Welcome! EMPLOYEE BENEFITS ORIENTATION for SPA Staff Employees Benefits Wading into the world of benefits can be daunting. This orientation is designed to guide you through the various benefits available to you and assist you in making the best selections for your specific needs and desires. Some enrollments require online registration/ enrollment and a printed form to WCU human resources, others require online enrollment only, others you will need to waive enrollment, and still others will require working directly with independent vendors . How this Benefits Orientation is Designed This orientation is divided into “Sections”. Section 1 is an outline of what items New SPA staff employees will need to bring with them to their appointment with the HR Benefits specialist. You need to allow yourself a couple hours to complete this orientation and make your benefits selections. Those of you with spouses and families may want to include them in your review and selection of benefits. If you start the process and have to stop in the middle, just make a note to yourself where you left off. Then when you return, left click anywhere inside the slide show and you get a pop-up menu that will allow you to “go to slide” and choose the slide you want to return to. Tips to Navigation Other helpful tips: You can go to previous slide, next slide or end the slide show by left clicking in the show OR run your cursor over the lower left corner of any slide and you have those options as arrows. You can go to a particular Section from the Index by clicking on the Section. To return to the Index – left click anywhere and the pop-up menu will allow you to choose “go to slide” and choose the “INDEX” slide you want to return to. Take time to read the instructions slides and even print those slides as you enter the various benefits web sites. These will serve as good guides as you make your selections and print forms, etc. NOTE: You will need to view in “slide show view” in order for links to work INDEX sections 1 to 4 Section 1 - Outline and Forms Checklist – What to bring with you to your appt with HR Benefits specialist Section 2 - Retirement Options Teachers’ and State Employees’ Retirement System (TSERS) Supplemental Retirement – available from vendors Section 3 - Disability Income Benefit – NC provided Status changes that require your action! Section 4 –North Carolina State Health Plan (PPO) General information about the plan and links to sign up! Section 5 - Prescription Benefits Explanation of the prescription benefits for PPO participants Section 6 – Health Coverage changes – what to do? INDEX Sections 5 to 9 Section 7 – NCFlex optional benefit plans Section 7a – Vision Section 7b – Dental Section 7c - AD&D Section 7d - Term Life Section 7e - Cancer Section 7f - Critical Illness Section 8 – NCFlex spending accounts Describes what these pretax spending accounts can do for you and how to sign up Section 9 – Supplemental Insurances - available from vendors Section 9a - Supplemental Disability plan Section 9b - Supplemental insurances - Life and Long Term Care INDEX Sections 10 to 15 Section 10 – Workers Compensation Section 11 – Tuition Waiver and Reimbursement Section 12 – Campus Health Services Section 13 – Unemployment Insurance Section 14 – SEANC/SEIU– State Employees Association of North Carolina Section 1 – Outline and Forms Checklist 1. Retirement: – TSERS - notify HR benefits specialist at your benefits enrollment appointment – Supplemental Retirement Plans – work with vendors directly 2. Health Insurance Enrollment Form complete online, print and bring to your benefit enrollment appointment 3. NC Flex Enrollment Forms complete online – print for your own information 4. Supplemental Disability complete form online, print and bring to your benefit enrollment appointment – TSERS – Liberty Mutual 5. Other Supplemental Insurances – Life and Long Term Care - work with vendor directly Section 2 - Retirement Retirement Mandatory enrollment TSERS (Teachers’ and State Employees’ Retirement System) TSERS Overview Teachers’ and State Employees’ Retirement System Defined Benefit Plan – Steady income until death – Benefit determined by a formula – Stable and secure retirement income – Professional asset management – Accumulate retirement income without individual risk TSERS Overview You contribute 6%, and the university contributes a total of 14.23% – (5.30% goes into Retiree Health Plan Reserve, 8.33% in Retirement, .44% into Disability, .16% into Death Benefit). Death benefit paid to your beneficiary if you die in active service Mandatory for SPA employees TSERS Benefit Calculation Retirement benefits are based on: – Years of Service – Average Final Compensation – Actuarial Formula – Payment Option Chosen TSERS and ORBIT ORBIT is your online resource for information on your retirement plan – ORBIT (Online Retirement Benefits through Integrated Technology) at: https://orbit.myncretirement.com/orbit/Comm on/Pages/BPASLogin.aspx New SPA employees are able to log into ORBIT after receiving first paycheck. At that time, it is very important to log in to indicate beneficiary information. TSERS TSERs Risk and Decisions Low investment risk and no investment decisions. Portability Portable only to other North Carolina agencies and credits available for transferring to local government employers. Retirement Full and reduced retirement options that depend on age and years of service. Supplemental Retirement Save $$$ by making contributions on a pre-tax basis (NC401(k) and 403(b) also include a post tax Roth option). Contributions are payroll deducted. Loan options are available. Plans are portable. Plan Comparison 403(b) 457 401(k) Carriers TIAA-CREF Fidelity Prudential Prudential (Traditional Pre-Tax and Roth Options Available) Available Products 403(b)(1) fixed and variable annuity accounts. 403(b)(7) custodial accounts investing in mutual funds. Fixed accounts, variable accounts and mutual funds. Stable Value Fund and 8 mutual funds. Asset allocation tools available. Retirement and Health Insurance Employees hired on or after 10/1/2006 must satisfy minimum service requirements to be eligible for health insurance upon retirement. – Free coverage for retirees with 20 or more years of retirement credit. – 50% premium reduction for retirees with 10 to 20 years of retirement credit. – No reduction (you pay full cost) for retirees with 5 – 10 years of retirement credit. Section 3 – Disability Income The state of North Carolina provides a basic disability income plan to all employees who participate in a North Carolina retirement plan. Disability Income Plan Less Than 5 Years in a Retirement System – No disability benefit for the first year of membership – After one year of membership, a shortterm benefit of (50%) for one year only Disability Income Plan Five or More Years in a Retirement System – One year of short-term benefits (50%) – Long-term benefit (65%) until you qualify for unreduced retirement benefits Section 4 State Health Plan www.shpnc.org Health Insurance Definitions Plan Year – based on the State of North Carolina’s fiscal year (July 1 to June 30) Plan Year Deductible - The amount of allowable charges that members must pay each Plan year before benefits are payable. Health Insurance Definitions Coinsurance - The amount the member must contribute toward the cost of covered medical expenses. (For example: If you are in the Standard Plan, once the Plan year deductible is met, the Standard Plan pays 80% of allowable charges while the member pays 20%.) Co-payment - Specified portion of a charge for which the member is responsible. Co-payments are required for services such as prescription drugs, professional services, emergency room visits, outpatient hospital, ambulatory surgical facility, and inpatient hospital benefits. SHP Enrollment (PPO) Eligibility and Enrollment Permanent employees Must enroll within 30 days to cover pre-existing conditions Employee coverage paid by WCU except for small premium with Smart Choice Plus. Spouse and dependent coverage paid by staff member Premiums are deducted on pre-tax basis. NC SmartChoice PPO Options EMPLOYEE MONTHLY CONTRIBUTION RATES Standard State Monthly 70/30 80/20 Contributio n $0 $22.76 $432.56 Employee + Child(ren) $198.06 $286.16 $432.56 Employee + Spouse $510.32 $629.64 $432.56 Employee + Family $543.54 $666.18 $432.56 Coverage Types Employee only Basic NC SmartChoice PPO Options PPO utilizes the extensive Blue Options Network which includes: • Participating providers in all 100 counties • More than 22,000 health care providers • 90% of the primary care physicians in the state • 85% of the specialists in the state • 97% of the hospitals in the state • Providers available nationwide and worldwide PPO OPTIONS Basic (70/30) Annual Deductible (Individual/ Family) Plan Coinsurance (what you pay) Coinsurance Maximum (Ind/Fam) Standard(80/20 ) In-Network Out In-Network Out $933/ $2,799 $1,866/ $5,598 $700/ $2,100 $1,400/ $4,200 30% of eligible 50% of eligible expenses after deductible and the difference between the allowed amount and the charge 20% of eligible 40% of eligible $3,793 / $11,379 $7,589/ $22,758 $3,210/ $9,630 $6,420/ $19,260 expenses after deductible expenses after deductible expenses after deductible and the difference between the allowed amount and the charge PPO OPTIONS Basic Standard In-Network Out In-Network Out Physician Office Visits Primary Care Specialist $351 $811 50% coinsurance after deductible. $301 $701 40% coinsurance after deductible. Urgent Care $87 Same as in-network $87 Same as in-network Inpatient Copay $291, plus 30% coinsurance after deductible $291, then 50% coinsurance after deductible $233, plus 20% coinsurance after deductible $233, then 40% coinsurance after deductible Outpatient Hosp & Amb Surg Ctr Copay 30% coinsurance after deductible 50% coinsurance after deductible 20% coinsurance after deductible 40% coinsurance after deductible Same as in-network benefit $233, plus 20% coinsurance after deductible Same as in-network benefit Emergency Room Copay $291, plus 30% coinsurance after deductible 1. In-network hospital owned or operated practices may be subject to deductible and coinsurance. Please call your physician or see the Provider Directory to determine if your physician’s practice is hospital owned or operated. Online Enrollment https://Wcu.hrintouch.com LOGIN ID – first name/initial of last name and last 4 digits of social security number Password is “social” Change your password to a new password Complete your enrollment Section 5 - Prescription Benefits Prescription benefits for PPO participants – Administered by Medco – Pharmacy Benefit Manager – You are issued an ID card which you take to any participating pharmacy. – Anticipate a 3-4 week wait for cards and plan accordingly. www.shpnc.org Prescription Benefits Higher benefit for medications listed on the Preferred Drug List http://www.shpnc.org/myPharmacyBenefits/default. aspx Co-payment for each 30-day supply: $12.00 Generic $40.00 Preferred Brand without Generic $64.00 Non-Preferred Brand Section 6 - Health Coverage changes You may want to initiate coverage changes if status change occurs. – Change in marital status – Dependent change due to birth, adoption or death of dependent – Court order to provide coverage Notify the Human Resources Benefits specialist immediately when a change in status occurs. Health Coverage Adding a dependent – effective date of coverage is the first day of the month following an eligibility event – such as marriage. Newborn – mother must be an enrolled employee or enrolled spouse to receive newborn benefits. Effective date – is birth date of child – change to employee/child first of the month in which child is born. Health Coverage General Information PPO Customer Service: 888-234-2416 Website: www.shpnc.org Section 7 - NCFlex – Optional Benefit Plans NCFlex Vision Dental Accidental Death and Dismemberment Core AD&D up to $10,000 – no premium Term Life Insurance Supplemental Cancer Insurance Critical Illness Section 7a – Vision Three Plan Designs Offered – Superior Vision Plan 1 provides fully-insured eye exams & materials Plan 2 provides fully-insured materials only Both Plans (1 & 2) have a new covered contact lens exam with a $25.00 copay Plan 3 Enhanced Plan – all services every 12 months – $150.00 frame allowance – $150.00 contact lens allowance – Covered contact lens exam after $25.00 copay NCFlex Vision Plan One – $6.84 (employee) or – $17.37 (family) – Exam, lenses and contacts every 12 months – Contacts covered up to $100 if not medically necessary – $20 co-payment for exams (InNetwork) – Eyeglass frames every 24 months NCFlex Vision Plan Two – $5.14 (employee) or – $12.72 (family) – Examinations not covered – Eyeglass lenses and contacts every 12 months – Contacts covered up to $100 if not medically necessary – Eyeglass frames every 24 months NCFlex Vision Plan Three – $9.98 (employee) or – $25.10 (family) – Exam, lenses and contacts every 12 months – Contacts covered up to $150 if not medically necessary – $20 co-payment for exams (InNetwork) – Eyeglass frames every 12 months NCFlex Vision Use In-Network Providers to enjoy maximum benefits Provider Network Ophthalmologists (M.D.s) Optical Chain Locations Lenscrafters Wal-Mart Opticals Optometrists Sears Opticals Opticians Pearle Vision (O.D.s) J C Penney Opticals Sam’s Club 33 Section 7b - NCFlex Dental – High or Low option High Option Services Benefit Oral Exams/Prophylaxis (every 6 months) 100% no deductible X-rays (1 bitewing per calendar yr) 100% no deductible Basic Services (Fillings, Extractions, Root Canal, General Anesthesia, Wisdom Teeth) 80% after deductible Major Services (Crowns, Dentures, Bridges) 50% after deductible Child Orthodontics 50% up to $1500 lifetime max NCFlex Dental Low Option Services Benefit Oral Exams/Prophylaxis 100% after deductible X-rays (1 bitewing per calendar yr) 100% after deductible 50% after deductible Basic Services (Fillings, Extractions, Periodontal) Section 7c – NCFlex AD&D Accidental Death and Dismemberment Insurance – Insured by UNUM – As little as $0.96 per month for employee for $50,000 coverage – As high as $9.50 per month for employee for $500,000 coverage – Family coverage available, ranging from $1.50 ($50,000) to $15.00 per month ($500,000) NCFlex AD&D ASSIST AMERICA Worldwide Emergency Assistance Services for Travelers – – – – – Emergency air evacuation Transportation of a friend or relative Care of a minor child Medically supervised repatriation Return of mortal remains Participants Receive an I.D. Card Section 7d – NCFlex Term Life The plan pays a benefit to your beneficiaries if you die while covered. Evidence of Insurability is not necessary if you elect coverage when first offered (unless you elect coverage above $100,000). Be aware of tax implications for insurance amounts over $50,000 – explained on NCFlex website. NCFlex Term Life Calculate the amount of income added to your pay - visit www.ncflex.org for instructions and example. The death benefit under TSERS is also included in calculation. Section 7e – NCFlex Cancer Insurance High, Low, and Premium Options for Employee and Employee/Family Benefits for: – Hospital Confinement – Surgery – Radiation/Chemotherapy – Bone Marrow/Stem Cell Transplant – Cancer Screening – Hospice – Many other benefits NCFlex Cancer Insurance Coverage for Employees & their dependents Guaranteed issue when first eligible Pre-existing conditions apply Evidence of Insurability (EOI)* required for: – Late applicants – Those moving from Low to High option *EOI must be approved by vendor within 60 days from date of election form or automatically denied. Effective first of the month following approval. Section 7f – Critical Illness This insurance is administered by MetLife and complements your existing medical coverage, but does not replace it. A lump-sum payment of $15,000 is paid directly to you when you experience a covered condition: Cancer Related Conditions Heart-Related Conditions Other Conditions: – Major organ transplant – Kidney failure Category of Benefits Category 1: CancerRelated Conditions Full Benefit Cancer Partial Benefit Cancer* Bone Marrow Transplant Category 2: HeartRelated Conditions Heart Attack Stroke Coronary Artery Bypass Graft Heart Transplant Category 3: Other Conditions Major Organ Transplant** Kidney Failure *For some types of cancer and a coronary bypass graft, the covered employee will receive 25% of the category benefit amount. The remaining 75% is available should that employee experience another one of the covered conditions in that category while the certificate is in force. **Other than bone marrow transplant and heart transplant. Benefit Payment Example Diagnosed Covered Condition Category Impacted Lump-sum Benefit Payment Received Category 1: Cancer Remaining Benefit Category 2: Heart Remaining Benefit Category 3: Other Remaining Benefit You are diagnosed as having lung cancer Category 1: Cancer $15,000 $0 $15,000 $15,000 Two years later, you have a coronary artery bypass graft Category 2: Heart $3,750 $0 $11,250 $15,000 The following year, you suffer a debilitating stroke Category 2: Heart $11,250 $0 $0 $15,000 Three years later, you have kidney failure Category 3: Other $15,000 $0 $0 $0 Total = $45,000 Waiting Period & Pre-existing Conditions Waiting Period A 30-day waiting period for all covered conditions applies Pre-existing Conditions A pre-existing condition is a sickness or injury for which, in the 12 months before a covered person becomes insured under a certificate, medical advice or treatment or care was sought by a covered person, or recommended by, prescribed by or received from a physician or other practitioner of healing arts MetLife will not pay benefits for a covered condition that is caused by or results from a pre-existing condition if the covered condition occurs during the first 12 months that a covered person is insured under the certificate Section 8 – NCFlex Spending Accounts Spending accounts are simple to use. When you join, you choose to contribute a set amount to your account through payroll deduction on a pre-tax basis. When you have an expense that qualifies for reimbursement, you attach your receipt or the insurance company explanation of benefits (EOB) to a claim form and you will receive a tax-free reimbursement. With these accounts, you are reimbursed with the pre-tax dollars you set aside to pay for eligible expenses. Be advised that you must “estimate” your annual need closely, as it is a “use it or loose it” – there is no rollover or reimbursement of funds to you at the end of the year. NCFlex Spending Account – (HCFSA) The Health Care Flexible Spending Account (HCFSA) You choose to contribute a set amount to your account through payroll deduction on a pre-tax basis. With this account, you are reimbursed with the pretax dollars you set aside to pay for medical, dental or other health care expenses not reimbursed by a health plan. This account can benefit almost all eligible employees, their spouses, children and dependents who satisfy the “Dependent Eligibility” rules as defined in the NCFlex Program section on line. NCFlex Spending Account – (HCFSA) Health Care Spending Account – $10 – minimum per month – $416.66 – maximum per month – Reimbursement is made up to the amount you have agreed to put in the plan for the year, not the amount you have in your account currently. – Participants must re-enroll each year. NCFlex Spending Account – (DDCFSA) The Dependent Day Care Flexible Spending Account (DDCFSA) is designed to benefit employees with young dependent children or disabled dependents of any age. Eligible day care expenses may be reimbursed for your “qualifying child” as per guidelines found on NCFlex web site. NCFlex Spending Account – (DDCFSA) Dependent Care Spending Account $10 – minimum per month $416.66 – maximum per month Reimbursement is made up to the amount in your account. Participants must re-enroll each year. NCFlex Spending Accounts Contribute a set amount to your account through payroll deduction on a pre-tax basis. Examples With Spending Account Without Account Gross Pay $32,000 $32,000 Pre-Tax Contribution Taxable Income -1,000 $31,000 $32,000 Federal Income Tax -3,180 -3,330 NC State Income Tax -1,497 -1,567 Social Security & Medicare -2,372 -2,448 After-tax Expenses Take-Home Pay -1,000 $23,951 $23,655 NCFlex Spending Accounts When you incur expenses, send in documentation with a claim form or use your optional Convenience Card. NCFlex Convenience Card Allows payment for eligible Spending Account expenses Checks your Spending Account for available balances Benefits – Fewer out-of-pocket expenses – No reimbursement delays $6 annual fee Receipts must be submitted. NCFlex Online Enrollment Register for first-time visitors Go to: www.ncflexonline.org and click Register. NCFlex Online Enrollment On the First Time Visitor page, enter the Personal Information requested and click Continue. Note that required fields are marked with a * NCFlex Online Enrollment Create your own username and password in the fields provided and click REGISTER For help in creating your username and password click the yellow question mark icon. NCFlex Online Enrollment Click Enroll Online to Begin enrollment Click links for benefits information Click Enroll Online to begin enrolment NCFlex Online Enrollment You are eligible to enroll in all of the benefits listed on the left side of the NCFlex screen. For more information about each benefit, click on the name of each benefit If you want to enroll in some but not in other benefits you will need to waive the ones you do not want to enroll in. Review the welcome message displayed for specific information NCFlex Online Enrollment To begin the enrollment process click on the yellow Enroll Online button. Review the enrollment instructions and click the yellow Start Enrollment button or select the benefit you would like to enroll in from your To Do List (this list is conveniently located on the NCFlex website as you begin your election of enrollments for NCFlex optional benefits.) Be sure to “waive” any you do not want to participate in NCFlex Online Enrollment Review Your Information Review your personal and dependent/beneficiary information. To add a dependent’s or beneficiary’s information, click the yellow Add Dependent/Beneficiary button and follow directions. IMPORTANT Providing dependent and beneficiary information here does not automatically enroll a dependent in coverage or designate the beneficiary for your Group Term Life insurance and/or AD&D coverage NCFlex Online Enrollment Review Benefit Summary: •Verify that you have elected all of the correct coverage amounts and dependent elections on the benefits •Below the benefits summary, verify that you have designated beneficiaries for both your basic life and supplemental AD&D (if applicable) coverage. •Print benefits summary by clicking the yellow Printer Friendly Version button at the bottom of the page for your files. •Click the Exit Enrollment link located at the bottom of your To-Do List. Section 9 - Supplemental Insurances Other various supplemental insurances are available to you as a Western Carolina University employee. Section 9a - Supplemental Disability Plan TSERS participants can purchase a supplemental plan through Liberty Mutual for additional coverage – Benefit up to 66 2/3% of earnings up to $10,000 monthly – Benefits available during the first year – Cost of.00233 of monthly salary Section 9b – Life and Long Term Care Voluntary additional Life Insurance available for purchase from: – Prudential Life Insurance – Boston Mutual Long-Term Care Benefits plan available for purchase from: – Prudential Insurance Company Comparison of Optional Life Insurance Prudential AGE Life Amount Premium Under 25 $50,000 $3.25 Age 50 $50,000 $14.50 SEANC (requires monthly dues) AGE Life Amount Premium Under 35 $50,000 $4.00 Age 50 $50,000 $24.50 ING (through NCFLEX) AGE Life Amount Premium Under 25 $50,000 $2.70 Age 50 $50,000 $18.30 Section 10 - Workers Compensation Used for job related or occupational illnesses. Accidents or occupational disease must be reported to your supervisor as soon as possible. The employee is responsible for filing. Workers Compensation information can be found at: http://www.wcu.edu/11810.asp Section 11 - Tuition Waiver Permanent employees working at least 30 hours per week are eligible. Courses may be taken at any of the 17 UNC constituent institutions. Tuition waived for two courses per year (fall or spring). Supervisor involvement and approval is required. Tuition Reimbursement Permanent employees working at least 30 hours per week are eligible. Courses must be deemed directly related to the employee’s classification. Courses may be taken at accredited colleges or universities. Supervisor involvement and approval is required. Section 12 – Campus Health Services The WCU Campus Health center has options for faculty and staff – check the web site for information at: http://www.wcu.edu/7862.asp Mandatory $3.00 monthly contribution Up to 3 free visits per Fiscal Year Fee for visits beyond three Treatment for occasional illnesses and injury Not available for chronic conditions or ongoing condition management Section 13 - Unemployment Insurance For information and eligibility requirements for unemployment, go to the Employment Security Commission web site. https://www.ncesc.com/default.aspx Section 14 – SEANC/SEIU State Employees Association of North Carolina This is an association of NC employees that: – Serves as an advocate for its members in state government – Offers benefits to its members: AD&D Insurance Boston Mutual Group Term Life Auto, home and renter’s insurance Supplemental medical Scholarships and educational loans Group buying discounts Participation is voluntary and cost is an $8.00 monthly payroll-deducted fee For information see SEANC at: http://www.seanc.org/ Congratulations! You have reached the end of your Benefits Orientation. Be sure to complete the forms as outlined in Section 1 and bring with you to your appointment with the HR benefits specialist – Peg Shafer. She can be reached at 828-227-3138 or by email at shafer@email.wcu.edu To end this show – right click for Welcome Aboard! pop up and choose “end show” or click square in lower left – below.