Welcome to Your Benefits Open Enrollment!

Welcome to Your Benefits Open Enrollment! Willamette University 2013 Key Contact Information The following table provides important phone numbers an...
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Welcome to Your Benefits Open Enrollment! Willamette University 2013

Key Contact Information The following table provides important phone numbers and websites that you may need when enrolling for your benefits and throughout the year.

Options

Website

Group #

Phone Number

Health Insurance [ ] Pioneer Medical Plan [ ] Kaiser Medical Plan

http://www.willamette.edu/de pt/hr/benefits/insurance/plans /index.html

#842995020

888.367.2116

#02014

503.813.2000

http://www.willamette.edu/de pt/hr/benefits/insurance/plans /index.html

#842995020

888.367.2116

#02014

503.813.2000

#29399-001

503.588.2988 ext. 312

https://www.eflexgroup.com/p articipants/

#501

877.933.3539

https://www.divinvest.com

T069446 00001

800.755.5801

Dental Insurance [ ] Pioneer Dental Plan [ ] Kaiser Dental Plan Life Insurance [ ] Optional Group Term Life and AD&D (Buy-up)

http://www.willamette.edu/de pt/hr/benefits/OtherBenefits/li feinsurance/index.html

Flexible Spending Account [ ] Health Care [ ] Dependent Care [ ] Mass Transit Retirement Plans [ ] Universal Access to Voluntary Retirement Accounts (pre and post-tax) AFLAC [ [ [ [ [

] Accident ] Cancer ] Hospital ] Short-Term Disability ] Whole Life Insurance

http://www.willamette.edu/de pt/hr/benefits/aflac/index.html

KA555

http://www.benefitscom.com/ groups/WillametteUniversity/

#37588

503.910.5777

Pre-Paid Legal [ ] Family Legal Plan [ ] Identity Theft Shield

Still Have Questions? I’m happy to help you:

503.508.9711

Katie Lahey HR Generalist, Benefits/HRIS 503-370-5443 [email protected]

February 2013

Dear Colleagues, Starting on Monday, February 11, 2013 and continuing through Friday, March 1, 2013, we would like to invite you to take part in our Benefits Open Enrollment period. This is your annual opportunity to review your existing benefit plans, evaluate any anticipated needs, learn more about your benefits and make adjustments for the upcoming plan year. Action is required during Open Enrollment if you want to:  Make any benefit, coverage level, or dependent changes effective 4/01/2013  Enroll in a Health or Dependent Care Flexible Spending Account (FSA)  Waive University health insurance for the next plan year and receive the $100 per month employer contribution to a Health FSA If you do not act during Open Enrollment, your participation in your medical and dental insurance will remain the same. If you do not enroll in the FSA reimbursement account, you will not be a participant in the next plan year that starts April 1, 2013.

Your medical and dental plan costs:  

Premiums are not increasing for the Pioneer Medical, Pioneer Dental, and Kaiser Dental plans in the upcoming year. Kaiser Medical Plan will increase by 6.7%. This increase follows last year’s 0% increase and is driven by a significant rise in our claims experience (medical services utilization). The two-year average increase for the last two plan renewals is 3.35% for Kaiser and 2.5% for Pioneer, compared to 6.5% average increase over the last two CUPA-HR Benefits surveys of colleges and universities.

New for 2013-14: 



Under both medical plans, the following women’s preventive health services will be available at no cost for in-network and preferred providers: o Well-woman visits o Screening for gestational diabetes o HPV testing o Sexually transmitted infections and HIV counseling o FDA-approved contraception methods and counseling o Breastfeeding support, supplies and counseling o Screening and counseling for interpersonal and domestic violence Kaiser Medical Plan changes: o Vision benefits are now equal to Pioneer plan, increasing from a $150 maximum benefit to $250 for prescription eyeglasses and contact lenses every 24 months. o Addition of alternative care benefits to include $25 co-pay for visits for chiropractic, naturopathic, massage therapy, and acupuncture to a provider in our service area who is a part of The CHP Group network. There is a $1,500 benefit maximum for all services combined and massage therapy visits are limited to 12 visits per year. o Specialty care office-visits, unless preventative, will be $35 co-pay (was $25).* o Special diagnostic procedures (CT, MRI, and PET scans) are now $50 co-pay (was $25).* o Outpatient-administered medications, except immunizations and allergy shots, are now paid at 80%, with 20% co-insurance responsibility for the insured.* o Co-insurance for covered Outpatient Durable Medical Equipment (DME), External Prosthetic Devices, and Orthotic Devices now count toward the Out-of-Pocket Maximum.* * Denotes changes initiated by Kaiser for all employer groups; other changes negotiated without premium impact.

(Turn Over)

Ways to Help Improve Costs The University strives to provide high quality, affordable health insurance to faculty and staff, and their dependents. Delivering on this goal is truly a partnership, and there are many ways we can all help in this effort. Human Resources provides many opportunities to learn about the ways you can take advantage of free wellness programs and activities, as well as preventative health screenings. These programs can help improve overall health, as well as serve to catch health problems before they get more serious. Using mail order pharmacy benefits and generic medications also serves to lower your copays and overall costs to the plan. Be on the lookout for events, like the coming Benefits & Wellness fair, that can help educate you on ways to improve your health.

Flexible Spending Accounts Open Enrollment is the time to enroll or re-enroll in Dependent Care and/or Health Flexible Spending Accounts (FSA). You must re-enroll during Open Enrollment if you wish to participate during the 2013-14 plan year. To participate, you must contribute a minimum of $180 per year. The Health FSA annual maximum contribution is now $2,500 to comply with provisions in the Affordable Care Act. If both you and your spouse are WU employees, you may each contribute up to $2,500. The IRS maximum contribution amount for the Dependent Care FSA continues to be $5,000 ($2,500 if married filing a separate tax return). The eflexgroup website (www.eflexgroup.com) provides a list of eligible FSA expenses and links to FSA calculators to help you estimate the amount you should contribute and your potential tax savings. Choose your contribution amount carefully as these plans are subject to IRS “use it or lose it” rules.

Benefits & Wellness Fair - February 21, 2013 The annual Benefits & Wellness Fair will be held on Thursday, February 21, 2013 in the Montag Den from 10am – 2pm. Knowledgeable representatives from our benefits vendors will be available to provide information and answer questions about our plans and programs. Come and learn about the full array of benefits available to you and how you can best take advantage of our programs. Raffle prizes, benefits updates, health activities and light refreshments will be available at the event.

Enclosed in this Packet In keeping with our efforts at reducing paper consumption, only those items that must be distributed in “hard copy” will be distributed via campus mail. Departments with a large number of employees who have limited computer access will be provided with Open Enrollment forms and information to be maintained in the department. Hard copies can also be requested by emailing us at [email protected] or calling ext. 6210. All other Open Enrollment materials can be found at: http://www.willamette.edu/dept/hr/resources/include/open_enrollment/index.html As always, we welcome the opportunity to assist you with any questions you have about this year’s renewal, feel free to see an Insurance Representative at the Benefits & Wellness Fair or come by Human Resources, we are happy to help.

This summary of changes is effective as of the new plan year, April 1, 2013 and is not intended to inclusive of all changes that may have taken place in the plans, but should include all of the changes of impact. Please see the Summary Plan Descriptions for complete information on each plan. Where information in this document and that of the Summary Plan Descriptions vary, the Summary Plan Descriptions shall govern.

Medical and Dental Insurance Rates Employee’s Salary: $0-$50,000 Pioneer Medical Plan Employee Employee + 1 Family

Kaiser Medical Plan

Total Employee Pays WU Pays $594.81 $29.74 $565.07 $1,189.75 $416.41 $773.34 $1,655.35 $579.37 $1,075.98

Pioneer Dental Plan Employee Employee + 1 Family

Total $56.75 $113.54 $158.94

Employee Employee + 1 Family

Total Employee Pays $431.04 $21.55 $862.07 $258.62 $1,198.28 $419.40

WU Pays $409.49 $603.45 $778.88

Kaiser Dental Plan Employee Pays $0.00 $39.74 $71.52

WU Pays $56.75 $73.80 $87.42

Employee Employee + 1 Family

Total $58.71 $117.41 $163.20

Employee Pays $0.00 $41.09 $73.44

WU Pays $58.71 $76.32 $89.76

Employee Pays $38.79 $275.86 $479.31

WU Pays $392.25 $586.21 $718.97

Employee Pays $5.87 $46.96 $76.70

WU Pays $52.84 $70.45 $86.50

Employee Pays $51.72 $318.97 $539.23

WU Pays $379.32 $543.10 $659.05

Employee Pays $8.81 $58.71 $81.60

WU Pays $49.90 $58.71 $81.60

Employee’s Salary: $50,001-$100,000 Pioneer Medical Plan Employee Employee + 1 Family

Total $594.81 $1,189.75 $1,655.35

Kaiser Medical Plan Employee Pays $53.53 $475.90 $662.14

WU Pays $541.28 $713.85 $993.21

Pioneer Dental Plan Employee Employee + 1 Family

Total $56.75 $113.54 $158.94

Employee Employee + 1 Family

Total $431.04 $862.07 $1,198.28

Kaiser Dental Plan Employee Pays $5.68 $45.42 $74.70

WU Pays $51.08 $68.12 $84.24

Employee Employee + 1 Family

Total $58.71 $117.41 $163.20

Employee’s Salary: $100,001+ Pioneer Medical Plan Employee Employee + 1 Family

Total $594.81 $1,189.75 $1,655.35

Kaiser Medical Plan Employee Pays $71.38 $535.39 $744.91

WU Pays $523.43 $654.36 $910.44

Employee Pays $8.51 $56.77 $79.47

WU Pays $48.24 $56.77 $79.47

Pioneer Dental Plan Employee Employee + 1 Family

Total $56.75 $113.54 $158.94

Employee Employee + 1 Family

Total $431.04 $862.07 $1,198.28

Kaiser Dental Plan Employee Employee + 1 Family

Total $58.71 $117.42 $163.20

Willamette University 2013-14

MEDICAL PLAN COMPARISON Plan Name & Provider Network Annual Deductible Annual Out-of-Pocket Maximum Annual Maximum Benefit Preventive Care Primary and Specialty Care Diagnostic Lab & X-Ray Inpatient Stay/Surgery Outpatient Surgery Urgent Care

Pioneer Medical Regence BlueCross Blue Shield Network In-Network Out-of-Network Individual -$250 Individual -$500 Family -$750 Family -$1,500 Individual -$2,000 Individual -$6,000 Family -$6,000 Family -$18,000

Individual -$1,500 Family -$3,000

$2,000,000

None

Employee pays 0% (deductible waived)

Employee pays 40% (after deductible)

$25 co-pay (deductible waived) Employee pays 20% (deductible waived) Employee pays 20% (after deductible) Employee pays 20% (deductible waived) Plan pays 100% after $25 co-pay (deductible waived)

Employee pays 40% (after deductible) Employee pays 40% Employee pays 40% (after deductible) Employee pays 40% (after deductible) Employee pays 40%

Emergency Room

$150 co-pay, then employee pays 20% (deductible waived if admitted)

Ambulance Services Durable Medical Equipment

Employee pays 20% (after deductible) Employee pays 20% Employee pays 40% (after deductible) (after deductible)

Alternative Care (Acupuncture, Chiropractic, Massage Therapy, Naturopathic)

20% (deductible waived) Does not apply toward maximum co-insurance 24-visit limit per calendar year

Prescription Retail (Up to 30 – day supply) Mail Order Prescriptions (Up to 90 – day supply)

$20 generic $40 preferred $60 non-preferred $30 generic $60 preferred $90 non-preferred

Vision Benefits

Annual exam – Plan pays 100% (deductible waived). Hardware: $250 per calendar year maximum benefit.

Kaiser Medical Kaiser Providers In-Network Only None

$0 co-pay $25 co-pay Primary $35 co-pay Specialty $25 per department visit $500 per admission $75 co-pay $45 co-pay $100 co-pay plus other applicable fees (waived if admitted) $75 co-pay Employee pays 20% $25 co-pay 12-visit calendar limit on Massage Therapy only $1,500 max for all services per calendar year $15 generic $30 brand-name $30 generic $60 brand-name Routine eye exam - $25 co-pay Prescription eyeglasses & contact lenses - balance after $250 credit every 24 months.

Please note: This summary provides a brief description of the Plan benefits. Please refer to the Summary Plan Description for a complete list of benefits, the limitations, and exclusions that apply and a definition of medical necessity.

Willamette University 2013-14

DENTAL PLAN COMPARISON Plan Name & Provider Network

Pioneer Dental Any Licensed Dentist

Kaiser Dental Kaiser Providers

Annual Deductible

Individual - $50 Family - $150

None

Annual Maximum Benefit

$1,500 per person

$1,500 per person

Office Visits

None

$15 co-pay

Preventive Services Exams, cleanings, x-rays, fluoride treatment

Employee pays 0% (deductible waived)

Fully covered after office visit charge

Basic Services Fillings, simple extractions

Employee pays 20% after deductible

Fully covered after office visit charge

Major Services Crowns, Bridges, Dentures

Employee pays 50% after deductible

Employee pays 20%

Emergency Treatment

Employee pays 20% after deductible

$25 co-pay in-network Plan pays up to $100 for out-of-area emergency

Orthodontia No age limit

Employee pays 50% $1,500 per claimant lifetime maximum% (deductible waived)

Employee pays 50% $1,500 per claimant lifetime maximum

Orthodontia Lifetime Maximum

$1,500

$1,500

Please note: This summary provides a brief description of the Plan benefits. Please refer to the Summary Plan Description for a complete list of benefits, the limitations, and exclusions that apply and a definition of medical necessity.

Willamette University 2013-14

Annual Legal Notices THE WOMEN’S HEALTH CANCER RIGHTS ACT OF 1998 (WHCRA) 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 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 coinsurance applicable to other medical and surgical benefits provided under this plan. NEWBORNS ACT DISCLOSURE – FEDERAL Group health plans and health insurance issuers generally may not, under Federal law, 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 section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). NOTICE OF PREEXISTING CONDITIONS If applicable, the existence and terms of a pre-existing condition exclusion clause are disclosed in your benefit booklet. Individuals have a right to request a certificate of creditable coverage from a prior plan or insurance issuer. If necessary, the plan can assist you in obtaining a certificate of creditable coverage. Please contact human resources for more information or to request assistance. NOTICE OF SPECIAL ENROLLMENT RIGHTS If 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 31 days after the marriage, birth, adoption, or placement for adoption. Further, if you decline enrollment for yourself or eligible dependents (including your spouse) while Medicaid coverage or coverage under a State CHIP program is in effect, you may be able to enroll yourself and your dependents in this plan if:  coverage is lost under Medicaid or a State CHIP program; or  you or your dependents become eligible for a premium assistance subsidy from the State. In either case, you must request enrollment within 60 days from the loss of coverage or the date you become eligible for premium assistance. To request special enrollment or obtain more information, contact person listed at the end of this summary. NOTICE OF PATIENT PROTECTIONS THAT REQUIRE DESIGNATION OF A PCP Kaiser group health plans generally requires the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact Kaiser Customer Service. For children, you may designate a pediatrician as the primary care provider. MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) OFFER FREE OR LOW-COST HEALTH COVERAGE TO CHILDREN AND FAMILIES If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can 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 of these programs, you can either 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, you can ask the State if it has a program that might help you pay

the premiums for an employer-sponsored plan. Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. You should contact your State for further information on eligibility – OREGON – Medicaid and CHIP Medicaid & CHIP Website: http://www.oregonhealthykids.gov Medicaid & CHIP Phone: 1-877-314-5678 STATEMENT OF ERISA RIGHTS: As a participant in the plan you are entitled to certain rights and protections under the employee retirement income security act of 1974 (“erisa”). Erisa provides that all participants shall be entitled to: Receive Information about Your Plan and Benefits  Examine, without charge, at the Plan Administrator’s office and at other specified locations, the Plan and Plan documents, including the insurance contract and copies of all documents filed by the Plan with the U.S. Department of Labor, if any, such as annual reports and Plan descriptions. 

Obtain copies of the Plan documents and other Plan information upon written request to the Plan Administrator. The Plan Administrator may make a reasonable charge for the copies.



Receive a summary of the Plan’s annual financial report, if required to be furnished under ERISA. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report, if any.

Continue Group Health Plan Coverage: If applicable, you may continue health care coverage for yourself, spouse or dependents if there is a loss of coverage under the plan as a result of a qualifying event. You and your dependents may have to pay for such coverage. Review the summary plan description and the documents governing the Plan for the rules on COBRA continuation of coverage rights. If you have creditable coverage from another plan, you may be entitled to a reduction or elimination of exclusionary periods (if applicable) of coverage for preexisting conditions under your group health plan. You should be provided a certificate of creditable coverage, free of charge, from your group health plan or health insurance issuer when you lose coverage under the plan, when you become entitled to COBRA continuation of coverage, when COBRA continuation of coverage ceases, if you request before losing coverage or if you request it up to 24 months after losing coverage. Without evidence of prior creditable coverage, you may be subject to a preexisting condition exclusion for 12 months (18 months for late enrollees) after your enrollment date in your coverage. Prudent Actions by Plan Fiduciaries: In addition to creating rights for participants, ERISA imposes duties upon the people who are responsible for operation of the Plan. These people, called “fiduciaries” of the Plan, have a duty to operate the Plan prudently and in the interest of you and other Plan participants. No one, including the Company or any other person, may fire you or discriminate against you in any way to prevent you from obtaining welfare benefits or exercising your rights under ERISA. Enforce your Rights: If your claim for a welfare benefit is denied in whole or in part, you must receive a written explanation of the reason for the denial. You have a right to have the Plan review and reconsider your claim. Under ERISA, there are steps you can take to enforce these rights. For instance, if you request materials from the Plan Administrator and do not receive them within 30 days, you may file suit in federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent due to reasons beyond the control of the Plan Administrator. If you have a claim for benefits which is denied or ignored, in whole or in part, and you have exhausted the available claims procedures under the Plan, you may file suit in a state or federal court. If it should happen that Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose (for example, if the court finds your claim is frivolous) the court may order you to pay these costs and fees. Assistance with your Questions: If you have any questions about your Plan, this statement, or your rights under ERISA, you should contact the nearest office of the Employee Benefits and Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits and Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210.

DISCLOSURE OF PLAN INFORMATION UNDER ERISA FOR WILLAMETTE UNIVERSITY EMPLOYEE BENEFIT PLANS The Employee Retirement Income Security Act of 1974 (ERISA) requires that we provide you annually with information - known as a Summary Annual Report - on the financial information filed with the Internal Revenue Service and the U.S. Department of Labor for the plans listed below in which you may be a participant, eligible to participate, or a beneficiary. As permitted by Department of Labor regulations, in lieu of a Summary Annual Report, a copy of the Annual Return/Report filed on behalf of the plan will be furnished to you free of charge, upon receipt of a written request. Reports are available for the following: Willamette University Defined Contribution 403(b) Retirement Plan Willamette University Long Term Disability Insurance Plan Willamette University Group Life Insurance Plan and ADD-Basic and Voluntary Pioneer Educators Health Trust (PEHT, filed by Trust Account Management) Willamette University Employee Welfare Benefit Plans, including: Willamette University Flexible Spending Plan Kaiser Permanente Health Plan Employee Assistance Program A copy of the Form 5500 and the “Disclosure of Plan Information under ERISA” Notice will be sent to you within 30 days of your request. Please submit your written request to: Keith Grimm, SPHR Director of Human Resources Willamette University 900 State Street Salem, OR 97301

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