Employee Benefit Guide

2022

Inside

the Guide

Welcome…………………………………………………………………………………………………………………………..3

Eligibility…………………………………………………………………………………………………………………………...4

Medical……………………………………………………………………………………………………………………………. 5

Dental……………………………………………………………………………………………………………………………….7

Vision……………………………………………………………………………………………………………………………….. 8

Health Savings Account (HSA)…….………………………………………………………………………………….9

Flexible Spending Account (FSA)…………………………………………………………………………………..11

Life and AD&D……………………………………………………………………………………………………………… 12

Long-Term Disability Insurance……………………………………………………………………………………. 13

Employee Assistance Plan (EAP)………………………………………………………………………………14-15

Important Contacts……………………………………………………………………………………………………….. 16

Welcome

At Wittenberg University, we recognize our ultimate success depends on our talented and dedicated

workforce. We understand the contribution each employee makes to our accomplishments and so

our goal is to provide a comprehensive program of competitive benefits to attract and retain the

best employees available. Through our benefits programs we strive to support the needs of our

employees and their dependents by providing a benefit package that is easy to understand, easy

to access and affordable for all our employees. This brochure will help you choose the type of plan

and level of coverage that is right for you.

You can also view summaries of our benefit plans by browsing to our Benefits webpage.

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Eligibility

Eligible Employees:

Full time employees working at least 30 hours per week are eligible to participate in our benefit

plans.

Eligible Dependents:

If you are eligible for our benefits, your dependents may also be eligible. In general, eligible

dependents include your spouse and children up to age 26. Working spouses with an offer of medical

coverage from their own employer. Additionally, mentally or physically disabled children may continue

coverage beyond age 26 provided evidence of the ongoing disability is shown. Children may include

natural, adopted, stepchildren and children obtained through court- appointed legal guardianship.

When Coverage Begins:

Benefit coverage for newly hired employees and dependents is effective on the first day of the month

on or following your official start date. Elections are in effect for the entire plan year, with the

exception of HSA and TIAA contributions which can be changed at any time. All other benefits can

only be changed during Annual Enrollment, unless you experience a qualified family status event.

Family Status Change:

A change in family status is a change in your personal life that may impact your eligibility or

dependent’s eligibility for benefits. Examples of some family status changes include:

◼ Change of legal marital status (i.e. marriage, divorce, death of spouse, legal separation)

◼ Change in number of dependents (i.e. birth, adoption, death of dependent, ineligibility due to

age)

◼ Change in employment or job status (spouse loses job, etc.)

If such a change occurs, you must make the changes to your benefits within 30 days of the event

date. Documentation may be required to verify your change of status. Failure to request a change of

status within 30 days of the event may result in your having to wait until the next Annual Enrollment

period to make your change. Please contact HR to make these changes.

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Medical Insurance Wittenberg University will continue to offer

medical through Anthem Blue Cross and Blue

Shield. The charrts below are a brief outline of

what is offered. Please refer to the summary

plan description for complete plan details.

Anthem Blue Cross & Blue Shield

In-Network Benefits

Annual Deductible

Maximum Out-of-Pocket

Physician Office Visit

Preventive Care

Diagnostic Services

Retail Pharmacy (30 Day Supply)

Mail Order Pharmacy (90 Day Supply)

Individual / Family $2,800 / $5,600

Coinsurance Covered in full after deductible

Individual / Family $3,500 / $7,000

Primary Care / Specialty Care Covered in full after deductible

Adult Wellness Exams Covered in full, not subject to deductible

Well-Child Care Covered in full, not subject to deductible

X-ray and Lab Tests Covered in full after deductible

Complex Radiology Covered in full after deductible

Urgent Care Office Visit Covered in full after deductible

Covered in full after deductible

Inpatient Facility Charges Covered in full after deductible

Outpatient Facility and Surgical Charges Covered in full after deductible

Generic (Tier 1) $15 copay after deductible

Preferred (Tier 2) $30 copay after deductible

Non-Preferred (Tier 3) $45 copay after deductible

Preferred Specialty (Tier 4) 25% up to $250 max after ded

Generic (Tier 1) $30 copay after deductible

Preferred (Tier 2) $60 copay after deductible

Non-Preferred (Tier 3) $90 copay after deductible

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Emergency Room Facility Charges*

Medical Contributions

Employee Contributions (Monthly)

Medical

Employee $144.00

Employee & Spouse $303.00

Employee & Child(ren) $259.00

Family $432.00

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Dental major services.

Superior Dental Care Benefits

In-Network Out-of-Network

Annual Deductible

Annual Maximum

Orthodontia

Dental

Individual $25 $25

Family $75 $75

Waived for Preventive Care Yes Yes

Per Person / Family $1,500 $1,500

Preventive 100% 100%

Basic 50% after deductible 80% after deductible

Major 50% after deductible 50% after deductible

Dependent Child(ren) to age 19 50% after deductible

Lifetime Maximum $1,000

Employee $28.13

Employee & Spouse $55.29

Employee & Child(ren) $74.69

Family $110.58

Dental Insurance

Wittenberg University offers Dental coverage to

eligible employees through Superior Dental Care.

The Dental plan offers a wide network of

national providers and provides coverage for

routine visits, basic and major services.

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Employee Contributions (Monthly)

Vision Plans Vision coverage is offered to eligible

major services.

Anthem Blue Vision Benefits

Plan Type Materials Only

Routine Exams (Annual)* Not covered Not Covered

Vision Materials In-Network Out-of-Network

Prescription Lens Copay

Single

Bifocal

Trifocal

$15 copay

Reimburse up to $40

Reimburse up to $60

Reimburse up to $80

Frames $130 allowance, 20% off any

remaining balance Reimburse up to $45

Contacts

(in lieu of glasses) remaining balance Reimburse up to $105

Non-Elective Contacts Covered in Full Once every

calendar year

Reimburse up to $210

Frequency Lenses every 12 months

Frames every 24 months

Lenses every 12 months

Frames every 24 months

*Routine Exams are covered under the Medical Plan

Vision

Vision Insurance

Vision coverage is offered to eligible employees

through Anthem Blue Vision. The Vision plan

offers a wide network of national providers and

provides coverage for materials.

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$130 allowance, 15% off any

Employee + Spouse $8.80

Family $15.38

Employee $4.56

Employee + Child(ren) $15.38

Employee Contributions (Monthly)

Health Savings Account (HSA) When you are enrolled in a qualified High Deductible Health Plan (HDHP) and meet the eligibility requirements,

the IRS allows you to open and contribute to a Health Savings Account or HSA.

What is a Health Savings Account (HSA)?

An HSA is a tax-sheltered bank account that you own to pay for eligible expenses for you and your covered

dependents. Eligible expenses include current or future healthcare, dental, or vision expenses. The Health

Savings Account (HSA) is yours to keep, even if you change jobs or medical plans. There is no “use it or lose

it” rule; your balance carries over year to year.

Plus, you get extra tax advantages with an HSA because:

◼ Money you deposit into an HSA is exempt from federal income taxes

◼ Interest in your account grows tax free

◼ You don’t pay income taxes on withdrawals used to pay for eligible health expenses. (If you withdraw

funds for non-eligible expenses, taxes and penalties apply).

◼ You also have a choice of investment options which earn competitive interest rates, so your unused

funds grow over time.

Are you eligible to open a Health Savings Account (HSA)?

Although everyone can enroll in the qualified High Deductible Health Plan, not everyone is eligible to open

and contribute to an HSA. The following requirements must be met:

◼ You must be enrolled in a qualified High Deductible Health Plan (HDHP)

◼ You must not be covered by another non-qualified HDHP, such as a spouse’s PPO plan.

◼ You are not enrolled in Medicare.

◼ You are not in the TRICARE or TRICARE for Life military benefits program.

◼ You have not received Veterans Administration (VA) benefits within the past three months.

◼ You are not claimed as a dependent on another person’s tax return.

◼ You are not covered by a traditional health care flexible spending account (FSA). This includes your

spouse’s FSA. (Enrollment in a limited purpose health care FSA is allowed).

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2022 HSA Contributions

You can contribute to your Health Savings Account on a pre-tax basis through payroll deductions up to the

IRS statutory maximums. The IRS has established the following maximum HSA contributions for the 2021 Tax

Year:

◼ $3,650 Individual

◼ $7,300 Family

◼ If you are age 55 and over, you may contribute an extra $1,000 catch up contribution

◼ Wittenberg University will also make an annual contribution of $650 for individual coverage and

$1,300 for all other tiers. Prorated contributions will be made on a monthly basis.

How do I get reimbursed for my eligible expenses?

The easiest way to use your HSA dollars is by using your HSA Debit Card at the time you incur an eligible

expense (see link below). But keep your receipts! You must be able to prove that you are paying for an eligible

expense if you are audited. If you use your HSA funds for non-eligible expenses, you will be charged a 20%

penalty tax (if under age 65) as well as federal income taxes. You can manage your HSA at www.chard-

snyder.com 24 hours a day, seven days a week. If you prefer, you can also download the mobile app from

your app store. For additional assistance, please go online or call Chard Snyder customer service at 800-982-

7715.

Eligible Medical Expenses

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Flexible Spending & Dependent Care Accounts The Flexible Spending Account (FSA), Limited Flexible Spending Account (LMT) and Dependent Care Account

(DCA) with Chard Snyder allow you to set aside pre-tax dollars to cover qualified expenses you might normally

pay out of your pocket with post- tax dollars. The plans are comprised of a health care spending account for

participants not enrolled in the HDHP or contributing to an HSA, a limited health care spending account specifically

designed for participants enrolled in the HDHP and contributing to an HSA who want to make additional

contributions for dental & vision expenses only, and a dependent care account for qualified dependent care

expenses. You pay no federal or state income taxes on the money you place in an FSA, LMT, or DCA.

How FSAs/LMTs/DCAs work:

◼ Choose a specific amount of money to contribute each pay period, pre-tax, to your elected accounts

during the year.

◼ The amount is automatically deducted from your pay at the same level each pay period.

◼ As you incur eligible expenses, you may use your debit card to pay at the point of service OR submit the

appropriate paperwork to be reimbursed by the plan. Eligible healthcare FSA and Limited FSA expenses

can be found here: chard-snyder.com/benefits

Important rules to keep in mind:

For 2022, the healthcare and limited FSA carry-over amounts have been updated to coincide with Notice

2020-33. Now, the maximum carryover amount will be equal to 20% of the maximum salary reduction

contribution allowed under section 125(i). This means that each year, as the FSA contribution limits are

indexed for inflation, the carry over amount will increase accordingly. For 2022, the FSA maximum salary

contribution amount hasn’t been released yet. Assuming it remains the same as 2021, the carry over

amount will be $550. If it is increased, the carry over amount will automatically increase accordingly.

The Dependent Care FSA does not allow for any carry-over into the next year. If you do not use the full

amount in your DCA in the year elected, you will lose any remaining funds.

Once you enroll in the FSA, LMT, or DCA, you cannot change your contribution amount during the

year unless you experience a qualifying life event. Exceptions may be granted for Covid-19 based

on recent legislation. Contact HR if you have questions.

You cannot transfer funds from one FSA to another.

Only amounts payroll deducted to date are available for distribution with Dependent Care Accounts .

Employees enrolled in the Anthem HDHP may use their HSA, or for extra dental and vision

expenses their Limited Purpose FSA.

Re-enrollment into the FSA, LMT, or DCA is required each year.

Maximum Annual Election

NOTE: 2022 maximum annual FSA elections have not been announced as of 10/13/2021.

The limits below represent 2021 limits. Updates will be made as soon as 2022 limits are released.

Health Care FSA $2,750

Limited Purpose FSA $2,750

Dependent Care $5,000

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Life and AD&D Wittenberg University provides Basic Life and AD&D benefits to eligible employees in the amount of 1.5 times

your annual base salary, to a maximum of $400,000. The Life insurance benefit will be paid to your designated

beneficiary in the event of death while covered under the plan. The AD&D benefit will be paid in the event of

a loss of life or limb by accident while covered under the plan.

Voluntary Life In addition to the employer paid Basic Life and AD&D coverage, you have the option to apply for and purchase

additional voluntary life insurance to cover any gaps in your existing coverage that may be a result of age

reduction schedules, cost of living, existing financial obligations, etc. Your election, however, could be subject to

medical questions and evidence of insurability.

Voluntary Life Insurance

This plan is 100% employee paid via payroll deductions, at a group rate. There is an option to purchase coverage

for the employee, spouse and eligible children. The employee must be enrolled in order to elect coverage for

the spouse and/or child(ren).

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Long-Term Disability Insurance Wittenberg University provides eligible exempt employees, at no cost, with Long Term Disability coverage

should they become disabled with an illness or injury. After being disabled for 90 days, if you are unable

to perform your own occupation and upon claim approval, the LTD plan may pay 60% of your eligible pre-

disability earnings to maximum of $7,000 per month for up to 2 years if you have a medical condition that

prevents you from performing the duties of your own occupation. Please see the summary plan description

for complete plan details.

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Employee Assistance Program

Professional support and guidance for everyday life

Life doesn’t always go as planned. And while you can’t always avoid the twists and turns, you can get help to keep moving forward.

We can help you and your family, those living at home, get professional support and guidance to make life a little easier. Our Employee Assistance Program (EAP) is available to you in addition to the benefits provided with your MetLife insurance coverage. This program provides you with easy to use services to help with the everyday challenges of life — at no additional cost to you.

Help is always at your fingertips.

Our mobile app makes it easy for you to access and personalize educational content important to you.

Expert advice for work, life, and your well-being The program’s experienced counselors provided through LifeWorks — one of the nation’s premier providers of Employee Assistance Program services — can talk to you about anything going on in your life, including: • Family: Going through a divorce, caring for an elderly family member, returning to work

after having a baby • Work: Job relocation, building relationships with co-workers and managers, navigating

through reorganization • Money: Budgeting, financial guidance, retirement planning, buying or selling a home, tax issues • Legal Services: Issues relating to civil, personal and family law, financial matters, real

estate and estate planning • Identity Theft Recovery: ID theft prevention tips and help from a financial counselor if you

are victimized • Health: Coping with anxiety or depression, getting the proper amount of sleep, how to kick

a bad habit like smoking • Everyday Life: Moving and adjusting to a new community, grieving over the loss of a loved

one, military family matters, training a new pet

Convenient and confidential help when you want it, how you want it Your program includes up to 5 phone or video consultations with licensed counselors for you and your eligible household members, per issue, per calendar year. You can call 1-888-319-7819 to speak with a counselor or schedule an appointment, 24/7/365.

When you call, just select “Employee Assistance Program” when prompted. You’ll immediately be connected to a counselor.

If you’re simply looking for information, the program offers easy to use educational tools and resources, online and through a mobile app. There is a chat feature so you can talk with a consultant to guide you to the information you are looking for or help you schedule an appointment with a counselor.

Log on to metlifeeap.lifeworks.com, user name: metlifeeap and password: eap

blue heart icon. Store or Google Play, then select theSearch "LifeWorks" on iTunes App

Log in with the user name: metlifeeap and password: eap

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Answers to important questions

Are Employee Assistance Program services confidential? Yes. Any personal information provided to LifeWorks stays completely confidential.*

How do I get help? Getting professional help is just a phone call away. Simply call 1-888-319-7819 to speak with a counselor or to schedule a phone or video conference appointment. These services are available 24 hours a day, 7 days a week.

When is the right time to call? That’s up to you. Counselors are here whenever you need them —whether you simply need to talk or want guidance on something you are going through.

Is my Employee Assistance Program included with my MetLife coverage? Yes. There is no cost to you because your employer pays for the services provided within our program. While we offer a broad range of services, there may be some assistance that’s not included. You can still work with counselors for these services by arranging to pay for them directly.

Does the program have any limitations? While we offer a broad range of services, we may not cover all services you may need. Your Employee Assistance Program does not provide: • Inpatient or outpatient treatment for any medically treated illness • Prescription drugs • Treatment or services for intellectual disability or autism • Counseling services beyond the number of sessions covered or requiring longer term

intervention • Services by counselors who are not LifeWorks providers • Counseling required by law or a court, or paid for by Workers’ Compensation

When you need some support, we’re here to help.

Phone 1-888-319-7819

Web metlifeeap.lifeworks.com

user name: metlifeeap and password: eap

Mobile App user name: metlifeeap

and password: eap

*MetLife and LifeWorks abide by federal and state regulations regarding duty to warn of harm to self or others. In these instances, the consultant may have a duty to intervene and report a situation to the appropriate authority.

Some restrictions may apply to all of the above-mentioned services. Please contact your employer or MetLife for details.

Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166 OPT1 L0219512036[exp0320][All States][DC,GU,MP,PR,VI] © 2019 MetLife Services and Solutions, LLC

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Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166

OPT1 L0219512036[exp0320][All States][DC,GU,MP,PR,VI] © 2019 MetLife Services and Solutions, LLC

Important Contacts

Have Questions? Need Help?

Wittenberg University is excited to offer access to the USI Benefit Resource Center (BRC), which is designed

to provide you with a responsive, consistent, hands-on approach to benefit inquiries. Benefit Specialists are

available to research and solve elevated claims, unresolved eligibility problems, and any other benefit issues

with which you might need assistance. The Benefit Specialists are experienced professionals and their primary

responsibility is to assist you.

The Specialists in the Benefit Resource Center are available Monday through Friday 8:00am to 5:00pm Eastern

& Central Standard Time at 855-874-0829 or via e-mail at BRCMidwest@usi.com. If you need assistance

outside of regular business hours, please leave a message and one of the Benefit Specialists will promptly

return your call or e-mail message by the end of the following business day.

Carrier Customer Service

COVERAGE CARRIER PHONE WEBSITE

Medical HDHP Anthem 833-639-1634 www.anthem.com

Dental PPO Superior Dental Care 800-762-3159 www.superiordental.com

Vision Anthem 888-224-4902 www.anthem.com

Life and AD&D MetLife 800-638-5433 www.metlife.com

Long Term Disability (LTD) MetLife 800-638-5433 www.metlife.com

Voluntary Life MetLife 800-638-5433 www.metlife.com

Employee Assistance Program

(EAP) MetLife 888-319-7819 www.metlifeeap.lifeworks.com

Flexible Spending Accounts

(FSA) Chard Snyder 800-982-7715 www.chard-snyder.com

Health Savings Account Chard Snyder 800-982-7715 www.chard-snyder.com

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Metropolitan Life Insurance Company | 200 Park Avenue | New York, NY 10166

OPT1 L0219512036[exp0320][All States][DC,GU,MP,PR,VI] © 2019 MetLife Services and Solutions, LLC

This brochure summarizes the benefit plans that are available to Wittenberg University eligible employees and their dependents. Official plan documents, policies and

certificates of insurance contain the details, conditions, maximum benefit levels and restrictions on benefits. These documents govern your benefits program. If there is any

conflict, the official documents prevail. These documents are available on the HR Benefits page or upon request through the Human Resources Department. Information provided in this brochure is not a guarantee of benefits.