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Medicare Part D
Prescription Drug Coverage
If you have Medicare or will become eligible for Medicare, a new Federal law gives you more
choices about your prescription drug coverage. Please see pages 34-35 for more details.
2018 BENEFITS GUIDE
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MEMORANDUM Linda Height
Vice President Finance and Administration
Welcome to Lawrence Tech’s 2018 Benefits Open Enrollment! Lawrence Tech continues to be committed to providing all eligible employ-ees with a comprehensive and competitive benefit package. Each year we conduct an extensive review of our benefit package. This year is no different as Lawrence Tech researched alternative plan designs with our current carriers as well as plans offered by other medical, den-tal and vision carriers. With guidance from our benefits consultant, Gallagher, and our Benefits Committee, we determined that the medi-cal products provided by Alliance Health and Life (AHL) and Health Alliance Plan (HAP) as well as the products provided by our other insur-ance providers continues to be benefit-competitive with the most affordable packages for value offered. Lawrence Tech values wellness – from both a health and financial perspective. We believe in empowering you and your families to live healthy, productive, high energy lives by implementing programs that support an integrated approach to wellness and benefit, promoting personal wellness as well as individual accountability, maintaining a balance between affordability for the University, and a comprehensive level of coverage with reasonable out-of pocket expenses annually for our employees. In support of this belief, the HAP Aspire Health Engagement HMO plan will continue to be offered. By offering this wellness based health plan we have made strides toward building a healthier workforce and would like to continue to make more strides in the future. The Alliance Health and Life PPO plan will continue to be offered as well. We are not changing medical carriers for 2018. This means that the PPO and HMO co-payments, deductibles and co-insurance amounts will be the same as they were in 2017. This is also true for the dental, vision, life and disability plans. Benefits Coverage — 2018 LTU’s 2018 costs will increase approximately 6.1%. Overall, the University will continue to pay 75% of the medical premium costs while employees will pay 25%.
Lawrence Tech is a strong advocate for preventive health care. This past year, we have all seen the benefit of the “health e ngage-ment” plan as we see people shedding pounds and reducing the need for blood pressure medicine. We are pleased that we can co n-tinue this program as it rewards those who commit to making better health choices. This is not only smart, it’s economical. Just like last year, when you enroll in the HAP Aspire Health Engagement HMO, you will need to complete the online Health Assess-ment and meet other requirements to continue to be elig ible for lower out -of-pocket costs. Both medical plans offered include deductibles, co-payment and co-insurance costs. The vision and dental plans may also include these out-of-pocket costs. To help you defray these costs, we encourage the use of the health care flexible spending account (F SA) administered by WageWorks. The FSA program provides a way for you to pay for some of these expenses with tax-free dollars. Because you bypass payroll withholding taxes, you save money. Basic life and disability for 2018 continue to be offered to all eligible employees at no cost. Other optional benefits for legal services/identity theft shield plan and auto and homeowners insurance discount program continue to be available. Open Enrollment To continue our “green” sustainability commitment to the University, you will not receive paper enrollment materials. During the week of October 23rd, you will receive an email that will contain links to all of your open enrollment materials (i.e. 2018 Open Enrollment Newsletter, Benefits Guide, Enrollment/Change Forms). All open enrollment materials may be found on Lawrence Tech’s Human Resources website at: http://www.ltu.edu/human_resources/benefit_forms.asp. The newsletter will provide you with high level information on all plan offerings. For detailed information, please be sure to read the Benefits Guide in its entirety as it contains important information on your benefits to help you make informed decisions regarding your health care participation for the 2018 plan year. For complete details, please review the Benefits Enrollment Instructions located in this booklet. Return your forms to the Office of Human Resources no later than November 3, 2017. Please contact the Office of Human Resources at x2108, or via email at [email protected] if you have any questions regarding your benefits.
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TABLE OF CONTENTS
Introduction ......................................................................................................................................................................................... 1
Benefits Enrollment Instructions ...................................................................................................................................................... 1-2
Access to Benefits Information ........................................................................................................................................................... 3
Insurance Providers ............................................................................................................................................................................ 4
Employees Responsibilities ................................................................................................................................................................. 5
Special Enrollment Period ................................................................................................................................................................... 6
Benefits ............................................................................................................................................................................. 7
Medical Insurance Options ............................................................................................................................................................. 8-11
Medical Plan Comparisons ................................................................................................................................................................ 12
Vision Insurance ................................................................................................................................................................................. 13
Dental Insurance ................................................................................................................................................................................ 14
Monthly Health Insurance Rates ....................................................................................................................................................... 15
Wavier of Insurance Coverage .......................................................................................................................................................... 16
Life Insurance Plan ............................................................................................................................................................................. 17
Disability Coverage ............................................................................................................................................................................ 18
Employee Assistance Program and Travel Assistance Program......................................................................................................... 19
Reimbursement Accounts ............................................................................................................................................................. 20-23
LegalShield/Identity Theft Shield ....................................................................................................................................................... 24
Other Voluntary Benefits .................................................................................................................................................................. 25
Health Care Terms ............................................................................................................................................................................. 26
Laws ............................................................................................................................................................................... 27-32
HIPAA Notice of Privacy Practices ..................................................................................................................................................... 33
Medicare Part D Notice of Creditable Coverage .......................................................................................................................... 34-35
HAP– Aspire Health Engagement Summary of Benefits .............................................................................................................. 36-37
AHL PPO Summary of Benefits ..................................................................................................................................................... 38-39
Please note: This is not a contract. You and your provider should contact the insurance carrier for full benefits description and applicable restrictions (if any) before services are provided. See your plan certificates for clarification.
1
INTRODUCTION & BENEFITS ENROLLMENT INSTRUCTIONS
Newly Hired or New Benefit Eligible
Employee
All new employees must complete the 2018 Benefits
Election/Change Summary-Form 3075 and applicable
benefit enrollment form(s) located on the HR web site at
http://www.ltu.edu/human_resources/
benefit_forms.asp. All benefit forms must be received by
the Office of Human Resources within 30 days of
eligibility. Failure to submit elections within the 30-day
deadline will result in no insurance coverage for the
entire plan year. The coverage effective date is the 1st of
the month following 30 days of hire.
Qualifying Status Change Event/Special
Enrollment Period
If you have a qualifying “status change” event during the
year, you may be allowed to make changes to your
benefits mid-year. See page 6, Special Enrollment Period
for a list of qualifying status change events. Complete and
return the Benefits Election/Change Summary– Form 3075
and applicable enrollment/changes forms to the Office of
Human Resources within 30 days of the event.
Benefits Open Enrollment
During the benefit open enrollment period, current eligible
employees may switch, add, adjust or cancel insurance and/
or add or remove spouse or dependent(s) from insurances.
See Benefits Open Enrollment Instructions to complete your
2018 elections.
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INTRODUCTION
In this 2018 Benefits Guide, we’ll help you understand Lawrence
Technological University’s benefit programs and how to ensure
proper selection for your 2018 benefits coverage. The benefit
programs include medical, vision, dental, life and disability
insurance, flexible spending account, legal and identity theft shield
plans, retirement plan and other voluntary benefits.
New Health Insurance Marketplace Coverage Notice
All states have created healthcare Marketplaces, previously
referred to as Exchanges, as a means for people who are
uninsured or underinsured to obtain healthcare coverage.
You can download a copy of the New Health Insurance
Marketplace Coverage Notice from our web site at http://
www.ltu.edu/human_resources/benefits_home_page.asp.
Lawrence Tech continues to provide coverage to you at a level and
a cost that exceeds the Federal guidelines for providing adequate
insurance at an acceptable premium. Keep in mind that you have
the right to explore your options with the Marketplaces, but you
will not be eligible for a subsidy if you elect the Marketplace over
Lawrence Tech coverage. For more information about Health Care
Reform or the Michigan Marketplace, please call 1.800.318.2596
or visit www.healthcare.gov.
Limitations
The university in its sole discretion may modify, amend, or
terminate the benefits provided in this booklet with respect to any
individual receiving benefits, including active employees, retirees,
and their dependents. Although the university has elected to
provide these benefits for the upcoming year, no individual has a
vested right to any of the benefits provided. Nothing in these
materials gives any individual the right to continued benefits
beyond the time the university modifies, amends, or terminates
the benefit. Anyone seeking or accepting any of the benefits
provided will be deemed to have accepted the terms of the
benefits programs and the university’s right to modify, amend or
terminate them.
BENEFITS ENROLLMENT Generally, there are three times when you can enroll in or may be
able to change your benefits: 1) as a newly hired or benefit
eligible employee, 2) after experiencing a qualifying status
change, or 3) during open enrollment. Follow the procedures
below to complete your enrollment. Access the benefit forms and
materials online at http://www.ltu.edu/human_resources/
benefit_forms.asp.
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BENEFITS OPEN ENROLLMENT INSTRUCTIONS
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Review Your Benefits Open Enrollment material... Be sure to:
Read this newsletter and 2018 Benefits Guide to learn about what’s happening for 2018.
Review your current benefits and dependent/beneficiary information online at www.ltu.edu/bannerweb.
Access Benefit Materials and Information about all of LTU’s Benefit plans at http://www.ltu.edu/human_resources/open_enrollment.asp.
Complete Your 2018 Benefit Election Forms located at http://www.ltu.edu/human_resources/benefit_forms.asp to:
A. Enroll in Plan - if you are currently waiving coverage and want add coverage for 2018, complete the 2018 Benefits Election/Change Summary Form #3075 and applicable enrollment/ change forms.
B. Cancel Plan/ Coverage- if you are currently enrolled in a plan and do not want coverage for 2018, complete the 2018 Benefits Election/Change Summary Form #3075 and applicable enrollment/ change forms.
C. Waive Medical Insurance - If you waived LTU medical insurance in 2017 and want to continue to waive coverage in 2018, you must complete the 2018 Benefits Election/Change Summary Form #3075. You must attest that you have other medical coverage for 2018 and provide proof of your other medical insurance information.
D. 2018 FSA Health Care and/or Dependent Care Elections - Complete the 2018 Benefits Election/Change Summary Form #3075.
E. Add or remove spouse or dependent(s) - Complete the 2018 Benefits Election/Change Summary Form #3075 and applicable insurance change forms.
F. Switch Coverage- If you want to switch your current 2017, complete the 2018 Benefits Election/Change Summary Form #3075. and applicable insurance change forms..
G. Life Insurance– add or increase—If you want to add or increase your supplemental (additional) life insurance or dependent life insurance, complete the 2018 Benefits Election/Change Summary Form #3075 and Reliance Life Insurance form.
NOTE: If you are not making the elections indicated above, no action is necessary. Your current 2017 coverage (except FSA and waive medical insurance elections) will continue next year unless you submit 2018 election and enrollment forms. You must submit your FSA and waive medical elections annually.
Submit your 2018 Benefit Elections: Submit your 2018 Benefits Election/Change Summary Form #3075 and applicable insurance enrollment/change forms to the Office of Human Resources. Submit your signed forms.
Note: Benefit enrollment forms contain sensitive information including social security numbers and date of birth. You may choose to submit your forms to Human Resources by one of the following methods:
Inter-office campus mail
Fax forms to 248.204.2118
Bring forms to the BSB, Office of Human Resources
You can elect benefits in 3 steps:
Scan forms and email to [email protected]
Submit all signed forms to Human Resources by November 3, 2017.
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ACCESS TO BENEFITS INFORMATION
Faculty and staff have access to benefits information 24 hours a day, seven days a week. By logging onto
BannerWeb at www.ltu.edu/bannerweb, employees may view their benefits information from home or office,
anytime or anywhere. For additional information or assistance, employees may also contact the Office of
Human Resources as follows:
Office Location Lawrence Technological University Business Services Building Office of Human Resources 21000 West Ten Mile Road Southfield, MI 48075
Office of Human Resources Deshawn Johnson, Executive Director Starlett Sinclair, Senior Manager, Benefits / HRIS Lorana Stewart, Employment & Compliance Manager Michele Moss, Human Resources Generalist Nynesha Jones, Employment & Human Resource Representative
Office Hours Monday – Friday 8:00 am to 4:30 pm
Phone 248.204.2108
Email Benefits staff will answer your benefits questions by email. Address your questions to [email protected]
Office of Human Resources website http://www.ltu.edu/human_resources
Limitations
Lawrence Tech in its sole discretion may modify, amend, or
terminate the benefits provided in this handbook with
respect to any individual receiving benefits, including
active employees, retirees, and their spouses, partners,
and dependents. Although Lawrence Tech has elected to
provide these benefits in a calendar year, no individual has
a vested right to any of the benefits provided. Nothing
in these materials gives any individual right to continued
benefits beyond the time Lawrence Tech modifies, amends,
or terminates the benefit. Anyone seeking or accepting of
the benefits provided will be deemed to have accepted the
terms of the benefits programs and Lawrence Tech’s right
to modify, amend or terminate them.
Notice of Non-Discrimination Policy
Lawrence Technological University adheres and conforms to
all applicable federal, state and local civil rights regulations,
statutes and ordinances. No person, student, faculty or
staff member will knowingly be discriminated against
relative to the above statutes. Lawrence Technological
University is an Equal Opportunity Employer.
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INSURANCE PROVIDERS
You can access your insurance customer service to request a physician provider directory, medical
membership ID cards, or to locate a network provider via phone or internet as follows:
Benefit Customer Service Number Hours Available Internet
Lawrence Technological University Office of Human Resources
248.204.2150 or 248.204.2108 Fax: 248.204.2118
Monday – Friday: 8:00 am - 4:30 pm
www.ltu.edu/human_resources Email: [email protected]
ADN Dental 888.236.1100 or
248.901.3705 Monday – Friday:
8:00 am - 5:00 pm EST www.adndental.com
Health Alliance Plan (HAP) 800.422.4641 or
888.819.2540
Monday – Friday: 7:00 am - 7:00 pm
Saturday: 8:00 am - 12:00 pm www.hap.org
Alliance Health & Life (AHL) 888.999.4347 Monday – Friday:
8:00 am - 5:00 pm Saturday: 8:00 am - 12:00 pm
www.hap.org
EyeMed Vision Care/ECPA 866.939.3633 Monday – Saturday: 8:00 am - 11:00 pm
Sunday: 11:00 am - 8:00 pm www.eyemedvisioncare.com
Gallagher Benefit Services Nicole Lee, Benefits Consultant
Benefit Questions 248.502.1129
Monday – Friday: 8:30 am - 5:00 pm
Liberty Mutual Insurance Group (Home/Auto Insurance Discount)
248.489.4291, ext 58795
Monday – Friday: 8:30 am - 5:00 pm;
Weekends and Evenings hours by appointment
www.libertymutual.com/benjaminpaddock
Email: [email protected]
Pharmacy Advantage Mail Order Rx Inquires
800.456.2112
Monday – Friday: 7:00 am - 11:00 pm Saturday & Sunday: 8:00 am - 5:00 pm
www.pharmacyadvantagerx.com
The LegalShield Plan/Identity Theft Shield
248.376.2858 Monday – Friday:
8:00 am - 5:00 pm Email: [email protected]
TIAA-CREF Retirement Plan 800.842.2776 Monday – Friday:
8:00 am - 10:00 pm Saturday: 9:00 am - 6:00 pm
www.tiaa-cref.org/ltu
Reliance Standard Life Insurance 800.351.7500 Monday – Friday:
8:00 am - 7:00 pm www.reliancestandard.com
Reliance Standard/ ACI Employee Assistance Program
855.775.4357 24 hours www.rsli.acieap.com
On Call/Travel Assist 800.456.3893 24 hours www.reliancestandard.com
WageWorks Flexible Spending Account (Health and Dependent Care)
877.924.3967 Fax: 877.353.9236
Monday – Friday: 8:00 am - 8:00 pm
www.wageworks.com Email: [email protected]
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EMPLOYEES RESPONSIBILITIES
Enrollment Deadlines It is important that employees review their benefits information, make their
benefits selections, and enroll within 30 days of eligibility. Failure to
submit elections within the 30-day deadline will result in no insurance
coverage for the entire year. (Note: For benefits open enrollment, all
changes to benefits must be submitted no later than November 3, 2017.)
Review Plan Limitations and
Restrictions
The information provided in this Guide is meant to help you and your family choose the health
care options best suited to your needs. Be sure to study each option carefully. Although the
Summary of Benefits and Benefits-at-a-Glance materials provide a summary of coverage available
under these options, it does not address important limitations and restrictions that may apply
to the health care plans. It is your responsibly to understand how the options work - including
the limitations and restrictions – and to make the appropriate health choices. More detailed
information on all these plan options can be obtained from the Office of Human Resources. In
the event of a discrepancy between the Summary of Benefits and Benefits-at-a-Glance materials and
the plan’s membership booklet, certificates and riders, the latter will govern.
Update Address Information The employee is responsible for notifying the Office of Human Resources immediately if their
address changes.
Monitor Your Benefits
Deductions
Employee should verify benefits deductions on their pay stub to be sure they match the coverage
requested. Employees can review their pay stub online by logging onto BannerWeb at
www.ltu.edu/bannerweb.
If You Find an Error in Your
Deductions
Contact the Office of Human Resources immediately if any data entry errors are found. The
University is not responsible for any excess contributions made because the employee failed
to provide proper notification of ineligibility of a dependent. This notification must be
submitted in writing to the Office of Human Resources. You are urged to keep copies of all forms
turned in as well as official University notices.
If You Provide False
Information
Employees who submit false information intended to provide health coverage for alleged
dependents not eligible for such coverage may be subject to discipline up to and including
discharge. Such employee will also be held financially responsible for all claims filed, and will
be required to reimburse the University for any payments made on behalf of or for the benefit
of an ineligible person claimed as a dependent.
Make Dependent Coverage
Changes Promptly
Employees are responsible for notifying the Office of Human Resources if they experience a
qualified “status change” within 30 days of the event if the change have affected or will affect
their coverage. See Special Enrollment Period for more information.
Federal Laws Refer to Federal Laws that affect your benefits and privacy listed in this booklet.
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6
SPECIAL ENROLLMENT PERIOD
Elections made to medical, dental, vision, life insurance and flexible
spending accounts are binding selections for the entire benefit plan year
January 1st through December 31st. Therefore, benefit elections will remain in
effect throughout the plan year and cannot be changed until benefits open
enrollment. However, special enrollment is allowed if employees experience
a “status change.” Status changes include the following:
Change in marital status
Birth or adoption of a child
Death of a spouse or dependent
Commencement or termination of your spouse’s employment (for
termination if a period of unemployment for more than 30 days)
Switch from full-time to part-time employment and vice versa by
employee or employee’s spouse
You or your spouse begin or return from an unpaid leave of absence
Change in dependent eligibility
Your spouse has a significant change in health coverage directly
attributable to your spouse’s employment
You are placed on an unpaid Family and Medical Leave, Worker’s
Compensation or Leave of Absence
You elected to participate in the University Medical Opt-out
Program and you lose your other medical coverage
A status change must be reported to the Office of Human Resources within
30 days of occurrence in order to allow selection of different benefit
options.
Based on your elections, you authorize the appropriate payroll adjustment
accordingly.
Employee’s Dependent Eligibility
Upon enrollment in benefits, eligible full-
time employees become Subscribers. The
Subscriber can enroll their eligible
dependents in the medical, dental,
vision and dependent life insurance.
Coverage eligibility applies to
dependents that are:
Not covered by the University as
an employee
Not covered by the University as
a dependent on another
University’s employee’s coverage
The Subscriber’s dependents may be
enrolled in benefits provided they meet
the requirements as follows: Legal spouse,
registered same-sex domestic partner,
dependent child under age 27, sponsored
dependent, permanently and totally
disabled children, and dependent
grandchildren.
Note:
For same-sex domestic partner eligibility, employees must complete the Affidavit of Domestic Partnership Form #3032. For
additional information regarding this benefit, contact the Office of Human Resources at 248.204.2108 or via email at
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7
PAYING FOR BENEFITS
The University makes a sizable investment in your benefits by paying a significant portion of the cost. You
pay any balance through automatic deductions from your pay. You are responsible for making sure
that your pay covers the cost of the benefits you choose.
Cost of your benefit plans Each benefit plan has its own rate structure. The cost of each benefit is published
annually in the Benefits Guide booklet. This booklet includes rate information that will
help you determine the amount of your specific deductions.
Frequency of deductions Full-time employees are paid on a semi-monthly basis – the 15th and last day of the
month. Your benefit payroll deductions will be taken in 24 equal installments from
the first and second paychecks each month. The monthly cost of benefits as indicated
in the Benefits Guide will be divided by two and deducted from your pay on a semi-
monthly basis.
Faculty employees who elect 18 pay installments do not have benefit deductions
processed during the summer months (June, July and August). Therefore, any benefit
deductions to cover the summer months will be processed with the May 31 payroll
cycle. Starting with the September 15 payroll cycle, benefit deductions will be
reinstated to the regular semi-monthly amount(s).
Pre-tax/after-tax options for paying
your share of benefits cost
The Premium Only program complies with Section 125 of the Internal R evenue
Service that allows you to pay certain insurance premiums with pre-tax dollars or
after-tax dollars. With pre-tax deduction, the premium is subtracted from your pay
before federal, state, and FICA taxes are calculated. That reduces your taxable
income and saves you money in taxes every payday. Note that when you reduce
your FICA taxes, you will also be reducing your Social Security contribution which
may affect your future Social Security benefits. Deductions for applicable medical
insurance premiums and flexible spending accounts are automatically deducted on
a pre-tax basis. Deductions for optional additional life, dependent life and legal plans
premium are automatically deducted after-tax.
Same-sex domestic partner tax
information
The employee may be responsible for tax liability on the premium costs to cover the
same-sex domestic partner and their dependent(s). The monthly premiums for
employees covering a same-sex domestic partner and the partner’s children are
identical to the premium for employees covering a spouse and children. However,
the employer cost of providing benefits for same-sex domestic partners and their
children is considered ordinary income or “imputed income” and is, therefore, subject
to taxes, including FICA, FICA Medicare, federal, state and city taxes, where
applicable. As a result, the cost to the employee of obtaining benefits for a same-sex
domestic partner and dependents are actually more than just the cost of the
employee’s required monthly premium.
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8
is a
Health Maintenance Organization Plan (HMO). This
plan is only available to Michigan residents. Under this
plan, you must select a participating Primary Care
Physician (PCP) through whom all your care will be
directed. You are required to obtain a referral from
your Primary Care Physician in the event that you need
to see a specialist. Females using this plan may select a
PCP as well as an OB/GYN and are not required to
obtain referrals for routine OB/GYN services. Regular
services are allowed twice per year. If you seek services
from a physician or hospital outside of the network, no
benefits will be payable (unless specified as an
emergency). To find a Health Alliance Plan provider or
to change your PCP, log on to www.hap.org.
See the HAP Aspire Health Engagement guide located
at http://www.hap.org/healthinsurance/
healthengagement/docs/aspire_member_guide/ for
a
is provided through a Preferred
Provider Organization (PPO), where a network of pre-
selected hospitals and doctors is available for your
use. This is a national plan and is available to all U.S.
residents. If you use the network, you will receive the
highest level of benefits offered by the plan. While the
network is available, you are not required to use it.
You always have the complete freedom to select any
provider whenever you need care. However, the out-
of-network benefits are lower and your out-of-pocket
costs are higher. If you use a non-participating
provider, you may also be billed the difference
between the approved amount and the provider’s
charge. To find a AHL PPO provider online, visit
www.hap.org.
MEDICAL INSURANCE OPTIONS
Lawrence Tech offers two medical insurance options for each employee and his/her spouse or
same-sex domestic partner and his/her eligible dependents. Depending on the plan elected by the
employee, the cost of the monthly premium may be shared by Lawrence Tech and the employee.
The employee’s cost depends on the number of people covered and the plan that is chosen. Additional
cost to the employee may also include co–payments, deductible and co-insurance.
The basic medical insurance plans coverage includes preventive care, hospitalization, emergency
services, urgent care, mental health and chemical dependency treatment, outpatient services, and
prescription drug coverage. Additional details regarding the plans are available in the Office of
Human Resources.
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Summary of Benefits and Coverage (SBC)- under healthcare reform all plans must distribute new summary of benefits which describes what the plan covers and what it costs. The SBC also includes coverage examples and a glossary of terms. The SBC documents are available for download at http://www.ltu.edu/human_resources/benefit_forms.asp. You may request a hard copy of the SBC documents by emailing [email protected].
9
HAP ASPIRE HEALTH ENGAGEMENT HMO
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The HAP Aspire Health Engagement Program is designed to
reward participants with lower out-of-pocket costs in return for
making healthy choices.
The HAP Aspire Health Engagement Program provides you with
two levels of plan coverage, Enhanced and Standard. When you
enroll you are automatically placed in the Enhanced plan with
lower out-of-pocket costs for your first 90 days of coverage. To
remain in the Enhanced plan you and your covered spouse will
need to complete the following steps by March 31, 2018:
1. Complete the online HAP Health Risk Assessment
(HRA).
2. Make sure you have a PCP. If you or your spouse
needs assistance finding a PCP, go to Provider Search
and PCP Select at www.hap.org. or call HAP’s PCP
Select line toll-free at (888) 742-2727.
3. Meet with your personal Primary Care Physician
(PCP) to complete the Member Qualification Form
(MQF). The Member Qualification Form is available
by logging in to the Online Services page at
www.hap.org, and clicking on Member Health
Reminders. Results from a physician and lab work
completed in the last nine months will qualify, but
your physician must complete and sign the form.
The form must be returned to HAP.
4. Achieve specific wellness targets or commit to
participating in health improvement programs or
treatment plans. You and your spouse must score at
least 80 out of 100 possible points to qualify for the
Enhanced plan. You can learn more about wellness
targets and what to do if your score is less than 80 by
logging in to the HAP Aspire Health Engagement
program at www.hap.org.
If you and your covered spouse have not completed these
steps by March 31, 2018, both of you (and your dependents)
will be placed in the Standard plan for the remainder of the
plan year. With the Standard plan, you have the same access
to quality care and physicians, but you will have higher out-of-
pocket costs.
The HAP Aspire Health Engagement Program concentrates on
seven important health measures:
Preventive Services
Tobacco Use
Weight Management
Blood Pressure
Cholesterol
Blood Sugar
Alcohol Use
HAP chose these measures because you can control them
through smart choices and they have an impact on your
health and your risk of developing chronic diseases.
Your doctor will determine if you meet the wellness target for
each health measure. You and your covered spouse must
score 80 points or more and complete the Health Risk
Assessment with 90 days after your annual effective date to
qualify for the Enhanced plan.
10
HAP ASPIRE HEALTH ENGAGEMENT HMO
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Both the Enhanced and Standard plans provide coverage for prescription drugs. Please review the plan design as the copays have
changed.
If you enroll in the HAP Aspire Health Engagement HMO plan, this plan will pay on a primary basis for you.
If your spouse has coverage under his/her employer plan and the Lawrence Tech plan, that employer’s plan
will be primary for your spouse and the HAP Aspire Health Engagement HMO plan will pay on a secondary
basis. You must follow the rules under both plans in order for coverage to be payable. If you are covering
your dependent children under both plans, the plan of the parent whose birthday is earlier in the year is
the primary plan.
Enhanced Plan
Covered medication falls into one of three tiers. The first tier is
generic drugs, and the copay is $15. The second tier is preferred
brand-name drugs, and the copay is $50. The third tier also
includes brand-name drugs, but these particular medications
are non-preferred because there are lower-cost alternatives
available. (“Lifestyle” drugs and injectables are also found in the
third tier.) There is a $50 copay for drugs in the third tier.
Standard Plan
Covered medication falls into one of three tiers. The first tier is
generic drugs, and the copay is $20. The second tier is preferred
brand-name drugs, and the copay is $40. The third tier also
includes brand-name drugs, but these particular medications
are non-preferred because there are lower-cost alternatives
available. (“Lifestyle” drugs and injectables are also found in the
third tier.) There is a $60 copay for drugs in the third tier.
HAP’s Formulary, Maintenance and Generic/Brand Rx
Most medications approved by the U.S. Food and Drug Administration (FDA) are found in HAP’s formulary (list of covered drugs),
although there are some restrictions. If your drug is not listed in the formulary, your provider may send in a “medical exception
request” to HAP, and request that the drug be covered for you. (There is no guarantee this request would be approved.) In addition,
some covered drugs - most of them in the third tier - may require prior authorization from HAP before being dispensed. To see HAP’s
formulary, or to find out which drugs require prior authorization, please visit the “prescriptions” section on HAP’s website at hap.org.
HAP has classified certain medications as “maintenance drugs.” These are drugs that are taken on a regular basis to treat chronic
health conditions. Up to a 90-day supply can be dispensed at an eligible 90-day HAP retail pharmacy or by using the Home Delivery
Pharmacy Service. You will pay the cost of 2 co-pays. The “maintenance drug” list can be found at hap.org; the majority of these
drugs are available as generics.
When your physician prescribes medication, you will receive the generic drug unless the physician writes “Dispense as Written”
or “DAW” on the script. However, if there is a generic equivalent and you specifically request “DAW” on your script, you will
pay the applicable brand-name copay plus the difference in cost between the brand-name drug and the generic equivalent.
11
HAP ASPIRE HEALTH ENGAGMENT HMO FREQUENTLY ASKED QUESTIONS
(Back to Table of Contents)
How often can I see my doctor for preventive care, such as
meeting with my doctor to complete the Member
Qualification Form?
For those preventive services that are recommended once a
year, HAP will cover them once in a calendar year (January 1
through December 31), without cost-sharing to you. If your
HAP plan allows cost-sharing such as a copay or coinsurance,
you may have to pay out of pocket if you receive preventive
services more often than once in a calendar year.
What if my spouse does not want to work toward health
goals?
Both the cardholder and spouse on the contract must
complete the three steps if they choose the Enhanced plan.
Once they complete the steps, everyone covered on the
contract – including dependent children – will be placed in
the Enhanced plan.
What information will be shared with my employer?
Your privacy is very important to us. No personal information
from your Health Risk Assessment or Member Qualification
Form will be shared with your employer.
Can I get an extension if I am unable to schedule an
appointment with my personal care physician during the
qualification period?
Unfortunately, no. Both the Health Risk Assessment and the
Member Qualification Form are due by the end of the
qualification period. If you have any difficulty in getting an
appointment with your personal care physician, call HAP’s
Client Services and they will assist you.
How often can I switch plans?
Each year during the qualification period you and your covered
spouse have the opportunity to decide to participate in the
Enhanced or Standard plan.
Do I need to complete the same three steps each year if I
choose the Enhanced plan?
Yes. To choose the Enhanced plan, you and your covered
spouse must complete the three steps annually.
Can I print a Member Qualification Form?
Yes. Log in at hap.org, using your HAP ID number and
password. If you have not registered for the HAP website,
you must do that first. After logging in, select Health
Engagement from the My Plan tab to download a form.
I recently went to my physician for a physical. Do I have
to go back to get the Member Qualification Form filled
out?
Please contact your personal care physician’s office to
determine if there is enough information on file for your
physician to complete the Member Qualification Form
without the need for a return visit.
How can I tell if my Member Qualification Form has been
received?
Log in at hap.org, using your HAP ID number and password.
If you have not registered for the website, you must do
that first. After logging in, select Health Engagement from
the My Plan tab and check your status.
12
MEDICAL PLAN COMPARISONS
(Back to Table of Contents)
Health Alliance Plan (HAP) - Aspire Health Engagement HMO
Alliance Health & Life (AHL) - PPO
HAP Aspire Health Engagement HMO AHL PPO
Enhanced Standard In-Network Out-of-Network
CALENDAR YEAR DEDUCTIBLE
Single $500 $1,000 $500 $1,000
Family $1,000 $2,000 $1,000 $2,000
Coinsurance 80% 70% 80% 60%
CALENDAR YEAR COINSURANCE MAXIMUM (Does not include copays)
Single $1,500 $2,000 $2,500 $5,000
Family $3,000 $4,000 $5,000 $10,000
CALENDAR YEAR OUT OF POCKET MAXIMUM (Includes copays)
Single $6,600 $6,600 $6,600 $13,200
Family $13,200 $13,200 $13,200 $26,400
Lifetime Maximum Benefit None None None None
PHYSICIAN OFFICE SERVICES
Office Visit (Illness/ Injury Related) $20 copay $30 copay $20 copay 60% after deductible
Specialist/Referral Office Visit $40 copay $50 copay $20 copay 60% after deductible
PREVENTIVE SERVICES
Adult Periodic Wellness Exams 100% 100% 100% Not covered
Well-Baby and Child Care 100% 100% 100% Not covered
EMERGENCY MEDICAL SERVICES
ER Copay (waived if admitted) $100 copay $150 copay $150 copay $150 copay
Ambulance Services Copay 80% after deductible 70% after deductible 80% after deductible 80% after deductible
Urgent Care Visits $40 copay $50 copay $20 copay $20 copay
HOSPITAL CARE
Inpatient Hospital Services 80% after deductible 70% after deductible 80% after deductible 60% after deductible
Outpatient Surgery 80% after deductible 70% after deductible 80% after deductible 60% after deductible
PHARMACY
Generic Copay Preferred Brand Copay Non-Preferred Brand Copay Mail Order
$15 $50 $50
2x copay for 90 day
supply
$20 $40 $60
2x copay for 90 day
supply
$15 $60
50% ($10 - $100)
2x copay for 90 day supply
Not covered
13
VISION INSURANCE— EYEMED VISION CARE
(Back to Table of Contents)
LTU offers vision care coverage through EyeMed Vision Care. The premium cost for this
benefit is shared by the University and employee and covers the employee and their
eligible dependents. You are responsible for applicable copayments.
Vision Care Services
EyeMed Vision Care offers a network of over 35,000 optical providers including optical
retailers LensCrafters , Target Optical and most Sears Optical and Pearle Vision
locations who have agreed to provide their services at reduced fees. This means lower
out-of-pocket costs for you. You do not have to use a network provider, however you
pay less out-of-pocket costs if you use a network provider. The process for members to
access their EyeMed vision care benefit is simple. You can access providers by calling
the toll-free locator service, visiting the web site, or referring to the provider listings
that are part of the member brochure/ID Cards you will receive.
Every 12 months, the new vision plan covers the following benefits less the exam and
material copays:
Other Benefits
Secondary Discount
EyeMed Vision Care offers members
discounts on purchases through their
secondary purchase plan. These
discounts are available on services
and products that are purchased
after the covered benefits have been
used. This plan provides reduced fees
for exams, frames, lenses, contact
lenses, and accessories, saving
members money on these additional
purchases.
Laser Vision Correction Benefits
Members utilizing their EyeMed Vision
Care benefit receive a 15% discount
off the retail price or 5% off the
promotion price for LASIK (Laser In-Situ
Keratomileusis) and PRK
(Photorefractive Keratectomy)
treatments through the U.S. Laser
Network, which is administered by
LCA-Vision. This includes all pre- and
post-operative care at no additional
charge if the treatment is performed
at a Lasik Plus Center, which is part of
the U.S. Laser Network.
Procedure In-Network Out-of-Network
Eye Exam
Contact Exam Option
- Standard
- Premium
Frames
Lenses
Contacts
- Conventional
- Disposables
Covered - $10 copay
Covered up to $55
10% off retail price
$0 copay, $100 allowance for a
frame plus 20% off balance over
$100
Covered $25 copay, up to
allowable amount (one copay/
lenses and frames)
Covered $115 allowance
toward materials, 15% discount
off balance over $115
Covered $115 allowance, plus
balance
Reimbursement up to $35
N/A
N/A
Reimbursement up to $45
Reimbursement to
predetermined amount
after copay
Reimbursement to $92
Reimbursement to $92 over
$115
EyeMed Vision Care - Explanation of Benefits (EOB)
An EOB is a summary statement provided when EyeMed processes claim(s) for you. EyeMed automatically provides EOB to you in
electronic format via the member website. For information and instructions to access the member website and locate your EOB,
visit our site at http://www.ltu.edu/human_resources/employee_benefits.asp#tab16
14
DENTAL INSURANCE—ADN DENTAL
(Back to Table of Contents)
Formed in 1993, ADN is the largest independent dental PPO in
Michigan, offering more than 3,100 dentists in Michigan and
many more in other states. Though the ADN network, its
affiliation with Michigan Dental Plans (MDP) and Dentemax,
you have access to a broad range of dentists. Dentemax adds
over 600 providers to the network. Your dental card will
reflect the new Dentemax logo.
How does this benefit me?
When you seek dental services with a participating ADN Dental
Network, MDP or Dentemax dentist, you receive no billing
except for deductibles and copays. This means you will not be
responsible for a dentist exceeding the "reasonable and
customary" charges; by contract, network providers agree
that this won't happen. We encourage you to contact ADN if
your provider does not currently participate with ADN or
Dentemax. Seeking care from a participating dentist results
in a greater benefit and less out-of-pocket costs for you.
Do I have to use a participating ADN Network Dentist?
No. You are not required to use an ADN, MDP or Dentemax
dentist. However, if you do not use an ADN Network Dentist,
your out-of-pocket costs are greater.
Will I have to submit any claim forms?
No. Your dentist should mail all claims directly to ADN.
When you pay your copay depends on your dentist. Some
dentists may ask for your copay at the time service is
rendered. Other dentists may bill first, then send you a bill for
your copay amount.
LTU Dental Benefits at a Glance
In-Network Out-Network
Annual Deductible:
Applies to Type 2 and
Type 3 Benefits Only $50 per individual
$150 per family
$50 per individual
$150 per family
Annual Benefit Maximum: $1,000 $1,000
Type 1 - Preventive Services: 100% 100%
Exams, X-Rays, Cleaning,
Fluoride for Children
(to age 14)
Type 2 - Basic Services: 100% 85%
Fillings, Extractions, Root
Canals, Treatment of Gum
Disease, Repairs to
Dentures and Bridges
Type 3 - Major Services: 60% 50%
Crowns (caps) fixed,
Bridges, Removable Partial
or Complete Dentures
Type 4 - Orthodontia
(to age 18): 50% 50%
Lifetime Maximum $1,500 $1,500
LTU offers dental coverage through ADN Dental. The premium cost for this benefit is shared by the University and employee and covers
the employee and their eligible dependents. You are responsible for applicable copayments and deductibles.
ADN Dental - Explanation of Benefits (EOB)
An EOB is a summary statement provided when ADN Dental processes claim(s) for you. ADN Dental automatically provides EOB to you
in electronic format via the member website. For information to access the member website and locate your EOB, visit our site at
http://www.ltu.edu/human_resources/employee_benefits.asp#tab4
15
MONTHLY HEALTH INSURANCE RATES
(Back to Table of Contents)
The following chart summarizes the monthly health insurance rates for the various plans based
on the coverage level. Review the 2018 Benefits Guide available at https://www.ltu.edu/
human_resources/benefit_forms.asp for other benefit rates or plan information.
Insurance Plan Monthly Premium LTU Monthly Contribution
Employee Monthly Contribution
HAP Aspire Health Engagement HMO (HAP Aspire HE HMO)1
Single $650.56 $488.98 $161.58
2 Person $1,496.29 $1,125.17 $371.12
Family $1,691.47 $1,271.87 $419.60
Sponsored Dependent (each) $813.20 $0.00 $813.20
AHL PPO
Single $862.96 $434.86 $428.10
2 Person $2,114.49 $997.11 $1,117.38
Family $2,643.09 $1,233.91 $1,409.18
Sponsored Dependent (each) $1,078.70 $0.00 $1,078.70
ADN Dental
Single $33.74 $16.88 $16.86
Family $97.28 $48.66 $48.62
EyeMed Vision
Single $5.43 $2.71 $2.72
Couple $10.22 $5.12 $5.10
Family $14.96 $7.48 $7.48
1 HAP Aspire HE HMO members have access to two benefits levels: enhanced and standard. Enhanced benefits have lower deductible and lower copayments, so members save money when using health plan services. To receive enhanced benefits, employees and their covered spouse must choose to meet the requirements. If you and/or spouse choose not to meet the requirements, you will still have health care coverage, but you will receive the standard benefit level, with higher out-of-pocket costs. Your Employee Monthly Contribution amount above will not change for the plan year. Learn more about the HAP Aspire HE HMO plan at www.hap.org. Payroll Deductions Certain benefits are paid for by payroll deduction from your salary on a pre-tax basis (before federal, state, and FICA taxes are calculated). The benefits plans with pre-tax deductions are medical, dental, vision, flexible spending accounts and retirement contributions. The plans with after-tax deductions are legal/identity theft shield plan, supplemental life and dependent life insurance deductions. Frequency of Deductions The employee monthly contribution amounts shown above are divided by two and subtracted from pay in 24 equal installments. Note: Faculty employees who elect 18 pay installments do not have benefits deductions processed during summer months (i.e., June, July and August). Therefore, any benefit deductions to cover the summer months will be processed in a lump sum with the May 31st payroll cycle.
2018 Monthly Health Insurance Rates Effective January 1, 2018 through December 31, 2018
16
WAIVER OF INSURANCE COVERAGE— MEDICAL, VISION AND DENTAL
If you have medical, vision and dental insurance elsewhere, you may elect to waive Lawrence Tech's coverage. In lieu of benefits, you
will be paid opt-out cash per pay period. Lawrence Tech offers two plan options to opt out of coverage as follows:
Plan Options
Plan 1
Plan 2
Program
Medical opt out
Medical, dental and vision opt out
Opt-Out Cash
$25.00 per pay period
$30.00 per pay period
If you choose Plan 1, you opt out of Lawrence Tech’s medical coverage only,
however you may enroll in the dental or vision plans. If you choose Plan 2, you opt
out of Lawrence Tech’s medical, dental and vision coverage. Both plan options are
taxable benefits and subject to FICA, Federal, state and city taxes. The amount
deducted for taxes depends on individual circumstances. Calculations will not be
provided prior to actual payment.
Employees who terminate employment during the plan year will forfeit any
remaining waiver fee.
If you experience a loss of your other medical insurance coverage, you must re-
establish medical coverage and provide your new medical insurance information to
the Office of Human Resources. You may establish medical coverage with the University.
You will be required to provide proof of loss of coverage and notify the Office of Human
in writing within deadline specified below:
If you are declining enrollment for yourself, or your dependents (spouse/
children) because of coverage under another plan, you may be able to enroll
yourself or your dependents in the University plan in the future, provided you
request enrollment within thirty (30) days after your other coverage ends.
If you are declining enrollment for yourself, or your dependents (spouse/
children) because of coverage under Medicare or Medicaid, you may be able to
enroll yourself or your dependents in the University plan in the future,
provided you request enrollment within sixty (60) days after your other
coverage ends.
In order to qualify for this special enrollment period, you must certify other coverage
was the reason for declining/waiving enrollment in coverage provided through
Lawrence Technological University.
Under the Affordable Care Act, individual mandates require most legal citizens and residents have minimum essential healthcare coverage. See the Federal Laws section of this booklet regarding information about the ACA.
To enroll in either plan:
1. Complete the 2018 Benefits
Election/Change Summary
Form #3075.
2. Show proof of other insurance
by providing a copy of an
insurance I.D. card. Note,
Canadian citizens covered by
OHIP are also required to
show proof of insurance.
3. Submit both documents to
the Office of Human
Resources.
(Back to Table of Contents)
17
LIFE/AD&D INSURANCE-RELIANCE STANDARD PERSONAL & DEPENDENT COVERAGE
Optional Coverage
If you wish, you may purchase Additional
Life/AD&D insurance, on a payroll
deduction basis, up to times your
annual wage, up to $750,000 overall.
The monthly cost of this Life/AD&D
insurance is based on your age (see
chart).
You may elect to add or drop Additional Life/AD&D insurance. If you add
or increase your Additional Life/AD&D insurance, you are required to
complete an Evidence of Insurability form. If you don't choose the extra
Life/AD&D insurance option, you will maintain your current level of
coverage. At age 70, the base and supplemental coverage reduces by
50% up to $50,000.
Employee’s Age
Cost of Coverage Month per $1,000
Calculate your Monthly Additional Life/AD&D Insurance Costs:
Select amount of coverage to multiply by annual wage, round amount up to next $1,000. Omit 000, then multiply by rate to get monthly cost.
Select Amount of Coverage _________ x = Round amount x =
(1-4 times annual wage) Additional Annual Base Amount of up to nearest $1,000, Rate Your Monthly
Life/AD&D Wage Coverage then omit 000) Cost
Additional Life/AD&D Selection = 2 Annual Base Earnings = $31,342 Age 31 years old
Select Amount of Coverage x = Round amount x =
(1-4 times annual wage) Additional Annual Base Amount of up to nearest $1,000, Rate Your Monthly
Life/AD&D Wage Coverage then omit 000 Cost
Dependent Life Coverage
Two options are offered for Dependent Life Insurance. Both plans cover the employee's
spouse and dependent children.
If you choose to cover your spouse, you must provide satisfactory proof of insurability for
that individual before this coverage becomes effective. You do not need to provide
proof of insurability for children. Your monthly cost for additional life insurance is
deducted from your paycheck on an after-tax basis.
Note: If you elect to change your life insurance coverage, your beneficiary on file will be considered your beneficiary for the new level
of coverage. If you wish to change your beneficiary designation, please contact the Human Resources Department to request a
Beneficiary Change Form. If you don't designate a beneficiary or don't have one on file, benefits will be paid to your estate or as
required by law.
The two plans are: Plan 1 Plan 2
(Back to Table of Contents)
Basic Coverage
Because your income is
so important to those
who depend on you,
the University provides
group term life and
accidental death and
dismemberment
(AD&D) insurance coverage equal to your annual wage
up to $150,000. This amount is rounded up to the
nearest $1,000. The first $50,000 of coverage can be paid
with pre-tax dollars. The Internal Revenue Service
requires taxation on a portion of your premium for
amounts in excess of $50,000. Any applicable taxation
will be applied semi-monthly.
18
DISABILITY COVERAGE
Disability Income Benefits
After the completion of one year of service, the University provides eligible full-time
employees disability income protection benefits during an approved medical leave of
absence.
Short Term Disability Income Protection
The Short Term Disability (STD) income protection is a benefit that provides partial or full
pay (depending on employee classification) for employees who are unable to work due to
his or her own non-work related illness, injury, or disability.
Faculty or Academic Administrative employees may receive short-term
disability income benefits that compensates at 100% of salary during the contract term and is available if needed,
until long-term disability takes effect.
Staff or Non-Academic Administrative employees may receive short-term disability income benefits that
compensates at 60% of your basic earnings for the period of disability after your leave time has been applied.
Employees are required to use any available sick days until they are exhausted. After the employee's sick time is
exhausted, the employee may elect to use their accrued vacation time and/or personal days, so as to be paid for all or
a portion of the leave before short-term disability income benefits may apply.
There is a waiting period of seven (7) calendar days before STD income benefits apply. The STD coverage would be continued to
the end of the disability or to a maximum period of 90 calendar days (65 work days) counting from the first day of disability. If the
employee is disable past 90 days, he/she may be covered under the long-term disability plan if the nature of the illness meets the
disability qualifications definition.
Long Term Disability Insurance
The Long-Term Disability (LTD) income benefits pays 60% of the employee's salary, to a maximum of $7,500/month, in the event
that the employee is found to be disabled and unable to work. This plan also provides the disabled employee with continued
contributions of a percentage of the paid monthly benefit into his/her retirement fund. If the disability is severe the percentage of
coverage may be increased to 80% based on established criteria. This benefit begins on the ninety-first day of illness and
continues to end of disability or to age 65. The University pays the full cost of this coverage.
(Back to Table of Contents)
19
EMPLOYEE ASSISTANCE PROGRAM AND TRAVEL ASSISTANCE PROGRAM
(Back to Table of Contents)
Employee Assistance Program (EAP)
Reliance Standard’s EAP program,
offered by ACI, helps you and
your family cope with life, from
the everyday to the unexpected.
Whether managing everyday issues such as job pressures,
relationships, retirement planning , finding child care, grief, loss,
or the impact of a disability, Reliance Standard is your resource
for professional support.
Help is only a phone call away. We encourage you to take
advantage of the resources available through Reliance Standard’s
EAP program offered by ACI.
1-855-775-4357
www.rsli.acieap.com
Please contact Human Resources for information on this program.
Employee Travel Assistance Program
We are pleased to offer a free Travel
Assistance Program through Reliance
Standard called On Call. This program
provides toll-free emergency assistance to
you, your spouse and your dependents 24
a day, seven days a week when traveling
100 miles or more from your primary
home or in a foreign country. On Call offers you and your
dependents the following services:
Pre-Trip Assistance:
Inoculation requirements information
Passport/visa requirements
Currency exchange rates
Consulate/embassy referral
Health hazard advisory
Weather information
Emergency Medical Transportation:
Emergency evacuation
Medically necessary repatriation
Visit by family member or friend
Return of traveling companion
Return of dependent children
Return of vehicle
Return of mortal remains
Emergency Personal Services:
Urgent message relay
Interpretation/translation services
Emergency travel arrangements
Recovery of lost or stolen luggage/personal possessions
Legal assistance and/or bail bond
Medical Services Include:
Medical referrals for local physicians/dentists
Medical case monitoring
Prescription assistance and eyeglasses replacement
Convalescence arrangements
Services available for business and personal travel.
For inquires within the U.S. call toll free: 1-800-456-3893
EAP and Work-Life Benefits: From the stress of everyday life to relationship issues or even work related concerns, the EAP can help with any issue affecting overall health, well-being and life management.
Unlimited Telephonic Sessions of Professional Assessment for Employees and Family Members
Unlimited Child Care and Elder Care Referrals
Legal Consultation for Unlimited Number of Issues per Year
Financial Consultation for Unlimited Number of Issues per Year
Unlimited Pet Care Consultation
Unlimited Education Referrals and Resources
Unlimited Referrals and Resources for any Personal Service
Unlimited Community-based Resource Referrals
Online Legal Resource Center
Affinity™ Online Work-Life Website
myACI App for Mobile Access
Multicultural and Multilingual Providers Available Nationwide
EAP benefits are free of charge, 100% confidential, available to all family members regardless of location, and easily accessible through ACI’s 24/7, live-answer, toll-free number. EAP services are provided by ACI Specialty Benefits, under agreement with Reliance Standard Life Insurance Company
20
FLEXIBLE SPENDING ACCOUNT— HEALTH CARE AND DEPENDENT CARE
(Back to Table of Contents)
Reimbursement Accounts -
Tax Savers
Lawrence Tech offers a Health Care
and Dependent Care Flexible
Spending Account (FSA) program. The
FSA plans are funded by a salary
reduction program and administered
through WageWorks. The Health
Care Reimbursement Account
provides a tax-free method of paying
for many health care expenses not
covered by your medical, dental and
vision plans. The Dependent Care
Reimbursement Account provides tax-
free payment for expenses such as day
care for a child or other qualified
dependent(s). When you make
contributions to these accounts, you
shelter the amount you contribute
from taxes. The money is then
available for paying your health care
and/or dependent care expenses. The
benefit period for Reimbursement
Accounts is January 1 - December 31, in
which your annual contribution will be
reduced from your pay.
Use-it-or-lose-it
Although the accounts offer you the
opportunity to pay expenses tax free,
IRS rules require that any amount not
used for covered expenses under your
Health Care and/or Dependent Care
Reimbursement Account cannot be
returned to you. This is known as the
"use-it-or-lose-it" rule. Careful
planning will help you avoid this
situation.
How the Reimbursement Accounts Work
You make new Reimbursement Account choices each year. During the annual enrollment
period, you decide how much money per pay period should go into one or both of the
accounts to pay for the next year’s expenses (January 1 - March 15, 2019). You
deposit your own before-tax contributions into the account(s).
The Reimbursement Account(s) are designed to reimburse you - not to pay expenses
directly. Here are highlights of how the process works:
1. Money is deposited into the account(s) with before-tax dollars from your pay.
2. When you have an eligible expense during the year, you pay it.
3. After paying the expense, you submit a claim form and documentation (for example, a
receipt from your day care provider or an Explanation of Benefits, or EOB) to receive
reimbursement. (For health care claims, always submit claims to the plan under which
you're covered before submitting for reimbursement. Submit claims only for
unreimbursed health care expenses to the Health Care Reimbursement Account).
4. Then, you're reimbursed from your account:
a. Health Care Reimbursement Account - you can be reimbursed for the full
annual amount you elected to contribute (your weekly amount times 52
weeks).
b. Dependent Care Reimbursement Account - you can be reimbursed up to the
amount you currently have in your account.
Grace period gives you more time to use your plan
The account(s) reimburses you for services, products, or treatment incurred within the
benefit period. You have from January 1, 2018 through March 15, 2019 to incur
dependent care or health care expenses. You have until May 31, 2019 to submit your
claim for the expenses which have accumulated from January 1, 2018 through March 15,
2019. This means you can continue to spend your current 2018 account funds for 2 1/2
months after the end of the plan year. A run-out period will follow the new grace period,
giving you time to file claims for those expenses incurred during the previous plan year
and/or during the new grace period.
21
FLEXIBLE SPENDING ACCOUNT— HEALTH CARE AND DEPENDENT CARE
(Back to Table of Contents)
The Health Care Reimbursement Account
You may deposit up to $2,600 per year in the Health Care
Reimbursement Account. You can use this account to pay
for any health care expenses allowed by the IRS and not
covered by your health care plans. However, health care
insurance premiums or premiums for any other types of
coverage are not reimbursable. Here are examples of eligible health care expenses:
Healthcare FSA accounts will no longer reimburse for over-the-counter medicine
(except insulin) unless it is prescribed by a physician. Regular prescribed
medications can still be run through your FSA, as well as all other previously eligible
medical expenses. A complete list of FSA health care eligible expenses are
available at www.WageWorks.com.
Deductibles and copays
Routine physical exams
Mental health/substance abuse services
Vision care/glasses & contacts
Dental expenses
Doctor's office, clinic visits
Prescription drugs
Doctor’s prescribed over-the-counter drugs
Hearing care/aids
Nursing home expenses
FSA Eligible Medical Items That do NOT Require a Doctor’s Prescription
FSA Eligible Medical Items That Require a Doctor’s Prescription
Bandages and related items (over-the-counter) Birth control (over-the-counter)
Blood pressure monitors
Cholesterol test kits and supplies
Condoms
Contact lenses, cleaning solutions, etc.
Crutches, canes, walkers or like equipment (purchase or rental)
Dentures, bridges, etc.
Diabetic monitors, test kits, strips and supplies
Eye related equipment/materials
Eyeglasses (over-the-counter)
Fertility monitors (over-the-counter)
First aid kits (over-the-counter)
Hearing aids and batteries
Incontinence supplies
Insulin, testing materials and supplies
Magnetic therapy (over-the-counter)
Medical equipment (for treatment of medical condition) & repairs
Medical monitoring and testing devices
Medical supplies (for treatment of a medical condition)
Monitors & test kits (over-the-counter)
Occlusal guards to prevent teeth grinding
Orthotics
Orthopedic and surgical supports
Over-the-counter bandages and related items
Ovulation monitor (over-the-counter)
Pregnancy tests (over-the-counter)
Reading glasses (over the counter)
Teeth grinding prevention devices
Urological products
Walking aids (canes, walkers, crutches and related supplies)
Wheelchair and repairs
Wound care (over-the-counter)
Acne treatments
Allergy .& sinus medicine and products
Antacids
Antibiotic ointment
Aspirin or other pain relievers
Asthma medicines or treatments
Canker & cold sore treatments
Chest rubs
Cold &flu medicines
Corn and callus removers
Cough drops & sore throat lozenges
Cough syrup
Diaper rash ointments and creams
Ear drops & wax removal
Gastrointestinal medications
Herbal or homeopathic medicines
Laxatives
Lice treatments
Motion & nausea medicines
Over-the-counter products for dental, oral and teething pain
Pain relievers
Propecia (for treatment of a medical condition)
Retin-A (for iron .cosmetic purposes)
Sleep aids
Toothache and teething pain relievers
Wart removal treatments
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FLEXIBLE SPENDING ACCOUNT— HEALTH CARE AND DEPENDENT CARE
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The Dependent Care Reimbursement Account
The Dependent Care Reimbursement Account works in much the same way as the Health
Care Reimbursement Account. However, it is a completely separate account with its own
rules and procedures.
The maximum amount you can put into your Dependent Care Reimbursement Account
depends on your Federal income tax filing status. You can put up to $5,000 each year in the
account or $2,500 per year if you are married and file a separate income tax return.
The maximum limit is a legal limit that applies to all plans to which you may contribute. So,
if you participate in a plan through your spouse's employer, it is your responsibility to
coordinate your contributions to be sure you stay within the limit. Also, as with the Health
Care Reimbursement Account, only expenses accumulated from January 1 through the
following December 31 are eligible for reimbursement (although you have until May 31 of
the following year to file a claim).
You may use your Dependent Care Reimbursement Account to pay for expenses that are directly related to the care of dependent
children or adults if the care enables you to work. If you're married, your spouse must be employed outside the home, disabled, or a
full-time student. In addition, for dependent care expenses to be eligible, the following conditions apply:
Your dependent must be:
Under age 13 and claimed by you as a dependent on your Federal income tax return; or
Any age if physically or mentally incapable of self-support and claimed as a dependent on your Federal income tax
return. (So, elder care may be reimbursable).
The services can be provided almost anywhere - including your home.
You cannot claim your care provider as a dependent for tax purposes. (Your
provider can, however, be a family member, as long as you don't claim that
family member as a dependent.)
The amount to be reimbursed must not be greater than your annual income
or your spouse's, whichever is lower. (If your spouse is a full-time student or
is mentally or physically incapacitated and does not have regular income, IRS
rules base your spouse's financial status on an assumed monthly income of
$200).
A complete list of FSA dependent care eligible expenses are available at
www.WageWorks.com.
Some examples of eligible
dependent care expenses are:
Infant/toddler
Preschool
Before/after school care
School half days
In-service days (no school)
School holidays/vacations
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FLEXIBLE SPENDING ACCOUNT— HEALTH CARE AND DEPENDENT CARE
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Choosing the Best Tax
Advantage for
Dependent Day Care
If you are a working parent,
compare the tax advantage of
the Dependent Care
Reimbursement Account and
the Federal child care tax
credit. If you choose to use the Dependent Care
Reimbursement Account, the amount you can deduct under
the Federal tax credit will be reduced by the amount you
contribute to the Dependent Care Reimbursement Account.
This is an important decision, because it affects both your
enrollment decision and your Federal income tax return. You
may want to check with a tax advisor to find out what's best
for you.
Things to Think About
When making your Reimbursement Account choices, here are
some things to keep in mind:
What expenses did you have this year? What kinds of
expenses do you expect next year? You can enroll in either
or both accounts.
You can contribute to the Health Care Reimbursement
Account even if you elect no health care coverage.
Your spouse's unreimbursed health care expenses are
eligible for reimbursement through the Health Care
Reimbursement Account even if he or she is insured
through another employer.
Use the worksheet below to help you determine how much you
may want to contribute.
Health Care Expenses Deductibles and copays Doctor’s office, clinic visits Routine physical exams Prescription drugs Mental health/substance abuse services Dental expenses Vision care/glasses & contacts Hearing care/aids Nursing Home expenses TOTAL
Estimated 2018 Expenses You Will Pay ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________
______________________
Dependent Care Expenses Infant/toddler Preschool Before/after school care School half days In-service days (no school) School holidays/vacations Summer day camp* Elder care TOTAL *Expenses for overnight camps are not reimbursable
Estimated 2018 Expenses You Will Pay ______________________ ______________________ ______________________ ______________________ ______________________
______________________ ______________________ ______________________ ______________________
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LEGAL PLAN/ IDENTITY THEFT SHIELD PLAN
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All full-time Lawrence Tech faculty, staff and administrative employees are eligible to enroll in this program at the special group rates
listed below:
BENEFIT OPTIONS MONTHLY FEE:
Legal Plan $15.95
Identity Theft Shield (employee only) $ 8.95
Identity Theft Shield (employee and spouse) $12.95 There is a $3.00 discount if the employee and spouse enroll in both Legal Shield and Identity Theft Shield plans. There is an additional $1.00 fee to add your dependent child(ren) under age 18 to the employee and spouse Identity Theft Shield plan.
LegalShield Benefit Includes:
24/7 emergency assistance for covered legal emergencies
Preventive Legal Services Telephone consultations for personal or business questions Letters/phone calls (plus 2 business letters or calls per year) Legal document review (up to 10 pages) plus 1 business document per year Will preparation and updates Trust preparation available at a 25% discount
Motor Vehicle Legal Services Assistance with moving traffic violations Assistance with certain motor vehicle related criminal charges Up to 2.5 hours for help with driver’s license issues and personal injury legal assistance
IRS Audit Legal Services Schedule benefits up to 50 hours of professional services
Preferred Member Discount Any other legal services not otherwise covered by the membership are available at a
25% discount
Trial Defense Services Assistance with the defense of civil suits and job-related criminal charges. Up to 60
hours of assistance the 1st membership year, which includes 57.5 hours of trial time and 2.5 hours of pretrial time. Schedule of benefits increase to a maximum of:
2nd year - 120 total hours 3rd year - 180 total hours
Additional features Access to full service law firm All members of the firm are members of the Michigan Bar Association Fees for covered services provided by Plan Attorney are fully covered No claim forms are needed Covers you, your spouse / domestic partner, dependent children / step children in
all 50 states
4th year - 240 total hours
5th year - 300 total hours
Identity Theft Shield
Benefit Includes:
Credit report for you and
your spouse / domestic
partner
24/7 credit monitoring
with immediate
notification via e-mail if
there is any activity
with the credit
repository, as well as a
monthly activity
statement
Restoration of your
identity by a licensed
investigator if you find
you have become a
victim of identity theft
Covers you and your
spouse / domestic partner
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OTHER VOLUNTARY BENEFITS
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Lawrence Tech offers a voluntary personal automobile and homeowners insurance discount program.
The program is at the employee’s expense with payment options; however, this program is not
administered through payroll deduction.
How to Enroll
Refer to the Liberty Mutual Insurance Group contact person under Insurance Provider listing.
The University’s recreational facility known as the Don Ridler Field House is available for use by employees and students. There is an annual membership (Begins on first visit to Field House) fee to join the Ridler Field House. The facility includes: ….
Treadmills and elliptical trainers
Four racquetball/wallyball courts
Three volleyball courts
Two full-court basketball areas
Cardio-room with bikes and rowing machines
Stairmasters and cross-trainers
Ping-pong tables
Billiards room
Free-weight room
Multipurpose weight room
Fitness track
Locker rooms and saunas
Additional information (i.e., hours of operation,
fees, etc.) is available on the website at http://
www.ltu.edu/athletics/ridler_facilities.asp
How to Join the Ridler Field House
Employees can join the facility by completing and
returning the Ridler Field House Authorization for
Payroll Deduction form. The form is available upon
request from the Payroll Office, [email protected].
The University offers the Lawrence Technological University Defined Contribution Retirement Plan to eligible employees. There are three contribution sources to the Plan: Employee Pre-Tax Match with Employer Match and the Employee Pre-Tax (non-matching). There are specific eligibility requirements that must be met before participating in the Plan. The contributions you defer into the Plan generally will be contributed on a pre-tax basis. Deferrals (and related earnings) are always fully vested and cannot be forfeited. The Plan is subject to the discretion of the University to modify, add or eliminate at any time. The Summary Plan Description (SPD) document summarizes the important features of the Plan, including the eligibility requirements, benefits and obligations under the Plan. Download a copy of the SPD document at https://www.ltu.edu/human_resources/retirement.asp or request a paper copy free of charge by emailing [email protected].
How to Enroll
Contact the Office of Human Resources for additional information.
The University bookstore is located in the Wayne H. Buell Management Building. The bookstore sells a wide variety of items including books, instruments, supplies, clothing, greeting cards, etc. Employees of the University receive a 10% discount at the bookstore on all items except: computer software, electronics, food, magazines, rings and textbooks. How to Receive University Bookstore Discounts
Employees may receive discounts on some bookstore purchases when they show their Lawrence Tech picture identification card. Identification cards are issued at the One Stop Center.
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HEALTH CARE TERMS
Annual Copay Maximum: The maximum amount you will pay out
of your own pocket for covered medical expenses during the year.
Once your payments total the out-of-pocket maximum, the plan pays
100% of covered expenses for the rest of the plan year.
Beneficiary: A person who is eligible to receive benefits under a
health benefits plan. Sometimes “beneficiary” is used for eligible
dependents enrolled under a benefits plan; “beneficiary” can also be
used to mean any person eligible for benefits, including both
employees and eligible dependents.
Benefit Year: The coverage period, usually 12 months long, which is
used for administration of a health benefits plan.
Brand-Name Drug: A drug manufactured by a pharmaceutical
company which has chosen to patent the drug’s formula and register
its brand name.
Carrier: A term historically used for licensed insurance companies,
although now sometimes used to include both licensed insurers and
HMOs.
Case Management: Coordination of services to help meet a
patient’s health care needs, usually when the patient has a condition
that requires multiple services from multiple providers. This term is
also used to refer to coordination of care during and after a hospital
stay.
Coinsurance: The percentage of the cost you pay after the
deductible has been met.
Coordination of Benefits: A provision in a contract that applies
when a person is covered under more than one group health benefits
program. It requires that payment of benefits be coordinated by all
programs to eliminate over- insurance or duplication of benefits.
Copayment (copay): What the participant pays at the time of
service. Copayments are predetermined fees for physician office
visits, prescriptions or hospital services. Usually, the plan pays 100%
of eligible expenses after you pay the copay.
Deductible: The money an individual or family must pay from their
own funds toward covered medical expenses, usually based on a
calendar year. For example, if a plan has a $100 deductible, the
deductible is met once the first $100 of the covered medical expenses
for that year have been paid. After that, the plan begins to pay toward
the cost of covered health care services.
Dependent: A person eligible for coverage under an employee benefits
plan because of that person’s relationship to an employee. Spouses,
children and adopted children are often eligible for dependent coverage.
Explanation of Benefits (EOB): A statement provided by the health
benefits administrator that explains the benefits provided, the
allowable reimbursement amounts, any deductibles, coinsurance or other
adjustments taken and the net amount paid. A participant typically
receives an explanation of benefits with a claim reimbursement check
or as confirmation that a claim has been paid directly to the provider.
Extension of Benefits: When a person’s coverage is extended under
certain conditions, such as disability, after their group health coverage
would otherwise have ended.
Formulary: A list of preferred drugs. Medications on this formulary list
have been shown to be safe, effective and affordable. Formulary includes
brand-name and generic drugs that have been approved by the Food and
Drug Administration.
Generic Drug: A prescription drug that has the same active-ingredient
formula as a brand-name drug. A generic drug is known only by its
formula name and its formula is available to any pharmaceutical company.
Generic drugs are rated by the Food and Drug Administration (FDA) to be
as safe and as effective as brand-name drugs and are typically less costly.
Health Maintenance Organization (HMO): An HMO requires a Primary
Care Physician must be selected and members must work with the PCP
for specialty care referrals. HMOs are prepaid capitated health care
plans structured to emphasize care and cost containment. HMO is the
most restrictive plan in health care, giving the greatest level of benefit.
Maintenance Medication: Medication that is prescribed for long-term
treatment of chronic conditions, such as diabetes, high blood pressure or
asthma. Maintenance medications are often available through the carrier’s
mail order service for up to a 90-day supply and at participating network
retail pharmacies for up to a 30-day supply.
Non-formulary (Non-preferred): A drug which is not on an approved
list for use and/or coverage by the plan.
Network: A group of providers (doctors, hospitals and others) who
have contracted with a plan to provide health care services.
Preferred Provider Organization (PPO): The PPO offers coverage in or out
of network, without a referral. No PCP is required. In-network coverage is
at a higher level than out-of-network.
Reasonable and Customary Charges: The commonly charged or
prevailing fees for health services within a geographic area. A fee is
considered reasonable if it falls within the parameters of the average or
commonly charged fee for the particular service within that specific
community.
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FEDERAL LAWS
As a participant in the Lawrence Tech Medical, Dental, Vision, and FSA (referred to here as "the plan(s)"), you are receiving this notice that describes your right to COBRA continuation coverage. COBRA, or the Consolidated Omnibus Budget Reconciliation Act of 1985, is a federal law affecting most employers who offer group health benefits to their employees. Under this law, you and other members of your family may have the right to temporarily continue your group health benefits when you would ordinarily lose coverage. This document describes your right to this COBRA continuation coverage, when it may become available to you and your family and what you must do to protect your right to receive it.
What is COBRA continuation coverage? COBRA continuation coverage extends your health plan coverage when it would otherwise end because of a life change (known here as a qualifying event). After a qualifying event, COBRA continuation coverage must be offered to each person who is a qualified beneficiary. You, your spouse and your dependent children could become qualified beneficiaries if coverage under the plan is lost because of the qualifying event. Qualified beneficiaries who elect COBRA continuation coverage may be required to pay up to 102% of the full cost of the benefit. As an employee covered by the plan, you will become a qualified beneficiary if you lose your plan coverage because:
Your hours of employment are reduced, or
Your employment ends for any reason except for gross misconduct on your part.
As the spouse of a covered employee, you will become a qualified beneficiary if you lose your plan coverage for any of the following reasons:
Your spouse dies.
Your spouse's hours of employment are reduced.
Your spouse's employment ends for any reason other than gross misconduct.
Your spouse becomes entitled to Medicare benefits.
You become divorced or legally separated from your spouse. As a dependent child of a covered employee, you will become a qualified beneficiary if you lose your plan coverage for any of the following reasons:
Your employee-parent dies.
Your employee-parent's hours of employment are reduced.
Your employee-parent's employment ends for any reason other than gross misconduct.
Your employee-parent becomes entitled to Medicare benefits.
You cease to be a "dependent child" under the terms of the plan.
When is COBRA coverage available? You are eligible for COBRA continuation coverage only after the plan administrator has been notified that a qualifying event has occurred.
Who is responsible for notifying the plan administrator of a qualifying event?
Your employer is responsible for notifying the plan administrator if the qualifying event is one of these:
Your termination or a reduction in your hours of employment.
Your death.
Your becoming entitled to Medicare. You are responsible for notifying the plan administrator that a qualifying event has occurred when the event is one of these:
You become divorced or legally separated from your spouse.
Your dependent child ceases to be eligible under the plan. You must notify the plan administrator within 60 days after the qualifying event has occurred. Provide this notice in writing to:
Lawrence Technological University Office of Human Resources, Business Services Building 21000 West Ten Mile Road Southfield, MI 48075
What happens next? Once the plan administrator has received notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each person will have an independent right to elect or decline the coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouse, and parents may elect the coverage on behalf of their children.
How long does COBRA continuation coverage last? COBRA continuation coverage is temporary coverage. Generally, it lasts only up to 18 months, when the qualifying event is a reduction in your hours of employment or your employment ends.
COBRA continuation coverage can last up to 36 months when the qualifying event is one of the following:
You die.
You become entitled to Medicare benefits.
You and your spouse become divorced or legally separated.
Your dependent child ceases to be eligible under the plan. An 18-month coverage period can be extended in two ways: through (i) disability or (ii) a second qualifying event.
Disability extension If the Social Security Administration determines you or another covered individual in your family to be disabled and you notify the plan administrator in a timely manner (within 60 days of the Social Security
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FEDERAL LAWS
determination), you and your family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started sometime before the 61st day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. If you qualify for the disability extension, you may be required to pay up to 150% of the full cost of the benefit for the additional 11 months of COBRA continuation coverage.
A second qualifying event
If your family experiences a second qualifying event during its 18-month period of COBRA continuation coverage, other qualified beneficiaries in your family can obtain an additional 18 months of coverage, for a maximum of 36 months, if the plan administrator is notified in a timely manner of one of these second events:
You die.
You become entitled to Medicare benefits.
You become divorced or legally separated from your spouse.
Your dependent child ceases to be an eligible dependent under the plan.
A "second qualifying event" extension may be available to your spouse and dependent children only if the event would have caused them to lose coverage under the plan had the first qualifying event not occurred.
Protect your rights
Always keep the plan administrator informed of any address change for any family member.
Whenever you correspond with the plan administrator, keep a copy for your records.
Keep in mind that this notice is only a summary of the most important provisions of COBRA. If you have questions or need additional information about COBRA continuation coverage or your group health plan, review your Summary Plan Description or contact the plan administrator:
Lawrence Technological University Office of Human Resources, Business Services Building 21000 West Ten Mile Rd. Southfield, MI 48075 Phone: 248.204.2150 or 248.204.2151
For answers to your questions concerning your rights under COBRA, ERISA, HIPAA and other laws affecting group health plans, contact the nearest regional or district office of the U.S. Department of Labor's Employee Benefits Security Administration or visit the EBSA web site at www.dol.gov/ebsa.
Women's Health and Cancer Rights Act of 1998 - Annual Notice
Federal law requires a group health plan to provide coverage for the following services to an individual receiving plan benefits in connection with a mastectomy:
Reconstruction of the breast on which the mastectomy has been performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance, and
Prostheses and physical complications for all stages of a mastectomy, including lymph edemas (swelling associated with the
removal of the lymph nodes).
The group health plan must determine the coverage in consultation with the attending physician and patient. Coverage for breast reconstruction and related services will be subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan.
Newborn and Mother's Health Protection Act - Annual Notice
This 1998 Federal law states: "Group plans and health insurers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth.”
The law provides that neither you nor your newborn baby may be sent home less than 48 hours following a natural childbirth. If you have a Caesarean section, you may remain at the hospital for 96 hours. A longer stay is based on medical necessity, which is determined by your physician. However, the law does not prohibit either of you from going home in less than 48 hours, or 96 hours following a Caesarean section, provided that you and your physician agrees that is safe to do so.
Medicaid /CHIP Special Enrollment Period
If you are or a dependent is covered under a Medicaid or a State child health medical plan (CHIP) plan and coverage is terminated as a result of the loss of eligibility for Medicaid or CHIP coverage, you may be able to enroll yourself and/or your dependent(s). However, you must request enrollment within 60 days after the date eligibility is lost.
Finally, if you or a dependent becomes eligible for premium assistance under an applicable State Medicaid or CHIP plan to purchase coverage under the group health plan, you may be able to enroll yourself and/or your dependent(s). However, you must request enrollment within 60 days after you or your dependent is determined to be eligible for State premium assistance. Please note that premium assistance is not available in all states.
GINA
The Genetic Information Nondiscrimination Act of 2008 (P.L 110-233, 122 Sta. 881), also referred to as GINA, is a new Federal law that prohibits discrimination in the health coverage and employment based on genetic information. The President signed the act into law on May 21, 2008.
Summary of Benefits and Coverage (SBC)
Under healthcare reform all plans must distribute new summary of benefits which describes what the plan covers and what it costs. The SBCs
also include coverage examples and a glossary of terms. The SBC documents are available for download at http://www.ltu.edu/human_resources/benefit_forms.asp. You may request a hard copy of the SBC documents by emailing [email protected].
Same Sex Marriage
On June 26, 2015, the Supreme Court of the United States ruled that all couples have a fundamental right to marriage, whatever their gender, in all 50 states. Under the terms of Health Benefit Plans, all spouses, regardless of gender, are entitled to the same legal obligations, responsibilities, protections and benefits provided under state law. To comply with the requirements of the law, Lawrence Technological University’s Health Benefit Plan(s) include coverage for all legal marriages.
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FEDERAL LAWS
Michelle’s Law A law referred to as “Michelle’s Law” now applies to Lawrence Tech beginning on January 1, 2010. Michelle's Law requires group health plans to provide continued coverage for dependent children who are covered under Lawrence Tech’s group health plan as a student if they lose their student status because they take a medically necessary leave of absence from school. This new law will apply to medically necessary leaves that begin on or after January 1, 2010. This continuation of coverage is described below. If your child is no longer a student, as defined in the plan, because he/she is on a medically necessary leave of absence, your child may continue to be covered under the plan for up to one year from the beginning of the leave of absence. This continued coverage applies if, immediately before the first day of the leave of absence, your child was (1) covered under the plan and (2) enrolled as a student at a post-secondary educational institution (includes colleges, universities, some trade schools and certain other post-secondary institutions). For purposes of this continued coverage, a “medically necessary leave of absence” means a leave of absence from a post-secondary educational institution, or any change in enrollment of the child at the institution, that: 1. begins while the child is suffering from a serious illness or injury, 2. is medically necessary, and 3. causes the child to lose student status for purposes of coverage
under the plan. The coverage provided to dependent children during any period of continued coverage: 1. is available for up to one year after the first day of the medically
necessary leave of absence, but ends earlier if coverage under the plan would otherwise terminate, and
2. stays the same as if your child had continued to be a covered student and had not taken a medically necessary leave of absence.
If the coverage provided by the plan is changed under the plan during this one-year period, the plan will provide the changed coverage for the dependent child for the remainder of the medically necessary leave of absence unless, as a result of the change, the plan no longer provides coverage for dependent children. If you believe your child is eligible for this continued coverage, the child’s treating physician must provide a written certification to the plan stating that your child is suffering from a serious illness or injury and that the leave of absence (or other change in enrollment) is medically necessary. Coordination with COBRA Continuation Coverage If your child is eligible for Michelle's Law's continued coverage and loses coverage under the plan at the end of the continued coverage period, continuation coverage under COBRA may be available at the end of Michelle's Law's coverage period and a COBRA notice will be provided at
that time. If further federal guidance permits the plan to apply this continued coverage to the period of time COBRA coverage is available, the plan will reduce the COBRA period by any period of coverage under coverage extended under Michelle’s Law. Questions? If you have any questions regarding the information in this notice or your child’s right to Michelle's Law's continued coverage, or if you would like a copy of your Summary Plan Description (which contains important information about plan benefits, eligibility, exclusions, and limitations), you should contact Human Resources.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). __________________________________________________________________
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of January 31, 2015. Contact your State for more information on eligibility:
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FEDERAL LAWS
ALABAMA – Medicaid GEORGIA – Medicaid
Website: www.myalhipp.com
Phone: 1-855-692-5447
Website: http://dch.georgia.gov/
- Click on Programs, then Medicaid, then Health Insurance Premium Payment (HIPP)
Phone: 1-800-869-1150
ALASKA – Medicaid INDIANA – Medicaid
Website: http://health.hss.state.ak.us/dpa/programs/medicaid/
Phone (Outside of Anchorage): 1-888-318-8890
Phone (Anchorage): 907-269-6529
Website: http://www.in.gov/fssa
Phone: 1-800-889-9949
COLORADO – Medicaid IOWA – Medicaid
Medicaid Website: http://www.colorado.gov/hcpf
Medicaid Customer Contact Center: 1-800-221-3943
Website: www.dhs.state.ia.us/hipp/
Phone: 1-888-346-9562
FLORIDA – Medicaid KANSAS – Medicaid
Website: https://www.flmedicaidtplrecovery.com/
Phone: 1-877-357-3268
Website: http://www.kdheks.gov/hcf/
Phone: 1-800-792-4884
KENTUCKY – Medicaid NEW HAMPSHIRE – Medicaid
Website: http://chfs.ky.gov/dms/default.htm
Phone: 1-800-635-2570
Website: http://www.dhhs.nh.gov/oii/documents/hippapp.pdf
Phone: 603-271-5218
LOUISIANA – Medicaid NEW JERSEY – Medicaid and CHIP
Website: http://www.lahipp.dhh.louisiana.gov
Phone: 1-888-695-2447
Medicaid Website: http://www.state.nj.us/humanservices/ dmahs/clients/medicaid/ Medicaid Phone: 609-631-2392 CHIP Website: http://www.njfamilycare.org/index.html CHIP Phone: 1-800-701-0710
MAINE – Medicaid NEW YORK – Medicaid
Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.html
Phone: 1-800-977-6740 TTY 1-800-977-6741
Website: http://www.nyhealth.gov/health_care/medicaid/
Phone: 1-800-541-2831
MASSACHUSETTS – Medicaid and CHIP NORTH CAROLINA – Medicaid
Website: http://www.mass.gov/MassHealth
Phone: 1-800-462-1120
Website: http://www.ncdhhs.gov/dma
Phone: 919-855-4100
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) Cont’d
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FEDERAL LAWS
MINNESOTA – Medicaid NORTH DAKOTA – Medicaid
Website: http://www.dhs.state.mn.us/id_006254
Click on Health Care, then Medical Assistance
Phone: 1-800-657-3739
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/
Phone: 1-800-755-2604
MISSOURI – Medicaid OKLAHOMA – Medicaid and CHIP
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 573-751-2005
Website: http://www.insureoklahoma.org
Phone: 1-888-365-3742
MONTANA – Medicaid OREGON – Medicaid
Website: http://medicaid.mt.gov/member
Phone: 1-800-694-3084
Website: http://www.oregonhealthykids.gov
http://www.hijossaludablesoregon.gov Phone: 1-800-699-9075
NEBRASKA – Medicaid PENNSYLVANIA – Medicaid
Website: www.ACCESSNebraska.ne.gov
Phone: 1-855-632-7633
Website: http://www.dpw.state.pa.us/hipp
Phone: 1-800-692-7462
NEVADA – Medicaid RHODE ISLAND – Medicaid
Medicaid Website: http://dwss.nv.gov/
Medicaid Phone: 1-800-992-0900
Website: www.ohhs.ri.gov
Phone: 401-462-5300
SOUTH CAROLINA – Medicaid VIRGINIA – Medicaid and CHIP
Website: http://www.scdhhs.gov
Phone: 1-888-549-0820
Medicaid Website: http://www.coverva.org/
programs_premium_assistance.cfm
Medicaid Phone: 1-800-432-5924
CHIP Website: http://www.coverva.org/
programs_premium_assistance.cfm
CHIP Phone: 1-855-242-8282
SOUTH DAKOTA - Medicaid WASHINGTON – Medicaid
Website: http://dss.sd.gov
Phone: 1-888-828-0059
Website: http://www.hca.wa.gov/medicaid/premiumpymt/pages/ index.aspx
Phone: 1-800-562-3022 ext. 15473
TEXAS – Medicaid WEST VIRGINIA – Medicaid
Website: https://www.gethipptexas.com/
Phone: 1-800-440-0493
Website: www.dhhr.wv.gov/bms/
Phone: 1-877-598-5820, HMS Third Party Liability
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) Cont’d
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FEDERAL LAWS
UTAH – Medicaid and CHIP WISCONSIN – Medicaid and CHIP
Website:
Medicaid: http://health.utah.gov/medicaid
CHIP: http://health.utah.gov/chip
Phone: 1-866-435-7414
Website:
https://www.dhs.wisconsin.gov/badgercareplus/p-10095.htm
Phone: 1-800-362-3002
VERMONT– Medicaid WYOMING – Medicaid
Website: http://www.greenmountaincare.org/
Phone: 1-800-250-8427
Website: http://health.wyo.gov/healthcarefin/equalitycare
Phone: 307-777-7531
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) Cont’d
To see if any other states have added a premium assistance program since January 31, 2015, or for more information on special enroll-ment rights, contact either: U.S. Department of Labor U.S. Department of Health and Human Services Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa www.cms.hhs.gov 1-866-444-EBSA (3272) 1-877-267-2323, Menu Option 4, Ext. 61565
Affordable Care Act Under the Affordable Care Act, individual mandates require most legal citizens and residents have minimum essential healthcare cover-age. Individuals who fail to maintain qualifying coverage will have to pay a tax. Eligible individuals may receive medical coverage from sources such as 1) Federal Medicare, 2) State Programs for low-income – such as Medicaid or Children’s Health Insurance Plan (CHIP), 3) Veteran’s Program and 4) Individually purchased health insurance. For information about the public Healthcare Marketplace Programs, visit www.healthcare.gov. Under the ACA, all group health plans, including the Lawrence Technological University Health Plan, must report annually to the Inter-nal Revenue Services (IRS), commencing in January 2016 for calendar year 2015, those months that each employee, eligible spouse and dependent child(ren) was covered under the LTU Health Plan. Each individual must be identified by name and Social Security number (or if applicable, another taxpayer identification number TIN), then the individual’s date of birth must be provided. This information is required by the IRS to establish whether each individual is meeting his/her obligation under the ACA to have minimum essential health coverage.
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HIPAA NOTICE OF PRIVACY PRACTICES
We understand that medical information about you and your health is personal. We are committed to protecting your medical
information. For plan administration purposes, the health plan creates a record of reimbursed health care claims.
Because we create this record we are required to follow federal health information privacy laws. This notice is to remind you
that as a participant in the Lawrence Technological University Benefit Plan you are protected by these laws and you have a
right to a copy of our plan’s Privacy Notice upon request. In addition, you will automatically be provided an updated notice if
the current privacy policy is changed. This updated notice will be made available within 60 days of the date a material change
is made to the privacy policy.
As required by HIPAA, the Plan will: make sure that medical information which identifies you is kept private; give you notice of
our legal duties and privacy practices with respect to medical information about you; and follow the terms of the policy and
notice that is currently in effect.
The program benefits that are subject to the privacy laws include: dental and/or health care reimburesement accounts.
While we treat all information confidentially, other benefit programs are not subject to the same requirments and there is no
specific privacy notice for those plans. If you have questions, please call 248-204-2108.
To request a copy of the privacy notice please forward a written request for a copy of the Plan’s privacy notice to (please allow
two weeks for the delivery of the notice):
Lawrence Technological University
c/o Office of Human Resources
Business Services Building
21000 West Ten Mile Road
Southfield, MI 48075-1058
(248) 204-2150 or 2108
Or you may download a copy of the privacy notice at www.ltu.edu/human_resources/privacy.asp.
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MEDICARE PART D—NOTICE OF CREDITABLE COVERAGE
Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug
coverage with Lawrence Technological University and about your options under Medicare’s prescription drug coverage. This
information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should
compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering
Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your
prescription drug coverage is at the end of this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:
1 Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you
join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug
coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer
more coverage for a higher monthly premium.
2 Lawrence Technological University has determined that the prescription drug coverage offered by the Lawrence
Technological University Plan is, on average for all plan participants, expected to pay out as much as standard Medicare
prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is
Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a
Medicare drug plan.
Important Notice from Lawrence Technological University (LTU)
About Your Prescription Drug Coverage and Medicare
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become
eligible for Medicare and each year from October 15th
through December 7th.
However, if you lose your current creditable prescription
drug coverage, through no fault of your own, you will also
be eligible for a two (2) month Special Enrollment Period
(SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to
Join A Medicare Drug Plan?
If you decide to join a Medicare drug plan, your current
Lawrence Technological University coverage will not be affected.
Summary of Options for Medicare Eligible Employees (and/
or Dependents):
Continue medical and prescription drug coverage and do not
elect Medicare D coverage. Impact – your claims continue to
be paid by the Lawrence Technological University health plan.
Continue medical and prescription drug coverage and elect
Medicare D coverage. Impact - As an active employee (or
dependent of an active employee) the Lawrence
Technological University health plan continues to pay primary
on your claims (pays before Medicare D).
Drop the coverage and elect Medicare Part D coverage.
Impact – Medicare is your primary coverage. You will not be
able to rejoin the Lawrence Technological University health
plan unless you experience a family circumstance change or
until the next open enrollment period.
If you do decide to join a Medicare drug plan and drop your
current coverage, be aware that you and your dependents
will not be able to get this coverage back unless you
experience a family status change or until the next open
enrollment period.
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MEDICARE PART D—NOTICE OF CREDITABLE COVERAGE
When Will You Pay A Higher Premium (Penalty) To Join A
Medicare Drug Plan?
You should also know that if you drop or lose your current
coverage with Lawrence Technological University and don’t
join a Medicare drug plan within 63 continuous days after
your current coverage ends, you may pay a higher premium
(a penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable
prescription drug coverage, your monthly premium may go
up by at least 1% of the Medicare base beneficiary premium
per month for every month that you did not have that
coverage. For example, if you go nineteen months without
creditable coverage, your premium may consistently be at
least 19% higher than the Medicare base beneficiary
premium. You may have to pay this higher premium (a
penalty) as long as you have Medicare prescription drug
coverage. In addition, you may have to wait until the
following November to join.
For More Information About This Notice Or Your Current
Prescription Drug Coverage…
Contact the Office of Human Resources at (248) 204-2150 or
2108 for further information. NOTE: You’ll get this notice
each year. You will also get it before the next period you can
join a Medicare drug plan, and if this coverage through
Lawrence Technological University changes. You also may
request a copy of this notice at any time.
For More Information About Your Options Under Medicare
Prescription Drug Coverage…
More detailed information about Medicare plans that offer
prescription drug coverage is in the “Medicare & You”
handbook. You’ll get a copy of the handbook in the mail every
year from Medicare. You may also be contacted directly by
Medicare drug plans.
For more information about Medicare prescription drug
coverage:
Visit www.medicare.gov
Call your State Health Insurance Assistance Program
(see the inside back cover of your copy of the
“Medicare & You” handbook for their telephone
number) for personalized help
Call 1-800-MEDICARE (1-800-633-4227). TTY users
should call 1-877-486-2048.
If you have limited income and resources, extra help paying for
Medicare prescription drug coverage is available. For information
about this extra help, visit Social Security on the web at
www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-
800-325-0778).
Updated October 15, 2017
Lawrence Technological University
Office of Human Resources
Business Services Building
21000 West Ten Mile Road
Southfield, MI 48075
(248) 204-2150 or 2108
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage
and, therefore, whether or not you are required to pay a higher premium (a penalty).
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Health Alliance Plan—Health Engagement HMO
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Health Alliance Plan—Health Engagement HMO
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Alliance Health & Life (AHL) - PPO Plan
39
Alliance Health & Life (AHL) - PPO Plan
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40
Notes
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This guide summarizes certain features of the company’s benefits plans. Full details of the plans can be found in the official plan documents, the official plan documents will govern. The company reserves the right to amend or terminate these benefits at any time. The information in this guide does not constitute a contract of employment. If you have any questions about the benefit plans described in this guide, please contact your Human Resources Representative.
