for out-of-area emergencies. This plan’s
network has more than 1,200 dentists and specialists at over 850
dental clinics in 71 Minnesota counties and border communities.
Customer Service: 952-883-5000
Toll free: 800-883-2177
TTY: 952-883-5127
www.healthpartners.com/uofm
Benefits Enrollment
UPlan HealthPartners Dental Choice is a broad network plan
that also offers out-of-network benefits. Seeing a dentist in the
HealthPartners network will help you receive the highest level of
benefits. The network for this plan has more than 2,000 dentists and
specialists at over 1,300 dental clinics in 71 Minnesota counties and
border communities.
Page 42
Dental: Plan Availability
County
HP Dental
Delta Dental
and Dental PPO
Choice
Aitkin •
•
Anoka •
•
Becker •
•
Beltrami •
•
Benton •
•
Big Stone Blue Earth • •
Brown • •
Carlton •
•
Carver •
•
Cass •
•
Chippewa •
•
Chisago •
•
Clay •
•
Clearwater •
Cook Cottonwood •
•
Crow Wing •
•
Dakota •
•
Dodge Douglas •
•
Faribault •
Fillmore •
•
Freeborn •
•
Goodhue •
•
Grant •
Hennepin •
•
Houston •
•
Hubbard •
•
Isanti •
•
Itasca •
•
Jackson •
•
Kanabec •
•
Kandiyohi •
•
Kittson •
•
Koochiching •
•
Lac Qui Parle •
•
Lake •
•
Lake of the Woods •
Le Sueur •
•
Lincoln • Lyon •
•
Mahnomen •
Benefits Enrollment
Delta Dental
Premier
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
County
HP Dental
Delta Dental
and Dental PPO
Choice
Marshall Martin •
•
McLeod •
•
Meeker •
•
Mille Lacs •
•
Morrison •
•
Mower •
•
Murray • Nicollet •
•
Nobles •
•
Norman Olmsted •
•
Otter Tail •
•
Pennington •
•
Pine •
•
Pipestone •
•
Polk •
Pope •
Ramsey •
•
Red Lake Redwood •
Renville • •
Rice •
•
Rock •
•
Roseau •
Scott •
•
Sherburne •
•
Sibley •
•
St. Louis •
•
Stearns •
•
Steele • •
Stevens •
•
Swift Todd •
•
Traverse •
•
Wabasha •
•
Wadena •
•
Waseca •
Washington •
•
Watonwan
•
•
Wilkin •
Winona •
•
Wright •
•
Yellow Medicine
•
•
Delta Dental
Premier
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Page 43
Dental: Plan Comparison
Delta Dental Premier
Annual maximum for all benefits per
person per contract year is $1,800
In-network
Emergency Services
Emergency dental services
provided same as eligible
dental services
Out-of-network
After $125 annual deductible,
emergency dental services
provided same as eligible
out-of-network services
Delta Dental PPO
Annual maximum for all benefits per
person per contract year is $1,800
In-network coverage only
In-network services provided same
as any service; out-of-network
services apply $50 deductible then
same as any in-network service
Diagnostic/preventive care
Oral examinations, dental cleanings, x-rays, special periodontic
care, topical fluoride (to age 19),
space maintainers
100% coverage
50% coverage
100% coverage
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
Composite (white)
Composite (white)
Composite (white)
Composite (white)
Amalgam (silver)
Composite (white)
Sealants, to age 19
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
Extractions and other
oral surgery
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
Periodontics
(gum disease therapy)
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
Endodontics
(root canal therapy)
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
Restorative crowns
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
Inlays & onlays, repair
of crown
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
Fixed or removable bridgework
50% coverage
No coverage
50% coverage
Implants as alternative treatment
50% coverage
No coverage
50% coverage
Full or partial dentures
50% coverage
No coverage
50% coverage
Denture relines or rebases
50% coverage
No coverage
50% coverage
Basic restorative care
Fillings (customary restorative materials)
Coverage on back teeth based on
Coverage on front teeth based on
Major restorative care
Coverage limited to dependents up to age 19
Orthodontics
80% coverage
Orthodontics*
50% coverage
Coverage limited to
dependents up to age 19
80% coverage
* Orthodontic benefit subject to separate $2,800 lifetime maximum per covered dependent, which does not start over if you change plans.
Benefits Enrollment
Page 44
Dental: Plan Comparison
University Choice
UPlan HealthPartners Dental Choice
Annual maximum for all benefits per
person per contract year is $1,800
Annual maximum for all benefits per
person per contract year is $1,800
Open access
Emergency dental services
provided same as eligible
dental services
In-network
UPlan HealthPartners Dental
Annual maximum for all benefits per
person per contract year is $1,800
Out-of-network
In-network coverage only
Emergency dental services
provided same as eligible
dental services
After $125 annual deductible,
emergency dental services
provided same as eligible
out-of-network services
In-network services provided same
as any service; out-of-network
services apply $50 deductible then
same as any in-network service
100% coverage
50% coverage
100% coverage
After $50 deductible,
80% coverage
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
Composite (white)
Composite (white)
Composite (white)
Composite (white)
Composite (white)
Composite (white)
Amalgam (silver)
Composite (white)
After $50 deductible,
80% coverage
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
After $50 deductible,
80% coverage
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
After $50 deductible,
80% coverage
80% coverage
After $125 annual a deductible,
50% coverage
80% coverage
After $50 deductible,
80% coverage
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
After $50 deductible,
80% coverage
80% coverage
After $125 annual deductible,
50% coverage
80% coverage
After $50 deductible,
80% coverage
80 % coverage
After $125 annual deductible,
50% coverage
80% coverage
After $50 deductible,
50% coverage
50% coverage
No coverage
50% coverage
After $50 deductible,
50% coverage
50% coverage
No coverage
50% coverage
After $50 deductible,
50% coverage
50% coverage
No coverage
50% coverage
After $50 deductible,
50% coverage
50% coverage
No coverage
50% coverage
Use of Delta network dentists will
waive deductible and reduce your cost
100% coverage
Use of Delta network dentists will
waive deductible and reduce your cost
Use of Delta network dentists will
waive deductible and reduce your cost
Coverage limited to
dependents up to age 19
80% coverage
Coverage limited to dependents up to age 19
80% coverage
50% coverage
Coverage limited to
dependents up to age 19
80% coverage
* Orthodontic benefit subject to separate $2,800 lifetime maximum per covered dependent, which does not start over if you change plans.
Benefits Enrollment
Page 45
Dental: 2014 Rates per Pay Period
Work 75% to 100% time, pay “Employee contribution” per pay period. Work 50% to 74% time, pay “Total cost” per pay period.
Employee-only coverage Total cost
Base Plans:
Delta Dental PPO: Twin Cities and Duluth Delta Dental Premier: Greater Minnesota
$15.48
$13.63
$18.96 $17.11 University Choice Delta Dental Premier HealthPartners Dental HealthPartners Dental Choice
$21.81
$13.63
$8.18 $18.96 $13.63 $5.33 $17.17
$13.63
$3.54
$18.68
$13.63
$5.05
Employee and child/children coverage
Total cost
Base Plans:
Delta Dental PPO: Twin Cities and Duluth Delta Dental Premier: Greater Minnesota $36.86 $44.99 $19.17 $17.69
$27.30 $17.69 University Choice Delta Dental Premier HealthPartners Dental HealthPartners Dental Choice $52.00 $44.99
$42.08
$45.70
$19.17 $19.17 $19.17
$19.17 Employee and spouse/same-sex domestic partner coverage
Total cost
Less U contribution
Less U contribution
Less U contribution
Employee contribution
$1.85
$1.85
Employee contribution
$32.83
$25.82 $22.91 $26.53
Employee contribution
Base Plans:
Delta Dental PPO: Twin Cities and Duluth
Delta Dental Premier: Greater Minnesota $42.63 $52.24 $24.39
$34.00
University Choice Delta Dental Premier
HealthPartners Dental HealthPartners Dental Choice $60.31 $52.24 $47.38 $51.44 $26.42 $33.89
$25.56
$26.68
$24.74
$22.64
$25.18
$26.26
Employee and spouse/same-sex domestic partner
and child/children coverage Total cost Base Plans:
Delta Dental PPO: Twin Cities and Duluth Delta Dental Premier: Greater Minnesota
$42.63
$52.24 $19.60 $23.03 $29.21
$23.03
University Choice Delta Dental Premier HealthPartners Dental HealthPartners Dental Choice $60.31 $52.24
$47.38 $51.44 $17.38 $42.93 $18.38
$33.86
$19.01 $28.37
$18.48 $32.96 Benefits Enrollment
Less U contribution
$18.24 $18.24
Employee contribution
Page 46
Flexible Spending Accounts
Overview
The University offers eligible employees two types of Flexible Spending Accounts—a health care account and a dependent daycare account.
These Flexible Spending Accounts (FSAs) allow you to pay for related
eligible expenses using pre-tax dollars.
Upon enrollment, you elect an amount to be withheld from your
paycheck before federal, state, and Social Security taxes are withheld.
That amount is deducted from your pay in equal installments over the
remaining pay periods in the calendar year. When you incur an eligible
expense, you will submit a claim to ADP Benefit Solutions (ADP).
If you are a current participant in a health care FSA and plan to reenroll for 2014, keep your VISA®-branded, prepaid Flexible Spending
Account card to use again for eligible expenses in 2014. Your card will
be reloaded automatically with your new authorized election amount.
For more information about the
University’s Flexible Spending
Accounts, please see
www.umn.edu/ohr/benefits/fsa
or call Employee Benefits at
612-624-8647 or 800-756-2363.
If you are enrolling in a health care FSA for the first time in 2014, you
will receive a Flexible Spending Account card, a secure VISA®-branded
prepaid card from ADP, the University’s FSA Program administrator.
This spending account card gives you direct access to your health care
funds, avoiding the need to pay up front and then submit a claim for
health care reimbursement. The card allows you to access spending account funds at any location with a valid health care merchant category
code where VISA is accepted. This includes pharmacies, online merchants, doctors’ offices, dentists’ offices, and vision centers. You use the
card just as you would a credit or debit card and keep the transaction
receipt in case it is needed.
ADP partners with UPlan medical and dental providers and claims are
automatically submitted to ADP so that the paper claim verification
process can be avoided in many instances.
For the dependent daycare FSA, you may either have your claim form
signed by the daycare provider or attach documentation of expenses
that have been provided. Dependent daycare expenses may be submitted only after the service has been provided.
Please note that if you participate in both the health care and dependent daycare FSA, you may not use money from the dependent daycare
account to pay for health care expenses and vice versa.
Deposits, claims,
and statements
For the health care FSA, you may contribute a minimum of $100 and a
maximum of $2,500 each calendar year from your pay. For the dependent daycare FSA, the maximum amount is $5,000 per family.
You may file claims for expenses incurred from your effective date of
coverage through March 15, 2015, drawing on deposits made to your
account throughout 2014. For expenses incurred between January 1
and March 15 of each year, balances from the previous year are drawn
down before deductions are made against the current year’s contributions.
Benefits Enrollment
Page 47
fleXIble sPenDInG aCCoUnTs
The IRS requires that if you do not use the full balance in your FSA
for expenses incurred during this 14½-month period, you lose the
unused portion; any remaining balance in your FSA is forfeited and
retained by the plan. For this reason, you should calculate your expenses carefully before making your election to ensure you will use
the full amount.
Upon initial enrollment, you will receive information from ADP so
that you may sign up for direct deposit with ADP through their website. A check is mailed to your home address if you are not signed up
for direct deposit.
You can review balance information throughout the year on the ADP
website. Each fall, you will receive a statement from ADP detailing
your account activity for the year.
making changes
In compliance with IRS regulations, you may change or end your
participation in FSAs during the year only when you have a “status
change,” such as marriage or divorce, or birth or adoption of an
eligible dependent child. For the dependent daycare account, you
may also change the amount of your election if you change daycare
providers or the number of days you need daycare, provided there is
a change in the cost of care. In all cases, you must request the change
in writing within 30 days of the status change.
To continue your
participation in the fsa
accounts, you must re-enroll
each year during open
enrollment.
Check the special plan provisions if you take a leave of absence
without salary, terminate employment, retire, or are laid off from the
University. These status changes affect contributions to your account
and eligibility for incurring expenses.
How to enroll
For more detailed information on status changes, refer to the Making
Changes link on the website at www.umn.edu/ohr/benefits/fsa/
index.html.
Open Enrollment: Determine your annual election amount and
enroll online in Employee Self-Service by December 2 in order to
have an account for 2014.
New Employee: Determine your annual election amount and
enroll online in Employee Self-Service within the first 60
30 days of
employment or benefits eligibility. If you were hired in the fall,
you can make separate 2013 and 2014 elections.
Eligibility: You are eligible to participate in the Health Care FSA if
you are an employee who works 17½ hours or more per week in a
six-month or longer appointment each year.
Eligible dependents: You may use the health care FSA for an
Benefits Enrollment
Page 48
Flexible Spending Accounts
eligible dependent even if that dependent is not covered under your
medical or dental plan. Eligible dependents include spouse/same-sex
domestic partner, dependent children, and any other person who is
considered an eligible dependent for federal income tax purposes.
Health Care
Flexible Spending Account
Carefully estimate your health care election and base it on known
expenses such as prescription drug copays, office visit copays, planned
dental work, eyeglasses, or contact lenses .
Over-the-counter (OTC) medications (except insulin and prenatal
vitamins) are only eligible for reimbursement if the medication is
prescribed by your medical provider and processed as a prescription.
When a pharmacist fills
a prescription for certain OTC
medicines, it should be submitted
through the pharmacy program.
OTC medicines such as insulin,
smoking deterrents, and medications
for gastric disorders can be
submitted, subject to normal
copays. Details are in
the UPlan Formulary at
www.myprime.com/MyPrime/umn.
Please note that if you
simultaneously participate
in a medical Health Savings
Account (HSA), you may use
your health care FSA only for
eligible dental and vision
expenses.
Note: The rule does not apply to items for medical care that are not
medicine or drugs. OTC medical supplies and devices such as bandages,
crutches, and blood sugar test kits qualify for the Health Care FSA without a prescription.
Eligible expenses: To be eligible for reimbursement, health care
expenses must not be covered by your medical and dental plans and
must be considered expenses for medical care under Section 105(b)
and 213(d)(1) of the Internal Revenue Code. Examples of reimbursable
expenses include:
•
•
•
•
•
•
•
•
•
•
Deductibles and copayments under your medical plan or other
medical plans covering your eligible dependents
Dental copayments for restorative care or orthodontia and dental
implants for you and your eligible dependents
Prescription drug copayments
Over-the-counter medicine or drugs submitted with the required
medical provider’s written prescription stating patient’s name, name
of medicine/drug, diagnosis or medical condition warranting the
medication, dosage requirements, and signature of medical provider.
Durable medical equipment, including diabetic test strips and syringes
Prescription eyeglasses and contact lenses, including eye care supplies, such as contact lens cleaning or saline solutions
Laser eye surgery
Health care services obtained outside your provider network
Services and prescription drugs for infertility treatments
Mental health copayments and services over medical limits
A complete list of eligible expenses is available by going to the Spending Account Eligible Expense Guide link on the website at www.umn.
edu/ohr/benefits/fsa/index.html.
Examples of ineligible expenses under IRC Section 213(d)(1):
• Cosmetic surgery or treatment, such as a facelift, liposuction, hair
transplants, electrolysis, collagen injections, botox injections
Benefits Enrollment
Page 49
Flexible Spending Accounts
• Dental procedures done solely for cosmetic reasons, such as
bleaching, bonding, laminates, or veneers
• Drugs, such as Retin-A, Minoxidril, Propecia, or Rogaine, used solely
for cosmetic reasons
• Eye wear service agreement or insurance unless it includes a check-up
• Finance charges, late fees, or charges for failed/missed appointments
• Health club dues, YMCA/YWCA dues, or charges for steam baths or
massages for your general health or to relieve physical or mental
discomfort
• Non-prescription eyeglasses, sunglasses, clip-ons, and contact lenses
• Premiums for long-term care coverage
• Massage therapy unless a completed letter of medical necessity
signed by a licensed health care provider for a specific medical con dition is submitted to ADP
• Weight-loss programs for your general health even when prescribed
by a physician
• Expenditures merely beneficial or educational for your general
health
• Expenses that are incurred before your election effective date or after
March 15 of the following year
• Expenses that are incurred after your termination date unless you
elect to prefund your account or continue through COBRA
• Premium payments for any insurance or HMO contract, such as the
insurance premium paid for an individual policy or for the group
insurance/HMO premium for you or your eligible dependents even
if the premium was paid with after-tax dollars
• Any expense that may be reimbursed from another source, such as insurance
Please note that if you simultaneously participate in a medical
Health Savings Account (HSA), you may use your health care FSA
only for eligible dental and vision expenses.
Dependent Daycare
Flexible Spending Account
Eligibility: You are eligible to participate in the Dependent Daycare
FSA if you are a University employee scheduled to work 17½ hours or
more per week for six months or more each year and are:
• A single, working parent, or
• Married or have a registered same-sex domestic partner and one of
the following applies:
• The dependent daycare expenses you incur enable both of
you to work, or
• Your spouse/registered same-sex domestic partner is a fulltime student for at least five months in a calendar year, or
• Your spouse/registered same-sex domestic partner is disabled
and unable to provide care
You may not participate if your spouse/registered same-sex domestic
partner has no income unless he/she is disabled or a full-time student.
For divorced or separated parents, please note that only one parent (the
Benefits Enrollment
Page 50
Flexible Spending Accounts
custodial parent) may claim the tax credit in any tax year. The custodial
parent, as defined by the IRS, is “the parent with whom the child shares
the same principal place of abode for the greater portion of the calendar
year.”
Eligible dependents: In general, eligible dependents include (1) dependent
children under age 13, (2) dependents you may claim as a tax exemption on your federal income tax return who are physically or mentally unable to care for themselves and who spend at least eight hours per day in
your household, and (3) a spouse or registered same-sex domestic partner who is mentally or physically incapable of caring for him or herself.
For information concerning other eligible dependents, refer to the Eligible
Employees, Dependents & Providers link on the website at www.umn.edu/
ohr/benefits/fsa/index.html.
When determining the amount to contribute, note that dependent
daycare expenses for children who turn 13 years old in 2014 are not
covered after their 13th birthdays.
Eligible expenses: An eligible expense is the charge you pay for care of
your dependents while you (or you and your registered same-sex domestic
partner or spouse, if married) work or search for gainful employment.
This applies to eligible dependent children as well as a spouse or parent
who resides with you and who is physically or mentally incapable of self
care.
Examples of reimbursable expenses include:
• Daycare center and nursery school charges (if the provider cares for
fewer than seven individuals, licensing and compliance with state
and local regulations are not required for reimbursement)
• Babysitter costs for care including formal arrangements inside or
outside your home provided the care is not given by your spouse/
registered same-sex domestic partner or any other individual whom
you can take as a dependent on your tax returns
• Preschool or similar programs below the kindergarten level
(even if education may be a significant part of these programs)
• Expenses for before- or after-school care of an eligible dependent in
kindergarten or higher grade
• Specialty day camps (such as soccer or computer camps) if
otherwise qualified
• Nursing or custodial care for elderly or disabled dependents who
live with you at least eight hours per day and are unable to care
for themselves
Benefits Enrollment
Page 51
Flexible Spending Accounts
• Household services in your home if the services are at least in
part for the care of your eligible dependent(s)
• Transportation expenses furnished by a dependent daycare
provider, such as to a day camp or after-school program not on
school premises
• Indirect expenses, such as application and agency fees for
dependent daycare if required to obtain care
Examples of ineligible expenses:
• Expenses incurred after your last dependent child’s 13th birthday;
if your last dependent child turns age 13 during the year, you may
cancel your participation in this account
• Expenses for daycare provided by someone who does not provide
you with a taxpayer identification number, with the exception of a
non-profit organization
• Expenses for programs at the level of kindergarten and above,
whether at a public school, private academic institution, or early
learning center; Note: ineligible programs include kindergarten,
kindergarten plus, extended-day kindergarten, Montessori, and
other similar programs
• Summer school and tutoring programs that focus on “required,”
“remedial,” or “for credit” coursework
• Claims for summer programs and day camps submitted prior to the
date service is rendered
• All expenses incurred by noncustodial parent, even if that parent
has dependency exemption status under section 152(e) of the Internal Revenue Code; only the parent with whom the child shares the
same principal place of abode for the greater portion of the calendar year may file claims for expenses incurred
• Household expenses for food, clothing, or entertainment, unless
they are incidental to care and cannot be separated from the costs
of care
• Late fees and finance charges
• Diapers or diaper service
• Costs of transportation to or from a care facility unless furnished by
the day care provider
• Costs of an overnight camp
• Babysitting that is not work related
Benefits Enrollment
Page 52
Flexible Spending Accounts
• Costs of field trips, activity fees, or meals
• Amounts paid for services of a chauffeur
• Payments to a housekeeper to care for you while you are off work
due to illness
• Additional costs of driving alone instead of carpooling so you
may stay with your child(ren) until school starts
• Health care expenses for your eligible dependents
• Claims for deposits, application fees, and agency fees that are
submitted prior to the date the related service or program
commences
IRS Form 2441
Benefits Enrollment
The Internal Revenue Service requires that you complete Form 2441
— Child and Dependent Daycare Expenses — along with your
federal income tax return if you participate in any daycare benefits
during the year. The amount withheld from your salary for this
purpose is reported in box 10 on your W-2 Form.
Page 53
lIfe InsUranCe
basic benefit
There are changes to life insurance benefits for 2014. Some plan
changes are a result of the University’s efforts to simplify processes
and improve efficiency. Other new benefits are the result of a Life
Insurance Request for Proposal.
The basic life insurance amount is now 115% of your base salary,
rounded to the next $1,000, if not already a multiple thereof, with
a maximum of $200,000. If your appointment is 50 to 74 percent
time, the amount is based on your part-time equivalent salary. Basic
employee life is provided to you regardless of your health history.
The $5,000 to $25,000 additional basic employee life insurance for
Faculty and P & A staff has been eliminated.
life Insurance transfer
Employees who do not benefit from the changes to the basic life
coverage can transfer the difference in their basic life to additional
life without providing proof of good health. Employees affected by
the change will be notified in mid-December. The transfer request
will be made on a paper application, which will need to be returned
to Employee Benefits by January 17, 2014. The effective date of your
transfer of basic life to additional life coverage will be February 1,
2014. Additional life rates are age-rated.
Basic life insurance has a reduction schedule tied to the retirement
age used by Social Security. If you are age 67 or older, basic life is
reduced to 65 percent; at age 70, basic life is reduced to 50 percent; at
age 75, basic life is reduced to 25 percent of the original benefit.
additional coverage
available
You have the option to apply for additional coverage for yourself and
your dependents. The amounts referenced do not require evidence of
insurability if applied for within your first 60
30 days of employment or
eligibility or within 30 days of certain life events as noted below. You
can elect additional employee life insurance in multiples of $1,000,
subject to the following limits:
• An amount equal to the lesser of three times your annual base
salary (rounded to the next $1,000) or $500,000 without
evidence of insurability within your first 60
30 days of employment
or eligibility
• A maximum of $500,000 or, if greater, five times your annual base
salary (rounded to the next $1,000) but not more than $1 million
(requires evidence of insurability)
• Evidence of insurability is required for any amount elected
outside of the initial enrollment period of 60
30 days of employment
or benefits eligibility
You can elect spouse/same-sex domestic partner life insurance in
multiples of $1,000, subject to the following limits:
Benefits Enrollment
Page 54
lIfe InsUranCe
•
An amount of $5,000 or $10,000 without evidence of insurability
either within your first 30
60 days of employment or eligibility or
within 30 days of marriage or registration of your same-sex domestic
partner
•
A maximum of $500,000 (requires evidence of insurability)
•
Evidence of insurability is required for any amount elected outside
of your first 60
30 days of employment or eligibility or after 30 days of
marriage or registration of your same-sex domestic partner
You can elect child life insurance that covers each eligible dependent
child:
•
NEW: A new $10,000 Newborn Child benefit for your first child that
applies prior to your enrollment for Child Life, up to 30
60 days
•
An amount of $10,000 of Child Life without evidence of good health
either within your first 30
60 days of employment or eligibility or
within 30 days of the birth/adoption of your child.
•
NEW: Child Life can be elected during any designated Open
Enrollment without evidence of good health.
aD&D coverage
The amount of life insurance coverage automatically doubles in the
event of death by accident, except for child life insurance.
accelerated benefit option
Both the basic and additional insurance plans have an accelerated
option. This means if you or a family member become terminally
ill, you may be able to collect the full amount of the life insurance
benefit prior to death. Call the customer service number (800-8438358) at Minnesota Life for details.
legal services
The will preparation services with Minnesota Life are provided
through Ceridian LifeWorks. These online services allow you to draft
simple wills, financial power of attorney, living wills, or final arrangements using established legal formats.
The services include a 30-minute consultation with an attorney by
phone or in person to review your completed forms or consult on
other legal matters. You can purchase additional legal services beyond
the 30 minutes at a 25 percent discount through LifeWorks.
You can access the tools for creating documents and the network of
attorneys on the website at www.LifeWorks.com. The user ID is
“will” and the password is “preparation.”
Benefits Enrollment
Page 55
Life Insurance
Legacy planning services
Active and retired employees covered under the group life program
and their families can access resources designed to help them deal
with the loss of a loved one or plan for their own death.
Sharing your plans with loved ones ensures they are followed after
your death. These resources are available at https://www.securian.
com/legacy/ssl/home.do.
Beneficiary designation
Life events such as marriage, divorce, registration or termination of
a same-sex domestic partnership, or the birth/adoption of a child
are the time to evaluate life insurance coverage and review or update
your beneficiaries.
Minnesota Life provides a secure website, www.LifeBenefits.com,
for electing, storing, and updating your life insurance beneficiary
designation. This secure online service protects the privacy of your
information while ensuring your beneficiary information is available
when it is needed.
Visit www.LifeBenefits.com/plandesign/umn and log in using the
instructions on the website to securely designate your beneficiary
with Minnesota Life.
Your user ID is the letters UM followed by your seven-digit employee
ID number (example: UM1234567), and your initial password is
your eight-digit date of birth followed by the last four digits of your
Social Security number. After your initial log in, you will be prompted to change your password. You are strongly encouraged to set up
password help at that time.
You may view or update your beneficiary designation at any time
during the year.
If you have no named beneficiary, your current beneficiary is the
beneficiary listed in the plan.
1. your lawful spouse, if living; otherwise,
2. your natural or legally adopted children in equal shares, if living;
otherwise,
3. your parents in equal shares, if living; otherwise,
4. the personal representative of your estate.
Benefits Enrollment
Page 56
lIfe InsUranCe
How to enroll
Open Enrollment: Coverage requests after 60 days of employment
and amounts above what you can obtain as a new employee without
evidence of insurability require underwriting.
To apply, go to www.umn.edu/ohr/benefits/life/additional/index.
html to print a copy of the enrollment form. Minnesota Life will send
you a letter with instructions on how to access their website to submit
your health history electronically.
New Employee: Make your election online in Employee Self-Service
30 days of employment or benefits eligibility.
within the first 60
Note: If you apply for an increase in your life insurance while you
are on a partial or total leave of absence and coverage is approved by
Minnesota Life, the insurance will be effective upon your return to
full-time work.
basic life rates
additional life rates
The University pays the full cost of basic employee life insurance if
you are employed 75% to 100% time. If you are employed 50% to
74% time, you pay $.066 per $1,000 coverage per pay period based
on your part-time equivalent salary rounded to the next $1,000.
You pay the full rate for additional coverage for yourself and your
spouse/same-sex domestic partner.
attained age of employee/spouse/
same-sex domestic partner
Under 30
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Child life rates
$0.02
$0.02
$0.03
$0.03
$0.05
$0.08
$0.12
$0.20
$0.32
$0.51
$0.83
$1.33
$2.66
One premium insures each eligible child for $10,000 of coverage.
Coverage amount
$10,000
Benefits Enrollment
rate per $1,000 per
biweekly pay period
Total rate per pay period
$ 0.42
Page 57
sHorT-Term DIsabIlITy
basic benefit
Short-term Disability coverage provides an income to help meet your
financial obligations if you became disabled and unable to work for
an extended period of time. Benefits are paid from the first day of a
disability due to an accident, or the eighth day of a disability due to
sickness or pregnancy.
If you become disabled, benefits may continue during disability up
to 26 weeks, which is the maximum period for any one period of
continuous disability. You can elect an amount to replace up to
66-2/3 percent of your salary but no more than $5,000 per month.
Partial disability option
If you receive short-term disability benefits, you may be eligible to
receive a partial disability benefit if you return to work at reduced hours.
How to enroll
Open Enrollment: You can increase your existing amount of short-term
disability coverage by up to $200 without evidence of insurability. Make
your election on a paper application by December 2. The application is
available by going to www.umn.edu/ohr/benefits.
New Employee: Make your election online in Employee Self-Service
within the first 60
30 days of employment or benefits eligibility.
rates
Disability coverage
is provided by Cigna.
Benefits Enrollment
The employee biweekly rate depends on the monthly benefit for which
you are eligible and the amount that you elect. The maximum monthly
benefit amount is your annual salary multiplied by 66.67 percent;
divided by 12; and rounded down to the nearest $100. You may select
any benefit amount shown in the chart up to the lesser of your Maximum Monthly Benefit Amount or $5,000.
Maximum Monthly
Benefit Amount
Biweekly
Rate
$300
$400
$500
$600
$ 700
$ 800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$1.75
$2.33
$2.92
$3.50
$4.08
$4.66
$5.25
$5.83
$6.41
$7.00
$7.58
$8.16
$8.75
$9.33
$9.91
$10.49
$11.08
$11.66
$12.24
$12.83
$13.41
$13.99
$14.58
$15.16
Maximum Monthly
Benefit Amount
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
Biweekly
Rate
$15.74
$16.32
$16.91
$17.49
$18.07
$18.66
$19.24
$19.82
$20.41
$20.99
$21.57
$22.15
$22.74
$23.32
$23.90
$24.49
$25.07
$25.65
$26.24
$26.82
$27.40
$27.98
$28.57
$29.15
Page 58
Long-teRm DisaBiLity
Basic benefit
this benefit is not available if
you are a faculty or P&a staff
member with an appointment of
67 percent time or greater who
is covered by the academic
Disability Program.
Pre-existing conditions
How to enroll
Long-term Disability benefits are payable after you have been continuously disabled for 180 days and remain disabled with the maximum
benefit period up to the Social Security normal retirement age.
You may apply for a monthly LTD Benefit in multiples of $100 from
$300 per month to the lesser of $5,000 or 60 percent of your monthly
earnings, subject to pre-existing conditions.
Pre-existing conditions are not covered for the first 24 months after
insurance takes effect. A pre-existing condition is a mental or physical condition, diagnosed or not, for which you have consulted a physician, received
medical treatment, services or advice, undergone diagnostic procedures,
or taken prescribed drugs during the 12-month period just before your
LTD insurance becomes effective.
Open Enrollment: Enroll or make your change online by December 2.
30 days of
New Employee: Make your election online within the first 60
employment or benefits eligibility.
Rates
the maximum monthly Benefit
amount is the most you could
expect to receive from all
sources of disability income,
e.g., social security, pension
plans, workers’ compensation,
etc.
Disability coverage
is provided by Cigna.
Benefits Enrollment
The employee biweekly rate depends on the monthly benefit for which
you are eligible and the amount that you elect. The maximum monthly
benefit amount is your annual salary multiplied by 60 percent; divided
by 12; and rounded down to the nearest $100. You may select any
benefit amount shown in the chart up to the lesser of your Maximum
Monthly Benefit Amount or $5,000.
Maximum Monthly
Benefit Amount
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
Biweekly
Rate
$1.17
$1.56
$1.95
$2.34
$2.73
$3.12
$3.51
$3.90
$4.29
$4.68
$5.07
$5.46
$5.85
$6.24
$6.63
$7.02
$7.41
$7.80
$8.19
$8.58
$8.97
$9.36
$9.75
$10.14
Maximum Monthly
Benefit Amount
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
Biweekly
Rate
$10.53
$10.92
$11.31
$11.70
$12.09
$12.48
$12.87
$13.26
$13.65
$14.04
$14.43
$14.82
$15.21
$15.60
$15.99
$16.38
$16.77
$17.16
$17.55
$17.94
$18.33
$18.72
$19.11
$19.50
Page 59
required notice
Notice about the Early
Retiree Reinsurance
Program
You are a plan participant, or are being offered the opportunity to
enroll as a plan participant, in an employment-based health plan that
is certified for participation in the Early Retiree Reinsurance Program.
The Early Retiree Reinsurance Program is a Federal program that was
established under the Affordable Care Act. Under the Early Retiree
Reinsurance Program, the Federal government reimburses a plan
sponsor of an employment-based health plan for some of the costs of
health care benefits paid on behalf of, or by, early retirees and certain
family members of early retirees participating in the employmentbased plan. By law, the program expires on January 1, 2014.
Under the Early Retiree Reinsurance Program, your plan sponsor may
choose to use any reimbursements it receives from this program to reduce or offset increases in plan participants’ premium contributions,
copayments, deductibles, coinsurance, or other out-of-pocket costs.
If the plan sponsor chooses to use the Early Retiree Reinsurance
Program reimbursements in this way, you, as a plan participant, may
experience changes that may be advantageous to you, in your health
plan coverage terms and conditions, for so long as the reimbursements under this program are available and this plan sponsor
chooses to use the reimbursements for this purpose.
A plan sponsor may also use the Early Retiree Reinsurance Program
reimbursements to reduce or offset increases in its own costs for
maintaining your health benefits coverage, which may increase the
likelihood that it will continue to offer health benefits coverage to its
retirees and employees and their families.
If you have received this notice by email, you are responsible for
providing a copy of this notice to your family members who are
participants in this plan.
Benefits Enrollment
Page 60
.
This guide provides an overview of the benefits available to you as an eligible University
employee.
Please refer to the Summary of Benefits booklets for a complete description of your medical
and dental benefits, their limitations, and exclusions.
If there are any differences between this guide and the Summaries, the Summaries of Benefits
will govern.
The University is an equal opportunity educator and employer.
alternative print format of this guide can be made available upon request.
Call Employee Benefits at 612-624-8647 or 800-756-2363.
© 2013 regents of the University of minnesota. all rights reserved.
Printed on recycled paper with at least 10 percent postconsumer material.
Employee Benefits
200 Donhowe
319 15th avenue SE
minneapolis, mN 55455-0103