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This publication contains important information about your employee
benefit programs.
Please read thoroughly.
2016 OSU
BENEFITS
2
Oklahoma State University
Eligibility .............................................................. 3
Health Savings Account ........................................ 4
Flexible Spending Accounts ................................... 5
2016 Medical/Rx Benefit Summary ........................ 6
Dental ................................................................. 8
Vision .................................................................10
Voluntary Benefits ...............................................11
Resources ...........................................................13
Table of Contents
ImportantChange of Status EventYou cannot change your insurance
coverage during the year except in the
case of a qualified change of status.
You have 30 days from the date of a
qualifying change of status event to
notify OSU Benefits and change your
insurance selections. Most changes
are effective the first of the month
following notification. If you do not
make your changes during the 30-day
status-change period, your changes
cannot be made until the next OSU
Benefits Enrollment period in October.
Financial hardship and provider
network changes are not considered
qualifying events.
Here are some common examples of
qualified change of status events:
� Marriage, divorce, legal
separation, or spouse’s death
� Birth, adoption, medical child
support order, or dependent’s
death
� Change in residence if the change
affects your or your dependents’
current plan eligibility
� Gain or loss of other group
coverage, starting or returning
from leave of absence, or change
of job status (e.g., changing from
part-time to full-time)
Questions?E-mail: [email protected] or
call OSU Benefits 405.744.5449
3
2016 OSU Benefits
EligibilityIf you are appointed to work at least a six month assignment and have an FTE greater than 0.75 in an eligible staff or faculty employee position, you may participate in the University’s insurance plans.
All spouses recognized under applicable law are eligible for University benefits in accordance with the University’s plan documents. For questions about eligibility, please contact OSU Benefits, [email protected] or 405.744.5449
For OSU medical insurance and dental and vision benefits, your eligible dependents are as follows.
� Your spouse
� Your child under the age of 26; may be married or unmarried
� Does not need to be enrolled as a student; and/or may have a separate residence from you
� May be employed, but the employer must not offer group medical coverage to your child
� Your married or unmarried child of any age who is medically certified as disabled and dependent upon you for support and maintenance
Employees should carefully review the dependents they are covering on medical, dental, and/or vision insurance. During OSU Benefits Enrollment, employees should drop coverage for anyone who does not meet the criteria listed above for an eligible dependent. If covering eligible dependents, supporting documentation will be required to add them to the plan (e.g., marriage license, tax return, birth certificate).
Enrollment
OSU Benefits Enrollment
Annual enrollment occurs in October. During this time, you may review coverage and make changes to your insurance and add or remove dependents from coverage using the online enrollment system, Web For Employees (http://webemp.okstate.edu). Changes you make during OSU Benefits Enrollment will start January 1.
4
Oklahoma State University
Employees have the opportunity to contribute pre-tax dollars to an account to use for qualified medical expenses.
Employees who wish to participate in a HSA must be enrolled in a high deductible health plan, such as BlueEdge High Deductible, cannot be enrolled in Medicare, cannot be claimed as a dependent on another person’s tax return, and cannot be enrolled in any other non-qualified medical plan.
HSA’s are not use-it-or-lose-it plans. The contributions you make to the account rollover year to year and are yours to take with you if you leave the University. The HSA is not pre-funded. You use what is available in the account after it has been deposited. HSA participants can use the funds beyond medical expenses for such items as COBRA premiums, long-term care insurance and Medicare insurance premiums including A, B, C, and D products.
Health Savings Account
Management of your HSA is your responsibility. You must first open your account before funds may be deposited (including any employer contributions) or withdrawn to pay for qualified medical expenses.
You will receive a Welcome Kit in the mail or a link to open your account electronically. For either method, there are a few forms requiring personal information; this information is required by federal banking regulations under the Patriot Act, just as it would be required to open a traditional banking account. Look for the form titled “Master Signature Card” in your kit or online. Even if you electronically provide your signature to open your account, you should mail in this card. It gives you the ability to designate a beneficiary for your account. You can use your debit card, administered by BenefitWallet (https://mybenefitwallet.com/index.html), to pay for eligible expenses or you can reimburse yourself by writing a check from the account.
There are fees associated with your HSA account. When you access your account online, you will be directed to your homepage which includes forms and resources, including a fee schedule. Please review the fee schedule associated with your account.
For the 2016 tax year, the maximum contribution is $3,350 for individuals and $6,750 for family. You may also have an opportunity to make a $1,000 catch up contribution if you are age 55 or older.
Health Savings Accounts (HSA)
Flexible Spending Account (FSA)—HealthcareThe Flexible Spending Account for healthcare is administered by Chard-Snyder.
A healthcare FSA allows you to set aside a portion of your earnings to pay for qualified healthcare expenses as established by the IRS. Money deducted from your paycheck into the healthcare FSA account is not subject to payroll taxes, resulting in a substantial payroll tax savings to you. The annual plan maximum per participating employee for 2016 is $2,550.
� If you are in BlueEdge and do not have a Health Savings Account you can elect the healthcare FSA account.
� Under the Affordable Care Act, the Internal Revenue Service has set an annual limit on the maximum an employer can contribute to a health FSA; the 2016 limit is $500; therefore your monthly employer contribution to the health FSA will be $41.67 ($500 annual maximum).
You may use the FSA for the following expenses:
� Deductibles, coinsurance, and copayments
� Other qualified expenses which are allowable for a medical tax deduction
Please note expenses must be incurred in 2016 while you are a covered participant in the plan and elections cannot be stopped or changed during the year unless a qualified family status change occurs (as defined by the IRS) (see page 3).
Flexible Spending Account (FSA)—Dependent CareThe Dependent Care FSA lets you use pretax dollars towards qualified dependent care. The maximum amount you may contribute to the Dependent Care FSA is $5,000 per household (or $2,500 if married and filing separately) per calendar year.
Flexible Spending Accounts
5
2016 OSU Benefits
2016 Medical/Rx Benefit SummaryMaking a ChoiceTo determine the best plan for you, we have provided a side-by-side comparison of your choices in the following chart.
BlueOptions BlueEdge (HSA)
Benefits Blue Preferred Network
Blue Choice Network Out-of-Network Blue Choice
Network Out-of-Network
Calendar year deductible
Individual $750 $750 $750 $2,600 $2,600
Family $2,250 $2,250 $2,250 $5,200 $5,200
Out-of-pocket maximum includes deductibles
Individual $4,250 $4,250 $4,750 $6,550 $6,550
Family $12,700 $12,700 $12,700 $13,100 $13,100
Physician office visits
Primary care $30 $30 50% after deductible
20% after deductible
50% after deductible
Specialist $50 $50 50% after deductible
20% after deductible
50% after deductible
Preventive care
No charge for mammograms, child immunizations, or certain diagnostic tests in-or-out-of-network
100% 100% 30% after deductible
100% 30% after deductible
Immunizations-well child and adult
100% 100% 30% after deductible
100% 30% after deductible
Routine lab 100% 100% 30% after deductible
100% 30% after deductible
Routine bone density testing
100% 100% 30% after deductible
100% 30% after deductible
Women’s preventive care benefits
100% 100% 30% after deductible
100% 30% after deductible
Colorectal exam 100% 100% 30% after deductible
100% 30% after deductible
PSA (Prostate Specific Antigen) Test
100% 100% 30% after deductible
100% 30% after deductible
X-ray and lab services
Diagnostic test (X-ray,blood work)
100% 100% 50% after deductible
20% after deductible
50% after deductible
Imaging (CT/PET scans, MRIs)
20% after deductible
30% after deductible
50% after deductible
20% after deductible
50% after deductible
Urgent care 20% after deductible
30% after deductible
50% after deductible
20% after deductible
50% after deductible
6
Oklahoma State University
BlueOptions BlueEdge (HSA)
Benefits Blue Preferred Network
Blue Choice Network Out-of-Network Blue Choice
Network Out-of-Network
Hospital services
Inpatient 20% after deductible
30% after deductible
50% after deductible
20% after deductible
50% after deductible
Outpatient 20% after deductible
30% after deductible
50% after deductible
20% after deductible
50% after deductible
Emergency room(BlueOptions only: $100 copay per occurrence deductible; waived if admitted )
20% after deductible
20% after deductible
20% after deductible
20% after deductible
50% after deductible
Mental health/substance abuse
Inpatient 20% after deductible
30% after deductible
50% after deductible
20% after deductible
50% after deductible
Outpatient $30 copay or 20% after deductible
$50 copay or 30% after deductible
50% after deductible
20% after deductible
50% after deductible
Substance abuse
Inpatient 20% after deductible
30% after deductible
50% after deductible
20% after deductible
50% after deductible
Outpatient $30 copay or 20% after deductible
$50 copay or 30% after deductible
50% after deductible
20% after deductible
50% after deductible
Skilled nursing care 20% after deductible
30% after deductible
50% after deductible
20% after deductible
50% after deductible
Home healthcare 20% after deductible
30% after deductible
50% after deductible
20% after deductible
50% after deductible
Hospice care 20% after deductible
30% after deductible
50% after deductible
20% after deductible
50% after deductible
Durable medical equipment
20% after deductible
30% after deductible
50% after deductible
20% after deductible
50% after deductible
Prescription drugs
Generic $4 copay $4 copay $75 copay 20% after deductible
20% after deductible
Preferred brand $50 copay $50 copay $125 copay 20% after deductible
20% after deductible
Non-preferred brand $100 copay $100 copay $125 copay 20% after deductible
20% after deductible
Specialty drugs $150 copay $150 copay $200 copay 20% after deductible
20% after deductible
7
2016 OSU Benefits
DentalMaintaining healthy teeth and gums and seeking professional treatment when dental problems arise is important to your overall health. Employees and their families should maintain good dental habits and seek professional dental care.
OSU Offers Four Dental Plans � Healthchoice
� Delta Dental PPO
� Delta Dental Premier
� Delta Dental PPO-Choice
Please review the comparison grid below and choose the plan which best fits you and your dependents.
Your Costs for Network Services HealthChoice Dental
Delta Dental PPO In-Network and Out-of-
Network
Delta Dental Premier In-Network and Out-Of-
Network
Delta Dental PPO-Choice
Annual deductible Network: $25 basic and major services combined
Non-network: $25 preventive, basic, and
major services combined plus amounts above
allowed charges
$25 Per person, per year, applies to basic and
major care
$50 Per person, per year, applies to diagnostic, preventive, basic, and
major care
$100 Per person, per year, applies to major
care only (level 4)
Diagnostic and preventive care (e.g., cleanings, routine oral exams) allowed charges apply
Network: $0Non-network: $0 of
allowed charges after deductible
$0 of allowable amounts no deductible applies
$0 of allowable amounts after deductible
Schedule of covered services and copays
Basic care (e.g., extractions, oral surgery) allowed charges apply
Network: 15%Non-network: 30% plus amounts above allowed
charges deductible applies
15% of allowable amounts after deductible
30% of allowable amounts after deductible
Schedule of covered services and copays
Major care (e.g., dentures, bridge work) allowed charges apply
Network: 40%Non-network: 50% plus amounts above allowed
charges deductible applies
40% of allowable amounts after deductible
50% of allowable amounts after deductible
Schedule of covered services and copays
8
Oklahoma State University
Your Costs for Network Services HealthChoice Dental
Delta Dental PPO In-Network and Out-of-
Network
Delta Dental Premier In-Network and Out-Of-
Network
Delta Dental PPO-Choice
Orthodontic careAllowed charges apply
Network: 50%Non-network: 50% plus amounts above allowed charges No lifetime maximum covered for members under age 19 and members age 19 and older with TMD
40% of allowableamounts, up to lifetime maximum of $2,000 no deductibleNo waiting period Orthodontic benefits are available to employee and their lawful spouse and eligible dependent children
40% of allowable amounts, up to lifetime maximum of $2,000No deductibleNo waiting period Orthodontic benefits are available to employee and their lawful spouse and eligible dependent children
You pay amounts in excess of $50 per month lifetime maximum up to $1,800No deductibleNo waiting periodOrthodontic benefits are available to employee and their lawful spouse and eligible dependent children
Plan year maximum Network and non-network $2,500 per person per year
$2,500 per person, per year
$3,000 per person, per year
$2,000 per person, per year
Filing claims Network: no claims to fileNon-network: you file claims
Claims are filed by participating dentists
Claims are filed by participating dentists
Claims are filed by participating dentists
Note: After the deductible is satisfied, your cost shares will be the percentage shown on the grid.
This is only a sample of the services covered by each plan. For services not listed in this comparison chart, contact each plan or review online at http://hr.okstate.edu/benefits/dental.
Dental Monthly Premiums
Employee only EE + Spouse EE+ Child EE + Children EE + Spouse + Child Family
HealthChoice Dental $32.00 $64.00 $59.40 $100.20 $91.40 $132.20
Delta Dental PPO $33.64 $67.26 $62.90 $107.68 $96.52 $141.30
Delta Dental Premier $44.52 $89.04 $83.30 $142.58 $127.82 $187.10
Delta Dental-Choice $15.06 $49.24 $49.50 $98.66 $83.68 $132.64
9
2016 OSU Benefits
VisionMonthly Premiums
Monthly Vision Contributions
EE $9.50
EE and spouse $15.86
EE and child $15.62
EE and children $23.22
EE and spouse and child $21.98
Family $29.58
Vision benefits are essential towards maintaining your overall health and well-being, which is why we are proud to offer vision coverage through Vision Service Plan (VSP). VSP offers maximum value if you visit an in-network provider. For a complete listing of network providers, please visit www.vsp.com. Please review the outline of the plan below before electing coverage.
Covered Services In-Network Out-of-Network
Eye exam $10 copay $10 copay plan pays up to $35
Lenses per pair $25 copay $25 copay up to $80
Frames $25 copay $25 copay up to $45
Contact lenses $25 copay $0 copay plan pays up to $105
Laser vision correction 15% discount No benefit
After the copays above, the participant has a $120 credit towards glasses or contacts per year, and then a 20 percent discount on the remaining balance.
10
Oklahoma State University
Group Basic Life and AD&DOSU provides basic life and accidental death and dismemberment coverage to continuous, regular benefits eligible employees who work at least 30 hours a week (0.75 FTE.) Plus, OSU offers you the opportunity to purchase additional insurance for yourself and your family. Voya Employee Benefits provides the life insurance coverage, which is underwritten by ReliaStar Life Insurance Company.
Coverage Provided by OSU
Employees have basic life coverage provided by the OSU/A&M system of two-times annualized salary up to $200,000, with accidental death and dismemberment coverage. The Voya Employee Benefits plan includes:
� Accidental death and dismemberment coverage equal to basic life insurance coverage
� Accelerated death benefit which allows terminally ill employees to receive benefits while living
� Automatic reduction of coverage when reaching age 65
� $6,000 life insurance when you retire from OSU; must meet OSU retirement criteria
Voluntary Supplemental Coverage OpportunitiesEmployees may purchase additional coverage on themselves, spouse, and children. For more detailed information, please visit hr.okstate.edu/benefits/life or call 405.744.5449.
� No proof of good health is required if enrolled within 30 days of hire; limit of 2X’s salary for employee only and 1X’s employee salary for spouse
� Cost is based on age of employee and spouse
� Children coverage is based on coverage units, rather than age
� Proof of good health required if coverage is increased more than $5,000 each year or coverage exceeds two times annualized salary
� Portability is available to continue supplemental employee coverage upon separation and uses the same age-based cost available to active employees
� Employees can port supplemental life on their spouse and children if the employee ports supplemental life on theirself
� Even higher coverage limits are available at any time during the year by providing proof of good health satisfactory to ReliaStar Life Insurance Company—contact your Human Resources Office for assistance
If you are interested in applying for additional supplemental life insurance coverage, please complete the Life Insurance-Beneficiary Change Form and the Life Insurance-Evidence of Insurability forms and submit them to your Human Resources office for processing. You will receive notification from Voya, via your mailing address, regarding the status of your request. Voya also offers other services included in your life insurance policy; Funeral Planning and Concierge and Travel assistance services.
Voluntary Benefits
11
2016 OSU Benefits
Voluntary Benefits
Cancer Protection
OSU offers a Cancer Protection Insurance Policy through American Fidelity Assurance (AFA) Company. If you are diagnosed with cancer, AFA’s Limited Benefit Cancer Insurance Plan pays benefits directly to you. This money may be used however you need, allowing you to protect yourself from financial hardship.
How would you pay for these out-of-pocket medical expenses?
� Lost income
� Utilities
� Spouse’s lost income
� Meals and lodging
� Transportation costs
� Special diets
� Housekeeping expenses
� House/mortgage payments
Contact Kacey Boothe, Executive Account Specialist for enrollment 800.933.1853.
Long Term DisabilityOSU offers a Long Term Disability (LTD) policy through American Fidelity Assurance Company. This is a voluntary plan and premiums will be deducted from your paycheck as an after tax deduction.
No one plans to be disabled, but are you prepared if it were to happen to you? Disability can cause financial hardship. A disability plan is a great source for providing the income protection you need. It basically works as insurance on your income: when you are unable to work due to a disability, you would receive benefits to help pay for life’s necessities. Employees can apply for a LTD policy at any-time during the year. If you are within your first 30 days of hire, you are guaranteed issue of this policy.
Coverage Options and Costs50 percent at $0.26/$100 of covered monthly salary with $50,000 additional AD&D Life Insurance—$6,000 maximum.
60 percent at $0.62/$100 of covered monthly salary—$6,000 maximum.
Example for 60 percent LTD cost: $29,000/12 = $2,417/100 = $24.17 * 0.62 = $14.99 per month.
Questions?Contact the Human
Resources/Benefits office at
your OSU branch campus
or OSU Benefits, 106
Whitehurst, 405.744.5449, or
email osu-benefits@okstate.
edu. Forms and additional
information are posted on the
Human Resources website
at http://hr.okstate.edu/
benefits.
12
Oklahoma State University
Medical and PharmacyBlue Cross Blue Shield
877.258.6781
www.bcbsok.com/osu
PO Box 3283
Tulsa, OK 74102-3283
VisionVision Service Plan
800.877.7195
www.vsp.com
DentalHealth Choice
800.782.5218
www.healthchoiceok.com
Delta Dental
800.522.0188
www.deltadentalok.org
Basic/Supplemental LifeVoya
hr.okstate.edu/benefits/life
800.955.6965
Oklahoma Teachers Retirement System (OTRS)
trs.state.ok.us
877.738.6365
Health Savings Accountwww.mybenefitwallet.com
877.472.4200
Long Term Disability/CancerAmerican Fidelity Assurance
800.662.1113
Flexible Spending AccountChard-Snyder
800.982.7715
www.chard-snyder.com
Alternate Retirement Plan (ARP) Voluntary 403(b) & 457(b)
TIAA-CREF
www.tiaa-cref.org/okstate
800.842.2776
Employee Assistance ProgramComPysch
www.guidanceresources.com
855.850.2397
CancerAmerican Fidelity Assurance
800.933.1853
ResourcesFor any other questions, please feel free to contact the Oklahoma State University Benefits Department at 405.744.5449 or email [email protected]. We will be happy to help.
13
2016 OSU Benefits
Notes
14
Oklahoma State University
Notes
15
2016 OSU Benefits
© 2015 Lockton, Inc. All rights reserved. [Rev 09/29/15] Memphis\EB\OSUCE01\EE Comm\Enroll Guide\2016\16OE 454.pdf
This Employee Benefits Newsletter is
only intended to highlight some of the
major benefit provisions of the Company
plan and should not be relied upon
as a complete detailed representation
of the plan. Please refer to the plan’s
Summary Plan Descriptions for further
detail. Should this newsletter differ from
the Summary Plan Descriptions, the
Summary Plan Descriptions prevail.