Social Your health, our promise. Emotional · Anthem Concierge Services: Access to a health guide who will provide concierge level service with your medical issue from start to finish

2019 OPEN ENROLLMENT Enroll online from October 16 to November 2, 2018.

Social Environmental

Occupational Physical Spiritual

Intellectual Emotional

Financial

WELL-BEING FOR LIFE.

our promise.Your health,

For Life. Well-Being

DEAR FACULTY & STAFF,At Notre Dame, we strive to provide a comprehensive benefit and compensation package to help you and your family achieve an optimal state of well-being. We also work hard to manage our resources responsibly. Over the years, we’ve adopted several measures to manage the continued increases in health care costs to ensure faculty and staff are minimally affected.

Healthcare costs continue to rise across the country, and no employer —including Notre Dame—is immune from facing these escalating figures. As we’ve worked hard to remain good stewards of our resources, we had to find another solution for medical coverage. That is why we decided to switch to Anthem. While there will be out-of-pocket increases beginning in January, the increases are less than what we would have had through other providers. Additionally, Anthem offers you many more benefits:

• Members will no longer have to choose between Select and CHA. Instead, you will have access to one network that includes hospitals and providers nationwide.

• Concierge-style health guide who will help when you have questions

• On-site representative who can interact with you five days a week

• 24/7 access to medical providers via a computer or smartphone through LiveHealth Online

We believe all of these features will enhance your healthcare experience and allow you to continue to receive affordable, quality care from providers you like and trust. Most of your other benefits remain the same, including dental and vision.

If you have questions as you review the guide, be sure to take advantage of our information sessions prior to open enrollment, which begins on October 16 and ends on November 2.

In Notre Dame,

Denise M. MurphyDirector, Benefits and Wellness

TABLE OF CONTENTSHow to Enroll ..........................................4

What’s New for 2019 ..........................6

Anthem Services ..................................8

YOUR BENEFITS

Medical .................................................10

Healthcare Savings Accounts .......14

Flexible Spending Accounts ..........15

Prescription Drugs ............................16

Notre Dame Wellness Center .........17

Dental ...................................................18

Vision ....................................................20

Life Insurance .....................................22

Accident Insurance ...........................24

Critical Illness Insurance.................26

FAQs ......................................................28

Resources ............................................30

Notices .................................................31

The University of Notre Dame’s Office of Human Resources strives to offer resources and opportunities to help staff and faculty achieve a state of optimal well-being. There are eight categories of well-being, and we are well when each is properly aligned in the best way for our individual lives.

We are here to help you achieve well-being for life.

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EASY AS 1-2-3To enroll in your 2019 benefits, follow these three steps:

Medical Plan: Do you prefer the flexibility of out-of-network providers (PPO and HDHP) or lower out-of-pocket expenses (HMO)?

Dental: Do you want basic or more comprehensive coverage?

Vision: Would you like coverage for eye care or corrective lenses?

Flexible Spending Accounts: Do you want to set aside tax-free dollars for healthcare or dependent care expenses?

Life Insurance: Would you like more than the base coverage provided?

Voluntary Benefits: Are there any optional benefits like accident or critical illness insurance that you want?

Your netID, password

Full legal name, date of birth and Social Security number of dependents

Name and address of your life insurance beneficiaries

Enroll anytime from October 16 to November 2, 2018.

1. DECIDE WHAT BENEFITS YOU WANT

2. GATHER YOUR INFORMATION

3. ENROLL ONLINE AT MYBENEFITS.ND.EDU

HOW TO ENROLL

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KEY DATES BENEFITS ACTIVITY

Now – Nov. 2, 2018Health screenings available on campus, the Notre Dame Wellness Center or Beacon Health and Fitness

Oct. 16 – Nov. 2 at 11:59 p.m.

Open enrollment via MyBenefits.nd.edu

Oct. 16-17• Irish Health Benefits and Wellness Fair

• St. Joseph’s Mobile Mammogram Unit

Nov. 2• Last day of open enrollment

• Health screening deadline for premium credits

Late November Confirmation statements available at MyBenefits.nd.edu

Dec. 7

• Last day to submit enrollment corrections to [email protected]

• Last day to submit eligibility documentation for newly- enrolled spouse or dependents in MyBenefits.nd.edu

Jan. 1, 2019 2019 benefit elections take effect

ENROLLING NEW DEPENDENTS? If you are adding a spouse or new dependent, you are required to provide documentation to verify the dependent’s relationship to you. You must submit the documentation via MyBenefits.nd.edu no later than Dec. 7. Scans or legible photos of the documents are acceptable.

IMPORTANT: If documentation is not provided by the deadline, the spouse or dependent will not be enrolled. See hr.nd.edu/benefits/verify for more information on the required documentation.

HOW TO ENROLL

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YOUR HEALTH, OUR PROMISEEvery year, we review our benefits to ensure we’re offering comprehensive solutions that help you and your family pursue health and well-being. At the same time, we work hard to be good stewards of our resources—particularly in light of continued cost increases in healthcare coverage. As a result of our annual review, you can expect a few changes in 2019.

NEW HEALTH PLAN ADMINISTRATOR Anthem Blue Cross Blue Shield is replacing Meritain Health as our health plan administrator. With this change comes many exciting new programs, including:

LiveHealth Online: 24/7 access to medical providers via a computer or smartphone to manage minor medical and behavioral health issues —all at a $15 copay (HMO & PPO)!

Anthem Concierge Services: Access to a health guide who will provide concierge level service with your medical issue from start to finish —all via the Anthem call center.

Learn about these programs and more coming from Anthem on pages 8-9.

EXPANDED PROVIDER NETWORK You will no longer have to choose between local networks. In 2019, you have access to one network that includes hospitals and providers nationwide.

MEDICAL & PRESCRIPTION DRUG OUT-OF-POCKET INCREASES There will be out-of-pocket increases in 2019. See pages 11 and 16 for new amounts.

WHAT’S NEW

NEW FSA PROCESS IN 2019 Anthem will administer the Flexible Spending Accounts (FSAs), giving you control over how every claim reimbursement is managed. You simply log into anthem.com to decide if you want the reimbursement direct deposited to your account or sent directly to your provider’s office—the choice is yours.

Medical claims

• Medical expenses through any of our Notre Dame medical plans automatically transfer to your anthem.com FSA account.

• You decide how to reimburse: direct deposited to you or sent directly to your provider.

Prescription, dental and vision claims

• Prescription drugs, dental, vision and other expenses must be submitted on a claim form with supporting documentation.

• You decide how to reimburse: direct deposited to your account or sent directly to your provider.

For 2019 claims filed between Jan. 1 and March 19, 2019, visit hr.nd.edu/benefits/oe to understand the process and considerations during this transition period. You can learn more about your options (as well as how to handle remaining 2018 claims) on pages 14-15.

ALEX, YOUR PERSONAL BENEFITS GUIDE Deciding which plan is the best fit for you can be overwhelming. ALEX is here to help. This online, interactive tool explains your options in plain English with point-by-point comparisons, definitions and examples. ALEX gives you what you need to make informed decisions.

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WHAT’S NEW

Get started: Set up an account on anthem.com.

http://myalex.com/NotreDame/2018.

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Sign up at livehealthonline.comDownload the Live Health Online app

A NEW PARTNER IN HEALTHWith Anthem as our new medical plan administrator, faculty, staff and their families have access to several new programs and tools to put them on the road to better health.

ANTHEM HEALTH GUIDE Available via telephone, mobile app, email or online chat, an Anthem Health Guide can help you better understand your benefits, figure out the next steps in your healthcare, or compare costs of services.

• Call the number on the back of your ID card.

• Log in at anthem.com > Customer Support > Contact Us.

• Use our free Anthem Blue Cross and Blue Shield mobile app.

LIVE HEALTH ONLINE

NEW SERVICES

Consult a doctor right from your smartphone, tablet or computer for illnesses like: colds, flu, fever, allergies and sinus infections.

• See a board-certified doctor (including Spanish-speaking doctors) in a matter of minutes 24/7.

• It’s also easy to connect to pediatricians, as well as psychiatrists and other mental health professionals.

• There is no charge to sign up, there are no monthly fees—and with a $15 copay (HMO & PPO), the savings and convenience really add up!

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To get started in the program, call 800-828-5891, and one of our registered nurses will help.

NEW SERVICES

Download the Engage mobile app to see:

• What’s covered by your plan.

• Cost of services and care before setting up a visit.

• Access your digital insurance card.

• Replaces Castlight

Download the Engage app

The go-to source for all of your questions about pregnancy, Future Moms will answer your questions, help you follow a care plan and give you useful resources like The Mayo Clinic Guide to a Healthy Pregnancy book.

Participants who sign up in the first trimester and complete the program will receive a $500 credit towards pregnancy-related out-of-pocket expenses.

ANTHEM ENGAGE MOBILE APP

FUTURE MOMS PROGRAM (FORMERLY “BABY STEPS”)

EXCEPTIONAL CARE CLOSE TO YOUBenefit-eligible faculty and staff may choose among three medical plans. The plan you choose determines how much you pay for services, how much the plan pays, and whether or not you may visit out-of-network providers.

ANTHEM PPO• Lower deductibles

and out-of-pocket maximums

• May see out-of-network providers, but at a reduced coverage rate

ANTHEM HMO• Lowest deductibles

and low out-of-pocket maximums

• Must stay in-network for non-emergency care

ANTHEM HDHP WITH HRA

• Very low monthly premiums, but high deductibles and high out-of-pocket maximums

• Includes HRA, accident insurance and critical illness insurance

ANTHEM PPO

ANTHEM HMO

ANTHEM HDHP WITH HRA

With Employee

Screening*

Without Employee Screening

With Employee

Screening*


With Employee

Screening*


Individual $65 $80 $90 $105 $22 $37

Individual + 1 $190 $205 $244 $259 $105 $120

Family $258 $273 $336 $351 $129 $144

MONTHLY MEDICAL PREMIUMS

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MEDICAL

* Only faculty/staff and spouses are eligible for health screenings. You will receive an additional $8 discount on monthly premiums for completing a spouse health screening.

MEDICAL PLAN OVERVIEW

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MEDICAL

PPO HMO HDHP WITH HRA

Preventive Care 100%, No deductible

Deductible

In-Network$500 Individual $1,000 Family

$450 Individual $900 Family

$1,500 Individual $3,000 Family

Out-of-Network$900 Individual $1,800 Family

N/A$3,000 Individual

$6,000 Family

Health Reimbursement Account N/A$500 Individual $1,000 Family

Coinsurance (plan pays after deductible is met)

In-Network 85%

Out-of-Network 65% N/A 65%

Out-of-Pocket Maximum

In-Network$2,400 Individual

$5,000 Family$2,500 Individual

$5,000 Family$5,000 Individual $10,000 Family

Out-of-Network$4,800 Individual

$8,200 FamilyN/A

$10,000 Individual $20,000 Family

Primary Care

In-Network100% after $30 copay per physician office visit

Actual cost of service until deductible then

plan pays 85%

Out-of-Network

Actual cost of service until deductible, then

plan pays 65% of usual and customary

N/A

Actual cost of service until deductible, then

plan pays 65% of usual and customary

Specialist

In-Network100% after $35 copay per physician office visit

Actual cost of service until deductible then

plan pays 85%

Out-of-Network

Actual cost of service until

deductible, then plan pays 65%

N/AActual cost of service until deductible, then

plan pays 65%

Urgent Care In-Network $50 * $50 *Actual cost of service until deductible, then

plan pays 85%*

Lifetime Maximum Unlimited

* Immediate and primary care are also available at the Notre Dame Wellness Center, with a $15 copay for all medical plans.

CHOOSING A MEDICAL PLANWhich plan is right for you: PPO, HMO or HDHP?

Each plan offers different features. The most significant difference is not just how much you pay, but when. The HDHP offers the lowest monthly premiums, but requires you to cover more out-of-pocket costs at the time you receive care. On the other hand, the PPO and HMO require higher monthly premiums, but they allow you to pay less out-of-pocket at the time you receive care.

PPO PLAN • Low deductibles and out-of-pocket maximums

• Flexibility to see out-of-network providers at a reduced coverage rate

• Coinsurance instead of copays for some services

• 100% preventive care

• Balance of lower monthly premiums and out-of-pocket costs

HMO PLAN • Lowest deductible of the three plans

• Low out-of-pocket maximums, so you don’t pay as much of the costs at the time you receive care

• Higher monthly premiums

• Must stay in-network if your care isn’t an emergency (or pay the full cost of out-of-network care)


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MEDICAL

Provider search: anthem.com/find-doctor (Search in the National PPO network)

New this year, you also have access to ask ALEX to help decide which plan is best for you and your family at http://myalex.com/NotreDame/2018.

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MEDICAL

HIGH DEDUCTIBLE HEALTH PLAN (HDHP) WITH HRA• Lowest monthly premiums, offering a good way to save money if you

don’t incur too many medical claims

• Highest deductibles, which means you pay more out-of-pocket at the time you receive care

• Pay the full cost of services each time until you meet the deductible


• After deductible, 15% coinsurance until you reach your out-of-pocket maximum ($5,000 individual / $10,000 for individual +1 or families)

BENEFITS INCLUDED WITH HDHPAccident insurance and critical illness insurance are included with the HDHP at no cost. The free coverage for HDHP participants is limited to individual-only coverage for accident insurance and $5,000 of individual-only coverage for critical illness insurance. Additional coverages may be purchased for you and your family. See pages 24-27.

* Faculty and staff may not deposit additional funds into an HRA. To set aside dollars for anticipated 2019 healthcare expenses, consider a Flexible Spending Account. See page 14.

** For more information on accident insurance (including rates and information on adding additional coverage for yourself or your dependents), see page 24.

*** For more information on critical illness insurance (including rates and information on adding additional coverage for yourself or your dependents), see page 26.

INDIVIDUAL HDHP INDIVIDUAL + 1 HDHP FAMILY HDHP

Included Option to increase? Included Option to

increase? Included Option to increase?

HRA $500 No (Consider FSA)* $1000 No

(Consider FSA)* $1000 No (Consider FSA)*

Accident Insurance

Individual coverage

onlyYes**

Individual coverage

only Yes**

Individual coverage

only Yes**

Critical Illness Insurance

$5,000 Coverage

(individual only) Yes***

$5,000 Coverage

(individual only)Yes***

$5,000 Coverage

(individual only)Yes***

FUNDING YOUR HEALTHCAREWe provide ways for you to set aside money for healthcare expenses.

HRA* FSA

Medical plan Available with HDHP Available with PPO,

HMO or HDHP

Who funds Funded by University Funded by you

Unused money rolls forward to next year

YesNo. Unused funds forfeited

March 31, 2019

What funds are used for

Expenses that apply toward your deductible

Eligible medical expenses + dental and vision expenses

ExclusionsPrescriptions or

Wellness Center copaysOver-the-counter

medications

Portable

No. Balance forfeited if employment terminates or you elect a non-HDHP

plan in future

No. Money forfeited if leave Notre Dame before

spending money

Tax benefitTax-free dollars,

so the contribution doesn’t count as income

Pre-tax contributions, so your federal and state income

taxes may be reduced

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HRA/FSA

HEALTH REIMBURSEMENT ACCOUNT (HRA)*

University contribution of $500 (individual)/$1,000

(family) to help you pay for medical expenses

FLEXIBLE SPENDING

ACCOUNT (FSA)Employee contribution of

up to $2,650 in pre-tax funds for medical, dental

and vision expenses

* Available with High Deductible Plan only

HOW THE HRA AND FSA WORK TOGETHER• If you have an HRA and an FSA, eligible medical

expenses will be deducted from your HRA first.

• If you visit in-network providers, your eligible deductible and coinsurance expenses will automatically be paid from the HRA if you have the balance available.

• Claims will only be deducted from your FSA once your HRA is depleted.

DEPENDENT CARE FSAThe University also offers a dependent care FSA. The dependent care FSA reimburses expenses paid for daycare services while you and your spouse are at work. In addition to traditional daycare for young children, eligible dependent care expenses include latch-key programs and day camps for children under the age of 13, as well as elder care.

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HRA/FSA

FILING FSA CLAIMSFor 2018 claims: Sometimes there is a delay with a provider’s office filing a claim with your insurance, which means that a 2018 claim may not be sent for FSA reimbursement until the new year. If Meritain receives a medical claim for you that occurred in 2018, and you have funds remaining in a 2018 FSA, Meritain will automatically reimburse you, as they have in the past, with no interaction needed on your part.

For 2019 claims: Members have a grace period in 2019, from January 1 to March 15, in which they are able to receive reimbursement from any remaining 2018 FSA funds with claims that occur in 2019. Since Meritain will not automatically receive these claims during this time, members must submit claims manually to Meritain if they would like to be reimbursed with remaining 2018 FSA funds. During this grace period window, Anthem will not automatically process FSA reimbursements to give members an option to use 2018 FSA balances first. If you would like to use your 2019 FSA balances during this period, you must submit a manual claim to Anthem.

After March 31, 2019: Once the grace period window closes, normal processing of FSA claims will begin with Anthem. Members can log in to their anthem.com account and request reimbursement.

Track your FSA balance: anthem.comMore info: hr.nd.edu/benefits

Maximum FSA Contribution Limits

$2,650Healthcare FSA maximum

$5,000Dependent Care FSA maximum

Online ordering, status tracking, prescription history:optumrx.com/mycatamaranrx

Specialty drug information:BriovaRx.com

KEEPING YOU WELLThe University’s prescription plan administrator is OptumRx.

SPECIALTY DRUG NOTESpecialty medications represent one of the fastest-growing areas of medical costs. BriovaRx, OptumRx’s mail-order specialty drug pharmacy, helps patients requiring specialty medications to manage their costs.

TWO WAYS TO FILL A PRESCRIPTIONRetail Pharmacies: Fill short-term (30 days or less) prescriptions at any in-network pharmacy.

Mail Order: Long-term (over 30 days) prescriptions must be filled by mail or at the Wellness Center pharmacy.

OPTUMRXEveryone enrolled in a Notre Dame medical plan

automatically receives prescription drug coverage.

Retail Mail Order

Generic drugs $5 $12

Preferred brand-name drugs $40 $80

Non-preferred brand-name drugs $55 $110

Specialty drugs $100 $200

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PRESCRIPTION DRUGS

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WELLNESS

PRESCRIPTION REMINDERThe Notre Dame Wellness Center pharmacy is an exception to the mail-order rule: 90-day prescriptions may be filled for the same copays as mail order prescriptions.

REACHING FOR WELLNESSThe Wellness Center is in-network with $15 copays for those covered by a University medical plan.

WHO CAN USE THE WELLNESS CENTER?All full-time, benefit-eligible faculty and staff, their spouses and dependents may visit the Notre Dame Wellness Center. Benefit-eligible faculty and staff who waive University healthcare coverage may still use the Wellness Center.

Privacy Promise: The Notre Dame Wellness Center is operated by Premise Health, which assures privacy of all interactions and healthcare services at the Wellness Center. The University of Notre Dame has no access to personal health information obtained by the Notre Dame Wellness Center.

NOTRE DAME WELLNESS CENTERThe Notre Dame Wellness Center has been awarded the Medical Home status from the Accreditation Association for Ambulatory

Health Care. This stamp of approval recognizes the Wellness Center’s position as a first-choice provider of primary care

services, including care and management of chronic illnesses.

More info: WellnessCenter.nd.edu

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A REASON TO SMILEThe University offers two dental plan options through Delta Dental:

CHOICE OF PROVIDERSBoth plans allow you to choose any licensed dentist for your care.

• If you choose a dentist in the Delta Dental network, you will pay only your deductible (waived for preventive care and orthodontia) and coinsurance for covered services.

• If you choose an out-of-network dentist, Delta will reimburse you for the amount that would be paid to a participating dentist. You are responsible for any difference.

PREMIER PLANLower monthly premiums

in exchange for lower coverage and a lower

annual maximum

PPO POS PLANHigher coverage for

basic services, with a higher annual maximum

DELTA PREMIER* DELTA PPO POS*

2019 2020 2019 2020

Individual $16.74 $16.74 $21.36 $21.36

Individual + 1 $31.88 $31.88 $40.48 $40.48

Family $56.78 $56.78 $74.48 $74.48

DENTAL PLAN RATES

DENTAL

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Directory and list of covered services: deltadentalin.com Eligibility claims or reimbursements: toolkitsonline.com

DELTA PREMIER* DELTA PPO POS*

Participating Dentist

Non-Participating Dentist**

Participating Dentist

Non-Participating Dentist**

Network Delta Premier Other Dentists Delta PPO POS Delta Premier/Other Dentists

Deductibles $50 Individual/$150 Family $50 Individual/$150 Family

Diagnostic and Preventive Services 100% 100% of usual

and customary 100% 100% of usual and customary

Basic Services 50% (after deductible)

50% of usual and customary

(after deductible)

80% (after deductible)


(after deductible)

Major Services 50% (after deductible)


(after deductible)

50% (after deductible)


(after deductible)

Annual Benefit $1,000 per person, per year $1,500 per person, per year

Orthodontic Services

50% maximum lifetime benefit of $1,500

50% maximum lifetime benefit of $1,500

Periodontics Services 50% 50% 80% 50%

Endodontic Services 50% 50% 80% 50%

Paid at Usual and Customary: A usual and customary fee is the amount that your dental plan determines is the normal range of payment for a specific service within a given geographic area.

**When using a non-participating dentist, Delta Dental will reimburse you and not the dentist. This document is intended as a supplement to your Dental Care Certificate and Summary of Dental Plan Benefits. Please refer to your certificate and summary for policy exclusions and limitations.

PLAN COMPARISON

*If you enroll in a Delta Dental plan, you must remain enrolled for two years. You may switch between the two plans during open enrollment or when you have a qualifying event i.e. birth or marriage.

DENTAL

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Summary of benefits: hr.nd.edu/ benefits

EyeMed directory: eyemedvisioncare.com

YOUR VISION IS OUR FOCUSThe University’s vision benefit program is provided by EyeMed.

CHOICE OF PROVIDERSYou can see the vision provider of your choice, however, you’ll receive discounted pricing from optometrists and opticians in the EyeMed network.

These include:

• Independent optometrists, ophthalmologists and opticians

• Retail providers like LensCrafters, Pearle Vision, Target, Sears and JCPenney Optical

Note: Claim forms are not required for services from participating providers but may be submitted for reimbursement (up to plan maximum) for some services received from non-participating providers.

EYEMED VISIONThe program offers significant savings on eye exams, frames,

corrective lenses and laser vision correction.

Individual $9.90

Individual + 1 $18.72

Family $27.42

VISION PLAN RATES

VISION

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MEMBER COST OUT-OF-NETWORK ALLOWANCE

Exam with Dilation $0 Up to $35

Frames $0 copay, plus 20% off balance over $150 Up to $65

Standard Plastic Lenses

Single $10 copay Up to $25

Bifocal $10 copay Up to $40

Trifocal $10 copay Up to $55

Progressive Lens (Standard) $75 copay N/A

Contact Lenses

Fit and Follow-up (Standard) Up to $55 N/A

Fit and Follow-up (Premium) 10% off retail price N/A

Conventional $0 copay, plus 15% off balance over $130 Up to $104

Disposables $0 copay, plus balance over $130 Up to $104

Frequency

Exams, Frames, Lenses or Contact Lenses Once every calendar year

*The vision plan covers either glasses or contacts annually.

PLAN HIGHLIGHTS

ARE YOU A CONTACT USER?As a reminder, EyeMed plan participants can apply their in-network contact lens allowance online at contactsdirect.com.

VISION

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PLANNING FOR TOMORROW … TODAYThe University offers life insurance options through Securian Financial.

SUPPLEMENTAL LIFE INSURANCE: REDUCTION IN COVERAGE

WHAT IS EVIDENCE OF INSURABILITY?Evidence of Insurability (EOI) certifies the insured’s health status and discloses prior conditions or hospitalizations. EOI may be required if you increase coverage above a certain amount, are electing coverage for the first time, or had previously canceled coverage.

BASE LIFE INSURANCE

• Coverage of $25,000 to all benefit-eligible, full-time faculty and staff

• Provided free by the University

• No enrollment is required

SUPPLEMENTAL LIFE INSURANCE• Supplement to base

coverage provided by the University

• 1 to 10 times your salary, up to $1.5M

• Evidence of Insurability may be required

• Enrollment required

DEPENDENT LIFE INSURANCE

• Coverage for your spouse and dependent children (under age 26)

• Evidence of Insurability may be required

• Enrollment required

Your Age

Amount of Insurance as a Percentage of Amount Before 65

65-69 65% of pre-65 amount

70-74 50% of pre-65 amount

75+ 25% of pre-65 amount

LIFE

Once you reach age 65, the amount of supplemental life insurance coverage will be a percentage of the amount of your prior insurance coverage.

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Securian Financial: securian.com

Evidence of Insurability Form: hr.nd.edu/benefits

DEPENDENT LIFE INSURANCE

Monthly Rate

Spouse $12,500 $5.64

Spouse $25,000 $11.30

Child(ren) $5,000 $0.76

Child(ren) $10,000 $1.52

SUPPLEMENTAL LIFE INSURANCE

Your AgeMonthly Rate per

$1,000 of Coverage

<25 $.043

25-29 $.048

30-34 $.064

35-39 $.072

40-44 $.080

45-49 $.129

50-54 $.186

55-59 $.343

60-64 $.526

65-69 $1.166

70+ $1.645

WHEN BOTH SPOUSES WORK AT NOTRE DAMEA spouse who is also employed at the University and is eligible for base and supplemental life insurance is not eligible for coverage under dependent life. Additionally, either one, but not both, may insure their children.

LIFE INSURANCE RATESAll benefit-eligible faculty and staff receive $25,000 base life coverage at no cost. You may supplement your own coverage or cover your dependents:

NOTE: All life insurance premiums are an after-tax deduction.

Supplemental life: Evidence of Insurability will be required for a first-time election; for an increase of more than 1x salary; an increase to more than $750,000 of total coverage; or if you have previously canceled supplemental coverage.

LIFE

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Provider: metlife.com/mybenefits

Summary of benefits:hr.nd.edu/benefits

INVEST IN PEACE OF MIND The University offers benefit-eligible faculty and staff voluntary accident insurance through MetLife.

WHAT IS COVERED?Benefits are paid when an accident causes fractures, dislocations, loss of limbs, burns, hospital and ambulance expenses, accident-related disabilities or death. The amount you receive is based on the type of injury and care you receive.

METLIFE ACCIDENTAccident insurance provides a payment directly to you to protect from financial hardship if you or a covered family member dies or suffers a serious injury in an accident. The payment can help with your out-of-pocket expenses such as hospital/emergency room

care, injuries requiring surgery, ambulance fees, physical therapy, recovery income and family lodging.

Monthly Rate

Individual* $6.88

Individual + 1 $12.04

Family $16.46

PLAN RATES

ACCIDENT

Benefit reductions: 25% at age 65; 50% at age 70*Individual coverage is included at no cost with HDHP enrollment.

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BENEFIT PAYOUT

Daily Hospital Limit $100 per day

Hospital Admission• Up to 365 days • Must be confined to hospital for at least 24 hours within 180 days after accident • Subsequent diagnosis has 0-day separation period between conditions

Emergency Room Treatment

• Up to $100 • Payable only once per covered accident and per covered person • Occurrence must begin within 96 hours after covered incident

Ambulance (Ground/Air) $200/$750

Appliance Up to $500

Physical Therapy $15 per treatment

Fractures• Up to 6 treatments per accident • Up to $3,000 • Chip fractures: 25%

Dislocations Up to $3,000

AD&D (employee) • Up to $25,000 • 3 times for death on common carrier

Other Benefits

Blood, plasma, platelets; broken tooth; burns, skin graft, lacerations; coma; concussion; eye injury; hospital rehabilitation; inpatient surgery; lodging; medical testing; outpatient ambulatory surgery; pain management; prosthetic device; tendon, ligament, rotator cuff, ruptured disc; therapy services; torn knee cartilage; transportation

PLAN HIGHLIGHTS

WHEN BOTH SPOUSES WORK AT NOTRE DAMEIf both you and your spouse are benefit-eligible University employees, either one of you (not both) may choose individual +1 or family coverage. Additionally, only one of you may cover dependent children.

ACCIDENT

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SERIOUS MEDICINE, EXTRA CAREThe University offers benefit-eligible faculty and staff voluntary critical illness insurance through MetLife.

If you are diagnosed with a critical illness, this benefit provides a lump-sum payment. Critical illnesses may include a heart attack,

stroke, organ transplant, cancer, Alzheimer’s Disease or many others. You may choose to spend the benefit to fill in gaps in major medical insurance, protect assets or cover other living expenses

(child care, transportation, special medical equipment, etc.).

INITIAL BENEFIT RECURRENCE BENEFIT

Full Benefit Cancer 100% of initial benefit 50% of initial benefit

Partial Benefit Cancer 25% of initial benefit 12.5% of initial benefit

Heart Attack 100% of initial benefit 50% of initial benefit

Stroke 100% of initial benefit 50% of initial benefit

Coronary Artery Bypass Graft 100% of initial benefit 50% of initial benefit

Kidney Failure 100% of initial benefit Not applicable

Alzheimer’s Disease 100% of initial benefit Not applicable

Major Organ Transplant 100% of initial benefit Not applicable

Additional Covered Illnesses* 25% of initial benefit Not applicable

*Additional covered illnesses include: 25% Addison’s Disease; ALS (Lou Gehrig’s Disease); Cerebrospinal meningitis (bacterial); Cerebral palsy; Cystic fibrosis; Diphtheria; Encephalitis; Huntington’s Disease; Legionnaire’s Disease; Malaria; Multiple Sclerosis (definitive diagnosis); Muscular Dystrophy; Myasthenia Gravis; Necrotizing Fascilitis; Osteomyelitis; Poliomyelitis; Rabies; Sickle Cell anemia (excluding sickle cell trait); Systemic Lupus erythematous (SLE); Systemic Sclerosis (scleroderma); Tetanus; and Tuberculosis

WHAT IS COVERED?

CRITICAL ILLNESS

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Provider: metlife.com/mybenefits

Summary of benefits: hr.nd.edu/benefits

INDIVIDUAL* INDIVIDUAL + 1 FAMILY

Your age:** $10,000 $10,000 (individual) +$5,000 (+1)

$10,000 (individual) +$5,000 (per dependent)

<25 $5.30 $8.50 $11.40

25-29 $5.30 $8.50 $11.40

30-34 $7.30 $11.10 $14.30

35-39 $10.00 $14.70 $18.30

40-44 $15.10 $21.50 $26.00

45-49 $20.90 $29.30 $34.70

50-54 $28.10 $38.90 $45.60

55-59 $35.70 $49.10 $57.00

60-64 $43.90 $60.00 $69.30

65-69 $49.80 $67.80 $78.10

70+ $59.60 $80.90 $92.80

*$5,000 of individual coverage is included at no cost with HDHP enrollment **Age of individual Notre Dame faculty/staff member. Initial rate locked upon enrollment as long as you maintain the coverage. Benefits reductions: 25% at age 65; 50% at age 70.

PLAN RATES

WHEN BOTH SPOUSES WORK AT NOTRE DAMEIf both you and your spouse are benefit-eligible University employees, either one of you (not both) may choose individual +1 or family coverage. Additionally, only one of you may cover dependent children.

CRITICAL ILLNESS

WHAT IS MYBENEFITS.ND.EDU?MyBenefits.nd.edu is the online platform for selecting your benefits and managing your life insurance beneficiaries. The site is available day or night and includes easy access to plan information to help users make informed benefits decisions.

WHAT WILL I NEED TO ENROLL? You will need your University netID and password as well as your notes on the benefit elections you wish to make. If you are enrolling new dependents, you will need their full legal name, date of birth and Social Security number.

CAN I CHANGE MY BENEFITS DURING OPEN ENROLLMENT? Yes, MyBenefits.nd.edu is available 24 hours, 7 days a week from October 16 to November 2, 2018. You may log in anytime during this period to enroll in your benefits.

CAN I CHANGE MY BENEFITS ANY OTHER TIME? After your initial enrollment at hire, your opportunities to change benefits remain limited to two circumstances:

• During the annual open enrollment period

• Within 30 days of a qualifying event

WHEN CAN I REVIEW MY ELECTIONS IN MYBENEFITS? Your current elections are in the system and you can view them at any time. Your 2019 elections and your confirmation statement will be available for your review beginning late November.

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FAQS

Enroll between October 16 and November 2: MyBenefits.nd.edu

WILL I NEED TO RE-ENROLL MY CHILDREN, SPOUSE OR OTHER DEPENDENTS? Your dependents who are currently enrolled will appear in the MyBenefits system. You will not need to re-enter them or re-verify their eligibility (though you should double-check the accuracy of their information). If you wish to add any new dependents, you will need to enter their information.

WHAT IF I AM ENROLLING NEW DEPENDENTS?If you are adding a spouse or dependent, you are required to provide documentation to verify the dependent’s relationship to you. You must submit the documentation via MyBenefits.nd.edu no later than December 7. Scans or legible photos of the documents are acceptable.

WHAT IF I NEED HELP UNDERSTANDING BENEFITS OR ENROLLING?You can get help in several ways:

• Enrollment tutorial booklet: hr.nd.edu/benefits

• On-campus help sessions: Find the schedule at hr.nd.edu/benefits

• Irish Health: Computers and benefits team members will be on hand (October 16–17)

• askHR customer service center: 574-631-5900 or [email protected]

• Ask ALEX: myalex.com/NotreDame/2018

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WHAT IS A QUALIFYING EVENT?Certain life events may require changes to your benefits, such as marriage, divorce or loss of a dependent’s eligibility. If you experience an event that qualifies, then you may submit changes to your benefits in MyBenefits up to 30 days from the date of the event. See a full list of qualifying events at hr.nd.edu/benefits.

FAQS

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RESOURCES

YOUR MEDICAL GLOSSARYDeductible: Amount you must pay before your insurance pays; a low deductible means you pay less out-of-pocket when you have claims, but it usually requires a higher monthly premium.

Copay: A portion of the cost of care that you must pay, usually at the time of service; copays may vary depending on the type of service received.

Coinsurance: Portion of the cost of care that you must pay—but instead of a flat amount, it’s usually a percentage.

Health Reimbursement Account (HRA): Account used with HDHPs; money set aside by the University to pay for medical expenses that apply toward your deductible; unused dollars roll forward each year as long as you continue to participate in an HDHP.

CONTACT INFORMATION

Medical Anthem 833-835-2717 anthem.com

Prescription Drug OptumRX 866-270-0234 optumrx. com/mycatamaranrx

Dental Delta Dental 800-524-0149 deltadentalin.com

Vision EyeMed 866-800-5457 eyemedvisioncare.com

Life Insurance Securian Financial 800-843-8358 securian.com

Accident Insurance /

Critical Illness Insurance

MetLife 800-438-6388 metlife.com

Flexible Spending Accounts Anthem 833-835-2717 anthem.com

Health Advocate Health Advocate 866-695-8622 healthadvocate.com

Wellness Center Wellness Center 574-634-WELL wellnesscenter.nd.edu

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SPECIAL ENROLLMENT NOTICEIf you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.

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 July 31, 2018. Contact your State for more information on eligibility –

NOTICES

ALABAMA – MedicaidWebsite: http://myalhipp.com/ Phone: 1-855-692-5447

ALASKA – MedicaidThe AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com/ Phone: 1-866-251-4861 Email: [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

ARKANSAS – MedicaidWebsite: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)

COLORADO – Health First Colorado Colorado’s Medicaid Program & Child Health Plan Plus (CHP+)Website: http:// www.healthfirstcolorado.com/Health First Colorado Member Contact Center:1-800-221-3943/ State Relay 711CHP+: http:// Colorado.gov/HCPF/Child-Health-Plan-PlusCHP+ Customer Service: 1-800-359-1991/State Relay 711

FLORIDA – MedicaidWebsite: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268

GEORGIA – MedicaidWebsite: http://dch.georgia.gov/medicaid- Click on Health Insurance Premium Payment (HIPP)Phone: 404-656-4507

INDIANA – MedicaidHealthy Indiana Plan for low-income adults 19-64Website: http://www.in.gov/fssa/hip/Phone: 1-877-438-4479All other MedicaidWebsite: http://www.indianamedicaid.comPhone 1-800-403-0864

IOWA – MedicaidWebsite: http://dhs.iowa.gov/hawk-iPhone: 1-800-257-8563

KANSAS – MedicaidWebsite: http://www.kdheks.gov/hcf/Phone: 1-785-296-3512

KENTUCKY – MedicaidWebsite: https://chfs.ky.govPhone: 1-800-635-2570

LOUISIANA – MedicaidWebsite: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331Phone: 1-888-695-2447

MAINE – MedicaidWebsite: http://www.maine.gov/dhhs/ofi/public-assistance/index.htmlPhone: 1-800-442-6003TTY: Maine relay 711

MASSACHUSETTS – Medicaid and CHIPWebsite: http://www.mass.gov/eohhs/gov/departments/masshealth/Phone: 1-800-862-4840

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NOTICES

MINNESOTA – MedicaidWebsite: https://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/other-insurance.jspPhone: 1-800-657-3739

MISSOURI – MedicaidWebsite: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 573-751-2005

MONTANA – MedicaidWebsite: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084

NEBRASKA – MedicaidWebsite: http://www.ACCESSNebraska.ne.govPhone: (855) 632-7633Lincoln: (402) 473-7000Omaha: (402) 595-1178

NEVADA – MedicaidMedicaid Website: http://dhcfp.nv.govMedicaid Phone: 1-800-992-0900

NEW HAMPSHIRE – MedicaidWebsite: https://www.dhhs.nh.gov/ombp/nhhpp/Phone: 603-271-5218Hotline: NH Medicaid Service Center at 1-888-901-4999

NEW JERSEY – Medicaid and CHIPMedicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Medicaid Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710

NEW YORK – MedicaidWebsite: https://www.health.ny.gov/health_care/medicaid/Phone: 1-800-541-2831

NORTH CAROLINA – MedicaidWebsite: https://dma.ncdhhs.gov/Phone: 919-855-4100

NORTH DAKOTA – MedicaidWebsite: http://www.nd.gov/dhs/services/medicalserv/medicaid/Phone: 1-844-854-4825

OKLAHOMA – Medicaid and CHIPWebsite: http://www.insureoklahoma.orgPhone: 1-888-365-3742

OREGON – MedicaidWebsite: http://healthcare.oregon.gov/Pages/index.aspxhttp://www.oregonhealthcare.gov/index-es.htmlPhone: 1-800-699-9075

PENNSYLVANIA – MedicaidWebsite: http://www.dhs.pa.gov/provider/medicalassistance/healthinsurance premiumpaymenthippprogram/index.htm

Phone: 1-800-692-7462

RHODE ISLAND – MedicaidWebsite: http://www.eohhs.ri.gov/Phone: 855-697-4347

SOUTH CAROLINA – MedicaidWebsite: https://www.scdhhs.govPhone: 1-888-549-0820

SOUTH DAKOTA - MedicaidWebsite: http://dss.sd.govPhone: 1-888-828-0059

TEXAS – MedicaidWebsite: http://gethipptexas.com/Phone: 1-800-440-0493

UTAH – Medicaid and CHIPMedicaid Website: https://medicaid.utah.gov/CHIP Website: http://health.utah.gov/chipPhone: 1-877-543-7669

VERMONT– MedicaidWebsite: http://www.greenmountaincare.org/Phone: 1-800-250-8427

VIRGINIA – Medicaid and CHIPMedicaid Website: http://www.coverva.org/programs_premium_assistance.cfmMedicaid Phone: 1-800-432-5924CHIP Website: http://www.coverva.org/programs_premium_assistance.cfmCHIP Phone: 1-855-242-8282

WASHINGTON – MedicaidWebsite: http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-programPhone: 1-800-562-3022 ext. 15473

WEST VIRGINIA – MedicaidWebsite: http://mywvhipp.com/Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)

WISCONSIN – Medicaid and CHIPWebsite: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdfPhone: 1-800-362-3002

WYOMING – MedicaidWebsite: https://wyequalitycare.acs-inc.com/Phone: 307-777-7531

To see if any other states have added a premium assistance program since July 31, 2018, or for more information on special enrollment rights, contact either:

U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa1-866-444-EBSA (3272)

U.S. Department of Health and Human ServicesCenters for Medicare & Medicaid Serviceswww.cms.hhs.gov1-877-267-2323, Menu Option 4, Ext. 61565

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NOTICES

Paperwork Reduction Act StatementAccording to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email [email protected] and reference the OMB Control Number 1210-0137.

OMB Control Number 1210-0137 (expires 12/31/2019)

NEW HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS AND YOUR HEALTH COVERAGEPart A: General Information

When key parts of the health care law took effect in 2014, a new way to buy health insurance was developed: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer.

What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away.

Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.

Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?

Yes, if you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain costsharing if your employer does not offer coverage to you at all, or does not offer coverage that meets certain standards. If the cost of a plan from our employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, of if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit.1

Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution – as well as your employee contribution to employer-offered coverage – is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or contact: askHR (574) 631-5900. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

1. An employer-sponsored health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60% of such costs.

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NOTICES

Part B: Information About Your Health Coverage Offered by Your Employer

This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.

3. Employer Name: University of Notre Dame du Lac

4. Employer Identification Number (EIN): 35-0868188

5. Employer Address: 200 Grace Hall

6. Employer Phone Number: (574) 631-5900

7. City: Notre Dame

8. State: IN

9. Zip code: 46556

10. Who can we contact about employee health coverage at this job? askHR

11. Phone number (if different from above): NA

12. Email address: [email protected]

Here is some basic information about health coverage offered by this employer:

As your employer, we offer a health plan to:

All employees

Eligible employees (Eligible employees are defined in the Summary Plan Description which can be found on the Office of Human Resources website at hr.nd.edu)

With respect to dependents:

We do offer coverage. (Eligible dependents are all dependents of employees as defined by Indiana law.)

We do not offer coverage.

If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.

** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee, or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process.

NOTICE REGARDING WELLNESS SCREENINGThe Notre Dame Health Screening is a voluntary wellness program available to all full time employees. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate you must complete a biometric screening, which will include a blood test for the markers of diabetes and hypertension. You are not required to participate in the screening.

However, employees who choose to participate in the screening will receive an incentive in the form of a medical plan premium reduction of $180 spread out over the course of a year, and an employee whose spouse completes the screening will receive a reduction of an additional $96 in medical plan premium over the year.

The results from your biometric screening will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program, such as no cost visits with a Wellness Coach or Chronic Condition Nurse. You also are encouraged to share your results or concerns with your own doctor.

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NOTICES

Protections from Disclosure of Medical Information

We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and The University of Notre Dame may use aggregate information it collects to design a program based on identified health risks in the workplace, the administrators of the screening will never disclose any of your personal information either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.

Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. The only individual(s) who will receive your personally identifiable health information are the staff of the Notre Dame Wellness Center, administered by the third party, Premise Health, in order to provide you with services under the wellness program.

In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately.

You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.

If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact the askHR helpdesk at (574) 631-5900.

WOMEN’S HEALTH & CANCER RIGHTS ACT ENROLLMENT NOTICEIf you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:

• All stages of reconstruction of the breast on which the mastectomy was performed

• Surgery and reconstruction of the other breast to produce a symmetrical appearance

• Prostheses; and

• Treatment of physical complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same deductibles and co-insurance applicable to other medical and surgical benefits provided under this plan.

NOTICE OF AVAILABILITY OF HIPAA NOTICE OF PRIVACY PRACTICESThe Privacy Rule under The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires health plans to remind covered participants of the availability of the Privacy Notice and how they can obtain it.

The Notice of Privacy Practices for the University of Notre Dame’s Group Benefits Plan describes the uses and disclosures of your protected health information and your rights regarding them.

A copy of The Notice of Privacy Practices for the University of Notre Dame’s Group Benefits Plan can be obtained by:

• Visiting the Human Resources website at: hr.nd.edu/nd-faculty-staff/fed/

• Contacting the askHR customer service center at: 574-631-5900

• Emailing the askHR customer service center at: [email protected]

• Visiting Shared Services in the Office of Human Resources, Grace Hall, Second floor

MyBenefits.nd.edu

Enroll Oct. 16 – Nov. 2, [email protected] • 574-631-5900

hr.nd.edu/benefits • 200 Grace Hall

Documents

Social Your health, our promise. Emotional · Anthem Concierge Services: Access to a health guide who will provide concierge level service with your medical issue from start to finish