Benefit highlights guide
2014 plan year
Oregon Health & Science University knows how important it is to have good, affordable
health and welfare benefits. That’s why we offer competitive benefits that can provide
protection, peace of mind and savings. Whether it’s health care, income protection,
or other benefits, we’ve got you covered.
This guide provides a general overview of your benefit choices and enrollment information
to help you select the coverage that is right for you.
Know enrollment
When can I enroll?
New employees
As a new employee, you must enroll in benefits within 60 days of your
date of hire. Our benefits plan year runs from Jan. 1 through Dec. 31.
Open enrollment
As a benefits-eligible employee, you have an opportunity once a year to enroll
in or make changes to your benefit plans during the open enrollment period,
unless you experience a qualified family status change. Open enrollment is
typically held in October. Open enrollment for your 2014 benefits is Oct. 1
through Oct. 31, 2013 with elections effective Jan. 1, 2014.
Note: With the exception of flexible spending accounts, your current benefit
selections will remain unchanged in 2014 unless you go online and make a
change. However, if you did not complete the plan requirements for 2013, you
will be moved to the OHSU PPO Standard or 250 PPO Standard medical plan
for the 2014 plan year (see page 6).
How do I enroll?
Log on to Oracle Employee Self Service at http://ais.ohsu.edu/ to enroll
in or make changes to your benefits.
Before logging on, have a list of your benefit selections/changes, as well as
the names, Social Security Numbers, birthdates and addresses of those you
wish to designate as beneficiaries or enroll as dependents. If you plan to opt
out of OHSU medical or OHSU dental coverage, you must provide the other
employer’s name, group name and group plan number under which you
are covered.
• Go to http://ais.ohsu.edu/ and click “Click Here” to begin.
—— Login using your regular OHSU network username and password.
—— In the Main Menu under Employee Self Service, choose “Benefits”
to enroll or make changes.
Contents
Know enrollment................................................................................2
When can I enroll? .............................................................................2
How do I enroll?..................................................................................2
Know who is eligible...........................................................................3
Who can I cover?.................................................................................3
What if things change?.......................................................................3
Know the cost of your benefits..........................................................4
Medical and dental costs for 2014....................................................4
How it works........................................................................................4
Know your medical and prescription drug benefits......................5
Medical benefits summary.................................................................5
Eligibility for the lowest cost OHSU benefits..................................6
Know your wellness benefits.............................................................7
Healthy TEAM Healthy U.................................................................7
HealthySteps........................................................................................7
Weight Watchers.................................................................................7
Smoking Cessation.............................................................................7
Know your dental benefits.................................................................8
Know your vision benefits.................................................................8
Know your income protection benefits...........................................9
Life and AD&D coverage...................................................................9
Disability...............................................................................................9
Know your additional benefits.........................................................10
Flexible Spending Accounts (FSAs)................................................10
Employee Assistance Program (EAP).............................................10
Travel assistance.................................................................................10
Did you know?....................................................................................11
• Click “Add Dependents or Beneficiaries” to update before selecting benefits.
Know your rights...............................................................................11
• Click “Next” and follow the onscreen instructions to select your benefits.
Know how to get information..........................................................12
• Once you have successfully submitted your selections and completed
enrollment, print the confirmation page for your records.
2
https://o2.ohsu.edu/human-resources/benefits | benefits@ohsu.edu
Know who is eligible
Who can I cover?
Verification of dependents
You can enroll in the benefits listed in this guide if you are a 0.5 FTE or greater and working
in a benefits-eligible position. For more detailed information on employee and dependent
eligibility, visit the Benefits O2 website at: https://o2.ohsu.edu/human-resources/benefits.
If you participate in OHSU benefits, you also may enroll:
• Your spouse (opposite or same sex) or domestic partner (opposite or same sex;
registered or unregistered);
• Your child(ren) (including child(ren) of a domestic partner or spouse) up to age 26 who
does not have access to their own employer coverage. This applies regardless of marital
or student status;
• Your child(ren) of any age who is incapable of supporting themselves due to a mental
or physical disability and who is totally dependent on you; and
• Your child(ren) by adoption or court-ordered judgment who otherwise meet the
dependent eligibility.
In 2013, OHSU began the
practice of verifying dependents
enrolled in medical coverage—
a practice very common at
other employers. An audit of
all dependents was conducted
during the summer of 2013.
OHSU Benefits is working on an
ongoing audit process for newly
added dependents not verified
as part of that audit. Stay tuned
for updates from Benefits about
the new ongoing verification
process for new dependents.
Please refer to the plan summaries or contact OHSU Benefits for additional information.
What if things change?
The benefits you choose will be effective through the end of the calendar year. You cannot
make changes to your coverage during the year, unless you have a qualified family status
change including:
• Marriage, establishment of a domestic partnership, legal separation, divorce
or termination of a domestic partnership;
• Birth, legal adoption of a child, or placement of a child with you for legal adoption;
• Death of your spouse/domestic partner or dependent child; or
• Change in residence (only if your current coverage isn’t available in the new location
or if you are offered an option that you were not previously offered).
To make a change due to a qualified family status change, you must notify and submit
any applicable forms and/or documentation to OHSU Benefits within 31 days* of the
event. OHSU Benefits will review your request and determine whether the change you are
requesting is allowed. Only benefit changes which are consistent with the qualified family
status change are permitted.
*60 days if you, your spouse/domestic partner, or eligible dependent child loses coverage
under Medicaid or a state Children’s Health Insurance Program (CHIP) or becomes eligible
for state-provided premium assistance.
Know how to choose
When you think about your health care costs, the first thing that comes to mind is probably your premium—the amount that comes out
of every paycheck for coverage. But to see the total picture, you also have to consider what you’re likely to pay out of your pocket, such as
when you go to the doctor or get a prescription. Keep this in mind as you review the following health care options.
3
https://o2.ohsu.edu/human-resources/benefits | benefits@ohsu.edu
Know the cost of your benefits
OHSU provides benefit-eligible employees benefit dollars to apply toward the cost of benefits. OHSU provides you a set amount
of monthly funds depending on your employee representation and the coverage level you select. The funds are applied to the cost
of the medical and dental benefit options you choose to enroll in. If your benefit dollars don’t cover the complete cost of the benefits
you choose, the difference will be deducted from your paycheck 24 times a year.
Below are the benefit dollars that OHSU is contributing to your benefit selections for 2014.
OHSU’s monthly benefit
contribution
Unclassified
ONA represented*
AFSCME represented
Full-time
(.75 – 1.0)
Part-time
(.50 – .74)
Full-time
(.70 – 1.0)
Part-time
(.50 – .69)
Full-time
(.75 – 1.0)
Part-time
(.50 – .74)
$100
$50
$50
$50
$50
$0
Medical opt out**
Employee only
$664.00
$500.00
$662.64
$496.98
$662.64
$510.24
Employee & spouse/domestic partner
$880.00
$630.00
$848.42
$636.32
$899.52
$692.64
Employee & child(ren)
$765.00
$580.00
$697.62
$523.22
$739.64
$569.52
Employee & family
$970.00
$650.00
$938.76
$704.08
$995.30
$766.38
*As of the time of Open Enrollment, the ONA contract with the 2014 benefit dollars had not been finalized. ONA benefit dollars are calculated here based
on the current contract but may change when the ONA contract is ratified.
**The medical opt out rate reflects the contribution amount employees will receive and can use for dental, life and optional coverage.
Medical and dental costs for 2014
The rates listed below are the monthly costs for the medical and dental plans by coverage level (number of dependents) you choose.
Your benefit dollars paid to you by OHSU (shown above) help you pay for these premiums, along with FSA benefits you select.
(See pages 5 and 8 for medical and dental benefit summaries)
Monthly medical premiums
Employee only
Employee & spouse/
domestic partner
Employee &
child(ren)
Employee & family
OHSU PPO
$619.54
$928.38
$735.76
$979.18
OHSU PPO Standard
$650.82
$978.64
$772.92
$1,028.64
250 PPO
$760.40
$1,143.32
$902.60
$1,247.26
250 PPO Standard
$797.48
$1,199.10
$946.62
$1,308.10
Kaiser Permanente
$905.18
$1,348.72
$1,059.06
$1,412.18
Employee only
Employee & spouse/
domestic partner
Employee &
child(ren)
Employee & family
Monthly dental premiums
Moda Health
$43.10
$93.80
$104.74
$151.84
Kaiser Permanente
$87.08
$174.18
$156.76
$261.26
Williamette Dental Group
$45.40
$88.50
$80.30
$137.50
How it works
Here are two examples of how to apply benefit dollars to your benefit selections and understand your paycheck deduction.
Example 1—Mya:
Example 2—John:
Meet Mya. She is a single, full-time employee classified as an
unclassified employee. She’s selected the OHSU PPO medical plan
and Moda Health dental plan for 2014. Since she’s completed the
requirements listed on page 6, she’s eligible for lower medical plan
premiums in 2014 and to participate in the OHSU PPO, instead of the
OHSU PPO Standard.
Meet John. He is a married, full-time employee classified as an
AFSCME represented employee. He wants to cover his wife and three
children under the 250 PPO medical plan and Moda Health dental plan
for 2014. Since he’s not completed the requirements listed on page 6,
he’s not eligible for lower medical plan premiums in 2014 so cannot
participate in the 250 PPO, only the 250 PPO Standard.
• Employee only benefit premiums (monthly)
• Employee & family benefit premiums (monthly)
—— OHSU PPO Medical: $619.54
—— 250 PPO Standard Medical: $1,308.10
—— Moda Health Dental: $43.10
—— Moda Health Dental: $151.84
• OHSU Benefit Contribution: $664.00
• OHSU benefit contribution: $995.30
• Mya’s cost: Nothing, Mya will receive back $1.36 monthly
[($619.54 + $43.10) - $664.00 = $1.36]
• John’s cost: $464.64 monthly
[($1,308.10 + $151.84) - $995.30 = $464.64]
4
https://o2.ohsu.edu/human-resources/benefits | benefits@ohsu.edu
Know your medical and prescription drug benefits
Providing comprehensive and quality medical coverage at a reasonable cost is a challenge for all employers. OHSU meets that challenge by
providing employees with two medical plan options (three for certain long-term employees eligible for the Kaiser medical plan, described below).
If you enroll in the OHSU PPO or 250 plans, you automatically receive pharmacy and vision coverage. See page 8 for vision benefit information.
The information below is a summary of medical coverage only. Please visit www.modahealth.com or www.kp.org (depending on the medical
plan you are enrolled in) or https://o2.ohsu.edu/human-resources/benefits for plan summaries detailing coverage information, limitations and
exclusions. Any coinsurance or copays shown in the chart below are amounts for which you are responsible.
Medical benefits summary
Key features
OHSU PPO/OHSU PPO Standard
Non-OHSU
provider
OHSU provider
Requirements
Annual calendar year deductible
Medical out-of-pocket (OOP) max
(includes deductible)
250 PPO/250 PPO Standard
Kaiser Permanente
Non-network
provider
Network provider only
Network provider
Must select Primary Care Physician (PCP)
and complete two of six requirements (see
page 6).
Must select Primary Care Physician (PCP)
and complete two of six requirements
(see page 6).
Employees who didn’t participate in
wellness programs in 2013 can only select
the Standard option in 2014.
Employees who didn’t participate in
wellness programs in 2013 can only select
the Standard option in 2014.
$250/person or $750/family
$500/person or $1,500/ family
$1,600/person or
$3,250/family
Lifetime maximum
$4,250/person or
$8,750/family
$3,500/person or
$7,000/family
Unlimited
Home and doctor’s office visits
Preventive care
Lab and X-ray services
Hospital services
Inpatient (per admission)
Outpatient
Prescription OOP max
Retail prescription drug
(30-day supply)
Value
Generic
None
$1,000/person or
$2,000 family
Unlimited
Unlimited
40% of allowable
charges
$25 copay
40% of allowable
charges
$15 copay
No charge,
not subject to
deductible;
frequency
limitations apply
40% of allowable
charges; subject
to deductible;
frequency
limitations apply
No charge,
not subject to
deductible;
frequency
limitations apply
40% of allowable
charges; subject
to deductible;
frequency
limitations apply
No charge
20%
40% of allowable
charges
20%
40% of allowable
charges
No charge
20%
40% of allowable
charges
40% of allowable
charges
20%
20%
40% of allowable
charges
40% of allowable
charges
$200 copay per visit for
hospital/facility charge
$150 copay, then 20% of allowable charges
$150 copay, then 20% of allowable charges
$75 copay (waived if admitted)
$1,500/person or $2,500/family
$1,500/person or $2,500/family
Included in medical OOP max
$2
20%, $100 max
Preferred
30%, $100 max
Non-preferred
50%, $100 max
Mail-order prescription drug (90-day
supply)
Value
Generic
Preferred
Non-preferred
All care must be received by a
participating Kaiser Permanente facility,
except for true emergencies.
$25 copay
20%
Emergency care
(waived if admitted)
$4,250/person or
$8,750/family
Available only to AFSCME represented
employees hired before 10/1/1998 and
ONA represented and unclassified
employees hired before 1/1/1998.
$6
10%, $100 max
20%, $100 max
33%, $100 max
$4
25%, $10 min &
$100 max
35%, $10 min &
$100 max
50%, $10 min &
$100 max
Not covered
$2
20%, $100 max
30%, $100 max
50%, $100 max
$6
10%, $100 max
20%, $100 max
33%, $100 max
$4
25%, $10 min &
$100 max
35%, $10 min &
$100 max
50%, $10 min &
$100 max
$15 copay per formulary prescription
Not covered
(See page 4 for medical premiums)
5
https://o2.ohsu.edu/human-resources/benefits | benefits@ohsu.edu
Eligibility for the lowest cost OHSU benefits
For the past several years, OHSU has offered wellness programs that employees can participate in
to receive lower premiums on the OHSU PPO and 250 plans. Employees who haven’t participated
in the wellness programs have paid 5% higher in premium rates (termed the “Standard” plan option).
Employees who participate in the OHSU wellness program offerings will continue to see savings in their
medical costs next plan year. Note: New employees automatically are given the lower premium option
for their first year but must participate in the OHSU wellness program to continue to see savings
in their medical costs.
To qualify for savings on your 2015 medical costs, you must complete the following requirements by Sept. 30, 2014:
• Requirement #1—Designate a primary care provider (PCP) in Oracle. (There’s no need to repeat if you have previously completed
and there are no changes.)
• Requirement #2—This requirement only applies if your OHSU PCP has identified you to participate. Employees or their covered
dependents receiving an invitation from their OHSU PCP to participate in the OHSU Care Coordination Plus program must enroll
and complete the program. If eligible, you will receive a personalized invitation from your PCP.
—— The OHSU Care Coordination Plus program is for select patients with chronic conditions that require a range of services. Additional
benefits include: a designated Nurse Care Manager, better coordination of information and a single point of access to your care team
at OHSU.
• Requirement #3—Additionally, each employee must complete two of the following actions by Sept. 30, 2014. While only two of these
six actions are required to quality for the 2015 medical cost savings, employees are welcome to participate in more than one at no cost.
1. Complete the OHSU Benefits Quiz/Survey.
4. Complete the Healthy TEAM Healthy U program.
2. Get your flu shot by Oct. 31, 2013 at:
5. Complete the OHSU-sponsored smoking cessation program;
start by calling 1-866-QUIT4 LIFE or visit www.quitnow.net.
——One of the employee flu shot clinics; or
——A location of your choice. You will need to complete
and return the 2013-2014 OHSU influenza declination
form and fax the form to 503 494-4457. Forms are available
from Occupational Health Services.
3. Earn 1,000 points in the HealthySteps program.
6. Complete the OHSU-sponsored weight management program
with Weight Watchers; start by calling 1-800-8-AT WORK and
talk to a local Weight Watchers At Work manager about setting
up a meeting at your worksite.
Note: Employees not meeting these requirements will not be eligible
for medical cost savings for 2015.
Opting out of medical coverage
You must enroll in medical insurance unless you have coverage under another group medical plan. To opt out, you must provide proof
of coverage (name of group medical plan and policy number) to OHSU.
If you choose to opt out, you will receive reduced benefit dollars, shown on page 4.
If you lose coverage under another group plan, you must enroll in the OHSU medical coverage within 31 days after losing coverage.
Know your terms
Coinsurance A percentage of costs you pay
“out of pocket” for covered expenses after you
meet the deductible.
Copay (copayment) A fee you have to pay
“out of pocket” for certain services, such as
a doctor’s office visit or prescription drug.
6
Deductible The amount you pay “out of your
pocket” before the health plan will start
to pay its share of covered expenses.
Network Doctors, pharmacists and other
health care providers who make up the plan’s
preferred providers. When you use network
providers, you pay less because they have
agreed to negotiated pricing.
Out-of-pocket maximum (OOP max) The
most you pay each year “out of your pocket”
for covered expenses. Once you’ve reached
the out-of-pocket maximum, the health plan
pays 100% for covered expenses.
Preventive care Services you receive when
you are not sick or injured—so that you will
stay healthy. Preventive care services include
annual physicals, wellness screenings and
well-baby care.
https://o2.ohsu.edu/human-resources/benefits | benefits@ohsu.edu
Know more about your benefits
What about acupuncture and chiropractic benefits?—Acupuncture and
chiropractor visits are a drug-free way to minimize pain. Since people
often develop a tolerance to drugs or need higher dosages to achieve the
same effect, these forms of treatment are a great alternative. Also, they
allow your doctor to examine your response immediately and adjust
treatment as needed.
For employees enrolled in the OHSU PPO or 250 plan, OHSU pays for
70% of the allowable charges for acupuncture and chiropractic visits,
with a maximum of 60 visits per calendar year.
You can save money by using the “in” crowd—No matter which health
care options you choose, it’s critical to make sure your providers are in
the insurance carrier’s network before you enroll. It could have a large
impact on your out-of-pocket expenses if your providers are not innetwork. To see if your providers are in the network, refer to the
“Know how to get information” section on page 12.
Know your wellness benefits
Healthy Team Healthy U (HTHU) is a health promotion program
designed by OHSU faculty and staff and refined by our own employees.
It is a behavior-based program to help employees achieve and maintain
a healthy lifestyle and capture the power of employees working
together. Numerous benefits have been documented, including
reduced blood pressure, lower body weight among those who are
overweight, improved diet and exercise behaviors and feeling healthier.
Furthermore, employees felt less depressed, missed less work, and
reported being happier after participating in HTHU. For more
information on HTHU, including how to register, visit
https://hthu.ohsu.edu.
HealthySteps
HealthySteps is an individual-initiated employee wellness program
offered by OHSU Benefits and managed by The Division of Health
Promotion and Sports Medicine. HealthySteps is an OHSU website that
allows you to track and record your wellness activities. Being physically
active, controlling your body weight, attending health-related seminars,
giving blood and others, can all be tracked on the website.
For more information on HealthySteps, including how to register, visit
https://hthu.ohsu.edu.
Weight Watchers
Benefit-eligible OHSU employees can participate in Weight Watchers at
no cost. Employees can choose to attend a community Weight Watchers
meeting or coordinate a meeting at their worksite with their colleagues.
Employees can also participate independently in the Weight Watchers
online program.
For more information on the Weight Watchers benefit, including how
to register, visit https://o2.ohsu.edu/human-resources/benefits.
Smoking Cessation
If you use tobacco and would like to quit, OHSU Benefits wants to
provide support and resources to assist you. OHSU has partnered with
the American Cancer Society to provide free resources to employees
wanting to quit using tobacco. Resources include unlimited toll-free
access to Quit Coaches, free nicotine replacement therapy (patch or
gum) mailed directly to your home, and other tools to assist you in
your goal to quit using tobacco.
For more information on cessation resources available, please
call the American Cancer Society - Quit For Life Program
at 1-866-QUIT-4-LIFE (784-8454) or enroll online at
https://www.quitnow.net.
Know how to stay well
Did you know all the plans cover preventive care? It’s true! Network preventive care—like annual
physicals, wellness screenings, immunizations, and well-baby care—is 100% covered without
having to pay your deductible. So, be sure to schedule your annual preventive screening.
7
https://o2.ohsu.edu/human-resources/benefits | benefits@ohsu.edu
Know your dental benefits
Dental coverage is key to your overall health and wellness. You can enroll in dental benefits through Moda
Health, Kaiser Permanente or Willamette Dental Group for yourself and your family. If you use network
providers, you’ll pay less. You can still get care from any providers out of the network, but you’ll pay more.
Any coinsurance shown in the chart below are amounts for which you are responsible.
Dental benefits summary
Moda (ODS)
Kaiser Permanente
Willamette Dental
Group
$50 per person or $150 per family
None
None
No charge, not subject to deductible
No charge
No charge
$1,500
None
None
Routine fillings
20% after deductible is met
No charge
No charge
Root canals
20% after deductible is met
No charge
No charge
Prosthodontic care (crowns, bridges
and dentures)
50% after deductible is met
$75 copay per procedure/unit; $25
copayment for relines and rebases
$75 copay per procedure/unit
50% ($1,500 lifetime maximum)
Not covered
$150 copay for pre-orthodontia;
$1,200 copay for comprehensive
orthodontia (no lifetime maximum)
Key features
Annual deductible
Preventive and diagnostic services
Annual maximum benefit
Orthodontia services
(See page 4 for dental premiums)
Know your vision benefits
At no additional cost, you automatically are enrolled for Vision Service Provider (VSP) benefits if you participate in the OHSU or 250 Plan. If you
participate in the Kaiser medical plan, you are also automatically enrolled for vision benefits through the Kaiser vision plan at no additional cost.
This information is a summary of vision coverage only, visit www.vsp.com or www.kp.org for more information on your vision benefits.
Key
features
Exam
Lenses and
frames
OHSU PPO/OHSU PPO Standard
Frequency
8
Kaiser Permanente
VSP provider
Non-VSP provider
VSP provider
Non-VSP provider
Kaiser provider only
No charge
Plan reimburses up to $50
No charge
Plan reimburses up to $50
$15 copay
Single vision, lined bifocals
and lined trifocals:
$25 copay
Single vision lenses:
$50 copay
Bifocal lenses: $75 copay
Trifocal lenses: $100 copay
Frames: $70 copay
Single vision, lined bifocals
and lined trifocals:
$25 copay
Single vision lenses:
$50 copay
Bifocal lenses: $75 copay
Trifocal lenses: $100 copay
Frames: $70 copay
Up to $150 allowance
for lenses and frames
Up to $140 allowance for
elective contacts in lieu
of glasses
Up to $140 allowance for
elective contacts in lieu
of glasses
Up to $140 allowance for
elective contacts in lieu
of glasses
Up to $150 allowance for
elective contacts in lieu
of glasses
Up to $150 allowance
for frames
Contacts
250 PPO/250 PPO Standard
Up to $140 allowance for
elective contacts in lieu
of glasses
Exam allowed every 12 months; lenses and frames
or contacts every 24 months
Up to $150 allowance
for frames
Exam allowed every 12 months; lenses and frames or
contacts every 24 months
Exam every 12 months;
lenses and frames or
contacts every 24 months
https://o2.ohsu.edu/human-resources/benefits | benefits@ohsu.edu
Know your income protection benefits
OHSU provides eligible employees with a variety of plans to provide replacement income to you or your beneficiaries in the event of disability,
accident or death. This information is a summary of coverage only. Refer to your certificates of coverage for more detail.
Basic life coverage
OHSU provides you with basic life insurance in the amount of $25,000 at no cost to you.
Voluntary life and accidental death and dismemberment
(AD&D) coverage
You can also purchase additional life and AD&D insurance for yourself, your spouse/domestic partner and child(ren). Remember, life insurance
isn’t just about paying for memorial services. It’s also about making sure your family can maintain its standard of living over the long run. How
much your family would need depends on your situation (debts, expenses, etc.).
You can elect additional coverage for:
• Yourself: In increments of $25,000, from $25,000 up to a maximum of $1,000,000.
• Your Spouse/Domestic Partner: In increments of $25,000, up to a maximum of
$500,000.
• Optional Dependent Life: For any dependent, available in the amount of $4,000. This
is separate from and/or in addition to spouse/domestic partner life insurance.
• Optional AD&D:
—— Employee coverage is available in increments of $50,000, up to $500,000.
—— Family AD&D coverage is set at a fixed percentage of the employee coverage
you select.
Note: Life insurance premiums are based upon the dollar coverage amount you select and
your age or the age of the dependent you are covering. AD&D premiums are based upon
the dollar coverage amount you select. For more detail on premium costs, visit the OHSU
Benefits O2 page at https://o2.ohsu.edu/human-resources/benefits.
For new hires and newly benefit-eligible employees, medical certification for yourself or your
spouse/domestic partner is required for life insurance policies above $50,000. For current
benefit-eligible employees making changes to their life insurance coverage during open
enrollment, medical certification for yourself or your spouse/domestic partner is required
for life insurance policies above $25,000. All increases or changes to life insurance amounts
must be approved by The Standard before they can go into effect.
Disability
According to the National Safety Council, 490 Americans became disabled in the last 10 minutes. Without disability insurance, those Americans
could have no income for as long as they can’t work.
You have the option to buy short-term disability (STD) and long-term disability (LTD) insurance through The Standard.
• Short-Term Disability: Benefit pays 65% of your weekly pay for up to 180 days from the date of disability (some limitations apply).
You may choose an 8-day, 30-day, or 90-day waiting period.
• Long-Term Disability: Benefit pays 65% of your monthly earnings, coordinated with other income and benefits, after you have been
disabled for 180 days (some limitations apply).
STD and LTD insurance premiums are a percentage of your biweekly earnings based upon the waiting period you select. For more detail
on premium costs, visit the OHSU Benefits O2 page at https://o2.ohsu.edu/human-resources/benefits.
9
https://o2.ohsu.edu/human-resources/benefits | benefits@ohsu.edu
Know your additional benefits
Be ready for the
unexpected
Will you need dental
services—such as a filling,
root canal, or crown—in
the next year? Do you wear
glasses or contact lenses?
If you answered “yes” to
either of these questions,
consider the Health Care
Flexible Spending Account.
This account can help
soften the impact of
unexpected dental and
vision expenses—even if
you don’t enroll in medical
or dental coverage.
Flexible Spending Accounts (FSAs)
OHSU offers two types of FSAs—no matter which medical option you choose—that can help
you save for out-of-pocket expenses:
• You can use the Health Care FSA (HFSA) for eligible health care expenses such
as deductibles, copays, coinsurance, prescription drugs, dental and vision expenses.
• You can use the Dependent Care FSA (DFSA) for eligible child and elder care expenses
so you (and your spouse, if married) can work or go to school.
Each year, you can contribute up to $2,500 to the HFSA and up to $5,000 to the DFSA.
The amount you choose to contribute will be deducted from your paycheck 24 times a year.
There are tax savings, too, because contributions go from your paycheck into your FSA pre-tax.
This lowers your taxable income, so you pay less in taxes. Plus, when you have eligible expenses,
you pay for them with tax-free money.
Visit www.benefithelpsolutions.com for a current list of eligible expenses, claims filing
deadlines and other information about your accounts.
Employee Assistance Program (EAP)
OHSU’s EAP services are provided by Moda Health. The EAP provides you and eligible
members of your household 24/7 access to confidential counseling to help you address
issues such as relationships, drug and alcohol abuse, financial hardship and general stress
or depression.
Many issues can be addressed directly with your EAP professional; in some cases, you may
be referred to other resources. The EAP is available 24 hours, 7 days a week by visiting
www.cascadecenters.com or by calling 1-800-826-9231.
Travel assistance
OHSU provides benefit-eligible employees access to travel assistance through FrontierMEDEX.
Resources include help with travel, medical or security problems, anywhere in the world.
For more information, call FrontierMEDEX at 1-800-527-0218.
10
https://o2.ohsu.edu/human-resources/benefits | benefits@ohsu.edu
Did you know?
You have urgent care options
OHSU Family Medicine clinics at Richmond, Scappoose and the South
Waterfront offer evening and Saturday hours.
• Richmond and Scappoose are open Monday through Friday 8 a.m.
to 8 p.m. and Saturday 9 a.m. to 1 p.m.
• South Waterfront is open Monday through Friday 7 a.m. to 8 p.m.
and Saturday 9 a.m. to 1 p.m.
You have a voice - the Employee
Benefits Council
The EBC is a unique and valuable group that functions on the idea of
“by the people, for the people.” The Council is made up of your fellow
employees to discuss the important topics - like what medical plans you
are offered - and make decisions on how to move forward with your
needs in mind.
Employees enrolled in the OHSU PPO or 250 plan also can use urgent
care services at a ZoomCare clinic. With locations throughout the
Portland area, ZoomCare can be a convenient option when an employee
or family member is faced with an urgent need.
OHSU believes you know yourself best and you should have a voice in
the benefits available to you. It’s important you have good, affordable
health and welfare benefits to keep you and your family healthy.
For more information on ZoomCare locations and appointments,
visit www.zoomcare.com.
Much like our tree, which is a symbol of life, growth,and renewal, the
EBC represents you to make sure you have an array of health, wellness
and financial components available for your total compensation and
rewards at OHSU.
For more information about the EBC, visit
https://o2.ohsu.edu/human-resources/benefits
Know your rights
Women’s Health and Cancer Rights Act
Federal law requires a group health plan to provide coverage for the following
services to an individual receiving plan benefits in connection with a mastectomy:
• Reconstruction of the breast on which the mastectomy
has been performed;
• Surgery and reconstruction of the other breast
to produce a symmetrical appearance; and
• Prostheses and physical complications for all stages of a mastectomy, including
lymphedema (swelling associated with the removal of lymph nodes).
The group health plan must determine the manner of coverage in consultation
with the attending physician and patient. Coverage for breast reconstruction
and related services will be subject to deductibles and coinsurance amounts
that are consistent with those that apply to other benefits under the plan.
Medicaid and the Children’s Health
Insurance Program (CHIP)
Medicaid and CHIP offer free or low-cost health coverage to children and
families. If you are eligible for health coverage from your employer, but are
unable to afford the premiums, some states have premium assistance programs
that can help pay for coverage. Some states use funds from their Medicaid or
CHIP programs to help people who are eligible for employer-sponsored health
coverage, but need assistance in paying their health premiums. If you or your
dependents are NOT currently enrolled in Medicaid or CHIP, and you think
you or any of your dependents might be eligible for either of these programs,
you can contact your state Medicaid or CHIP office by calling 1-877-KIDSNOW or visiting www.insurekidsnow.gov to find out how to apply. You
must request coverage within 60 days of being determined eligible for
premium assistance.
11
Health Care Reform Notice
OHSU believes our Kaiser Permanente medical plan is a “grandfathered
health plan” under U.S. Health Care Reform legislation (Patient Protection
and Affordable Care Act, or the Affordable Care Act). As permitted by the
Affordable Care Act, a grandfathered health plan can preserve certain basic
health coverage that was already in effect when that law was enacted. Being
a grandfathered health plan means that your plan may not include certain
consumer protections of the Affordable Care Act that apply to other plans,
for example, the requirement for the provision of preventive health services
without any cost sharing. However, grandfathered health plans must comply
with certain other consumer protections in the Affordable Care Act,
for example, the elimination of lifetime limits on benefits.
Questions regarding which protections apply and which protections do not
apply to a grandfathered health plan and what might cause a plan to change
from grandfathered health plan status can be directed to the plan administrator
at www.kp.org. You may also contact the U.S. Department of Health and
Human Services at www.healthreform.gov.
Additional notices
Please contact OHSU Benefits for additional information and full notices on:
•
Medicaid and the Children’s Health Insurance Program (CHIP)
•
Health Insurance Portability and Accountability Act (HIPAA) of 1996;
•
Family and Medical Leave Act of 1993;
•
Continuation of Coverage Rights under COBRA;
•
Medicare Part D Creditable Coverage Notice; and
•
Other additional important notices about your rights.
https://o2.ohsu.edu/human-resources/benefits | benefits@ohsu.edu
Know how to get information
Refer to the charts below for additional contact information about your OHSU benefit options.
For individual benefits…
OHSU PPO or OHSU PPO Standard
250 PPO or 250 PPO Standard
Kaiser Permanente HMO (medical,
prescription and vision)
Dental options
Life and disability options
Flexible Spending Accounts
(HFSA and/or DFSA)
EAP
Travel assistance
For all benefits…
Contact ...
Call...
Medical: Moda Health
Group #10001819
1-855-232-6898
www.modahealth.com
Prescription: Moda Health
Group #10001819
1-855-232-6898
www.modahealth.com
Vision: VSP
Group #12157430
1-800-877-7195
www.vsp.com
Kaiser Permanente
Group #8553
In Portland: 503-813-2000
Outside Portland: 1-800-813-2000
www.kp.org
Moda Health
Group #10001819
In Portland: 503-265-2965
Outside Portland: 1-888-217-2365
www.modahealth.com
Kaiser Permanente
Group #8553
In Portland: 503-813-2000
Outside Portland: 1-800-813-2000
www.kp.org
Willamette Dental Group
Group #OR102
1-855-433-6825
www.willamettedental.com
The Standard
Group #631050
1-800-378-2390
www.standard.com
Benefit Help Solutions
In Portland: 503-219-3679
Outside Portland: 1-888-398-8057
www.benefithelpsolutions.com
Moda Health
1-800-826-9231
www.cascadecenters.com
FrontierMEDEX
1-800-527-0218
N/A
Contact ...
Call...
Visit...
E-mail/Visit...
benefits@ohsu.edu
General benefit questions
OHSU Benefits
In and outside Portland: 503-494-7617
https://o2.ohsu.edu/human-resources/
benefits
About this guide
This guide highlights your benefits.
Official plan and insurance
documents govern your rights and
benefits under each plan. For more
details about your benefits, including
covered expenses, exclusions and
limitations, please refer to the
individual summary plan descriptions
(SPDs), plan document, or certificate
of coverage for each plan. If any
discrepancy exists between this
guide and the official documents, the
official documents will prevail. OHSU
reserves the right to make changes
at any time to the benefits, costs and
other provisions relative to benefits.
12
OHSU Benefits
Mail code: HR
3181 S.W. Sam Jackson Park Road
Portland, OR 97239
tel 503 494-7617
fax 503 494-5990
benefits@ohsu.edu
https://o2.ohsu.edu/human-resources/benefits | benefits@ohsu.edu