Welcome to the Colorado Christian University Annual Enrollment Meeting! For Benefits Effective July...
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Transcript of Welcome to the Colorado Christian University Annual Enrollment Meeting! For Benefits Effective July...
Welcome to the Colorado Christian
UniversityAnnual Enrollment Meeting!
For Benefits Effective July 1, 2013
Welcome
Monday, May 20 through Wednesday, May 29
All insurance changes must be made by close of business on Wednesday, May 29, 2013
Enrollment Information
During Open Enrollment you may elect to:
– Enroll in medical, dental, or vision plans
– Enroll in or change your voluntary life election
– Add qualified dependents
– Drop covered dependents
– Waive coverage
IRS Rules
Per IRS rules, you will be locked into your selection until the next annual enrollment period unless you experience a qualified life event during the plan year.
A qualified life event includes, but is not limited to:
Marriage: Coverage effective 1st of the month following the marriage
Birth: Coverage effective on date of birth
Adoption: Coverage effective on the date of adoption
Loss of coverage: Coverage effective 1st of the month following loss of coverage
• Marriage • Divorce• Birth • Death• Adoption, or placement of a child
in your home for adoption• Change in work hours for you or
your spouse
You have 31 days from the date of the qualified event to make corresponding changes and return a completed change form to Human Resources. If you miss your 31 day window of opportunity, you must wait until the next enrollment period to make changes.
It is your responsibility to notify Human Resources when a change in status has occurred, such as legal separation,
divorce, a dependent child reaches the age limit, etc. Failure to do so could result in the inability to make changes or to
elect COBRA coverage.
What to Expect
• Save yourself hassle of additional coverage form– Verifies whether or not spouse/dependents have
additional coverage– Complete survey now to avoid delays in claim
processing– Only for those with spouse/dependents on plan
• Plan documents available within 60 days of plan start
Your Responsibilities
1. Participate in open enrollment meeting/review enrollment materials
2. Complete an Additional Coverage Survey only if you have a spouse or dependents on the plan
3. Complete an Enrollment/Change Form only if you are making any changesAdded “Employee + Child(ren)” tier – must complete enrollment form to take advantage of these rates
4. Complete a Waiver Form if you are waiving coverage for yourself, and/or qualified dependents for medical & vision, dental, indicate the reason.
5. Return completed enrollment/change/waiver forms to Human Resources no later than Wednesday, May 29, 2013.
Quick Overview
• Rate Increase– Rate shift in market– Starting to see effects of PPACA– Usage of 222 plan: 174% increase in utilization
• New Health Insurance Network– United Health Care Choice Plus Network
• New Third Party Administrator– UMR – replaces CNIC– Owned by United Health Care
Quick Overview
Plan Changes•Plan 222 is now titled “Select Plan”– Continues to be a no-deductible plan
•Plan 622 is now titled “Choice Plan”– Continues at $500/$1,500 deductible– Continues with $2,500/$5,000 out of pocket maximum
•Plan designs will not be identical
• Dental plan will have separate rate structure— Dental is now separate and not attached to medical
IntroductionIMA & UMR
Our New Insurance Broker – IMA
Our IMA Representative: Suzanne Vargas
Our UMR Representative: Donna Truitt
Service Category
Select Plan (No Deductible)
Choice Plan(Deductible)
In-Network Out-of-Network In-Network Out-of-Network
Plan Year Deductible
(Three month deductible carry-forward applies)
None$500 per person
$1,500 max per family
$500 per person
$1,500 max per family
$500 per person
$1,500 max per family
Plan Coinsurance
100% most services
60% 80% 60%
Annual Plan Maximum
$2,000,000 $2,000,000
Plan Year Out-of-Pocket
Coinsurance Maximum
(deductibles and co-pays do not apply)
$2,000 per person
$4,500 max per family
Per Covered Person: $10,000 Individual
$30,000 Family
$2,500 per person
$5,000 max per family
Per Covered Person: $10,000 Individual
$30,000 Family
Medical Plans
Service Category
Select Plan (No Deductible)
Choice Plan(Deductible)
In-Network Out-of-Network In-Network Out-of-Network
Physician Office Visit – Primary Care
(includes services incurred during the office visit)
$20 co-pay per visit; then covered 100%
60% after deductible
$20 co-pay per visit; then covered 100%
60% after deductible
Physician Office Visit – Specialist
$40 co-pay per visit; then covered 100%
60% after deductible
$40 co-pay per visit; then covered 100%
60% after deductible
Preventive Care Office Visit and preventivetesting / screenings
Covered 100% 60% after deductible
Covered 100% 60% after deductible
Routine Prenatal and Postpartum Office Visits
$20 co-pay per visit; then covered 100%
60% after deductible
$20 co-pay per visit; then covered 100%
60% after deductible
Medical Plans
If treatment or surgery is performed during a routine colonoscopy, the medical benefit will apply and the visit will be subject to deductible and coinsurance or co-pay
Service Category
Select Plan (No Deductible)
Choice Plan(Deductible)
In-Network Out-of-Network In-Network Out-of-Network
Diagnostic Lab & X-Ray Covered 100% 60% after deductible
Covered 100%, no deductible, at a free-
standing facility
Covered 80% after deductible for
Inpatient or Outpatient Hospital
60% after deductible
MRI, CT, PET Scans, Nuclear Medicine &
Other High Tech Services
$100 co-pay; then covered 100%
60% after deductible
80% after deductible
60% after deductible
Urgent Care Visit $50 co-pay per visit; then covered 100%
80% after deductible
Emergency Room
$100 co-pay per visit; then covered 100%.
(co-pay is waived if admitted to Inpatient Hospital on an emergency basis)
80% after deductible
Medical Plans
Service Category
Select Plan (No Deductible)
Choice Plan(Deductible)
In-Network Out-of-Network In-Network Out-of-Network
Outpatient Surgery$100 co-pay per visit;
then covered 100%(co-pay applies toward
out-of-pocket maximum)
60% after deductible
80% after deductible
80% after deductible
Inpatient Hospital$250 co-pay per admit;
then covered 100%(co-pay applies toward
out-of-pocket maximum)
60% after deductible
80% after deductible
60% after deductible
Durable Medical Equipment
Covered 80%,no deductible
60% after deductible
80% after deductible
60% after deductible
Chiropractic Care $40 co-pay per visit; then covered 100%
60% after deductible
$40 co-pay per visit; then covered 80%
60% after deductible
Medical Plans
Pre-Certification
Pre-Certification is required for:
•Inpatient hospital•Outpatient surgery (not performed in a physician’s office)•Inpatient rehabilitation•Home health care•Outpatient infusion therapy, chemo therapy, and radiation therapy•Transplants•Sleep disorder testing
You will be subject to a $250 penalty if pre-certification is not obtained.
Service CategoryBoth the Select (no deductible) and Choice (deductible) Plans
In-Network Out-of-Network
Retail Pharmacy: Up to a 90 Day Supply
Tier 1: Generics
$15/up to 30 day supply Not Covered
Tier 2:Brand-Name Formulary
$30/up to 30 day supply Not Covered
Tier 3:Non-Formulary Drugs
$50/up to 30 day supply Not Covered
Tier 4: Specialty / Injectables
20% coinsurance up to $250 per Rx Not Covered
Prescription Drugs
Mail Order: Up to 90 Day Supply
Service CategoryBoth the Select (no deductible) and Choice (deductible) Plans
In-Network Out-of-Network
Mail Order: Up to a 90 Day Supply
Tier 1: Generics
$30 Not Covered
Tier 2:Brand-Name Formulary
$60 Not Covered
Tier 3:Non-Formulary Drugs
$100 Not Covered
Tier 4: Specialty / Injectables
50% coinsurance up to $500 per Rx Not Covered
Mail Order – Getting started with Optum
• Prescriptions won’t transfer from WellDyne• Need new prescription for mail order – Contact doctor’s office
• Sign up for mail order online after 7/1
MonthlyMedical Payroll Deductions
Coverage Tier Select Plan(No Deductible)
Choice Plan(Deductible)
Employee Only $279.49 $103.80
Employee plus Spouse $535.68 $192.33
Employee plus Child / Children $461.15 $163.93
Employee plus Family $754.61 $273.22
Medical Plan-Your Pre-Tax Deductions
Salaried MonthlyAmount Your Payroll Deduction Will Increase for Medical
Coverage Tier Select Plan(No Deductible)
Choice Plan(Deductible)
Employee Only $132.48 $20.72
Employee plus Spouse $253.60 $38.10
Employee plus Child / Children $58.36 - $54.11
Employee plus Family $351.82 $55.18
Cost Changes
Hourly Bi-WeeklyAmount Your Payroll Deduction Will Increase for Medical
Coverage Tier Select Plan(No Deductible)
Choice Plan(Deductible)
Employee Only $71.89 $13.56
Employee plus Spouse $137.65 $24.98
Employee plus Child / Children $44.67 - $18.67
Employee plus Family $191.40 $35.98
Cost Changes
Dental Plan Key Benefits
Benefit DescriptionDelta Dental PPO Dentist
No Balance Billing
Delta Premier and Non-Participating
May Balance Bill
Calendar Year Deductible(Deductible resets every January 1st)
$50 per personUp to $150 maximum per family
Coinsurance Type I– Oral evaluations – Routine Cleanings
Covered 100%, no deductible for Type I services
Covered 80%, no deductible for Type I services
Type II– Basic Restorative (fillings)– Simple Extractions– Endodontics (root canal therapy)– Periodontics (gum disease treatment)
80% after deductible
(Note: Endodontics, Periodontics and Complex Oral Surgery are
covered at 50% after deductible)
80% after deductible
(Note: Endodontics, Periodontics and Complex Oral
Surgery are covered at 50% after deductible)
Type III– Crowns / Dentures / Bridges– Denture Rebase / Reline / Repairs
50% after deductible
50% after deductible
Type IV– Orthodontia Services (no age limit)
50% - no deductible for orthodontia services
50% - no deductible for orthodontia services
Dental Plan Key Benefits
Benefit DescriptionDelta Dental PPO Dentist
No Balance Billing
Delta Premier and Non-Participating
May Balance Bill
Calendar Year Dental Plan Maximum (Maximum resets every January 1st)
$1,250 per member, combined in-network
and non-network services
Orthodontia Lifetime Plan Maximum $1,500 per lifetime
Balance Billing
PPO Maximum Plan Allowance (MPA)
or actual fees charged, whichever is less.
Premier Dentist: Payment is based on the Premier
Maximum Plan Allowance (MPA), or the fee actually charged, whichever is less.
Non-Participating Dentist:Payment is based on the non-participating
Maximum Plan Allowance. Member is responsible for the difference between the
non-participatingMPA and the full fee charged.
Delta Dental Plan Amount You Pay Monthly
Employee Only $0
Employee plus Spouse $2.50
Employee plus Child / Children $7.50
Employee plus Family $10.00
Dental Plan-Your Pre-Tax Deductions
VSP Vision Key Benefits
Benefit Description
PPOIn-Network
PPONon-Network
YOU PAY . . . PLAN REIMBURSES . . .
Annual Exam Co-pay $10 co-pay Up to $45 for exams
Lenses$25 co-pay, then covered 100%(you pay additional amount for unlined bifocal, trifocal or progressive lenses,
coatings, tintings, etc.)
Single Lenses - up to $30Lined Bifocals – up to $50Lined Trifocals – up to $65
Progressive lenses – up to $50
Standard Retail Frames $130 allowance, no co-pay
Up to $70
Standard Contact Lenses(Instead of glasses)
$130 allowance; up to a $60 co-pay for contact lens exam,
fitting and evaluationUp to $105
Frequency of ServicesOnce every 12 months for exams, lenses, or contact lenses
Once every 24 months for frames
Discounts
You may receive a 20% discount from In-Network Providers for
certain services, such as the cost of a frame over $130, additional
glasses or sunglasses, etc.
N/A
VSP Vision Plan Monthly Amount You Pay
Employee Only $0
Employee plus One $3.51
Employee plus Family $12.49
Vision Plan-Your Pre-Tax Deductions
Sun Life Life/AD&D Insurance
Life / Accidental Death & Dismemberment (AD&D)
Company-Paid Benefit
All Eligible Employees
Life Benefit Amount1.5 times the employee’s basic annual earnings. The minimum benefit is $50,000; the maximum
benefit is $150,000
AD&D Benefit Amount Matches your Life Benefit Amount
Age Reduction ScheduleAt age 70: reduces to 67%At age 75: reduces to 50%
Benefits terminate at retirement
Monthly Premium This is a base benefit that is paid for by Colorado Christian University
Sun Life Short Term Disability
Short Term Disability (STD)Company-Paid Benefit
All Eligible Employees
Short Term Disability Benefit60% of Covered Earnings, up to a maximum benefit
of $1,000 per week(Benefit is taxable)
Benefits Begin On the 30th day of a qualified disability forsickness or accident
Benefit Duration Up to 9 weeks
24-Hour Coverage Only non-occupational sicknesses and accidents are covered under the plan
Special Features- Maternity covered the same as any other illness- No pre-existing condition limitations
Monthly Premium This is a base benefit that is paid for by Colorado Christian University
Sun Life Long Term Disability
Long Term Disability (LTD)Company-Paid Benefit
All Eligible Employees
LTD Benefit60% of Covered Earnings, up to a maximum benefit
of $6,000 per month(Benefit is taxable)
Benefits Begin On the 91st day of a qualified disability or at the end of the STD benefit period, whichever is later
Benefit Duration Up to your Social Security Normal Retirement Age (SSNRA)
24-Hour Coverage Yes. Covers on-the-job and off-the-job sicknesses and accidents
Loss of Income
First 24 months: You must not be able to earn more than 80% of your pre-disability earnings; After 24 months, you
must not be able to earn more than 60% of your pre-disability earnings
Own Occupation Definition
You must be disabled from the duties of your own occupation for the first 24 months; then any gainful occupation for which you are qualified due to experience, education or training
Long Term DisabilityCompany Paid!
All Eligible Employees
Physician Certification Required? Yes - you must be under the continual care of a licensed Physician
Must you be totally disabled to receive a benefit? No, you never have to be totally disabled
Pre-Existing Conditions Limitation Three-month look back period or 12 months on the Plan
Other Benefit Limitations - Mental Illness - Drug & Alcohol
- Benefit is limited to 24 months - Benefit is limited to 24 months
Survivor Benefit 3 month lump sum
Monthly Premium This is a base benefit that is paid for by Colorado Christian University
Sun Life Long Term Disability
Unum Voluntary Life/ AD&D Insurance
• Last year to elect voluntary life for spouse & dependents
• Due to recent Colorado civil unions legislation– Changes in definitions of spouse– Conflicts with our traditional family values
Unum Voluntary Life/AD&D Insurance
Voluntary Life / Accidental Death & Dismemberment (AD&D)
Voluntary Plan
Employee | Spouse | Child
Employee Life/AD&D Benefit Amount Elect up to $500,000 (in increments of $10,000), not to exceed 5 times your annual salary
Spouse Life/AD&D Amount – Employee must enroll
Elect up to 100% of the Employee amount (in increments of $5,000), not to exceed $500,000
Child Life/AD&D Amount – Employee must enroll (age 6 months to age 26)
Elect up to 100% of the Employee amount (in increments of $2,000), not to exceed $10,000. (Benefit is $1,000 for children age live birth to 6 months)
Age Reduction Schedule At age 65: reduces to 65% of the original amount;At age 70: reduces to 50% of the original amount
Life Insurance Guarantee Issue Amount (GI)Health questions & approval required in future years
Available for new-hires within initial eligibility period.Employee: $120,000
Spouse: $25,000 (not available in future years)Child: All amounts (not available in future years)
Special Features- Portable - Waiver of Premium- Conversion - Accelerated Benefit
Complete a new Enrollment Form if you want to move from your current plan
Complete a Waiver Form if you are waiving coverage for yourself, and/or qualified dependents for medical & vision, dental.
Return completed enrollment/change/waiver forms to Human Resources no later than close of business on Wednesday, May 29, 2013.
How to Change Plans
Per IRS rules, you will be locked into your selection until the next annual enrollment period unless you experience a qualified life event during the plan year.
A qualified life event includes, but is not limited to, marriage, divorce, death, birth, adoption, or placement of a child in your home for adoption purposes, or a change in work hours for you or your spouse.
You have 31 days from the date of the qualified event to make corresponding changes and return a completed change form to Human Resources. If you miss your 31 day window of opportunity, you must wait until the next enrollment period to make changes.
It is your responsibility to notify Human Resources when a change in status has occurred, such as legal separation, divorce, a dependent child reaches the age limit, etc. Failure to do so could result in the inability to make changes or to elect COBRA coverage.
Enrollment Information
The information contained in this Annual Benefits Enrollment Overview are outlines of your benefits and are intended to be used for illustrative purposes only.
Please refer to your actual benefit booklets for more details about each plan, including any limits or pre-authorization requirements.
These documents will be available on the Human Resources My CCU page
If there are any discrepancies, the Insurance Company contract and plan documents will prevail.
Important Notice