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Open Enrollment
Guide
Human Resources
November 4 to November 18, 2016
Table of Contents
Changes for 2017 ...................................................................................................... 2
General Information……………………………………………………………………...3-4
2017 Monthly Plan Premiums............................................................................. 5
2017 Bi-Weekly Plan Premiums ......................................................................... 6
Health Plan Information......................................................................................... 7
Prescription Drug Plan Information ................................................................. 8
Vision Coverage Information............................................................................... 8
Dental Plan Information..………………………………………………………………….9
Health Reimbursement Account ........................................................................ 10
Flexible Spending Account Plans……………………………………………………11
Dependent Changes………………………………………………………………………..12
This Guide provides general details about your health, dental,
vision, and retirement benefits.
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Dear Faculty & Professional Staff,
It’s Open Enrollment for Benefits season again! I’m pleased to provide this Open Enrollment Guide as a way of informing you about your health, dental, vision, and flexible spending plan benefits.
Here is a list of the changes that were approved by the Franklin & Marshall Fringe Benefits Committee for 2017:
Complete Blood Count (CBC) tests will be fully covered as part of your annual preventive screenings as it’s a helpful tool in evaluating your overall health. Be sure to notify your physician of this change so that they request a CBC for you every year!
Premiums – After several years of zero increases, premiums will increase modestly. (See page 5 for details.)
Emergency Room Co-Pays will increase to $100 per visit, but will continue to be waived for those that are admitted to the hospital.
In addition, I’m pleased to share the following enhancements to your Franklin & Marshall Benefits package:
Telemedicine! Online doctor’s visits from the comfort of your own home for a reduced co-pay of $15 per visit.
Enhanced Dental Benefits! The annual maximum per person is increasing from $1,000 to $1,500 per person, and the maximum orthodontic benefit is increasing from $1,000 to $1,500 per child.
Healthways Fitness Your Way! Discounted gym membership all over the country for $25/month.
PetPlan – 10% discount on pet insurance through Highmark.
It’s been a pleasure working with all of you this past year on your benefits needs and questions, and the HR team looks forward to supporting you in the year to come!
Sincerely,
Laura Laura M. Fiore
Associate Vice President, Human Resources
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Changes for 2017
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For an effective date of January 1, 2017, you may:
Enroll in coverage
Change coverage
Add an eligible dependent, including dependent children up to age 26
Remove a dependent from your coverage
Cancel coverage
Elect your annual contribution to the Flexible Spending Plan (either medical or dependent care). Your previous election will NOT roll over to the new plan year.
General Information
Questions about Your
Benefit Options?
Open enrollment is available on Inside F&M from Friday, November 4, through Friday, November 18. You must enroll online before the deadline, so we encourage you to submit your choices as soon as possible.
Plan booklets are available electronically. We recommend
reviewing plan booklets for details of each plan to be certain it
is the best choice for you and your family. Visit
www.fandm.edu/human-resources then click on Open
Enrollment to review these booklets.
If you lose your cards, please contact Highmark, Delta Dental or NVA Vision directly for a replacement.
Highmark (800) 345-3806
Delta Dental (800) 932-0783
Contact Fill (866) 234-1393
NVA Vision (800)672-7723
TIAA (800) 842-2776
Human Resources is available Monday through Friday from
7:30 a.m.-5:00 p.m. to assist with questions about open enrollment.
Christine Callender 358-3902
Kelly Bertani 358-3996
Lori Bush 358-4836
November 4 to 18,
2016
Plan Booklets
For assistance with logging into Inside F&M, contact the ITS Help Desk at 358-6789.
Who do I call at
F&M for help?
Health & Dental Cards
What you can do during Open Enrollment—IMPORTANT!
Page 3
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General Information
Page 4
Changes to your elections cannot be made during the calendar year unless you experience a qualifying life event that allows a change to your coverage. Qualifying life events include:
Birth, adoption
Marriage
Divorce or termination of a same-sex domestic partnership
Your spouse’s or dependent’s loss of eligibility for other group health insurance
Death of a spouse or dependent
Can I make changes
anytime during the
year?
A complete list of qualifying life events may be found in the Summary Plan Description found on the Open Enrollment website.
Opting Out of Health Insurance Coverage
You may decline health insurance offered by Franklin & Marshall College - this is called a Waiver of Coverage. If you waive coverage for yourself, you may not cover dependents under the F&M health plan. Note that if you decline coverage considered affordable and adequate under the Patient Protection and Affordable Care Act, you will not qualify for government subsidies to purchase individual health insurance. Electing to ‘Opt Out’ of coverage through open enrollment, or allowing your ‘opt out’ status to continue constitutes a Waiver of Coverage. The decision to waive coverage has consequences:
If you refuse employer coverage and don’t obtain coverage on your own (through another plan such as a spouse’s plan, Medicaid, or Medicare), you will be subject to a tax penalty.
If you are covered under another plan, but that coverage is lost, you may enroll in the F&M medical plan immediately. You must request to enroll in a plan within 30 days of losing the other coverage and provide proof of the loss of such coverage to Human Resources.
If you gain a new dependent through birth, adoption or marriage, you may enroll yourself, the new dependent, and your family at that time, but you must do so within 30 days of gaining the new dependent. If you miss the 30-day enrollment deadline, you must wait until the following open enrollment.
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Employee Only $111.35
Employee + 1 $181.86
Employee + Family $296.75
Annual F&M Contribution to Your HRA
Employee Only $74.56 $420
Employee + 1 $121.98 $840
Employee + Family $198.42 $1,260
Employee Only $3.33
Employee + 1 $4.88
Employee + Family $9.13
Employee Only $27.35
Employee + 1 $47.82
Employee + Family $71.47
2017 Health/Prescription Plan
Low Deductible Plan
High Deductible Plan
2017 Dental Plan
2017 Vision Plan
Monthly Premiums
Page 5
The below premiums reflect a modest increase over last year’s premiums.
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Employee Only $51.39
Employee + 1 $83.94
Employee + Family $136.96
Annual F&M Contribution to Your HRA
Employee Only $34.41 $420
Employee + 1 $56.30 $840
Employee + Family $91.58 $1,260
Employee Only $1.53
Employee + 1 $2.52
Employee + Family $4.21
Employee Only $12.62
Employee + 1 $22.07
Employee + Family $32.99
Health Plan Information
2017 Health/Prescription Plan
Low Deductible Plan
High Deductible Plan
2017 Dental Plan
2017 Vision Plan
Bi-Weekly Premiums
Page 6
The below premiums reflect a modest increase over last year’s premiums.
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Preventive care coverage is an important part of the Franklin & Marshall College Health Plan. You do not pay deductibles, coinsurance, or copays for eligible preventive healthcare services such as annual check-ups, well-child visits, routine screenings, and covered immunizations performed by a participating Highmark provider.
A Complete Blood Count (CBC) is a simple and easy blood test used to evaluate your overall health and detect a wide range of disorders, including anemia, infection and leukemia. This important blood test has been added to your preventive healthcare regimen as an extra measure to increase early detection of serious illnesses. Most health plans don’t include a CBC as preventive care, so you will need to notify your physician of this and request this important test annually.
Primary Care Physician $20 per visit Urgent Care Center $30 per visit Specialist $40 per visit Emergency Room Visit $100 per visit** In-Patient Hospital Stay $100 per stay
**New copay effective 1/1/2017
The College is pleased to continue to offer two Health Plan options so that you may choose the one that best meets your needs. This option offers modest monthly premiums and a low $300 per person and up to a $600 per family annual, in-network deductible. When receiving non-emergency services from a non-participating provider, the deductible is $750 per person and up to $1,500 per family, per year. This option combines the lowest premiums with a College-funded Health Reimbursement Account (HRA) to help offset the $1,000 per person and up to $2,000 per family annual in-network deductible. When receiving non-emergency services from a non-participating provider, the deductible is $2,000 per person and up to $4,000 per family, per year.
Preventive Care
NEW in 2017!
Office Visit Copays
Two Plan Options
A. Low Deductible
Health Plan
B. High Deductible
Health Plan
Page 7
Health Plan Information
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Prescription Drug Plan
Prescription Drug
Copays
You pay 85% of the drug cost, with a
$12 minimum and $37 maximum copay
per prescription
You pay 75% of the drug cost, with a
$40 minimum and $100 maximum
copay per prescription
You pay 65% of the drug cost, with a
$100 minimum and $160 maximum
copay per prescription
Annual
Maximum
The listed copays will apply when purchasing prescription drugs through a participating pharmacy or the Express Scripts mail order program.
You pay 85% of the drug cost, with a
$5 minimum and $15 maximum copay
per prescription
You pay 75% of the drug cost, with a
$20 minimum and $50 maximum
copay per prescription
You pay 65% of the drug cost, with a
$50 minimum and $80 maximum
copay per prescription
Eligible members and dependents are entitled to receive the following from a participating provider:
An examination once every calendar year covered at 100%
Lenses once every calendar year (covered at 100%)
Frames once every two calendar years (up to $60)
Contact Lenses in lieu of Lenses once every calendar year (up to $75 retail)
Laser Eye Surgery discounts including a free initial consultation with all in-network providers
Mail order is available for Contact Lenses through Contact Fill by calling 866-234-1393 or visiting www.contactfill.com.
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You will continue to pay a maximum of $1,500 per person, per
calendar year and up to $3,000 per family per calendar year for
prescription medications.
Tier 1
Generic Drugs
Tier 3 Non-Formulary and
Specialty Drugs
Retail Pharmacy
(31 day supply)
Mail Order
(90 day supply)
Tier 2
Brand Name Drugs
Vision Coverage
What is Covered?
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Page 9
Dental Plan Information
When visiting a participating Delta Dental provider:
100% coverage is provided for diagnostic and preventive services, including up to two cleanings and routine exams per calendar year, X-rays, fluoride treatments through age 18, and sealants up to age 14 (no deductible is required).
80% coverage is provided for basic restorative services such as fillings, extractions, treatment of gum disorders, and root canal therapy (participants will pay 10% of a contracted rate when visiting a participating dentist, plus the annual deductible).
50% coverage is provided for major restorative services such as crowns, dentures and bridgework (participants will pay 50% of a contracted rate when visiting a participating dentist, plus the annual deductible).
50% coverage is provided for orthodontia services for children through age 18, including braces, up to a maximum lifetime orthodontia benefit of $1,500 per child (no deductible).
A maximum benefit of $1,500 per person per calendar year is provided through this plan. Coverage is not provided for some services, including cosmetic procedures, implants and preventive plaque control procedures.
Dental Plan deductibles will remain $50 per person per calendar year, and up to $150 per year for a family. You will pay the deductible each year toward covered services before the dental insurer will begin making payments.
Delta Dental maintains an extensive network of providers. You will typically pay the lowest costs for dental services when visiting a participating provider.
Participants who visit a non-participating dentist will still
receive coverage, but will likely pay higher out-of-pocket
costs. If seeing a non-participating provider, you will be
responsible for normal coinsurance as listed above, plus all
fees charged by your provider in excess of Delta Dental’s
normal reimbursement rates to participating dentists.
What does the Plan
cover?
Increased Orthodontic
Benefit in 2017!
Increased Maximum
Annual Benefit in 2017!
Annual Deductible
Visiting a Non-
Participating Provider
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Health Reimbursement Account (High Deductible Only)
Health Reimbursement
Account (HRA)
HRA Annual Contributions
Carryover of Balances
How to Get Reimbursed
How Does the HRA Work If I
Also Have a Flexible Spending
Account for Medical Expenses?
Do I Keep the HRA Funds
Forever?
To help those who elect the High Deductible Health Plan pay the deductible, copays, and coinsurance, the College contributes money into a Health Reimbursement Account (HRA). Once you have incurred eligible health care expenses, you may receive reimbursement through the HRA up to your available balance.
Franklin & Marshall College contributes the following amounts to each HRA every January:
Employee Only $420
Employee + One $840
Employee + Family $1,260
Any funds remaining in an employee’s HRA as of December 31 will carry over to the next year, providing the individual remains employed and enrolled in the High Deductible Health Plan. These funds will be added to the contribution the College makes on behalf of each participant that year.
An HRA participant may receive reimbursement from his/her HRA by either charging eligible expenses using an HRA debit card, or by paying for the health care expense and uploading, faxing, or mailing a claim form to Highmark (the Administrator of the plan). HRA claim forms are available online.
For employees participating in both the HRA and the Flexible Spending Account (FSA) for Medical Expenses, eligible expenses will be reimbursed first from your Flexible Spending Account.
An employee who moves to a different Health Plan
Option, discontinues his/her health coverage through the
College, or terminates employment will permanently
forfeit the balance in his/her HRA. Upon employment
termination, a former employee may request
reimbursement from the HRA for eligible health care
expenses that were incurred through the termination
date. Retirees have a four-year period after their
retirement date to spend the balance of their HRA.
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What is a Flexible
Spending Account?
Do elections carry
over?
Annual Maximums
Deadlines
Eligible Expenses-
Medical
Eligible Expenses-
Dependent Care
What if I have an
HRA and a Medical
FSA?
How do I get
Reimbursed?
Flexible Spending Accounts provide a convenient way to contribute pre-tax dollars for qualified medical and dependent care expenses. The FSA is commonly known as the ‘use it or lose it’ account as funds not used by the deadlines below are forfeited. For this reason, please plan your FSA contributions carefully. You do not have to participate in a Health Plan to participate in a Flexible Spending Account Plan.
Your 2016 FSA elections will NOT carry over from year to year. You must elect a contribution via the online Open Enrollment process if you would like to participate in 2017.
Medical—$2,550 Dependent Care—$5,000 ($2,500 if married but filing separately)
Medical—Expenses incurred from January 1, 2017 to March 15, 2018 must be submitted for reimbursement by March 31, 2018. Dependent Care—Expenses from January 1, 2017 to December 31, 2017 must be submitted for reimbursement by March 31, 2018.
The Medical FSA can be used for expenses such as copays, deductible expenses, dental, and prescription drugs which are not reimbursed through any insurance plan. For a full list of eligible expenses, visit http://www.irs.gov/publications/p502/.
The Dependent Care FSA can be used for expenses such as the cost of childcare services for children through age 12.
For those who elect to participate in both the High Deductible Health Plan and the Medical FSA, eligible expenses will be reimbursed first from your Medical FSA. Since both the HRA and FSA can reimburse for the same types of eligible expenses, this decreases the risk of forfeiting unused FSA contributions. You may not be reimbursed for the same expense from both the FSA and the HRA, essentially being reimbursed twice for the same expense.
You may pay for eligible medical expenses (not dependent care expenses) with the debit card issued by Highmark. You may also submit a claim for reimbursement to Highmark online, fax, or by mail. You may elect to be reimbursed by check or by direct deposit, or you may choose to have Highmark send payment directly to the provider.
Flexible Spending Accounts (FSA)
Medical FSA – Dependent Care FSA
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Medical Coverage
New Benefits Feature! You may now modify your voluntary retirement contribution percent anytime throughout the year through Inside F&M > My Info > Benefits & Deductions.
If you will be making Plan changes during Open Enrollment that involve changes in your dependents, for example:
Going from Employee Only coverage to Employee +1 or plus family coverage
Going from Employee +1 or family to Employee Only coverage you must complete the online Dependent Change Form and submit supporting documentation to Human Resources within 10 Business Days. The Dependent Change Form can be found at the top of the benefit election page via the online Open Enrollment process on Inside F&M. It is also available on the Human Resources website – Open Enrollment.
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Changes to Dependents
Voluntary Retirement Plan Contributions
