Abilene Christian University

Abilene Christian University 2016 Benefit Guide This guide highlights the main features of many of the benefit plans sponsored by Abilene Christian...
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Abilene Christian University

2016 Benefit Guide

This guide highlights the main features of many of the benefit plans sponsored by Abilene Christian University. Full details of these plans are contained in the legal documents governing the plans. If there is any discrepancy between the plan documents and the information described here, the plan documents will govern. In all cases, the plan documents are the exclusive source for determining rights and benefits under the plans. Participation in the plans does not constitute an employment contract. Abilene Christian University reserves the right to modify, amend or terminate any benefit plan or practice described in this guide. Nothing in this guide guarantees that any new plan provisions will continue in effect for any period of time.

Table of Contents ELIGIBILITY GUIDELINES ................................................................................................................... 2 MEDICAL PLAN................................................................................................................................ 3 NURSE NAVIGATOR ........................................................................................................................ 9 ELAP SERVICES .............................................................................................................................. 11 HEALTHWATCH PROGRAMS ......................................................................................................... 13 DENTAL PLAN ................................................................................................................................ 14 VISION PLAN ................................................................................................................................. 15 LIFE INSURANCE ............................................................................................................................ 16 DISABILITY COVERAGE ................................................................................................................. 18 FLEXIBLE SPENDING ACCOUNTS (FSA)......................................................................................... 19 VOLUNTARY PLAN OPTIONS ......................................................................................................... 23 OTHER BENEFITS ............................................................................................................................. 24 REQUIRED NOTICES ....................................................................................................................... 28 MONTHLY PREMIUMS .................................................................................................................... 38 IMPORTANT CONTACTS ................................................................................................................ 40

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Eligibility Guidelines Employees Full-time and reduced full-time faculty and staff are eligible for benefits. Half-time employees are eligible for all benefits except for health and prescription coverage. Part-time employees do not qualify for benefits. Full-time, reduced fulltime and half-time employees become eligible for applicable benefits coverage on their date of hire. Dependents eligible for benefits include your legal spouse and your dependent child(ren). Dependent child(ren) include:  Natural children  Legally adopted children or children placed for adoption for whom legal adoption proceedings have been started  Stepchildren  Children for whom benefits must be provided through a qualified Medical Child-Support Order  Any other child for whom you have obtained legal guardianship. Regardless of marital status, children are eligible for medical, dental, life and vision coverage from birth up to age 26. If a child becomes mentally or physically disabled while covered under the benefit plans, the child’s coverage may be continued as long as the child remains disabled and depends on you for support.

Making Enrollment Changes During the Year In most cases, your pretax benefit elections are irrevocable and remain the same for the entire year (January 1–December 31). During each annual enrollment period, you will have the opportunity to review your benefit elections and make changes for the coming year. During Annual Enrollment, you may make changes to your coverage such as adding or dropping coverage for yourself and any dependents or changing to other plan options (if eligible and available). Certain coverages allow limited

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changes to elections during the year. These benefits include the medical, Flex–Medical, Flex– Dependent Care, vision and dental plans. Under these benefits you may make changes to your elections only during the year if you have a status change. Status Changes include:  Marriage, divorce, or legal separation  Gain or loss of an eligible dependent for reason such as birth, adoption, placement for adoption, court order, disability, or death;  An event that causes a dependent to satisfy or cease to satisfy the eligibility requirements of the Plan, such as reaching the dependent age limits or any similar circumstance  Changes in your spouse’s employment or benefit coverage that affect benefits eligibility

Changes in Dependent’s Benefits Eligibility The change to your benefit elections must be consistent with the status change. You have 30 days from the date of a status change to complete the online enrollment form. Notify Human Resources for instructions on how to make a change. Otherwise, you must wait until the next annual enrollment period to make a change to your elections unless you experience a status change or HIPAA Special Enrollment event. In some cases, your election will become effective on the first day of the month following your request. If your change is the result of birth, adoption or placement for adoption, your election will become effective on the date of the event.

Pretax Payroll Deductions Medical, Dental and Vision Plans, are offered on a pretax basis through the IRS Section 125. By making your contributions on a pretax basis, the premium is withheld from your pay before federal, state (in most cases), and FICA taxes are calculated. This can reduce the amount of taxes you pay per paycheck.

Medical Plan Abilene Christian University offers a Health Reimbursement Account plan (HRA), administered through Group & Pension Administrators (GPA). The HRA is a High Deductible Health Plan (HDHP) combined with an employer-funded account, which reimburses you for covered medical expenses incurred by you, your covered spouse and your covered dependents. ACU also offers a High Deducible Health Plan (HDHP) paired with a Health Savings Account plan (HSA). The HSA is an ACU and employee funded account. You can use this account to pay for medical, prescription drug, dental, vision and additional qualified healthcare related expenses. If you choose to contribute to the HSA, your deductions will be taken on a pre-tax basis. Both of these plans offer you quality care, comprehensive coverage and the ability to utilize the PHCS Network** for physician services. There are no requirements to choose a primary care physician (PCP) in network to coordinate your care. However, when you choose an in-network physician, your costs will be lower. For information on participating physicians in your area, contact Nurse Navigator (see page 10). Both the HRA and HSA encourage you to be more actively involved in your health and wellness. Both plans give you more responsibility for the financial impact of your healthcare choices. As always, you should work with your physician to make healthcare decisions that are best for you. Over the next few pages, you will be provided an overview of your benefits, along with many practical tips for taking advantage of everything GPA has to offer – so you can take control of your health and wellbeing.

High Deductible Health Plan The High Deductible Health Plan (HDHP) works much like a PPO plan in that you can choose to receive care from in-network or out-of-network providers when you need medical care—and it covers the same types of services—but you pay less out of your paycheck for coverage. However, the HDHP has higher deductibles and no office visit copays. Once you’ve met the in-network or out-of-network deductible, the plan begins sharing expenses. Your portion of the expense is the coinsurance. This also applies to prescription drugs, which are subject to the plan’s deductibles. Once the deductible is met, the plan pays 100% of your healthcare expenses.

**If you reside in the DFW area, the network you will utilize is the Independent Medical Systems (IMS) Network. For information on participating physicians in your area, contact Nurse Navigator (see page 10), or go to www.imsppo.com .

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Who is Eligible for the HSA? You can participate in the HSA only if you enroll in the HDHP. You are NOT eligible to contribute if:   

You are enrolled in Medicare. You are covered by another medical plan (such as your spouse’s plan) that does not qualify as a high deductible health plan. You or your spouse participates in a health care flexible spending account at Abilene Christian University or at your spouse’s employer.

What’s a Health Savings Account (HSA)? A Health Savings Account (HSA) is a tax-free account that earns interest. While you have the option to set up an HSA through any bank you choose, if you utilize HSA Bank, our HSA vendor, you will have the ability to make contributions pre-tax to your account from your paychecks throughout the year. You will also only receive the employer contribution to your HSA if you utilize HSA Bank. You can use the HSA to pay for eligible health care expenses, such as deductibles, coinsurance, and other out-ofpocket dental, vision, and prescription drug expenses not covered by a health plan. Your account balance can carry over from year to year, and you can take it with you if you leave Abilene Christian University. If you enroll in the HDHP and establish your HSA, Abilene Christian University will also contribute to your account.

High Deductible Health Plan

Protects you from big medical bills

Helps pay your deductible

Health Savings Account

Savings

Taxdeductible deposits

Tax-deferred growth Tax-free for medical care

Flexibility Unlike most other health care options, HSAs roll over from year to year, and because the HSA account belongs to the individual, the account is portable if the individual changes jobs. Availability is not limited by employer size, all amounts in the HSA are fully vested, and unspent balances remain in your account until spent.

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Taxes Annual contributions reduce the individual’s taxable income and qualified medical expenses are never taxed. All of the money set aside in an HSA grows tax-deferred until age 65, when funds can be withdrawn for any non-medical purpose at ordinary tax rates, or tax-free.

Annual Contribution Limits Individual

Family

$750

$1,500

Contribution Limit (includes ACU contribution)

$3,350

$6,750

Maximum Employee Contribution

$2,600

$5,250

Catch-up Contribution (age 55+)

$1,000

$1,000

ACU Contribution

Health Reimbursement Account ACU funds your health reimbursement account. For individual coverage, ACU will contribute $750. For dependent coverage, ACU will contribute $1,500 into your reimbursement account. That money is available to pay for medical expenses covered by your plan, so you spend less of your own money. Once the money in your HRA is gone, you pay for all qualified medical expenses (except preventive care) up to the deductible amount. When you reach that amount, the remainder of your eligible medical expenses is paid at 100%. Expenses from your own pocket for covered medical or prescription drug services are applied against your deductible. Your preventive care expenses that are covered and paid by your plan are not applied toward your deductible.

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Medical Contributions for HSA & HRA Abilene Christian University Contributions- HSA & HRA HSA Funding

Annual Funding

HRA Funding

EE Only

EE + Dependents

EE Only

EE + Dependents

$750

$1,500

$750

$1,500

HSA / HRA Accruals for New Hires Employee Only Funding

Employee + Dependents Funding

January

$750

$1,500

February

$688

$1,375

March

$625

$1,250

April

$563

$1,125

May

$500

$1,000

June

$438

$875

July

$375

$750

August

$313

$625

September

$250

$500

October

$188

$375

November

$125

$250

December

$63

$125

Hire Month

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Medical Plan Highlights The benefits below show what costs you, the employee (and your dependents), are responsible for.

GPA

Calendar Year Deductible

HSA

HRA

In-Network

Out-of-Network

In-Network

Out-of-Network

Individual

$4,000

$4,000

$4,000

$4,000

Family

$8,000

$8,000

$8,000

$8,000

100%

70%

100%

70%

0%

30%

0%

30%

Coinsurance (Insurance pays) Coinsurance (Member pays)

Out-of-Pocket Maximum (Deductible & ACU Account Contribution Included) Individual

$4,000

$8,000

$4,000

$8,000

Family

$8,000

$16,000

$8,000

$16,000

Emergency Room Facility Charge Physician's Fees and Other Charges

Urgent Care

Deductible & 0% Coinsurance

Deductible & 0% Coinsurance

Deductible & 0% Coinsurance

Deductible & 0% Coinsurance

0% after

30% after

0% after

30% after

Calendar Year

Calendar Year

Calendar Year

Calendar Year

Deductible

Deductible

Deductible

Deductible

Routine Services Office Visit (Primary/Specialist)

Preventive Care

0% after

30% after

0% after

30% after

Calendar Year

Calendar Year

Calendar Year

Calendar Year

Deductible

Deductible

Deductible

Deductible

0% of Allowable

30% of Allowable

Amount

Amount

0% of

30% of

Allowable

Allowable

Amount

Amount

0% after

30% after

0% after

30% after

Deductible

Deductible

Deductible

Deductible

Prescription Drugs Tier 1 Tier 2 Tier 3 Mail-Order

0% after Deductible

Not Applicable

0% after Deductible

Not Applicable

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Prescription Drug Coverage If you enroll in one of the Abilene Christian University medical plans, you will automatically receive prescription drug coverage. When you need prescriptions, you can purchase them through a local retail pharmacy or, for medications you take on an ongoing basis, through the mail order program.

Retail Prescription Program The retail prescription program uses a network of participating pharmacies available through CVS Caremark. To receive the highest level of benefits, you must use a participating pharmacy. Prescriptions you fill at non-participating pharmacies are generally not covered. For more information about a particular pharmacy or pharmacy chain, please visit the CVS Caremark website at www.caremark.com or call them at 866.475.0056. If you have questions about a specialty medication, call 800.238.7828.

Mail Order Program The mail order program offers a convenient and cost-effective way to fill prescriptions for medications that you take on a regular basis (maintenance medications). Your medications are mailed directly to your home. To order prescriptions through the mail order program, you must fill out and return a mail order form and return it with a 90-day prescription from your doctor and your payment. For more information about mail order, please visit the CVS Caremark website at www.caremark.com or call them at 888.202.1654.

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HEALTHWATCH NURSE NAVIGATOR

ASSIST WITH HEALTH PLAN BENEFITS OBTAIN MEDICAL RECORDS FOR APPOINTMENTS

MEDICATION COORDINATION

RS

SM

TO R

GA

G PA N U

LOCATE PROVIDER OPTIONS FOR MEDICAL SERVICES

RESEARCH PHYSICIAN QUALITY & CREDENTIALS

E N AV

I

SCHEDULE APPOINTMENTS

COORDINATE REQUIRED PROVIDER NEGOTIATIONS

PROVIDE CONTINUOUS PATIENT SUPPORT

PROVIDE GUIDANCE & EDUCATION BY A NURSE

See other side for more information on our programs >>>

CONTACT YOUR NURSE NAVIGATOR TODAY!

LOCAL PHONE: 972.619.2531 option 1 TOLL FREE PHONE: 800.843.6705 option 1 EMAIL: [email protected]

Locate Provider Options for Medical Services

Coordinate Required Provider Negotiations

The Nurse Navigator will assist you in locating diagnostic and lab testing and appropriate provider services based on your needs to include physician services, inpatient/outpatient facilities, durable medical equipment, home health care, therapy, and other needs as indicated.

The Nurse Navigator will provide you assistance in obtaining single-case agreements (as indicated), coordination of scheduling at a different facility (if necessary to prevent any delay in services), and facilitate coordination of care based upon individual needs.

Research Physician Quality & Credentials

Provide Guidance + Education by a Nurse

The Nurse Navigator will search public databases for qualified physicians based on location, specialist, network status, availability, as well as, patient reviews, board certification, and sanction/ malpractice information.

The Nurse Navigator will provide education regarding your treatment plan, diagnosis care options, medications, and any other questions pertaining to your specific needs. The Nurse Navigator and you together will decide upon the appropriate level of care based upon your needs, whether it’s a Primary Care Physician or a Specialist.

Schedule Appointments The Nurse Navigator will coordinate with you to determine appointment preferences and schedule those appointments for you based upon your preferences. The Nurse Navigator will obtain any indicated paperwork or forms for you to complete prior to your appointment, and provide maps/directions as needed.

Obtain Your Medical Records for Appointments The Nurse Navigator will obtain signed medical release forms from you to request your medical records to prevent duplication of services and encourage coordination of care between providers.

Medication Coordination The Nurse Navigator will coordinate with your PBM (Pharmacy Benefit Manager) to assist in arrangements with your separate pharmacy benefit vendor. In addition, we will provide education regarding brand medications vs. comparable generic alternatives as well as any other medication education needs that you may have.

Provide Continuous Patient Support The Nurse Navigator will be available to you until you have received assistance with each step of the process and you no longer have any remaining needs.

Assist with Health Plan Benefits The Benefit Advocate Specialist will assist you in understanding your benefit and deductible information and assist you with the understanding of your bills/ claims and/or correcting errors in bills/ claims processing.

HEALTHWATCH NURSE NAVIGATOR

Disclaimer: GPA Nurse NavigatorSM is brought to you by your employer and administered by Group & Pension Administrators, Inc. This program is offered at no cost to you as part of your health plan benefits. Your participation is voluntary with privacy, confidentiality and protection of your health information a priority for your employer and Group & Pension Administrators, Inc..

ELAP Services ELAP is here to help you with balance billing and collections notices! ELAP Services LLC is located at: 961 Pottstown Pike Chester Springs, PA 19425 Customer Service Phone: toll free (800) 977-7381

*Leave a message for call back

Fax: 1- (888)-560-2447 EMAIL: [email protected] Why did I get a bill? The reimbursement paid by your Benefits Plan conforms to Allowable Claim Limits that the Plan is permitted to pay for the service provided. The Provider is seeking reimbursement in excess of what your Plan has paid already. What should I do if I am asked to sign a payment plan at the time of my procedure? As you are aware, you are required to sign many forms prior to a procedure or admittance at a facility/hospital. Please read ALL correspondence carefully. NEVER sign a payment plan at a facility/hospital as this will take ELAP out of the process, due to the hospital/facility now having that YOU (the member) are taking responsibility for any outstanding balance. If you are asked to do such an act, please contact your HR department so they can notify GPA’s Account Manager immediately. This rarely happens, but please be aware. What should I do if I get a bill? If you receive a bill from the Hospital/Facility (Not Physician Bills) it is VERY important that you notify ELAP immediately. ELAP will arrange for an attorney to represent you, and that attorney is responsible for your defense in this matter. This defense is made available at NO cost to you. ELAP will work directly with the law firm and the Hospital/Facility to limit your involvement. The key for you is to call ELAP each time you receive a bill or a call. What happens after ELAP is involved? ELAP will ask you to sign a form, officially appointing a lawyer to represent you in this matter. Once you return the signed representation form, you can send all correspondence that you receive from the medical provider to ELAP. What do I have to pay under my Plan? Under

your

Plan,

you

are responsible for paying the out-of-pocket co-insurance and/or deductible) that are associated with these services.

expenses

(co-pay,

This amount is listed on your explanation of Benefits (EOB). Who do I call if I have a question about what I owe under the Plan? GPA 1-800-827-7223

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M a x imi z e Y o u r H e a lt h P l a n

Whenever And Wherever You Are The new GPA Mobile App, offered through your health plan, puts our most popular online features at your fingertips.

Th e GPA M o bi l e A pp a l l o w s y o u t o :

Ch e ck

Access your

View a nd

R ev iew yo u r

claim status

el igib ility

em a il y o ur

a cc ount s u m m a r y

informatio n

ID c a r d

a n d b ene f i t s

Have a question regarding your health plan? You can send a secure message to our Customer Service Department through the new “Message Center” or for more general inquiries, visit our Frequently Asked Questions page.

Download the GPA Mobile App today through the google play store or the apple app store! click here for Apple

Click here for Android

Available on Android and Apple devices, search for “Group Pension Mobile”, download the app for free, register and set up a user ID and password. It’s that simple!

www.gpatpa.com

HealthWatch Programs GPA HealthWatch care management and wellness services meet you at your specific level of health or illness and provide access to high quality, yet affordable care. The goal is to help you become as healthy as possibly by making healthcare easily accessible for you. If you are a health plan participant (both employees and family members), you are eligible to participate in GPA HealthWatch programs at no cost to you as part of the health plan. Participation and voluntary and any information you share with HealthWatch is completely confidential.

Take Charge Online The GPA website provides you with the complete details of your personal account and health information, right at your fingertips. You can:  Review your deductible information  Print temporary ID cards  Access your account summary  Review Explanation of Benefits (EOBs)  And more! To access the GPA Portal:    

Go to www.gpatpa.com Click on “Members” Log in using your username and password If you don’t have a login, you can click on “Proceed to our sign up process below” to create a login

Care Management Disease Management A specialized Care Coach will provide individual support for participants with chronic disease diagnoses, including Asthma, Diabetes,

Depression, Coronary Artery Disease, Congestive Heart Failure and Chronic Obstructive Pulmonary Disease. Your coach will help you improve your quality of life and reduce medical costs through early intervention and treatments, coordination among service providers and educational programs. Contact a Care Coach at 800.843.6705, option 3 or by email at [email protected].

Case Management In those situations where you need special support during treatment and assistance with overall quality of life, HealthWatch Case Management services help. Case Managers – who are Registered Nurses with direct experience in Oncology, Pediatrics, End Stage Renal Disease, Cardiology, Organ Transplants, Rehabilitation and more – provide one-on-one care and emotional, medical and financial guidance during your journey through life threatening illness. Support includes treatment program coordination and rate negotiation. Contact a Case Manager by calling 800.827.7223 and asking for Case Management.

GoodRX How can you locate the best options for your medications? Use GoodRX’s website to compare prices for your prescription medications at pharmacies near you. Visit www.goodRX.com. The website allows you to:    

Compare prices Find pharmacy coupons Find generics and comparable drug choices Find manufacturer discounts

You can also access GoodRX through a free mobile app on your iPhone or Android device to receive coupons and prices on the go!

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Dental Plan Abilene Christian’s Dental Plan is administered through Assurant and provides you and your family with coverage for typical dental expenses, such as cleanings, X-rays, and fillings, and orthodontia for children up to age 26.

Dental PPO Plan Dental coverage at ACU is an optional plan in which you may choose to participate at your expense. The Assurant Dental Plan helps you with the cost of many dental services, including orthodontia for your eligible child(ren) up to age 26. ACU’s Assurant dental network is “Assurant Dental Network.” With this dental plan, you are free to see any dentist you choose. Eligible benefits are paid subject to reasonable and customary charges. Although you are not required to use a network dentist, additional discounts may apply by doing so. To find a network dentist, go to www.assurantemployeebenefits.com and click on “For Members“ and then “Find a Dentist,” or call 800.522.1313. It’s always a good idea to ask for a predetermination of benefits for any services expected to exceed $300.

Plan Feature

Premium Plan - PPO

Annual Deductible 

Individual

$50



Family

$150

Annual Benefit Maximum

$1,500 per individual (includes implants)

Preventive Services

100% (no deductible)

(Exams, routine cleanings, fluoride treatments, space maintainers, x-rays) Basic Services

80% after deductible

(Fillings, sealants, denture repairs) Major Services

50% after deductible

(Crowns, inlays, onlays, bridges, dentures) Orthodontia

50%, up to a lifetime maximum of $1,000 (Child coverage up to age 26)

Late Entrant Waiting Periods

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Basic Restorative

6 months

All other Basic

12 months

Major and Ortho

24 months

Vision Plan Abilene Christian University’s Vision Plan promotes preventive care through regular eye exams and provides coverage for corrective materials, such as glasses and contact lenses. The Vision Plan is administered through Vision Service Plan (VSP).

Vision Coverage If you enroll for vision coverage, you can go to any eye care provider you choose for care. However, if you choose providers who are part of the VSP Choice Network, you will receive a discount on services. To find a network provider, go to www.vsp.com. The Vision Plan is designed to cover eye care needs that are visually necessary. You have to pay extra if you choose certain cosmetic or elective eyewear, so be sure to ask your eye doctor what items are covered by the plan before you purchase materials.

Plan Feature

In-Network

Non-Network (Plan Allowance)

Eye Exam

100% after $10 copay

Up to $40

Lenses

100% after $25 copay (applies to lenses and frames)

Single vision: Up to $40 Bifocal: Up to $60 Trifocal: Up to $80 Lenticular: Up to $80

Frames (Every 24 months)

Up to $120 allowance + 20% off remaining balance

Up to $45 retail

Contact Lenses

Up to $120 allowance

Up to $105

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Life Insurance Abilene Christian University offers life insurance coverage to provide financial protection in the event you or your dependents die while you are still working. This coverage is administered through Assurant. Abilene Christian University also offers Accidental Death and Dismemberment (AD&D) Insurance for you and your family to help with expenses in the event you or a covered dependent dies or becomes injured as a result of an accident. This coverage is administered through Assurant.

Basic Life Insurance with AD&D Abilene Christian University automatically provides Basic Life Insurance for all eligible Employees at no cost. Basic Life Insurance is equal to 1 times your annual base earnings, up to a maximum benefit of $300,000. The benefit is paid to your beneficiaries in the event of your death.

Optional Life Insurance with AD&D In addition to Basic Life Insurance, you may also purchase Optional Life Insurance for yourself, your spouse and your dependent children. However, you may only elect coverage for your dependents if you enroll for Optional Life coverage for yourself. You pay for the cost of Optional Life Insurance on an after-tax basis through payroll deductions. Optional Life Insurance for yourself cannot exceed the lesser of 5 times your annual salary or $500,000. You may elect up to $200,000 without providing evidence of insurability.

Dependent Optional Life Insurance with AD&D If you select Optional Life Insurance for yourself, you may also elect coverage for your dependents. You may elect up to the lesser of 50% of your (the employee’s) benefit amount or $250,000 for your spouse with a guarantee issue up to $50,000. Your child(ren) may be covered to a maximum of $10,000, and no evidence of insurability is required.

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Overview of Optional Life Benefits Type of Coverage

Coverage

Employee

ACU pays for an amount equal to1 times annual base earnings, up to a maximum of $300,000 For Optional Life, you may elect up to 5 times your annual base earnings, up to $500,000. If you wish to enroll or increase your coverage after your initial eligibility, any new amount you elect will be subject to Evidence of Insurability

Spouse Child(ren)

Up to $250,000 Up to $10,000

Beneficiary Designation You must designate a beneficiary for Basic and Optional Life Insurance benefits when you enroll. Your “beneficiary” is the person(s) who will receive the benefits from your life and AD&D coverage in the event of your death. You are always the beneficiary of any dependent life and AD&D insurance you elect. You can change your beneficiaries at any time during the year. If you do not name a beneficiary, or if your beneficiary dies before you, your life and AD&D benefits will be paid to your estate.

Benefits Reduce at Age 65 When you or a covered dependent reaches age 65, Basic and Optional Life Insurance benefits are reduced. For more information, refer to your Group Life Insurance booklet.

Age

Reduction Rate

65

35%

70

50%

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Disability Coverage Short-Term Disability “Base pay” means your annual base salary in effect at the time you become disabled, excluding bonuses, commissions or any other incentive payments.

You are responsible for the cost of this coverage, but because ACU offers this to a large group of our employees, the cost is substantially less than you would pay for an individual policy.

ACU wants to ensure that every employee is empowered to take care of their family if they become ill or injured. What happens if you have an unexpected injury or illness that leaves you unable to work or earn a paycheck? Few people believe it will happen to them, but the truth is, your risk of becoming disabled is far greater than you may think. If you are disabled according to your policy’s definition of disability, you will be eligible to receive a weekly benefit based on a percentage of your weekly income. Your benefits will begin after 7 days of injury or 7 days of sickness and are paid as long as you meet the definition of disability for a maximum period of 25 weeks. Your benefit is paid based upon 60% of your weekly earnings to a maximum payment of $1,750 a week. The Plan will not cover any disability caused by, or resulting from a preexisting condition. A preexisting condition means a condition for which you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed medicines in the 3 months prior to your effective date of coverage, and the disability begins in the first 12 months after your effective date of coverage. The table below will help you calculate your monthly rate for coverage. NOTE: If your weekly salary exceeds $2,917, use $2,917 as your weekly salary in the calculation. Annual Salary Your Weekly Benefit

÷ 52 = Weekly Salary ÷ 10 = Amount

x Benefit % = Your Weekly Benefit x Your Rate = Your Monthly Cost

Long-Term Disability ACU pays for LTD coverage for all eligible faculty and staff. The LTD benefit pays 60% of your total monthly earnings (less other income benefits) if you can’t work due to a total disability. The maximum monthly benefit is $7,500. The minimum monthly benefit is $100. Benefits become payable on a monthly basis once you have been disabled for 180 days (when your Short-Term Disability, if any, ends). Benefits may continue while you are disabled up to age 65. In some cases, benefit payments may extend past age 65, depending on the age you become disabled. Benefits for disability due to mental health or based on self-reported symptoms are limited to 24 months. Reduced benefits may be available for partial disability. The Plan will not cover any disability caused by, or resulting from, a preexisting condition. A preexisting condition means a condition for which you received medical treatment, consultation, care or services, including diagnostic measures, or took prescribed medicines in the 3 months prior to your effective date of coverage, and the disability begins in the first 12 months after your effective date of coverage. If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will begin on the date you return to active employment.

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Flexible Spending Accounts (FSA) Abilene Christian University allows you to contribute to one or both flexible spending accounts, which allow you to save taxes on certain out-of-pocket health care and dependent care expenses. The FSAs are administered by Discovery.

How the FSAs Work Abilene Christian University offers two types of FSAs:

 Healthcare FSA  Dependent Care FSA Remember – if you participate in the high deductible health plan paired with the HSA, you are not eligible to participate in the healthcare FSA. You may still participate in the dependent care FSA. If you elect to contribute to one or both of the FSAs, you choose an annual amount to be taken from your paycheck and deposited into your account throughout the year. Your contributions are taken out of your paycheck before you pay taxes, so you save money. Then, when you have eligible health care expenses, you can use the account to reimburse yourself, up to the amount you have elected to contribute to your account for the year. With the dependent care account, you can reimburse yourself up to the amount currently available in the account. With both accounts, the IRS requires you to use all of the money in your account by the end of the year or you lose it. This is called the “use it or lose it” rule.

FSA vs. HSA Plan Specifics Account Owner ACU Contributions Carryover of Unused Amount, Ability to Invest Balance & Earn Interest Eligible Expenses

Flexible Spending Account (FSA) Employer none No

IRS Code 213 incurred expenses during the coverage period. Cannot reimburse premiums

Distribution of Unused Amounts

Mid-year Changes

No

No, unless qualifying life event

Health Savings Account (HSA) Employee $750 (Employee) / $1,500 (Family) Yes

IRS Code 213 incurred expenses; reimburses COBRA, qualified LTC, other health premiums in certain circumstances Permitted but are taxable + 20% excise tax unless disabled, deceased or over 65 Yes, can change HSA election at any time

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Annual Contribution Amount You can contribute up to $2,550 per year to the Health Care FSA.

A Note About Over-the-Counter Medications You must have a doctor’s prescription to use the Health Care FSA to reimburse yourself for certain over-the-counter medications. Examples of medications that require you to submit a doctor’s prescription include: 

Acid controllers, digestive aids and stomach remedies



Allergy and sinus medicines



Anti-itch and insect bite remedies



Cold sore remedies



Cold, cough and flu drugs



Pain relief medications



Respiratory treatments



Sleep aids and sedatives

How the Debit Card Works All ACU employees electing to participate in Health Care FSA program will receive a Flex-Debit Card. You may use the debit card like a credit card when paying for approved medical expenses. If any amounts remain unused in your accounts as of the end of the Plan Year (March 15, 2017) after all claims have been processed, you will forfeit the remaining amount. No additional substantiation is required for debit card transactions that are approved at merchants using IIAS. IIAS approves eligible medical expenses at the point of purchase matching the item’s SKU to a list of eligible expenses. The debit cards may not be used at pharmacies that do not have IIAS in place. When you use your Discovery Benefits Debit Card to pay for expenses eligible under the flexible benefit plan at non-IIAS healthcare merchants (doctors’ offices and dental and vision providers), Discovery Benefits receives limited information from your card purchase. Since the IRS requires more than this to properly substantiate an expense, Discovery Benefits may follow up with you to request more information about the expense in order to support the eligibility of the purchase. If you choose not to use your debit card, you can always pay for your eligible expense and file a claim for reimbursement.

It’s important to keep copies of all your receipts—even if you are not required to submit them as proof of your expense. That way, if the IRS asks for substantiation of your expenses, you will have the receipts.

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Dependent Care FSA The Dependent Care FSA helps you afford day care for your children under age 13 or for a disabled dependent. There are some special rules for participating in this account:   

The day care expenses must be necessary so you can work. You can only be reimbursed for expenses incurred during the plan year. If you are married, your spouse must be: ― Employed ― A full-time student at least five months during the plan year, or ― Mentally or physically disabled and unable to provide care for himself or herself.

Eligible Dependent Care Expenses Generally, you may use the money in your Dependent Care FSA for care for:  

Your children under age 13 whom you claim as a dependent for tax purposes Other dependents of any age who are mentally or physically disabled and whom you claim as a dependent for tax purposes (spouses and dependents age 13 and older must spend at least eight hours a day in your home if you are reimbursing yourself for services provided outside the home).

Some typical expenses that are eligible for reimbursement under the plan are:    

Licensed nursery school and day care centers for children Licensed day care centers for disabled dependents Services from a care provider over the age of 19 (inside or outside the home) After-school care

For a complete list of eligible expenses, visit www.discoverybenefits.com.

Annual Contribution Amount You can contribute up to $5,000 per year to the Dependent Care FSA. If you are married and you and your spouse file separate tax returns, the maximum you can contribute is $2,500.

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Tax Savings Example Actual Savings will vary based on your individual tax situation

With Flex Account

Without Flex Account

Gross Salary

$40,000

$40,000

Health/Day Care Expenses (before-tax)

$5,600

N/A

Taxable Income

$34,400

$40,000

Tax (17.65%)

$6,072

$7,060

Net Salary

$28,328

$32,940

Health / Day Care (after-tax)

NA

$5,600

Take-home Pay

$28,328

$27,340

Your Tax Savings

$988

NA

Important FSA Considerations 



  

ACU elects to offer our employees an additional 2½-month grace period to incur Flex-Medical expenses. This means you have an extra 2½-months past the end of the plan year to incur expenses (until March 15, 2017) for the 2016 plan year. To be eligible for the grace period, you must be an active participant in the Flex-Medical plan on the last day of the plan year (December 31, 2016). The Health Care FSA and the Dependent Care FSA are separate accounts, each with its own contribution limits. You cannot use funds from one account to pay for expenses of the other. You also cannot transfer funds between the two accounts. If you use the Dependent Care FSA, you must provide your caregiver’s Social Security number or tax ID when you file a claim for reimbursement. If you use the Dependent Care FSA, remember that you can only reimburse yourself up to the amount that is currently available in your account. Both Healthcare FSA and Dependent Care FSA accounts are subject to the “use it or lose it” policy.

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Voluntary Plan Options Medical insurance is designed to cover the majority of medical expenses and pays the medical provider. With voluntary worksite-benefits, benefits are paid directly to you, the policyholder, unless otherwise assigned, regardless of any other insurance you may have. The money can be used to help cover medical expenses (copayments, deductibles, etc.), as well as non-medical expenses. These various insurance policies are voluntary and are only offered during Benefits Annual Enrollment. They are funded 100% by you through convenient payroll deductions. The policies described below are guaranteed-renewable and are fully portable for life including relocation, a new job and retirement. Enrollment in any of these benefits will be made available during our Annual Open Enrollment and will be done online along with all other benefit plans offered by ACU.

Critical Care Insurance Assurant’s critical illness insurance is a supplemental health insurance plan that is designed to provide a tax-free, lump-sum cash benefit at the first occurrence of seven (7) major critical illnesses including cancer, heart attack, and stroke. This benefit provides the pivotal financial support needed at the onset of a major illness, which can be used in any way, by the policy owner. This benefit is portable, which allows you to take the policy with you at a locked in, level rate. This coverage is also open to spouses and children of employees.

Accident Insurance Assurant’s Accident Insurance covers a wide range of injuries and accident-related expenses such as hospitalization, physical therapy, hospital intensive care, transportation and lodging plus coverage for: 



Accidental death Catastrophic accidents that involve the loss of use of sight, hearing, speech, arms or legs

These benefits are designed to help pay for out-of-pocket costs that may not be covered by traditional health insurance.

Universal Insurance Trustmark’s voluntary Universal Life Insurance program provides financial protection without the medical evidence of insurability that is often required before purchasing life insurance. This benefit is portable and allows you to lock in a rate and continue to pay the same rate at retirement or termination of employment. Rates are also available for spouse, children, and grandchildren. The Trustmark Universal Life Insurance policy has a Long Term Care rider included. This rider provides LTC coverage for amounts up to the face value of the Universal Life policy. This approach provides employees the benefits of Life Insurance and Long Term Care coverage in a single, low-cost policy.

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Other Benefits 403(b) It is critical to plan for your retirement. Making 403(b) contributions is an important step toward achieving your financial goals for later in life. We offer several options to help you make the most of your retirement and live a secure and happy life once your work years are behind you. A 403(b) plan can be a powerful tool in promoting financial security in retirement. The Abilene Christian University 403(b) Plan helps eligible employees save and invest for retirement while receiving certain tax advantages.

Eligibility Full-time, reduced full-time and half-time employees can make a percentage of base pay contribution into a 403(b) retirement plan. In turn, the university will contribute a matching amount into the plan. Employees have the option of contributing an amount of 0% to 8% of base pay into the 403(b) retirement plan. ACU will then contribute an equal percentage of an employee’s base pay into the plan, to a maximum of 8%. This retirement option gives participants the freedom of allocation changes and a three-year cliff vesting. For information on your retirement plans, please visit the TIAA-CREF website at www.tiaa-cref.org/acu. Below is a highlight of the benefit. Employee Contribution 0% Optional 1% Optional 2% Optional 3% Optional 4% Optional 5% Optional 6% Optional 7% Optional 8% Optional

Employer Matches 0% 1% 2% 3% 4% 5% 6% 7% 8%

Contributing to the Plan If you are or will be age 50 or older in this calendar year and contribute the maximum allowed to your account, you may also make “catch-up contributions” to your account. The catch-up contribution is intended to help you accelerate your progress toward your retirement goals. Contact your Plan Administrator for more details.

Changing or Stopping Your Contributions You may change the amount of your contributions any time. All changes will become effective as soon as administratively feasible and will remain in effect until modified or terminated by you. You may discontinue your contributions anytime. Once you stop making contributions, you may start again at any time.

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Supplemental Retirement Annuity Employees may also choose to pay additional funds into a tax sheltered Supplemental Retirement Annuity (SRA). However, these funds are not matched by the University. SRAs may be elected at the participant’s discretion; changes to the pretax deduction may be made at any time during the year. Any such election shall be effective with respect to Payroll Periods beginning after the Administrator’s receipt of the completed election form. Contact Human Resources for more information.

Identity Theft Identity theft is the fastest growing financial crime in America. In a matter of seconds, personal information such as a Social Security number, a credit card number, and/or an address can be stolen and used to obtain a new mortgage, line of credit, or additional credit card. Restoring one’s name and good credit can be a time-consuming and expensive process. Our goal at ACU is to work with vendors who use tools that help ensure your identity is kept safe. To further enhance our commitment to protect you and your family, ACU provides Identity Theft coverage to all benefitseligible employees at no cost to you. We also give you the option to purchase this coverage for your dependents. This service will offer income protection, reimbursement for allowable expenses related to the recovery of your identity, and a customer claims representative to aid you in the process of restoring your identity. We are happy to offer this program to assist you in the event that you are a victim of identity theft.

Adoption Assistance Plan All full-time and reduced full-time employees are eligible for the ACU Adoption Assistance Plan. If an eligible employee and his/her eligible spouse both work at ACU, only one employee can utilize the benefit. Each eligible employee is eligible to receive up to $5,000 in adoption assistance benefits for the adoption of an eligible child. The limit is increased to $6,000 for an adoption of an eligible child with special needs (as defined by IRS regulations). The adoption assistance benefit shall be in the form of reimbursements for qualified adoption expenses, such as reasonable and necessary adoption fees, court costs, and attorney’s fees. The Adoption Assistance benefit has a lifetime maximum limit of three adoptions per family. Please contact Human Resources for more information.

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Types of Leave at ACU Holidays All full-time, reduced full-time and half-time employees are eligible for paid university holidays which are posted on the HR website at www.acu.edu/hr. The purpose of the policy is to provide competitive paid-time-off benefits and to recognize traditional holidays. Halftime employees will receive the holiday only if it falls during designated work hours. Holidays New Year’s Day Martin Luther King Day Spring Break (Friday) Good Friday Memorial Day Independence Day Fall Break Thanksgiving (3 days) Christmas (Christmas Eve and the week between Christmas and New Year’s Day)

Sick Leave Sick leave accrues at the rate of 12 hours per month for all full-time faculty and staff. The maximum time an employee may accrue is 1,040 hours. Sick leave may be granted for the employee or the care of an immediate family member. Sick leave may also be used by an employee due to a death in the immediate family of the employee or the employee’s spouse. Reduced full-time and half-time employees accrue sick leave on a prorated basis.

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Shared Leave Bank The purpose of the Shared Leave Bank is to provide a safety net against salary interruption for employees who have a catastrophic health condition (for themselves or immediate family) causing them to be unable to perform their assigned job duties. Donations of sick leave hours by employees provide income to an affected employee who would otherwise be on unpaid leave. The purpose is not to provide unlimited sick leave for any medical reason. Visit acu.edu/hr to download an application for shared leave.

Vacation Full-time, reduced full-time and half-time staff employees earn vacation based on years of service. Vacation leave is earned from an employee’s first day of employment and may be taken after 6 months. Vacation accrues according to the schedule below. The next level of vacation is awarded on the employee’s annual anniversary date. Employees may rollover up to 80 hours of accrued and unused vacation at the end of each calendar year. Reduced full-time and half-time employees accrue vacation on a prorated basis. Years of Service

Amount of Vacation

0 to 4

80 hours (6.67 hrs/month)

5 to 9

120 hours (10 hrs/month)

10 to 14

140 hours (11.67 hrs/month)

15+

160 hours (13.3 hrs/month)

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Required Notices Notice of Special Enrollment Rights If you decline enrollment in medical coverage for yourself or your dependents (including your spouse) because of other health insurance coverage, you may be able to enroll yourself or your dependents in the company’s medical coverage 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 no more than 31 days after your or your dependent’s other coverage ends (or after the employer stops contributing to the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you can enroll yourself and your dependents in the company’s medical coverage as long as you request enrollment by contacting Human Resources no more than 31 days after the marriage, birth, adoption or placement for adoption.

60-Day Special Enrollment Period In addition to the qualifying events listed in the enrollment guide and this document, you and your dependents will have a special 60-day period to elect or discontinue coverage if:  

You or your dependent’s Medicaid or Children’s Health Insurance Program (CHIP) coverage is terminated as a result of loss of eligibility; or You or your dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP.

Women’s Health and Cancer Rights Act of 1998 If 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 mastectomyrelated benefits, coverage will be provided in a manner determined in consultations with the attending physician and the patient, for:  All states of reconstruction of the breast on which the mastectomy was performed  Surgery and reconstruction of the other breast to produce a symmetrical appearance  Prostheses  Treatment of physical complications of the mastectomy, including lymphedema These benefits will be provided subject to the same deductibles, copays and coinsurance applicable to other medical and surgical benefits provided under your medical plan. For more information on WHCRA benefits, contact Human Resources or your medical plan administrator.

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Newborn & Mothers Health Protection Notice For maternity hospital stays, in accordance with federal law, ACU does not restrict benefits, for any hospital length of stay in connection with childbirth for the mother or newborn child, to less than 48 hours following a vaginal delivery or less than 96 hours following a cesarean delivery. However, federal law generally does not prevent the mother’s or newborn’s attending care provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable). The plan cannot require a provider to prescribe a length of stay any shorter than 48 hours (or 96 hours following a cesarean delivery).

Notice of Privacy Practices The Health Insurance Portability and Accountability Act of 1996 deals with how an employer can enforce eligibility and enrollment for health care benefits, as well as ensuring that protected health information which identifies you is kept private. You have the right to inspect and copy protected health information which is maintained by and for the plan for enrollment, payment, claims, and case management. If you feel that protected health information about you is incorrect or incomplete, you may ask your benefits administrator to amend the information. For a full copy of the Notice of Privacy Practices, describing how protected health information about you may be used and disclosed and how you can get access to the information, contact Human Resources.

Expanded Coverage Preventive Care

for

Women’s

Under the Affordable Care Act, Abilene Christian University provides female plan participants with expanded access to recommended preventive services, including contraceptives, without cost sharing. Additional women’s preventive services that will be covered without cost sharing requirements include:      

Well-woman visits Gestational diabetes screening & HPV DNA testing Sexually transmitted infection counseling, and HIV screening and counseling Contraception and contraceptive counseling Breastfeeding support, supplies, and counseling Domestic violence screening

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Notice of Privacy Practices This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Our Company’s Pledge to You This notice is intended to inform you of the privacy practices followed by Abilene Christian University(the Plan) and the Plan’s legal obligations regarding your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The notice also explains the privacy rights you and your family members have as participants of the Plan. It is effective on January 1, 2016. The Plan often needs access to your protected health information in order to provide payment for health services and perform plan administrative functions. We want to assure the participants covered under the Plan that we comply with federal privacy laws and respect your right to privacy. Abilene Christian University requires all members of our workforce and third parties that are provided access to protected health information to comply with the privacy practices outlined below.

Protected Health Information Your protected health information is protected by the HIPAA Privacy Rule. Generally, protected health information is information that identifies an individual created or received by a health care provider, health plan or an employer on behalf of a group health plan that relates to physical or mental health conditions, provision of health care, or payment for health care, whether past, present or future.

How We May Use Your Protected Health Information Under the HIPAA Privacy Rule, we may use or disclose your protected health information for certain purposes without your permission. This section describes the ways we can use and disclose your protected health information. Payment. We use or disclose your protected health information without your written authorization in order to determine eligibility for benefits, seek reimbursement from a third party, or coordinate benefits with another health plan under which you are covered. For example, a health care provider that provided treatment to you will provide us with your health information. We use that information in order to determine whether those services are eligible for payment under our group health plan. Health Care Operations. We use and disclose your protected health information in order to perform plan administration functions such as quality assurance activities, resolution of internal grievances, and evaluating plan performance. For example, we review claims experience in order to understand participant utilization and to make plan design changes that are intended to control health care costs. However, we are prohibited from using or disclosing protected health information that is genetic information for our underwriting purposes.

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Treatment. Although the law allows use and disclosure of your protected health information for purposes of treatment, as a health plan we generally do not need to disclose your information for treatment purposes. Your physician or health care provider is required to provide you with an explanation of how they use and share your health information for purposes of treatment, payment, and health care operations. As permitted or required by law. We may also use or disclose your protected health information without your written authorization for other reasons as permitted by law. We are permitted by law to share information, subject to certain requirements, in order to communicate information on healthrelated benefits or services that may be of interest to you, respond to a court order, or provide information to further public health activities (e.g., preventing the spread of disease) without your written authorization. We are also permitted to share protected health information during a corporate restructuring such as a merger, sale, or acquisition. We will also disclose health information about you when required by law, for example, in order to prevent serious harm to you or others. Pursuant to your Authorization. When required by law, we will ask for your written authorization before using or disclosing your protected health information. Uses and disclosures not described in this notice will only be made with your written authorization. Subject to some limited exceptions, your written authorization is required for the sale of protected health information and for the use or disclosure of protected health information for marketing purposes. If you choose to sign an authorization to disclose information, you can later revoke that authorization to prevent any future uses or disclosures. To Business Associates. We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the Plan. We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information. For example, we may disclose your protected health information to a Business Associate to administer claims. Business Associates are also required by law to protect protected health information. To the Plan Sponsor. We may disclose protected health information to certain Employees of Abilene Christian University for the purpose of administering the Plan. These Employees will use or disclose the protected health information only as necessary to perform plan administration functions or as otherwise required by HIPAA, unless you have authorized additional disclosures. Your protected health information cannot be used for employment purposes without your specific authorization.

Your Rights Right to Inspect and Copy. In most cases, you have the right to inspect and copy the protected health information we maintain about you. If you request copies, we will charge you a reasonable fee to cover the costs of copying, mailing, or other expenses associated with your request. Your request to inspect or review your health information must be submitted in writing to the person listed below. In some circumstances, we may deny your request to inspect and copy your health information. To the extent your information is held in an electronic health record, you may be able to receive the information in an electronic format. Right to Amend. If you believe that information within your records is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information. Your request to amend your health information must be submitted in writing

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to the person listed below. In some circumstances, we may deny your request to amend your health information. If we deny your request, you may file a statement of disagreement with us for inclusion in any future disclosures of the disputed information. Right to an Accounting of Disclosures. You have the right to receive an accounting of certain disclosures of your protected health information. The accounting will not include disclosures that were made (1) for purposes of treatment, payment or health care operations; (2) to you; (3) pursuant to your authorization; (4) to your friends or family in your presence or because of an emergency; (5) for national security purposes; or (6) incidental to otherwise permissible disclosures. Your request to for an accounting of disclosures must be submitted in writing to the person listed below. You may request an accounting of disclosures made within the last six years. You may request one accounting free of charge within a 12-month period. Right to Request Restrictions. You have the right to request that we not use or disclose information for treatment, payment, or other administrative purposes except when specifically authorized by you, when required by law, or in emergency circumstances. You also have the right to request that we limit the protected health information that we disclose to someone involved in your care or the payment for your care, such as a family member or friend. Your request for restrictions must be submitted in writing to the person listed below. We will consider your request, but in most cases are not legally obligated to agree to those restrictions. Right to Request Confidential Communications. You have the right to receive confidential communications containing your health information. Your request for restrictions must be submitted in writing to the person listed below. We are required to accommodate reasonable requests. For example, you may ask that we contact you at your place of employment or send communications regarding treatment to an alternate address. Right to be Notified of a Breach. You have the right to be notified in the event that we (or one of our Business Associates) discover a breach of your unsecured protected health information. Notice of any such breach will be made in accordance with federal requirements. Right to Receive a Paper Copy of this Notice. If you have agreed to accept this notice electronically, you also have a right to obtain a paper copy of this notice from us upon request. To obtain a paper copy of this notice, please contact the person listed below.

Our Legal Responsibilities We are required by law to maintain the privacy of your protected health information, provide you with this notice about our legal duties and privacy practices with respect to protected health information and notify affected individuals following a breach of unsecured protected health information. We may change our policies at any time and reserve the right to make the change effective for all protective health information that we maintain. In the event that we make a significant change in our policies, we will provide you with a revised copy of this notice. You can also request a copy of our notice at any time. For more information about our privacy practices, contact the person listed below.

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If you have any questions or complaints, please contact: Wendy Jones Abilene Christian University 213 Hardin Administration Building Abilene, TX 79601 325-674-2359 [email protected] Complaints If you are concerned that we have violated your privacy rights, or you disagree with a decision we made about access to your records, you may contact the person listed above. You also may send a written complaint to the U.S. Department of Health and Human Services — Office of Civil Rights. The person listed above can provide you with the appropriate address upon request or you may visit www.hhs.gov/ocr for further information. You will not be penalized or retaliated against for filing a complaint with the Office of Civil Rights or with us.

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Health Insurance Market Place Notice PART A: General Information Since key parts of the health care law took effect in 2014, there is another way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the Marketplace and employmentbased 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 tax credit that lowers your monthly premium right away. Typically, you can enroll in a Marketplace health plan during the Marketplace’s annual Open Enrollment period or if you experience a qualifying life event.

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 cost-sharing 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 your 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, or 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. 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,

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including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.

PART B: Information About 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. 1. Company Name: Abilene Christian University 3. 5. 8. 9.

2. Employer Identification Number (EIN) 75-0851900 Employer address 4. Employer phone number ACU Box 29106 325-674-2359 City 6. State 7. ZIP code Abilene TX 79699 Who can we contact about employee health coverage at this job? Leah Shepherd Phone number (if different from above) 10. E-mail 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 are full time employees working at least 30 hours per week. 

X

With respect to dependents: We do offer coverage. Eligible dependents are: Your legal spouse, a child under the limiting age shown in your schedule of coverage, a child of your child who is your dependent for federal income tax purposes at the time application for coverage of the child is made, and any other child included as an eligible dependent under the plan. 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. Here's the employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.

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Medicare Prescription Drug Notice Important Notice from Abilene Christian University About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Abilene Christian 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. ACU has determined that the prescription drug coverage offered by the ACU 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.

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 to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will so 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 ACU coverage will not be affected. If you do decide to join a Medicare drug plan and drop your current ACU coverage, be aware that you and your dependents may not be able to get this coverage back.

When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? 36 | P a g e

You should also know that if you drop or lose your current coverage with ACU 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 October to join.

For More Information About This Notice Or Your Prescription Drug Coverage…

Current

Contact the person listed below 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 ACU 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 “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). 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). Date: October 2015 Name of Entity/Sender: Abilene Christian University Contact/Office: Wendy Jones / Human Resources Address: 213 Hardin Administration Building, Abilene, TX 79601 Phone Number: 325.674.2359

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Monthly Premiums Medical Coverage Level

HSA Wellness

HSA Standard

HRA Wellness

HRA Standard

Employee Only

$70

$130

$70

$130

Employee + Spouse

$280

$340

$280

$340

Employee + Child(ren)

$200

$260

$200

$260

Employee + Family

$425

$485

$425

$485

Dental Dental PPO

Employee Only

Employee & Spouse

Employee & Children

Employee & Family

$38.70

$78.53

$74.37

$113.55

Employee Only

Employee & Spouse

Employee & Children

Employee & Family

$9.75

$20.97

$20.97

$20.97

Vision 12/12/24

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Voluntary Life and AD&D Supplemental Life Premium Calculation: (Coverage Amount x Rate* / 1000 = Monthly Premium) *For Rate see table below

Employee

Spouse

Under 25

$0.057

$0.057

25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69

$0.057 $0.072 $0.102 $0.146 $0.232 $0.369 $0.568 $0.887 $1.541

$0.057 $0.072 $0.102 $0.146 $0.232 $0.369 $0.568 $0.887 $1.541

70-74

$2.750

$2.750

75+

$2.750

Child Rate AD&D

$2.750 $0.2 / $10,000 $0.026

Voluntary Short-Term Disability Employee Age Band

Rate per $10 of benefit

Under 25

$0.555

25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74

$0.577 $0.544 $0.468 $0.522 $0.566 $0.642 $0.892 $1.197 $1.295 $1.295

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Important Contacts Resource

Phone/Web Address Group and Pension Administrators, Inc. (Medical) Group # 3338284 | 800.827.7223 | www.gpatpa.com To find an in-network physician: Non-DFW Only: www.multiplan.com (PHCS Network) DFW: www.imsppo.com (IMS Network)

Medical & Rx

Dental Vision Health Savings Account Flex Spending Account Life/AD&D Disability Retirement Employee Assistance Program Identity Theft Nurse Navigator Abilene Christian University Benefits Advocate

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CVS Caremark (RX) www.caremark.com | 866.475.0056 Specialty Medications: 800.238.7828 Mail Order: 888.202.1654 ELAP Services (Balance Billing) 800.977.7381 | [email protected] Fax: 888.560.2447 Assurant – Group # 5473131 800.442.7742 | www.assurantemployeebenefits.com VSP- Group # 1109154 800.852.7600 | www.vsp.com HSA Bank 800.357.6264 | www.hsabank.com Discovery Benefits 866.451.3399 | www.discoverybenefits.com Assurant – Group # 5473131 800.451.4531 | www.assurantemployeebenefits.com Assurant – Group # 5473131 800.451.4531 | www.assurantemployeebenefits.com TIAA - CREF 800.842.2733 | www.tiaa.cref.org/acu Assurant EAP 816.474.2345 | www.assurantemployeebenefits.com AIG- Group # 7077631 866.434.3572 [email protected] 800.843.6705, option 1 Elsa Dunson 972.663.7304 [email protected] Hours: Monday – Friday 8 am to 5 pm (Central Time)

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