1. health and fitness

2012 Open Enrollment
Carleton College
Open Enrollment Period
Our 2012 Open Enrollment period begins October 31, 2011 and
concludes December 5, 2011.
Employees will access the on-line tool (benefitsCONNECT) on the Human
Resources website.
Be sure to review the refresher regarding your username and password;
passwords will remain the same for 2012 as they are in 2011.
This is a “passive” enrollment year, which means that unless you request a
plan change, your current medical, dental, voluntary life, and long-term
disability plans in 2011 (along with your corresponding dependents) will
remain active for 2012.
If you want a health care or dependent care flexible spending account in
2012, you will need to enter your annual election through our on-line
tool (benefitsCONNECT). We recommend this be done during the Open
Enrollment period.
2
2012 Benefit Plan Highlights/Changes
There are very minimal benefit plan changes for 2012.
The following initial screens in this presentation will detail the
highlights/changes for our plans:
•Health Care Reform Update
•TASC
•TIAA-CREF
•The Hartford
•Delta Dental
•Blue Cross and Blue Shield of Minnesota
Employees who would like an overview/refresher on how our plans work,
please stay for full presentation.
3
Health Care Reform Update
There are minimal health care reform changes effective in 2012. Listed below are the
highlights for 2012, which include requirements that may become effective within the
calendar year 2012.
Health Plan Summaries
User-friendly benefits summaries that will help individuals to more easily understand
their health plan and its key provisions must be presented in a four-page document
prepared by insurance carriers (for fully-insured plans) or by employers of self-funded
health plans. These plan summaries are to be presented to participants on/after March
23, 2012 (at the earliest).
W-2 Reporting
Large employers (who issued at least 250 W-2s in the previous year) will need to include
the value of employer provided health coverage on employees’ W-2s for the 2012 tax
year.
Encouraging Integrated Health Systems
The new law provides incentives for physicians to join together to form “Accountable
Care Organizations”. These groups allow doctors to better coordinate patient care and
improve the quality, help prevent disease and illness, and reduce unnecessary hospital
admissions.
4
Health Care Reform Update (Cont.)
Encouraging Integrated Health Systems (Cont.)
If Accountable Care Organizations provide high quality care and reduce costs to the
health care system, they can keep some of the money that they have helped save.
Linking Payment to Quality Outcomes
The law establishes a hospital Value-Based Purchasing program (VBP) in Traditional
Medicare. This program offers financial incentives to hospitals to improve the quality of
care. Hospital performance is required to be publicly reported, beginning with measures
relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated
infections, and patients’ perceptions of care. (Effective on/after October 1, 2012.)
Reducing Paperwork and Administrative Costs
Health care remains one of the few industries that relies on paper records. This new law
will institute a series of changes to standardize billing and requires health plans to begin
adopting and implementing rules for the secure, confidential, electronic exchange of
health information.
Using electronic health records will reduce paperwork and
administrative burdens, cut costs, reduce medical errors, and most importantly, improve
the quality of care. (First regulation is effective October 1, 2012.)
5
Health Care Reform Update (Cont.)
Understanding and Fighting Health Disparities
To help understand and reduce persistent health disparities, the law requires any
ongoing or new federal health program to collect and report racial, ethnic and language
data. The Secretary of Health and Human Services will use this data to help identify and
reduce disparities. (Effective March, 2012.)
CLASS Program
The law creates a voluntary long-term care insurance program (called CLASS) to provide
cash benefits to adults who become disabled. (A benefit plan is to be designated no later
than October 1,2012.) Please Note: HHS announced 10/14/11 that it will halt
implementation of the CLASS Act under PPACA.)
Please view more information on health care reform on the Human
Resources website (Benefits/Health Care Reform).
6
TASC:
Flex Spending
Here is an overview of the TASC features. There are new enhancements coming in 2012!
TASC Card
•
Streamlines the reimbursement of out-of-pocket expenses. It qualifies and pays eligible medical
expenses on the spot, ensuring the correct use of funds and helps monitor your healthcare
spending.
•
Removes the hassles of paperwork. It eliminates the need to send receipts and track medical
expenses and eliminates requests for reimbursements.
•
Offers convenience and choice. It provides easy access to reimbursement funds and lets you make
transactions without merchant restrictions on general spending.
MyBenefits:
•
Provides easy reimbursement for eligible healthcare expenses with the swipe of the card.
•
Auto-substantiates eligible expenses, eliminating requests for reimbursement.
•
Gives your dependents (spouse, adult child, etc.) the ability to draw funds from your benefit
account.
•
Lets you easily track expenses and reimbursements online.
MyCash (New in 2012!)
TASC card holders who do not use their TASC card to pay for an eligible expense may submit a request
for reimbursement via fax, mail, or online. Unless you have already chosen the direct deposit
option, your reimbursement will be deposited directly to your MyCash account.
7
TASC:
Flex Spending (Cont.)
MyCash (Cont.)
Benefits of the MyCash account include:
•
Out-of-pocket expenses are deposited directly into this account on your TASC card; no more
waiting for reimbursement checks to arrive by mail.
•
Provides a convenient online site for cardholders to track card activity.
•
Ensures control over spending. Funds can be spent any way, anywhere – just like cash at any
retailer that accepts VISA.
•
Cardholders can transfer funds to a personal checking or savings account, or withdraw at an ATM
with a PIN.
PLEASE NOTE: Currently the TASC Card does not work for MyCash (non-FSA) purchases at CVS
Pharmacy, Walmart, and Shopko or for pay-at-the pump purchases.
IMPORTANT MyCASH Information:
When your MyCash account is activated, all your benefit account reimbursements (where the TASC
Card was not used) will automatically be made to your MyCash account. If you prefer, you may elect
direct deposit and your reimbursements will automatically be made to a bank account of your choice.
Once MyCash is activated in 2012, paper reimbursement checks will be issued on a limited
basis and only upon request.
8
TASC:
Flex Spending (Cont.)
MyWay (New in 2012!)
•
Protects against embarrassing declines. If funds are unavailable in the MyBenefits account,
payment will be withdrawn from the MyCash account if there are sufficient funds.
•
Pays for healthcare and general expenses in one transaction. With one swipe of the card, eligible
expenses are automatically withdrawn from MyBenefits, while non-eligible items are paid from the
available funds in MyCash.
•
Allows dependents to access accounts. You can give your dependents access to your benefit
account(s) and cash account. In the future, cardholders will be able to elect the specific accounts
dependents can access.
•
Lets you transfer cash from MyCash to your personal accounts. Funds can be moved to a personal
savings or checking account.
•
Provides an easy way to save money. Reimbursements can accumulate in your MyCash account.
The “special stash” is a great way to save for a vacation or a shopping spree!!
•
Gives you control in general spending. Spend your money anyhow, anywhere, any way, at any
retailer that accepts VISA, or withdraw funds at an ATM.
MyTASC Mobile App (New in 2012!)
This new application allows participating employees the ability to access their account from anywhere at
any time using their mobile device. You’ll be able to check your account balances, submit a request for
reimbursement, submit substantiation via camera images and view account transactions. The TASC
Mobile app offers text messaging and email notification. **This feature is provided at no charge for
participants who possess a mobile device (phone or tablet) with an Apple® or Android™ operating
system.
9
TASC:
Flex Spending (Cont.)
Annual elections are required for
both the health care and dependent
care spending accounts.
Please enter your 2012 elections during our Open
Enrollment period (October 31 – December 5,
2011) via the on-line tool (benefitsCONNECT).
10
TIAA-CREF
Effective January 1, 2012, all voluntary (403b) contributions toward your retirement
must be made through a group supplemental retirement annuity (GSRA).
Employees with contributions made through the additional pension deferred option, as
well as those employees that retained the additional 1% contribution (resulting from the
change in employee mandatory contribution from 3% to 2% that occurred on July 1,
2009) will be required to:
•
•
•
Review investment options for your GSRA account (Lifecycle Funds or Build Your Own
Investment Mix).
Go online with TIAA-CREF to set up your GSRA account.
Complete the Agreement for Salary Reduction form and submit to Human Resources.
The benefits for this change include better customer service and reporting/tracking
capabilities for audit requirements.
Please contact Human Resources for support. We will help you in knowing what set ups
you may be required to complete and will assist you in the online enrollment process.
As a reminder, anyone 21 or older may open a voluntary (403b) plan via a Group
Supplemental Retirement Annuity (GSRA), regardless of your benefit eligibility status.
11
The Hartford:
Voluntary Life Insurance
Carleton College is pleased to announce that our rates for our group-term Voluntary Life
Insurance benefit will remain stable (no rate increases) for 2012. Employees that move
into a different (higher) age category will see an increase in premiums, however.
For newly hired benefit eligible non-union employees, The Hartford offers the
opportunity to purchase voluntary group term life insurance; the guaranteed issue of
this coverage is $150,000 (without requiring medical underwriting). The maximum
benefit allowed is $500,000, however, coverage between $150,000-$500,000 will
require completion of a Personal Health Application and a medical underwriting process.
Coverage can be purchased in increments of $10,000.
For existing benefit eligible, non-union employees that either do not have existing
coverage or would like to increase their coverage, the completion of a Personal Health
Application and medical underwriting will be required.
In order to request or increase your coverage, you will need to indicate the change on
benefitsCONNECT.
For specifics regarding the Voluntary Group-Term Life Insurance plan, please visit the
Human Resources website.
12
The Hartford:
Long-Term Disability
Carleton College is pleased to announce that our rates for our Long-Term
Disability benefit will remain stable (no rate increases) for 2012.
Newly hired benefit eligible non-union employees can elect to purchase
long-term disability coverage through The Hartford at time of hire without the
need for medical underwriting.
For existing benefit eligible, non-union employees without existing
coverage, the completion of the Personal Health Application and medical
underwriting will be required.
In order to request coverage, you will need to indicate your election on
benefitsCONNECT.
For specifics regarding the Long-Term Disability benefit, please visit the Human
Resources website.
13
2012 Dental Insurance Options
• Value Plan
• Comprehensive Premier Plan
14
2012 Dental Insurance
Our renewal rates for Delta Dental for 2012
are flat…there are no increases in premium!
There are no plan design changes with
either of our Delta Dental plans for 2012!
Both of our plans are voluntary and are
totally employee paid.
There is no
contribution made by the College towards
these premiums.
15
2012 Dental Premiums
Dental Insurance
Total Annual Premium
Monthly Premium
Bi-Weekly Premium
Employee
$400.80
$33.40
$15.42
Employee + Spouse
$804.60
$67.05
$30.95
Employee + Child(ren)
$757.20
$63.10
$29.12
$1,301.40
$108.45
$50.05
$508.80
$42.40
$19.57
$1,022.40
$85.20
$39.32
$961.20
$80.10
$36.97
$1,651.80
$137.65
$63.53
Value
Family
Comprehensive Premier
Employee
Employee + Spouse
Employee + Child(ren)
Family
2012 Medical Insurance Options
• Options Blue (Aware)
• Aware PPO
• Accord HRA
2012 Medical Insurance Renewal Rates
Aware PPO
The 2012 renewal rates for the Aware PPO plan had
a decrease of slightly over 1.5%.
Options Blue and Accord HRA
The 2012 renewal rates for both the Options Blue
and Accord HRA plans reflect an average increase
of 0.3%.
Ultimately, this reflects a 0% increase in our overall
yearly renewal rates for 2012.
18
2012 Employee Medical Premiums
Medical Insurance
Monthly Premium
Bi-Weekly Premium
Employee
$120.72
$55.72
Employee +1
$255.02
$117.70
Family
$402.72
$185.87
Employee
$84.48
$38.99
Employee +1
$172.98
$79.84
Family
$261.39
$120.64
Employee
$74.93
$34.58
Employee +1
$152.79
$70.52
Family
$230.70
$106.48
Aware PPO
Options Blue (Aware Network)
Accord HRA
2012 Renewal Bulletin and Plan Design Changes
Chiropractic Services:
Chiropractic office visits can no longer accumulate to the annual service limits for out-ofnetwork providers. Services for therapies and manipulations will continue to accumulate
to the service limit.
Prenatal and Well Child Care:
Health care reform requires that prenatal and well child care are covered at 100% of
billed charge for out-of-network providers.
Non-Participating Provider Pricing:
To provide greater transparency when members utilize non-participating providers, the
allowed amount will be determined based upon Medicare’s allowed amount.
This change does not impact the non-participating pricing for emergency services.
Allowed amounts for emergency services provided at an emergency department or a
hospital and by non-participating providers are based on billed charge.
Creditable Coverage Disclosure for Pharmacy Benefits:
There are two disclosures relating to creditable coverage: 1) disclosure to Medicareeligible members; and 2) disclosure to Centers for Medicare and Medicaid Services
(CMS).
20
2012 Renewal Bulletin and Plan Design Changes (Cont.)
Creditable Coverage Disclosure for Pharmacy Benefits (Cont.):
Member notification of creditable coverage status is due each year on October 15, upon
member request, upon plan design change, or upon termination of coverage. Member
notification is the employer’s responsibility.
Employers must also disclose creditable coverage status to CMS, which includes
information relating to the prior disclosure to members. The CMS disclosure must be
provided within 60 days after the beginning date of the plan year for which the entity is
providing the disclosure to CMS.
Massachusetts Creditable Coverage Service Option:
Massachusetts (MA) law requires that residents age 18 and older have health insurance.
To avoid monetary penalties, adults must have health insurance that meets minimum
creditable coverage requirements. Several employer and employee notification and filing
obligations accompany this creditable coverage requirement. Blue Cross and Blue Shield
of Minnesota offers services to assist employees and employers with this compliance
issue. (See the full 2012 Renewal Bulletin for specifics.)
Master Group Contract Update:
Language has been added to the master group contract under Article XIX-Health Care
Reform, section 5. Rebates. This change is related to rebates that would be required if
21
2012 Renewal Bulletin and Plan Design Changes (Cont.)
Master Group Contract Update (Cont.):
Blue Cross or Blue Plus does not meet thresholds for medical Loss Ratio (MLR).
(See the full 2012 Renewal Bulletin for specifics.)
Prescription Drug Terminology Change:
Blue Cross is changing terminology of prescription drugs from formulary/non-formulary
to preferred/non-preferred. This is a terminology change; the benefits will remain the
same.
Pain Medication Quantity Limits:
Blue Cross and Blue Shield of Minnesota recently reviewed narcotic analgesic and
combination paid medications, considering safety and usage details, as well as FDAapproved product labeling.
As a result of their findings, effective October 1, 2011, quantity limits will be
implemented for narcotic analgesics and combination pain medications for both of their
formularies (Carleton’s formulary is FlexRx).
22
2012 Renewal Bulletin and Plan Design Changes (Cont.)
Pain Medication Quantity Limits (Cont.):
Providers will receive letters with the names of their patients who were prescribed a
quantity over the limit for their medication. Member letters notifying that they were
prescribed pain medication exceeding the quantity limits will also be sent. Providers will
work with members to reevaluate their medication.
Please visit the Human Resources to access the 2012 Group Renewal Bulletin in
detail.
23
2012 Benefit Plan Overview/Refresher
Employees who wish to have a
refresher on our benefit plans for
BCBS, Delta Dental, The Hartford,
TASC, and TIAA-CREF may wish to
stay for the remainder of this
presentation.
Individual appointments may also be
scheduled with Andrea (x5989) or
Kerstin (x4068).
24
Options Blue-Aware
HEALTH PLAN
In-network
Out-of-network
Individual
$1,000
$1,000
2-Party/Family
$1,500/$2,000
$1,500/$2,000
Individual
$1,900
$1,900
2-Party/Family
$2,550/$3,800
$2,550/$3,800
Coinsurance
80%
80%
Lifetime maximum
Unlimited
Unlimited
HRA
$500 Individual,
$750 2-Party,
$1000 Family
$500 Individual,
$750 2-Party,
$1000 Family
Health Plan
Eligible
Expenses
Health Plan
Eligible
Expenses
Deductible
Out-of-pocket
maximum
Contribution
Rollover
Covered
expenses
Options Blue-Aware (Cont’d.)
Preventive
care
Routine cancer
screening
100%
100%
Routine physical
exams
100%
100%
Well-child care
(up to age 6)
100%
100%
Immunizations
(up to age 18)
100%
80% after
deductible
Routine hearing
exams
Lab and x-ray
services
Immunizations
Routine vision
exams
Options Blue-Aware (Cont’d.)
Covered services
Services received
Inpatient care

Facility services

Professional
services
Outpatient care

Facility services

Professional
services

Lab and x-ray
services
Physician’s office

Office visits for
illness

In-office surgery

Allergy-related
services

Urgent care

Lab and x-ray
services
Emergency room care

Emergency room

Physician services
• Ambulance services
In-network
Out-of-network
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
80% after deductible
Options Blue-Aware (Cont’d.)
Covered services
Maternity Care
Prescription
drugs
Generic Feature:
If a brand name is selected
when a generic is available,
the member will pay the
higher co-pay plus the
difference between the cost of
the brand and the generic.
The difference amount does
not accumulate toward the
OOPM.
In-network
Out-of-network
•Prenatal care
100%
100%
•Facility services for
delivery
80% after deductible
80% after deductible
•Professional services
for delivery
80% after deductible
80% after deductible
•Retail pharmacy
(31-day supply)
$15 Generic Drugs
$35 Brand Name Preferred Drugs
$55 Brand Name Non-Preferred
Drugs
$15 Generic Drugs
$35 Brand Name Preferred Drugs
$55 Brand Name Non-Preferred Drugs
Prescription Drug Out-of-pocket
maximum:
$750 Individual
$1,000 Family
Prescription Drug Out-of-pocket
maximum:
$750 Individual
$1,000 Family
$30 Generic Drugs
$70 Brand Name Preferred Drugs
$110 Brand Name Non-Preferred
Drugs
$30 Generic Drugs
$70 Brand Name Preferred Drugs
$110 Brand Name Non-Preferred
Drugs
Prescription Drug Out-of-pocket
maximum:
$750 Individual
$1,000 Family
Prescription Drug Out-of-pocket
maximum:
$750 Individual
$1,000 Family
Medical equipment and supplies
80% after deductible
80% after deductible
Behavioral health
(mental health
and chemical
dependency)
•Physician services
80% after deductible
80% after deductible
•Inpatient
80% after deductible
80% after deductible
•Outpatient
80% after deductible
80% after deductible
•90-day Rx
(retail or mail)
Step Therapy Classes:
Antidepressants, Cholesterol
Lowering, Diabetic Monitors &
Strips, Proton Pump
Inhibitors.
28
Options Blue-Aware (Cont’d.)
Covered services
In-network
Out-of-network
Rehabilitative care (physical, occupational,
speech therapy)
80% after deductible
80% after deductible
Chiropractic care
80% after deductible
($500 maximum for out-ofnetwork PT/OT/ST providers
combined)
80% after deductible
($500 maximum for out-ofnetwork Chiropractic
providers)
29
Options Blue-Aware
$2000
deductible
$1,500
deductible
$1,000
deductible
Aware PPO
Covered services
In-network benefits
Out-of-network
benefits
Individual
$500
$1,000
Family
$1,000
$2,000
Individual
$2,000
$4,000
Family
$4,000
$8,000
Lifetime maximum
Unlimited
Unlimited
Coinsurance
80%
60%
Deductible
Out-of-pocket
maximum
Aware PPO (Cont’d.)
Covered
services
In-network
benefits
Out-ofnetwork
benefits
Routine physical exams
100%
60% after deductible
Routine cancer screening
100%
60% after deductible
Routine hearing exams
100%
60% after deductible
Lab and x-ray services
100%
60% after deductible
Immunizations
100%
60% after deductible
Routine vision exams
100%
60% after deductible
Well-child care (up to age
6)
100%
100%
Immunizations (up to age
18)
100%
60% after deductible
Preventive care
Aware PPO (Cont’d.)
Covered services
Services received
In-network
benefits
Out-of-network
benefits
Inpatient care

Facility services
80% after deductible
60% after deductible

Professional services
80% after deductible
60% after deductible
Outpatient care

Facility services
80% after deductible
60% after deductible

Professional services
80% after deductible
60% after deductible
Lab and x-ray
services
Physician’s office
80% after deductible
60% after deductible

Office visits for
illness
In-office surgery
100% after $35 copay
60% after deductible
80% after deductible
60% after deductible
Allergy-related
services
Urgent care
80% after deductible
60% after deductible
100% after $35 copay
60% after deductible
Lab and x-ray
services
Emergency room care
80% after deductible
60% after deductible

Emergency room
100% after $75 copay
100% after $75 copay

Physician services
100%
100%
80% after deductible
80% after deductible





Ambulance services
Aware PPO (Cont’d.)
In-network benefits
Out-of-network
benefits
•Prenatal care
100%
100%
•Facility services
for delivery
80% after deductible
60% after deductible
•Professional
services for
delivery
80% after deductible
60% after deductible
•Retail pharmacy
(31-day supply)
$15 Generic Drugs
$35 Brand Name Preferred Drugs
$55 Brand Name Non-Preferred
Drugs
$15 Generic Drugs
$35 Brand Name Preferred Drugs
$55 Brand Name Non-Preferred
Drugs
Prescription Drug Out of Pocket
Maximum:
$500 Per Person
Prescription Drug Out of Pocket
Maximum:
$500 Per Person
$30 Generic Drugs
$70 Brand Name Preferred Drugs
$110 Brand Name Non-Preferred
Drugs
$30 Generic Drugs
$70 Brand Name Preferred Drugs
$110 Brand Name Non-Preferred
Drugs
Prescription Drug Out of Pocket
Maximum:
$500 Per Person
Prescription Drug Out of Pocket
Maximum:
$500 Per Person
80% after deductible
60% after deductible
Covered services
Maternity care
Prescription drugs
Generic Feature:
If a brand name is selected
when a generic is available, the
member will pay the higher copay plus the difference between
the cost of the brand and the
generic. The difference amount
does not accumulate toward
the OOPM.
Step Therapy Classes:
Antidepressants, Cholesterol
Lowering, Diabetic Monitors &
Strips, Proton Pump Inhibitors.
•90 day Rx
(retail or mail)
Medical equipment and supplies
34
Aware PPO (Cont’d.)
In-network benefits
Out-of-network
benefits
•Inpatient
80% after deductible
60% after deductible
•Outpatient
80% after deductible
60% after deductible
•Physician services
100% after $35 co-pay for office
visits. All other services 80%
after deductible.
60$ after deductible
Rehabilitative care (physical, occupational,
speech therapy)
100% after $35 co-pay for office
visits. All other services 80%
after deductible.
60% after deductible
($500 maximum for out-of
network PT/OT/ST providers
combined)
Chiropractic care
100% after $35 co-pay for office
visits. All other services 80%
after deductible.
60% after deductible
($500 maximum for out-of
network Chiropractic providers)
Covered services
Behavioral health (mental
health and chemical
dependency)
35
Aware PPO
Accord HRA
Summary of Providers not included in Accord:
• Mayo Clinic Providers
–
–
–
–
–
Mayo Clinic
St. Mary’s Rochester
Rochester Methodist
Kasson Mayo Family Practice (contracted under Mayo Clinic)
Kenyon Mayo Family Practice (contracted under Mayo Clinic)
• Hazelden Providers
–
–
–
–
Hazelden
Hazelden OP CD Treatment
Youth and Family & extended residential CD treatment
Mental health clinics
Note: All Mayo Health System clinics (Faribault,
Northfield, Owatonna, etc.) are in the Accord
network
Accord HRA (Cont’d.)
HEALTH PLAN
In-network
Out-of-network
Deductible
Individual
$1,000
$1,000
2-Party/Family
$1,500/$2,000
$1,500/$2,000
Individual
Out-ofpocket
2-Party/Family
maximum
Coinsurance
$1,900
$5,000
$2,550/$3,800
$7,500/$10,000
80%
60%
Lifetime maximum
Unlimited
Unlimited
HRA
$500 Individual,
$750 2-Party,
$1000 Family
$500 Individual,
$750 2-Party,
$1000 Family
Contribution
Rollover
Covered expenses
Health Plan Eligible Health Plan
Expenses
Eligible Expenses
Accord HRA (Cont’d.)
Covered
HEALTHservices
PLAN
In-network
In-network
Preventiv Routine cancer 100%
e care
screening
Routine physical 100%
exams
Routine hearing
exams
Lab and x-ray
services
Immunizations
Routine vision
exams
Well-child care
(up to age 6)
Immunizations
(up to age 18)
Out-of-network
Out-of-network
100%
100%
100%
100%
100%
60% after
deductible
Accord HRA (Cont’d.)
HEALTH PLAN
In-network
Services
Inpatient care
Covered services
received
In-network
Out-of-network
Out-of-network

Facility services
80% after deductible
60% after deductible

Professional services 80% after deductible
60% after deductible
Outpatient care

Facility services
80% after deductible
60% after deductible

Professional services 80% after deductible
60% after deductible

Lab and x-ray
services
Physician’s office
80% after deductible
60% after deductible

Office visits for
illness
In-office surgery
80% after deductible
60% after deductible
80% after deductible
60% after deductible
Allergy-related
services
Urgent care
80% after deductible
60% after deductible
80% after deductible
60% after deductible
Lab and x-ray
services
Emergency room care
80% after deductible
60% after deductible

Emergency room
80% after deductible
60% after deductible

Physician services
80% after deductible
60% after deductible
80% after deductible
60% after deductible




Ambulance services
Accord HRA (Cont’d.)
HEALTH PLAN
Maternity Care
Prescription
drugs
Generic Feature:
If a brand name is selected
when a generic is available,
the member will pay the
higher co-pay plus the
difference between the cost of
the brand and the generic.
The difference amount does
not accumulate toward the
OOPM.
In-network
Out-of-network
•Prenatal care
100%
100%
•Facility services for
delivery
80% after deductible
80% after deductible
•Professional services
for delivery
80% after deductible
80% after deductible
•Retail pharmacy
(31-day supply)
$15 Generic Drugs
$35 Brand Name Preferred Drugs
$55 Brand Name Non-Preferred
Drugs
$15 Generic Drugs
$35 Brand Name Preferred Drugs
$55 Brand Name Non-Preferred Drugs
Prescription Drug Out-of-pocket
maximum:
$750 Individual
$1,000 Family
•90-day Rx
(retail or mail)
Step Therapy Classes:
Antidepressants, Cholesterol
Lowering, Diabetic Monitors &
Strips, Proton Pump
Inhibitors.
$30 Generic Drugs
$70 Brand Name Preferred Drugs
$110 Brand Name Non-Preferred
Drugs
Prescription Drug Out-of-pocket
maximum:
$750 Individual
$1,000 Family
Prescription Drug Out-of-pocket
maximum:
$750 Individual
$1,000 Family
$30 Generic Drugs
$70 Brand Name Preferred Drugs
$110 Brand Name Non-Preferred Drugs
Prescription Drug Out-of-pocket
maximum:
$750 Individual
$1,000 Family
Medical equipment and supplies
80% after deductible
60% after deductible
Behavioral health
(mental health
and chemical
dependency)
•Physician services
80% after deductible
60% after deductible
•Inpatient
80% after deductible
60% after deductible
•Outpatient
80% after deductible
60% after deductible
41
Accord HRA (Cont’d.)
HEALTH PLAN
In-network
Out-of-network
Rehabilitative care (physical, occupational,
speech therapy)
80% after deductible
60% after deductible
Chiropractic care
80% after deductible
($500 maximum for out-ofnetwork PT/OT/ST providers
combined)
60% after deductible
($500 maximum for out-ofnetwork Chiropractic
providers)
42
Accord HRA
$2000
deductible
$1,500
deductible
$1,000
deductible
Two-party and family plans are
subject to individual deductibes
and out-of-pocket maximums.
An individual can meet their own
deductible and out-of-pocket
maximum before other family
members . Individuals within
the family may have claims
processed at different levels of
coverage. Total expenses will
not exceed plan deductibles and
out-of-pocket maximums.
Prescription Drug Out of pocket maximum comparison:
Options Blue
(Aware)
$750
Individual
$1,000 Family
Accord HRA
$750
Individual
$1,000 Family
Aware PPO
$500 per
person
2012 Delta Dental Plans
• Value Plan
A Snapshot of Your Coverage*
Service & Description
Diagnostic & Preventive Services
Exams & cleanings, x-rays, fluoride
treatments, sealants, space maintainers
Basic Services
Emergency treatment for relief of pain,
amalgam restorations (silver fillings) and
composite resin restorations (white
fillings)
Endodontics
Pulpotomies on primary teeth for
dependent children, root canal therapy
on permanent teeth
Periodontics
Surgical/Nonsurgical periodontics
Oral Surgery
Surgical/Nonsurgical extractions, all
other oral surgery
45
Delta Dental PPO
Delta Dental Premier®
Non-Participating
100%
100%
100% of maximum
allowable fee**
80%
80%
80% of maximum
allowable fee**
80%
80%
80% of maximum
allowable fee**
80%
80%
80% of maximum
allowable fee**
80%
80%
80% of maximum
allowable fee**
2012 Delta Dental Plans (Cont.)
• Value Plan
A Snapshot of Your Coverage* (Cont.)
Service & Description
Delta Dental
PPO
Delta Dental Premier®
Non-Participating
$50/$150
$50/$150
$50/$150
$750
$750
$750
Deductible
Per person/per family (calendar
year)
No deductible for diagnostic and
preventive services
Calendar Year Plan Maximum
Per person
Eligible Dependents
Spouse, qualified same sex domestic partner and unmarried dependent
children up to age 26.
*This is a summary of benefits only and does not guarantee coverage. For a complete list of covered services and
limitations/exclusions, please refer to the Dental Benefit Plan Summary.
**Dentists who have signed a participating network agreement with Delta Dental have agreed to accept the
maximum allowable fee as payment in full. Non-participating dentists have not signed an agreement and are not
obligated to limit the amount they charge; the member is responsible for paying any difference to the nonparticipating dentists.
46
2012 Delta Dental Plans (Cont.)
• Comprehensive Premier Plan
A Snapshot of Your Coverage*
Service & Description
Delta Dental PPO
Delta Dental Premier®
Diagnostic & Preventive Services
Exams & cleanings, x-rays, fluoride
treatments,
sealants,
space
maintainers
100%
100%
100% of maximum allowable
fee**
Basic Services
Emergency treatment for relief of pain,
amalgam restorations (silver fillings)
and
composite resin
restorations
(white fillings)
80%
80%
80% of maximum allowable
fee**
Endodontics
Pulpotomies on primary teeth for
dependent children, root canal therapy
on permanent teeth
80%
80%
80% of maximum allowable
fee**
Periodontics
Surgical/Nonsurgical periodontics
80%
80%
80% of maximum allowable
fee**
Oral Surgery
Surgical/Nonsurgical extractions, all
other oral surgery
80%
80%
80% of maximum allowable
fee**
Major Restorative
Crowns
50%
50%
50% of maximum allowable
fee**
80%
80%
80% of maximum allowable
fee**
Prosthetic Repairs and
Adjustments
Denture adjustments and repairs,
bridge repair
47
Non-Participating
2012 Delta Dental Plans (Cont.)
• Comprehensive Premier Plan
A Snapshot of Your Coverage* (Cont.)
Service & Description
Delta Dental PPO
Delta Dental Premier®
Non-Participating
Prosthetics
Dentures (full and partial), bridges
Orthodontics
Treatment for the prevention/ correction
of malocclusion, available for dependent
children only,
age 8 up to age 19
Deductible
Per person/per family (calendar year)
No deductible for diagnostic and
preventive services or orthodontics
50%
50%
50% of maximum allowable fee**
50%
50%
50% of maximum allowable fee**
$50/$150
$50/$150
$50/$150
$1000
$1000
$1000
$1000
$1000
$1000
Calendar Year Plan Maximum
Per person
Lifetime Ortho Maximum
Per eligible child
Eligible Dependents
Spouse, qualified same sex domestic partner and unmarried dependent children up to
age 26.
*This is a summary of benefits only and does not guarantee coverage. For a complete list of covered services and limitations/exclusions, please refer to
the Dental Benefit Plan Summary.
**Dentists who have signed a participating network agreement with Delta Dental have agreed to accept the maximum allowable fee as payment in full.
Non-participating dentists have not signed an agreement and are not obligated to limit the amount they charge; the member is responsible for paying any
difference to the non-participating dentists.
48
The Hartford: Long-Term Disability
• Voluntary Long-Term Disability Insurance pays you a portion of
your earnings if you cannot work because of a disabling illness or
injury.
• You may purchase coverage that pays you a benefit of 60% of
your earnings (to the maximum of $16,666.66 per month).
• You must be disabled for the later of 90 days or the date you
exhaust your Sick Leave before you are eligible to receive a
Voluntary Long-Term Disability Insurance benefit payment.
• Benefit payments will be reduced by other income received (e.g.
Social Security Disability Insurance, Workers’ Compensation,
Retirement Benefits, etc.).
• Employees without this current benefit can request coverage. A
Personal Health Application (PHA) will need to be completed,
followed by a medical underwriting process through The Hartford.
• Premium payroll deductions will ensue once confirmation of
coverage has been received.
49
The Hartford: Voluntary Life Insurance
•
•
•
•
•
50
Newly hired benefit-eligible (non-union) employees may purchase voluntary groupterm life insurance in increments of $10,000. Maximum amount of purchase is
$500,000. At the time of hire, employees can receive $150,000 in guaranteed
access (without need for medical underwriting).
Newly hired benefit-eligible (Union) employees may purchase voluntary group-term
life insurance in the following increments: $1,000, $2,000, $3,000, $4,000, $5,000,
$6,000 or $6,500. (The maximum benefit is $6,500.)
For existing benefit-eligible (non-union or union) employees without current
coverage, you may apply for the benefit; however, it will require the completion of a
Personal Health Application (PHA) and a medical underwriting process with The
Hartford. Premium payroll deductions will ensue upon confirmation of coverage.
For existing benefit-eligible (non-union or union) employees with existing coverage
that wish to increase their coverage (not to exceed the maximums listed above), the
completion of a Personal Health Application (PHA) and a medical underwriting
process with The Hartford will be required. Premium payroll deductions will remain
the same until authorization for the increase in coverage is received.
Benefit Reductions: Your benefits will be reduced by 35% at ages 65, 70, 75; and by
an additional 25% of the reduced amount at ages 80, 85, 90 and 85. All coverage
cancels at retirement.
Medical/Dependent Care Flexible Spending
• Medical Flex Spending Limit=
$5,000
• Dependent Care Flex Spending Limit =
$5,000
Both accounts have risk of forfeiture.
Please be conservative when making your
election.
OTC Medicines, FSAs & Health Care Reform
Health care reform legislation passed by Congress
and signed by President Obama in March, 2010
changed the rules for health care flexible spending
account (FSA) benefit plans.
Starting Jan. 1, 2011, you can no longer be
reimbursed from an FSA for over-the-counter (OTC)
drugs or medicines without a prescription.
Many OTC supplies, such as bandages, will still be
eligible
for FSA reimbursement
without
a
prescription.
52
OTC Medicines, FSAs & Health Care Reform (Cont.)
What this means to you?
• Decide how much to contribute to your
health care FSA with this law in mind.
• If you use OTC drugs or medicines
recommended by your doctor to treat a
medical condition, you may want to ask
your doctor for a prescription.
• You will purchase these drugs or medicines
by paying for them yourself. Then, you can
use your TASC debit card or fax, mail or go
online to www.tasconline.com to submit for
reimbursement from your FSA.
53
OTC Medicines, FSAs & Health Care Reform (Cont.)
Following are examples of OTC items that will
require a prescription for FSA reimbursement:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
54
Bengay, Flexall, pain relieving creams or gels
Calamine lotion
Canker/cold sore relievers
Cold medicines
Corn removal
Diaper rash ointment
GasX, baby gas drops
Hemorrhoid creams and treatments
Hydrogen Peroxide or rubbing alcohol
Indigestion or anti-acid relievers
Laxatives
Nicotine patch
Pain relievers (Tylenol, Advil, Aspirin, etc.)
Sinus medicines
Suppositories
Teething gel
Wart removal medication
Eligible Medical Expenses for a Health Care FSA
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
55
Acupuncture
Artificial limbs
Bandages
Birth control, contraceptive devices
Birthing classes/Lamaze – only the mother’s portion (not the coach/spouse) and
the class must be only for birthing instruction, not child rearing
Blood pressure monitor
Blood sugar test kits/test strips
Chiropractic therapy/exams/adjustments
Contact lens and contact lens solutions
Co-payments
Crutches (purchased or rented)
Deductible and co-insurance
Diabetic supplies
Eye exams
Eyeglasses, contacts, or safety glasses, prescription only (warranties are not
reimbursable)
Flu shots
Hearing aids and hearing aid batteries (warranties are not reimbursable)
Heating pad
Incontinence supplies
Infertility treatments
Insulin
Eligible Medical Expenses for a Health Care FSA (Cont.)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
56
Lactation expenses (breast pumps, etc.)
Laser eye surgery; LASIK
Legal sterilization
Medical supplies to treat an injury or illness
Mileage to and from doctor appointments
Nasal strips
Optometrist’s or ophthalmologist’s fees
Orthopedic inserts
Physicals
Physical therapy (as medical treatment)
Physician’s fee and hospital services
Pregnancy test
Prescription drugs and medications
Psychotherapy, psychiatric and psychological service
Reading glasses
Sales tax on eligible expenses
Services connected with donating an organ
Sleep apnea services/products (as prescribed)
Smoking cessation programs
Treatment for alcoholism or drug dependency
Vaccinations
Wrist supports, elastic wraps
X-ray fees
Eligible Dental Expenses for a Health Care FSA
•
•
•
•
•
•
•
57
Braces and orthodontic services
Cleanings
Crowns
Deductibles, co-insurance
Dental implants
Dentures, adhesives
Fillings
Eligible Expenses for the Disabled for a Health Care FSA
•
•
•
•
•
•
•
58
Automobile equipment and installation costs for a disabled person in excess of the
cost of an ordinary automobile; device for lifting a mobility impaired person into
an automobile
Braille books and magazines in excess of cost of regular editions
Note-Taker, cost of, for a hearing impaired child in school
Seeing eye dog (buying, training and maintaining)
Special devices, such as a tape recorder or typewriter for a visually impaired
person
Visual alert system in the home or other items such as a special phone required
for a hearing impaired person
Wheelchair or autoette (cost of operating/maintaining)
FSA Healthcare Expenses Requiring Additional Documentation
The following are some expenses eligible only when incurred to treat a diagnosed
medical condition. This type of expense requires a Prescription Order Form from your
physician to be submitted along with your request for reimbursement that contains
the medical necessity of the expense, the diagnosed condition, the onset of the
condition and the physician’s signature:
•
•
•
•
•
•
•
•
•
•
59
Ear plugs
Massage treatments
Nursing services for care of a special medical ailment
Orthopedic shoes (excess cost of ordinary shoes)
Oxygen equipment and oxygen
Speech therapy
Support hose
Varicose vein treatment
Veneers
Wigs (for mental health condition of individual who loses hair because of a
disease)
Eligible Expenses for a Dependent Care FSA
Eligible dependent care expenses must be employment related.
•
•
•
•
•
•
•
•
60
Day Camp – primary purpose must be custodial care and not educational in
nature
Dependent care expenses that are necessary for you (and your spouse) to
work, actively look for work, or attend school full time.
Dependent care for a child under age 13
FICA/FUTA taxes of day care provider
Late pick-up fees
Nanny expenses attributed to dependent care
Nursery school (Pre-School)
Registration fees – when allocated to dependent care services that have
been provided
TIAA-CREF
Defined Contribution Plan
(Carleton’s Regular Retirement Plan)
Carleton College’s retirement plan is a Defined Contribution plan that operates under
Section 403(b) of the Internal Revenue Code (IRC). The plan was established on 9/1/79
and it’s purpose is to provide retirement benefits for participating employees. Benefits
are provided through:
A. Teachers Insurance and Annuity Association (TIAA). TIAA provides a traditional
annuity and a variable annuity through its real estate account.
B. College Retirement Equities Fund (CREF). CREF is TIAA’s companion organization,
providing variable annuities.
Our plan year begins January 1 and ends December 31.
Eligible employees (all benefit-eligible employees, excluding bargaining unit employees)
can participate in the Plan. Independent Contractors are ineligible to participate.
61
403 (b) Retirement Plans
Defined Contribution Plan
(Carleton’s Regular Retirement Plan)
(Cont.)
Eligibility: Benefit-eligible employees that are 21 years of age or older.
Contributions: Mandatory Employer: 10%; Mandatory Employee: 2% on compensation
earned, excluding overtime pay, bonuses, and other forms of supplemental
remuneration. There are limits on contributions; the total amount made on your behalf
will not exceed the limits imposed by section 415 and section 403(b) of the IRC. For
2011, the limitation is $49,000.
Vesting: Your contribution to this account will be 100% vested immediately.
Investment Choices: A variety of investment choices from an array of asset classes to
help you diversity for your retirement portfolio are available to you. For the TIAA
annuity, you have a traditional annuity and real estate account; for the CREF, you have
stock, money market, bond, social choice, global equities, growth, equity index and
inflation-linked bond accounts available.
62
403 (b) Retirement Plans
Defined Contribution Plan
(Carleton’s Regular Retirement Plan)
(Cont.)
Expenses: Expenses vary from investment to investment. Reference the TIAA-CREF
website under the “Investment Choices” page; select an asset class and on the name of
the investment you would like to learn more about.
Distributions: When it’s time to decide how to take income from your Carleton College
Defined Contribution plan, there are a variety of options available. Please visit the TIAACREF website for specifics.
Taxation: Contributions are made pre-tax; federal income taxes are deferred until you
begin taking withdrawals later on. You can withdraw funds only after termination of
employment or age 59-1/2. If you withdraw before age 59-1/2, they are subject to an
additional 10% early-withdrawal penalty.
Loans: Our Carleton College Defined Contribution Plan does not offer a loan feature.
63
403 (b) Retirement Plans
Defined Contribution Plan
(Carleton’s Regular Retirement Plan)
(Cont.)
Retirement income usually begins at normal retirement age (65); you may begin to
receive annuity income at any time which may be either earlier or later than the normal
retirement age.
Retirement benefits must normally begin no later than April 1 of the calendar year
following the year in which you reach age 70-1/2, or, if later, April 1 following the
calendar year in which you retire. Failure to begin annuity income by the required
beginning date may subject you to a substantial federal tax penalty.
View the SPD for detailed specifics on the Defined Contribution Plan via the Human
Resources website.
64
403 (b) Retirement Plans
Tax Deferred Annuity Plan
Carleton’s Voluntary Retirement Plan – Group Supplemental Retirement Annuity
(GSRA)
This Plan was originally adopted on 1/1/1995 and runs from January 1 through December 31.
Eligibility: Employees that are 21 years of age or older, regardless of benefit eligibility status.
Contributions: This plan allows for only voluntary employee contributions, not to exceed the
maximum annual limits. For 2011, it is $16,500 (which includes contributions made to other
deferred plans). The age 50 “catch up” allows for an additional $5,500 in 2011. For employees
that have worked here at least 15 years, you can make a special catch-up contribution equal to
the smallest of three amounts as listed below:
1. $3,000
2. $15,000 minus the amount of the Special 403(b) Catch-Up Contributions made in prior
years.
3. $5,000 times the number of years you have worked for Carleton – minus – the total
amount of deferrals made while you worked for Carleton.
If you contribute too much to this plan as a deferral, the excess amount (plus any earnings on
the excess) must be taken from the plan by April 15th of the following year the money was
contributed. Failure to do so will impose additional taxation.
65
403 (b) Retirement Plans
Tax Deferred Annuity Plan
Carleton’s Voluntary Retirement Plan – Group Supplemental Retirement Annuity (GSRA)
(Cont.)
Employer Matching: There is no Carleton College employer match for this plan.
Vesting: Your contribution to this account will be 100% vested immediately.
Investments: A variety of investment choices from an array of asset classes to help you
diversity for your retirement portfolio are available to you (e.g. equities, real estate, fixed
income, money market, guaranteed, and multi-asset).
Expenses: Expenses vary from investment to investment. Reference the TIAA-CREF website
under the “Investment Choices” page; select an asset class and on the name of the investment
you would like to learn more about.
Withdrawing Funds: You may request distribution of deferrals at time of termination, if you
become disabled, when you reach 59-1/2, or on account of **hardship (**your hardship event
must meet the plan’s qualifications). Before taking a hardship distribution, you must take all
other distributions and non-taxable loans available to you under the plan. If taking a hardship
loan and you are under 59-1/2, the distribution is subject to a 10% penalty tax (unless you
were called to active military duty).
66
403 (b) Retirement Plans
Tax Deferred Annuity Plan
Carleton’s Voluntary Retirement Plan – Group Supplemental Retirement Annuity (GSRA)
(Cont.)
Loans: Loans are available from a minimum of $1,000 to a maximum of $50,000; how much you can
borrow depends on the amount you currently have in the plan and whether you have other outstanding
loans taken within the last year. If there are no outstanding loans in the previous year, the maximum
loan cannot be greater than one-half of your vested account balance or $50,000 (whichever is less).
There are further loan stipulations, as well. Please reference the SPD for specifics.
Distributions: There are a variety of options available to you when it’s time to begin taking money from
your TDA plan. You can withdraw funds from your account (while still employed) once you have
reached 59-1/2. Please see the TIAA-CREF website for a more comprehensive overview on distribution
options.
Age 70-1/2 Required Distributions: When you reach 70-1/2, you will need to begin taking distribution
each year based on your balance in the Plan.
Taxation: These voluntary contributions are made with pre-tax dollars; federal income taxes are
deferred on supplemental plans until you begin taking withdrawals. Funds can be withdrawn only after
termination of employment or age 59-1/2. If you withdraw funds before age 59-1/2, they would be
subject to a 10% early withdrawal penalty. For additional information and guidance, contact your tax
advisor.
67
Resources
• Enrollment resources are available
on HR web site
• BlueCross and BlueShield web site –
http://www.bluecrossmn.org
• BlueCross and BlueShield Customer
Service – (866) 870-0348
• One-on-one appointments can be
scheduled with Kerstin or Andrea
during the open enrollment period.