a guide to your employee benefits 2020
TRANSCRIPT
A Guide to Your Employee Benefits 2020
TABLE OF CONTENTS
Welcome Your well-being is important to us
Charles R Drew University of Medicine and Science (ldquoCDUrdquo) continues to offer health and wellness benefits to help you stay healthy and provide financial protection against high medical costs The program incorporates a variety of benefit plans from which employees can choose and the following pages provide a brief overview of the benefits available The various plans made available are very comprehensive
Eligibility amp Enrollment 2
Employee Contributions 3
Medical 4
Medical Plans Comparison 5
Medical Carrier Programs 6-7
Dental 8
Vision 9
Life and Accidental Death amp Dismemberment 10
Short Term Disability 11
Long Term Disability 12
Unum Voluntary Insurance 13
Flexible Spending Accounts 14
Employee Assistance Program 15
Other Benefits 16
University Holidays 18
CarrierVendor Contacts 19
Required Notices 20
PAGE 1
Health Care Reform
You have heard about
Healthcare Reform and the public
health insurance marketplaces
including Covered California
Individuals who are not offered
qualified healthcare coverage
through their employer may be
eligible for tax subsidies to help
pay for health insurance
premiums for plans purchased in
the public marketplaces (based
on the level of income and
number of dependents) Due to
the high standard of health
coverage CDU offers our
employees will generally NOT be
eligible for these subsidies
If you have Medicare or will become eligible for Medicare in the next 12 months a federal law gives you more
choices about your prescription drug coverage Please see page 23 for details
ELIGIBILITY amp ENROLLMENT
ELIGIBLE EMPLOYEESYou may enroll in our benefits program if you are a Regular or Conditional employee working a minimum of 20 paid hours per week
CHANGES IN BENEFIT ELECTIONS
Each year during Open Enrollment you will have the opportunity to change your elections for the following plan year
In general only during Open Enrollment will you have the opportunity to
bull Add or terminate coveragebull Add or terminate dependents
from coverage
FSA ELECTIONS
Each year you will also need to re-enroll for your FSA elections
QUESTIONS ABOUT YOUR BENEFITS
The CDU Benefits Call Center and Benefits portal are available to assist you with any benefit questions you may have
The Benefits Call Center is availableMonday ndash Thursday 5am - 5pm PST andFriday 5am ndash 3pm PST
(855) 230-0745extension 6412
customersupportbenxcelcom
wwwbenxcelnet
ELIGIBLE DEPENDENTSAs you become eligible for benefits so do your eligible dependents In general eligible dependents include your spouse or domestic partner (same or opposite sex) and children up to the age of 26 for Medical Dental Vision and Voluntary Life If your child is mentally or physically disabled coverage may continue beyond the age of 26 Children may include natural adopted stepchildren or domestic partnerrsquos children
WHEN COVERAGE BEGINSEmployees will be eligible for Medical Dental Vision Life Disability EAP and FSA benefits on the first day of the month following date of hire with CDU and completion of the required paperwork All elections are in effect for the entire plan year and can only be changed during Open Enrollment or if you experience a qualified status change
NOTE If you do not make health benefit elections within 30 days of your eligibility date you will be deemed to have waived coverage until the next open enrollment period
WHEN COVERAGE ENDSIn general your coverage under CDUrsquos Medical Dental and Vision plans ends the last day of the month in which you terminate employment Your coverage under CDUrsquos Life Disability EAP and FSA plans ends on your last day of active employment Covered employees and qualified dependents are permitted to continue certain coverages at their own expense after leaving CDU as provided by federal law (COBRA)
QUALIFIED STATUS CHANGES
You can make some limited changes during the year due to a Qualified Status Change You must notify CDU within 30 days of a qualified status change Some qualified status changes may include
bull Marriage or divorce
bull Birth of a child
bull Spousersquos termination or commencement of employment
bull A reduction or increase in hours of employment by the participant spouse or dependent including a shift between part-time and full-time status or going on or returning from an extended leave of absence
PAGE 2
EMPLOYEE CONTRIBUTIONSYour benefit contributions are automatically payroll deducted each pay period Contributions for Medical Dental Vision and Flexible Spending Accounts are deducted on a pre-tax basis Deductions for certain other benefits are deducted on an after-tax basis in order to receive a tax-free benefit at time of claim
The IRS requires that you pay taxes for domestic partner coverage if your domestic partner and the children of your domestic partner are not considered your IRS tax dependent This impacts you in two ways First your payroll contribution for domestic partner coverage is an after-tax deduction Second CDUrsquos cost of providing domestic partner coverage is added to your taxable income Please contact Human Resources for a detailed description of the domestic partner requirements
CARRIER COVERAGE CATEGORY EMPLOYEESEMI-MONTHLY
COST
CDUSEMI-MONTHLY
COST
Kaiser Medical HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$5250$16848$12805$22239
$24640$48911$40998$70421
Aetna Medical HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$5250$16848$12805$22239
$28670$57765$48249$82918
Aetna Medical OAMCEE Only
EE + SpouseEE + Child(ren)
EE + Family
$10060$29080$22926$39817
$43605$88652$73400$126088
DeltaCareUSA
Dental HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$175$442$421$653
$569$840$934$1434
Delta Dental of CA
Dental PPOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$554$1463$1668$2537
$2058$3729$3820$5917
VSP VisionEE Only
EE + SpouseEE + Child(ren)
EE + Family
$257$411$330$519
$087$278$324$513
CignaBasic Life ADampD
Dependent LifeVoluntary Life Ins
EE OnlyDependentsEE + Family
Employer PaidEmployee PaidEmployee Paid
MHN EAP EE + Family Employer Paid
Cigna STD LTD EE Only Employer Paid
BCC Health Care FSA amp Dependent Care
FSA
Health Care up to $2700yr
Dep Care up to $5000yr
Employee Paid
Unum Supplement Products
EE + Family Employee Paid
PAGE 3
MEDICAL
CDU has three medical plans to choose from Please refer to our Medical Plan Comparison Chart on the next page for more details about these plans or refer to your carrier benefit summaries
LOCATE A PROVIDER
To find participating providers go to httpwwwaetnacomdocfindhomedoor wwwkporg for a local Kaiser Permanente facility
AETNA HMO
AETNA OPEN ACCESS MANAGED CHOICE (OAMC)The Aetna OAMC plan offers more flexibility in selecting providers As a OAMC plan member you may receive health care services from any licensed health care provider However if you choose an in-network provider (a provider who belongs to the Aetna Open Access network) claims will be submitted to Aetna for you and there is a significant cost savings compared to using a non-network OAMC provider When using non-OAMC health care providers members are responsible for any difference between the in-network contracted rate and the actual charges as well as any deductible and coinsurance percentage
KAISER PERMANENTE HMOUnder the Kaiser HMO plan most services are covered in full or require a co-pay through Kaiser You may select a Primary Care Physician from any of the Kaiser Permanente locations but it is not required
You can enroll in the Kaiser Permanente HMO if you live or work within the Kaiser service area Under the plan you must receive non-emergency routine and scheduled services (eg preventive care appointments school physicals) from Kaiser physicians and facilities Emergency care is covered at any hospital facility including non-Kaiser facilities
PRESCRIPTION DRUGSIf you are on a maintenance medication (eg high blood pressure allergies birth control or other daily medications) you can save time and money by having your prescriptions dispensed through the mail order program
Please note that the prescription drug formulary lists are periodically updated by the insurance carriers Based on these updates some drugs will change Rx tier may require step therapypre-authorization or may require an alternative drug These updates generally apply to all of the carrierrsquos plans not just to CDUrsquos plan
PAGE 4
The Aetna HMO plan is designed for you to visit providers that are only contracted with Aetna You will need to choose a Primary Care Physician (PCP) and coordinate care with any Specialists through this PCP Note that services received outside the Aetna HMO network are not covered except for emergency services
MEDICAL PLANS COMPARISON
Each medical plan charges different co-pays and coinsurance for various services The chart below provides a comparison of basic costs and services of the plans CDU offers This chart is only a partial listing of plan features
MEDICAL PLAN OPTIONS
FEATURE OR SERVICE KAISER PERMANENTE HMO AETNA HMO
AETNA OPEN ACCESS MANAGED CHOICE (OAMC)
NETWORK NON-NETWORK
Annual Deductible None None $1000 Member$2000 Family
$2000 Member$4000 Family
Out-of-Pocket MaximumIndividualFamily
$1500$3000
$2000$4000
$3500$7000
$7000$14000
Office Visit $30 per visit $15 per visit (PCP)$30 per visit (Specialist)
$25 per visit (PCP)$50 per visit (Specialist)
40 after deductible
Preventive (physical exams well-baby etc)
No charge No charge No charge(deductible waived)
40 after deductible
Most X-Ray amp Lab No charge No charge 20 after deductible 40 after deductible
Urgent Care $30 copay $35 copay $35 copay 40 after deductible
Emergency Room(copay waived if admitted)
$100 copay $150 copay $150 copay + 20 $150 copay + 20
Chiropractic
Acupuncture
Not covered
$30 per visit for certain services
$15 per visit (20 visitsyear)
$15 per visit(20 visitsyear)
$50 (limited to 20 visitsyear)
$50 (limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
Hospital CoverageInpatient (to avoid addrsquol copays preauthorization is recommended)
Outpatient
$500 per admit
$100 per procedure
$250 per admit
$100 per surgery
20 after deductible
20 after deductible
40 after deductible
40 after deductible
Prescription Drug Retail Day Supply
Preferred GenericPreferred BrandNon-PreferredSpecialty
Up to 30 days$15 copay$30 copay
Not applicable30 up to $150script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Not Covered
Prescription Drug Mail Order Day Supply
Preferred GenericPreferred BrandNon-Preferred
Up to 100 days$30 copay$60 copay
Not applicable
Up to 90 days$20 copay$60 copay$100 copay
Up to 90 days$20 copay$60 copay
$100 copay
Not Applicable
PAGE 5
AETNA PROGRAMS AND SERVICES
AETNA PROGRAMS
Informed Health
Teledoc
Health Connections
Beginning Bright
Simple Steps To a Healthier Life
Discount Programs
Fitness Discounts
Rx Mail Order
247 NURSE LINE ndash INFORMED HEALTH reg | (800) 556-1555 The Informed Health reg program provides members with telephone and e-mail access to registered nurses to help them make informed healthcare decisions Nurses are available 24 hours a day and 7 days a week
BEGINNING RIGHT reg MATERNITY MANAGEMENT | (800) 272-3531Pregnancy can be an exciting time filled with hopes and dreams for your baby The most important thing you can do right now to make those dreams come true is to take good care of yourself This program is designed to help you have a safe delivery and a healthy child The line is staffed by registered nurses 24 hours a day seven days a week
WELLNESS AND DISCOUNT PROGRAMS
bull A toll-free number you can call about pregnancy labor what to expect before and after delivery newborn care and more
bull Some women have health conditions that could affect their pregnancies If you do you can work with a nurse case manager to help you lower those risks
bull Support to quit smoking and help to avoid you going into early labor
Simple Steps To a Healthier Life reg is a road to better health with programs and resources tailored to meet your needs
To locate the discounts that are available to you once yoursquore an Aetna member just log in to your member website at aetnacom You can find a vision hearing or natural therapy professional sign up for a weight-loss program buy health products find a gym and more
PAGE 6
TELEDOC reg | (855) 835-2362 Teladocreg is a convenient and affordable option for a variety of medical services including General Medical Dermatology and Behavioral Health Access quality healthcare from the comfort of home during your lunch break or while traveling You can even get a prescription sent to your local pharmacy when medically necessary
HEALTH CONNECTIONS reg DISEASE MANAGEMENT | (866) 269-4500Health Connections reg is a disease management program that helps members with chronic conditions achieve a healthy outcome through advanced tools techniques and systems Aetna personalizes the condition coaching for members to motivate and empower them to change their behaviors and therefore reduce health risks
KAISER PERMANENTEHEALTHY LIVING PROGRAMS
Kaiser | wwwkporg
bull Manage Your Health
bull Schedule Appointments
bull Refill Prescriptions
bull Email Your Doctor
bull View Test Results
bull Tools and Calculators
bull Health Classes
bull Healthy Lifestyle Programs
As a Kaiser Permanente member you have access to discounts on health products and services through ChooseHealthy As a comprehensive health website offering a directory of complementary health care providers information about complementary health care services and discounts on health and wellness products such as
Visit wwwkporgchoosehealthy and click on ldquocomplementary carerdquo or call American Specialty Health at (877) 335-2746 to learn more about this program sign up or take an online tour
MY HEALTH MANAGER | wwwkporgregister
bull Acupuncturebull Massage therapy servicesbull Fitness club memberships
My Health manager gives you access to powerful online tools designed to help you manage your health You can email your doctorrsquos office order prescription refills view most lab test results request routine appointments check past office visit information look up future appointments and more Once you register you will be able to get connected in a single visit without having to wait for your password to be emailed to you
bull Manage ongoing health conditions ndash When you join HealthMedia Care you will receive a plan for managing your symptoms medication and treatment as well as encouraging reminders for making healthy lifestyle changes
bull Lose Weight ndash HealthMedia Balance gives you personalized strategies for reaching your ideal weight with a program thatrsquos helped thousands of people lose weight and keep it off
bull Eat Right ndash HealthMedia Nourish gives you personalized strategies for making smart and delicious food choices to increase your energy level manage your weight and live a healthier life
bull Quit Smoking ndash This award-winning program can help you create a personalized quitting plan with proven strategies for decreasing your dependency and dealing with cravings
bull Overcome Stress ndash Examine your individual sources and symptoms of stress and develop a customized stress management plan that will help you start living a healthier and more relaxed life
Using the Kaiser Permanente web site you can access the latest healthy lifestyle and medical information right from your own home ndash anytime day or night Whether yoursquod like to quit smoking lose weight control your cholesterol start a fitness program manage your diabetes or reduce stress the Kaiser Permanente website can help
HEALTHY LIFESTYLE PROGRAMSKaiser Permanente has collaborated with HealthMedia to offer you programs such as
bull Chiropractic carebull Herbs vitamins and supplementsbull Health and fitness books and videos
PAGE 7
You and your eligible dependents have the option to enroll in one of two dental plans the Deltacare Dental DHMO plan or the Delta Dental DPPO plan
Under the DeltaCare Dental DHMO there are no deductibles and most dental benefits are unlimited Each family member must select a Primary DentistFacility from the list of Delta Dental dentists when they enroll All services and referrals to specialty care will be coordinated by the Primary DentistFacility
The Delta Dental DPPO allows you the flexibility of seeing a network dentist and receiving benefits at a discounted rate or seeing a non-network dentist and paying the difference between the fee schedule charges and what your dentist bills There is no need to select a dentist at enrollment under the Dental DPPO plan
DENTAL
Using Your Dental Benefits Wisely
bull To pay the least amount out-of-pocket always use in-network dentists under the DPPO
bull Use your preventive benefits and get cleanings for you and your family
bull If your services are estimated to be $350 or more by your dentist be sure to have your dentist get pre-determination of benefits to Delta Dental to ensure services are covered and to get an estimate of what the plan will pay
Fee Schedule Claims incurred outside of the Delta Dental PPO dental network are subject to fee schedule levels Fee schedule represents the maximum dollar amount Delta Dental will pay on certain services The member is responsible for any amounts charged over the fee schedule
DENTAL PLAN OPTIONS
FEATURE OR SERVICE
DELTACAREDHMO
DELTA DENTAL DPPO
NETWORK NON-NETWORK
Deductible None $50 Individual$150 Family
Deductible Waived on PreventiveServices
NA Yes
Annual Calendar Year BenefitMaximum
Unlimited $1500 $1250
Preventive Services copay schedule No charge 80 covered
Basic Services copay schedule 80 covered
Major Services copay schedule 50 covered
Orthodontia copay schedule lifetime max of $1500
PAGE 8
You have the opportunity to participate in the VSP Vision Plan The vision program allows you to utilize VSPrsquos network of eye care providers or see an eye care professional outside the network
VISION
How Long Has It Been Since Your Last Eye Exam
Your eyes provide a clear view of your blood vessels Optometrists and Ophthalmologists can be the first to detect symptoms of illnesses such as cardiovascular disease diabetes and thyroid disorders
Members may be offered discounted fees for extra features added to lenses such as tinting scratch coating and progressive (blended bifocals) lenses when they utilize VSP providers
Members have the choice between lenses or contacts each 12-month interval If you choose contact lenses you will not be eligible for a frame for 12 months following the date contacts were obtained Note the contact lens evaluation fee and fitting costs are separate from the comprehensive vision care exam
VISION PLAN HIGHLIGHTS
FEATURE OR SERVICE NETWORK NON-NETWORK
Deductible for Materials $20
Exams $15 $45 Allowance
LensesSingleLined-BifocalLined-Trifocal
Paid in fullPaid in fullPaid in full
$30 Allowance$50 Allowance$65 Allowance
Frames $120 Retail Allowance (plus 20 off amount over the allowance)
$70 Allowance
Contacts(including fitting amp evaluation)
$120 Retail Allowance $105 Retail Allowance
FrequencyExamsLensesFramesContacts (in lieu of lensesamp frames)
12 Months12 Months12 Months12 Months
NETWORK vs NON-NETWORK COVERAGEDollar for dollar you get the best value from your vision benefit when you visit a VSP in-network doctor If you decide to see a non-network doctor copays still apply and yoursquoll typically receive a lesser benefit When you use a non-network doctor you are required to pay the provider in full at the time of your appointment and submit a claim form to VSP for reimbursement
PAGE 9
LASER VISION CAREVSP has contracted with many of the nationrsquos laser surgery facilities and doctors offering members discounts off laser vision correction surgeries available through contracted laser centers Contact VSP to learn more
Life insurance is an important part of a complete benefits package offered by CDU CDU pays 100 of the cost of a Basic Life and Accidental Death amp Dismemberment (ADampD) for all eligible employees through Cigna
LIFE AND ACCIDENTAL DEATH amp DISMEMBERMENT
Voluntary Life Insurance Features
Accelerated BenefitIf you become terminally ill and are not expected to live beyond a certain period you may request a of your life insurance amount (to a certain maximum) Upon your death the remaining benefit will be paid to the designated beneficiary(ies)
Portability amp ConversionIf you retire reduce your hours or terminate employment you can generally take this coverage with you according to the terms outlined in the contract
VOLUNTARY LIFE PLAN OPTIONS
COVERAGE TYPE COVERAGE AMOUNTS
Employee bull In increments of $10000bull The lesser of $500000 or 5x salarybull Guarantee Issue $100000 (new employees only)
SpouseDomestic Partner bull In increments of $5000bull Maximum 50 of Employee Face Amount not to
exceed $250000bull Guarantee Issue $50000 (new employees only)
Children bull In increments of $2000bull Maximum of $10000bull Birth to 6 months limited to $1000 coverage amount
PAGE 10
The Guarantee Issue amounts apply only when you are first eligible for benefits under the CDU plan If you (andor your dependents) do not elect voluntary life insurance coverage when first eligible the entire amount of life insurance elected will require medical underwriting
BASIC LIFE amp ADampD INSURANCEThe basic life policy will pay a benefit of one times your annual salary to a maximum of $400000 with a minimum benefit of $50000 The benefit amount will reduce to 65 of the original amount when you reach age 65 and to 50 of the original amount at age 70
NOTE To avoid imputed income on the premium for life insurance amounts over $50000 you may opt to reduce your Basic LifeADampD coverage to $50000
OPTIONAL DEPENDENT LIFE COVERAGEYou also have the option to purchase life insurance in the amount of $2000 for your spouse and dependent child(ren)
VOLUNTARY LIFE COVERAGECDU also offers voluntary life insurance You may purchase additional Life insurance for not only yourself but also your dependents The coverage amount will reduce to 65 at age 65 and 45 at age 70 You are eligible to purchase the following amounts
VOLUNTARY LIFE MEDICAL UNDERWRITING
Please note that certain changes during the year (eg salary updates) could result in an adjustment to your payroll deduction amounts
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
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- Slide Number 5
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- Slide Number 7
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- Slide Number 18
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-
TABLE OF CONTENTS
Welcome Your well-being is important to us
Charles R Drew University of Medicine and Science (ldquoCDUrdquo) continues to offer health and wellness benefits to help you stay healthy and provide financial protection against high medical costs The program incorporates a variety of benefit plans from which employees can choose and the following pages provide a brief overview of the benefits available The various plans made available are very comprehensive
Eligibility amp Enrollment 2
Employee Contributions 3
Medical 4
Medical Plans Comparison 5
Medical Carrier Programs 6-7
Dental 8
Vision 9
Life and Accidental Death amp Dismemberment 10
Short Term Disability 11
Long Term Disability 12
Unum Voluntary Insurance 13
Flexible Spending Accounts 14
Employee Assistance Program 15
Other Benefits 16
University Holidays 18
CarrierVendor Contacts 19
Required Notices 20
PAGE 1
Health Care Reform
You have heard about
Healthcare Reform and the public
health insurance marketplaces
including Covered California
Individuals who are not offered
qualified healthcare coverage
through their employer may be
eligible for tax subsidies to help
pay for health insurance
premiums for plans purchased in
the public marketplaces (based
on the level of income and
number of dependents) Due to
the high standard of health
coverage CDU offers our
employees will generally NOT be
eligible for these subsidies
If you have Medicare or will become eligible for Medicare in the next 12 months a federal law gives you more
choices about your prescription drug coverage Please see page 23 for details
ELIGIBILITY amp ENROLLMENT
ELIGIBLE EMPLOYEESYou may enroll in our benefits program if you are a Regular or Conditional employee working a minimum of 20 paid hours per week
CHANGES IN BENEFIT ELECTIONS
Each year during Open Enrollment you will have the opportunity to change your elections for the following plan year
In general only during Open Enrollment will you have the opportunity to
bull Add or terminate coveragebull Add or terminate dependents
from coverage
FSA ELECTIONS
Each year you will also need to re-enroll for your FSA elections
QUESTIONS ABOUT YOUR BENEFITS
The CDU Benefits Call Center and Benefits portal are available to assist you with any benefit questions you may have
The Benefits Call Center is availableMonday ndash Thursday 5am - 5pm PST andFriday 5am ndash 3pm PST
(855) 230-0745extension 6412
customersupportbenxcelcom
wwwbenxcelnet
ELIGIBLE DEPENDENTSAs you become eligible for benefits so do your eligible dependents In general eligible dependents include your spouse or domestic partner (same or opposite sex) and children up to the age of 26 for Medical Dental Vision and Voluntary Life If your child is mentally or physically disabled coverage may continue beyond the age of 26 Children may include natural adopted stepchildren or domestic partnerrsquos children
WHEN COVERAGE BEGINSEmployees will be eligible for Medical Dental Vision Life Disability EAP and FSA benefits on the first day of the month following date of hire with CDU and completion of the required paperwork All elections are in effect for the entire plan year and can only be changed during Open Enrollment or if you experience a qualified status change
NOTE If you do not make health benefit elections within 30 days of your eligibility date you will be deemed to have waived coverage until the next open enrollment period
WHEN COVERAGE ENDSIn general your coverage under CDUrsquos Medical Dental and Vision plans ends the last day of the month in which you terminate employment Your coverage under CDUrsquos Life Disability EAP and FSA plans ends on your last day of active employment Covered employees and qualified dependents are permitted to continue certain coverages at their own expense after leaving CDU as provided by federal law (COBRA)
QUALIFIED STATUS CHANGES
You can make some limited changes during the year due to a Qualified Status Change You must notify CDU within 30 days of a qualified status change Some qualified status changes may include
bull Marriage or divorce
bull Birth of a child
bull Spousersquos termination or commencement of employment
bull A reduction or increase in hours of employment by the participant spouse or dependent including a shift between part-time and full-time status or going on or returning from an extended leave of absence
PAGE 2
EMPLOYEE CONTRIBUTIONSYour benefit contributions are automatically payroll deducted each pay period Contributions for Medical Dental Vision and Flexible Spending Accounts are deducted on a pre-tax basis Deductions for certain other benefits are deducted on an after-tax basis in order to receive a tax-free benefit at time of claim
The IRS requires that you pay taxes for domestic partner coverage if your domestic partner and the children of your domestic partner are not considered your IRS tax dependent This impacts you in two ways First your payroll contribution for domestic partner coverage is an after-tax deduction Second CDUrsquos cost of providing domestic partner coverage is added to your taxable income Please contact Human Resources for a detailed description of the domestic partner requirements
CARRIER COVERAGE CATEGORY EMPLOYEESEMI-MONTHLY
COST
CDUSEMI-MONTHLY
COST
Kaiser Medical HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$5250$16848$12805$22239
$24640$48911$40998$70421
Aetna Medical HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$5250$16848$12805$22239
$28670$57765$48249$82918
Aetna Medical OAMCEE Only
EE + SpouseEE + Child(ren)
EE + Family
$10060$29080$22926$39817
$43605$88652$73400$126088
DeltaCareUSA
Dental HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$175$442$421$653
$569$840$934$1434
Delta Dental of CA
Dental PPOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$554$1463$1668$2537
$2058$3729$3820$5917
VSP VisionEE Only
EE + SpouseEE + Child(ren)
EE + Family
$257$411$330$519
$087$278$324$513
CignaBasic Life ADampD
Dependent LifeVoluntary Life Ins
EE OnlyDependentsEE + Family
Employer PaidEmployee PaidEmployee Paid
MHN EAP EE + Family Employer Paid
Cigna STD LTD EE Only Employer Paid
BCC Health Care FSA amp Dependent Care
FSA
Health Care up to $2700yr
Dep Care up to $5000yr
Employee Paid
Unum Supplement Products
EE + Family Employee Paid
PAGE 3
MEDICAL
CDU has three medical plans to choose from Please refer to our Medical Plan Comparison Chart on the next page for more details about these plans or refer to your carrier benefit summaries
LOCATE A PROVIDER
To find participating providers go to httpwwwaetnacomdocfindhomedoor wwwkporg for a local Kaiser Permanente facility
AETNA HMO
AETNA OPEN ACCESS MANAGED CHOICE (OAMC)The Aetna OAMC plan offers more flexibility in selecting providers As a OAMC plan member you may receive health care services from any licensed health care provider However if you choose an in-network provider (a provider who belongs to the Aetna Open Access network) claims will be submitted to Aetna for you and there is a significant cost savings compared to using a non-network OAMC provider When using non-OAMC health care providers members are responsible for any difference between the in-network contracted rate and the actual charges as well as any deductible and coinsurance percentage
KAISER PERMANENTE HMOUnder the Kaiser HMO plan most services are covered in full or require a co-pay through Kaiser You may select a Primary Care Physician from any of the Kaiser Permanente locations but it is not required
You can enroll in the Kaiser Permanente HMO if you live or work within the Kaiser service area Under the plan you must receive non-emergency routine and scheduled services (eg preventive care appointments school physicals) from Kaiser physicians and facilities Emergency care is covered at any hospital facility including non-Kaiser facilities
PRESCRIPTION DRUGSIf you are on a maintenance medication (eg high blood pressure allergies birth control or other daily medications) you can save time and money by having your prescriptions dispensed through the mail order program
Please note that the prescription drug formulary lists are periodically updated by the insurance carriers Based on these updates some drugs will change Rx tier may require step therapypre-authorization or may require an alternative drug These updates generally apply to all of the carrierrsquos plans not just to CDUrsquos plan
PAGE 4
The Aetna HMO plan is designed for you to visit providers that are only contracted with Aetna You will need to choose a Primary Care Physician (PCP) and coordinate care with any Specialists through this PCP Note that services received outside the Aetna HMO network are not covered except for emergency services
MEDICAL PLANS COMPARISON
Each medical plan charges different co-pays and coinsurance for various services The chart below provides a comparison of basic costs and services of the plans CDU offers This chart is only a partial listing of plan features
MEDICAL PLAN OPTIONS
FEATURE OR SERVICE KAISER PERMANENTE HMO AETNA HMO
AETNA OPEN ACCESS MANAGED CHOICE (OAMC)
NETWORK NON-NETWORK
Annual Deductible None None $1000 Member$2000 Family
$2000 Member$4000 Family
Out-of-Pocket MaximumIndividualFamily
$1500$3000
$2000$4000
$3500$7000
$7000$14000
Office Visit $30 per visit $15 per visit (PCP)$30 per visit (Specialist)
$25 per visit (PCP)$50 per visit (Specialist)
40 after deductible
Preventive (physical exams well-baby etc)
No charge No charge No charge(deductible waived)
40 after deductible
Most X-Ray amp Lab No charge No charge 20 after deductible 40 after deductible
Urgent Care $30 copay $35 copay $35 copay 40 after deductible
Emergency Room(copay waived if admitted)
$100 copay $150 copay $150 copay + 20 $150 copay + 20
Chiropractic
Acupuncture
Not covered
$30 per visit for certain services
$15 per visit (20 visitsyear)
$15 per visit(20 visitsyear)
$50 (limited to 20 visitsyear)
$50 (limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
Hospital CoverageInpatient (to avoid addrsquol copays preauthorization is recommended)
Outpatient
$500 per admit
$100 per procedure
$250 per admit
$100 per surgery
20 after deductible
20 after deductible
40 after deductible
40 after deductible
Prescription Drug Retail Day Supply
Preferred GenericPreferred BrandNon-PreferredSpecialty
Up to 30 days$15 copay$30 copay
Not applicable30 up to $150script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Not Covered
Prescription Drug Mail Order Day Supply
Preferred GenericPreferred BrandNon-Preferred
Up to 100 days$30 copay$60 copay
Not applicable
Up to 90 days$20 copay$60 copay$100 copay
Up to 90 days$20 copay$60 copay
$100 copay
Not Applicable
PAGE 5
AETNA PROGRAMS AND SERVICES
AETNA PROGRAMS
Informed Health
Teledoc
Health Connections
Beginning Bright
Simple Steps To a Healthier Life
Discount Programs
Fitness Discounts
Rx Mail Order
247 NURSE LINE ndash INFORMED HEALTH reg | (800) 556-1555 The Informed Health reg program provides members with telephone and e-mail access to registered nurses to help them make informed healthcare decisions Nurses are available 24 hours a day and 7 days a week
BEGINNING RIGHT reg MATERNITY MANAGEMENT | (800) 272-3531Pregnancy can be an exciting time filled with hopes and dreams for your baby The most important thing you can do right now to make those dreams come true is to take good care of yourself This program is designed to help you have a safe delivery and a healthy child The line is staffed by registered nurses 24 hours a day seven days a week
WELLNESS AND DISCOUNT PROGRAMS
bull A toll-free number you can call about pregnancy labor what to expect before and after delivery newborn care and more
bull Some women have health conditions that could affect their pregnancies If you do you can work with a nurse case manager to help you lower those risks
bull Support to quit smoking and help to avoid you going into early labor
Simple Steps To a Healthier Life reg is a road to better health with programs and resources tailored to meet your needs
To locate the discounts that are available to you once yoursquore an Aetna member just log in to your member website at aetnacom You can find a vision hearing or natural therapy professional sign up for a weight-loss program buy health products find a gym and more
PAGE 6
TELEDOC reg | (855) 835-2362 Teladocreg is a convenient and affordable option for a variety of medical services including General Medical Dermatology and Behavioral Health Access quality healthcare from the comfort of home during your lunch break or while traveling You can even get a prescription sent to your local pharmacy when medically necessary
HEALTH CONNECTIONS reg DISEASE MANAGEMENT | (866) 269-4500Health Connections reg is a disease management program that helps members with chronic conditions achieve a healthy outcome through advanced tools techniques and systems Aetna personalizes the condition coaching for members to motivate and empower them to change their behaviors and therefore reduce health risks
KAISER PERMANENTEHEALTHY LIVING PROGRAMS
Kaiser | wwwkporg
bull Manage Your Health
bull Schedule Appointments
bull Refill Prescriptions
bull Email Your Doctor
bull View Test Results
bull Tools and Calculators
bull Health Classes
bull Healthy Lifestyle Programs
As a Kaiser Permanente member you have access to discounts on health products and services through ChooseHealthy As a comprehensive health website offering a directory of complementary health care providers information about complementary health care services and discounts on health and wellness products such as
Visit wwwkporgchoosehealthy and click on ldquocomplementary carerdquo or call American Specialty Health at (877) 335-2746 to learn more about this program sign up or take an online tour
MY HEALTH MANAGER | wwwkporgregister
bull Acupuncturebull Massage therapy servicesbull Fitness club memberships
My Health manager gives you access to powerful online tools designed to help you manage your health You can email your doctorrsquos office order prescription refills view most lab test results request routine appointments check past office visit information look up future appointments and more Once you register you will be able to get connected in a single visit without having to wait for your password to be emailed to you
bull Manage ongoing health conditions ndash When you join HealthMedia Care you will receive a plan for managing your symptoms medication and treatment as well as encouraging reminders for making healthy lifestyle changes
bull Lose Weight ndash HealthMedia Balance gives you personalized strategies for reaching your ideal weight with a program thatrsquos helped thousands of people lose weight and keep it off
bull Eat Right ndash HealthMedia Nourish gives you personalized strategies for making smart and delicious food choices to increase your energy level manage your weight and live a healthier life
bull Quit Smoking ndash This award-winning program can help you create a personalized quitting plan with proven strategies for decreasing your dependency and dealing with cravings
bull Overcome Stress ndash Examine your individual sources and symptoms of stress and develop a customized stress management plan that will help you start living a healthier and more relaxed life
Using the Kaiser Permanente web site you can access the latest healthy lifestyle and medical information right from your own home ndash anytime day or night Whether yoursquod like to quit smoking lose weight control your cholesterol start a fitness program manage your diabetes or reduce stress the Kaiser Permanente website can help
HEALTHY LIFESTYLE PROGRAMSKaiser Permanente has collaborated with HealthMedia to offer you programs such as
bull Chiropractic carebull Herbs vitamins and supplementsbull Health and fitness books and videos
PAGE 7
You and your eligible dependents have the option to enroll in one of two dental plans the Deltacare Dental DHMO plan or the Delta Dental DPPO plan
Under the DeltaCare Dental DHMO there are no deductibles and most dental benefits are unlimited Each family member must select a Primary DentistFacility from the list of Delta Dental dentists when they enroll All services and referrals to specialty care will be coordinated by the Primary DentistFacility
The Delta Dental DPPO allows you the flexibility of seeing a network dentist and receiving benefits at a discounted rate or seeing a non-network dentist and paying the difference between the fee schedule charges and what your dentist bills There is no need to select a dentist at enrollment under the Dental DPPO plan
DENTAL
Using Your Dental Benefits Wisely
bull To pay the least amount out-of-pocket always use in-network dentists under the DPPO
bull Use your preventive benefits and get cleanings for you and your family
bull If your services are estimated to be $350 or more by your dentist be sure to have your dentist get pre-determination of benefits to Delta Dental to ensure services are covered and to get an estimate of what the plan will pay
Fee Schedule Claims incurred outside of the Delta Dental PPO dental network are subject to fee schedule levels Fee schedule represents the maximum dollar amount Delta Dental will pay on certain services The member is responsible for any amounts charged over the fee schedule
DENTAL PLAN OPTIONS
FEATURE OR SERVICE
DELTACAREDHMO
DELTA DENTAL DPPO
NETWORK NON-NETWORK
Deductible None $50 Individual$150 Family
Deductible Waived on PreventiveServices
NA Yes
Annual Calendar Year BenefitMaximum
Unlimited $1500 $1250
Preventive Services copay schedule No charge 80 covered
Basic Services copay schedule 80 covered
Major Services copay schedule 50 covered
Orthodontia copay schedule lifetime max of $1500
PAGE 8
You have the opportunity to participate in the VSP Vision Plan The vision program allows you to utilize VSPrsquos network of eye care providers or see an eye care professional outside the network
VISION
How Long Has It Been Since Your Last Eye Exam
Your eyes provide a clear view of your blood vessels Optometrists and Ophthalmologists can be the first to detect symptoms of illnesses such as cardiovascular disease diabetes and thyroid disorders
Members may be offered discounted fees for extra features added to lenses such as tinting scratch coating and progressive (blended bifocals) lenses when they utilize VSP providers
Members have the choice between lenses or contacts each 12-month interval If you choose contact lenses you will not be eligible for a frame for 12 months following the date contacts were obtained Note the contact lens evaluation fee and fitting costs are separate from the comprehensive vision care exam
VISION PLAN HIGHLIGHTS
FEATURE OR SERVICE NETWORK NON-NETWORK
Deductible for Materials $20
Exams $15 $45 Allowance
LensesSingleLined-BifocalLined-Trifocal
Paid in fullPaid in fullPaid in full
$30 Allowance$50 Allowance$65 Allowance
Frames $120 Retail Allowance (plus 20 off amount over the allowance)
$70 Allowance
Contacts(including fitting amp evaluation)
$120 Retail Allowance $105 Retail Allowance
FrequencyExamsLensesFramesContacts (in lieu of lensesamp frames)
12 Months12 Months12 Months12 Months
NETWORK vs NON-NETWORK COVERAGEDollar for dollar you get the best value from your vision benefit when you visit a VSP in-network doctor If you decide to see a non-network doctor copays still apply and yoursquoll typically receive a lesser benefit When you use a non-network doctor you are required to pay the provider in full at the time of your appointment and submit a claim form to VSP for reimbursement
PAGE 9
LASER VISION CAREVSP has contracted with many of the nationrsquos laser surgery facilities and doctors offering members discounts off laser vision correction surgeries available through contracted laser centers Contact VSP to learn more
Life insurance is an important part of a complete benefits package offered by CDU CDU pays 100 of the cost of a Basic Life and Accidental Death amp Dismemberment (ADampD) for all eligible employees through Cigna
LIFE AND ACCIDENTAL DEATH amp DISMEMBERMENT
Voluntary Life Insurance Features
Accelerated BenefitIf you become terminally ill and are not expected to live beyond a certain period you may request a of your life insurance amount (to a certain maximum) Upon your death the remaining benefit will be paid to the designated beneficiary(ies)
Portability amp ConversionIf you retire reduce your hours or terminate employment you can generally take this coverage with you according to the terms outlined in the contract
VOLUNTARY LIFE PLAN OPTIONS
COVERAGE TYPE COVERAGE AMOUNTS
Employee bull In increments of $10000bull The lesser of $500000 or 5x salarybull Guarantee Issue $100000 (new employees only)
SpouseDomestic Partner bull In increments of $5000bull Maximum 50 of Employee Face Amount not to
exceed $250000bull Guarantee Issue $50000 (new employees only)
Children bull In increments of $2000bull Maximum of $10000bull Birth to 6 months limited to $1000 coverage amount
PAGE 10
The Guarantee Issue amounts apply only when you are first eligible for benefits under the CDU plan If you (andor your dependents) do not elect voluntary life insurance coverage when first eligible the entire amount of life insurance elected will require medical underwriting
BASIC LIFE amp ADampD INSURANCEThe basic life policy will pay a benefit of one times your annual salary to a maximum of $400000 with a minimum benefit of $50000 The benefit amount will reduce to 65 of the original amount when you reach age 65 and to 50 of the original amount at age 70
NOTE To avoid imputed income on the premium for life insurance amounts over $50000 you may opt to reduce your Basic LifeADampD coverage to $50000
OPTIONAL DEPENDENT LIFE COVERAGEYou also have the option to purchase life insurance in the amount of $2000 for your spouse and dependent child(ren)
VOLUNTARY LIFE COVERAGECDU also offers voluntary life insurance You may purchase additional Life insurance for not only yourself but also your dependents The coverage amount will reduce to 65 at age 65 and 45 at age 70 You are eligible to purchase the following amounts
VOLUNTARY LIFE MEDICAL UNDERWRITING
Please note that certain changes during the year (eg salary updates) could result in an adjustment to your payroll deduction amounts
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
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- Slide Number 10
- Slide Number 11
- Slide Number 12
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- Slide Number 14
- Slide Number 15
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- Slide Number 18
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- Slide Number 20
- Slide Number 21
- Slide Number 22
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- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
-
ELIGIBILITY amp ENROLLMENT
ELIGIBLE EMPLOYEESYou may enroll in our benefits program if you are a Regular or Conditional employee working a minimum of 20 paid hours per week
CHANGES IN BENEFIT ELECTIONS
Each year during Open Enrollment you will have the opportunity to change your elections for the following plan year
In general only during Open Enrollment will you have the opportunity to
bull Add or terminate coveragebull Add or terminate dependents
from coverage
FSA ELECTIONS
Each year you will also need to re-enroll for your FSA elections
QUESTIONS ABOUT YOUR BENEFITS
The CDU Benefits Call Center and Benefits portal are available to assist you with any benefit questions you may have
The Benefits Call Center is availableMonday ndash Thursday 5am - 5pm PST andFriday 5am ndash 3pm PST
(855) 230-0745extension 6412
customersupportbenxcelcom
wwwbenxcelnet
ELIGIBLE DEPENDENTSAs you become eligible for benefits so do your eligible dependents In general eligible dependents include your spouse or domestic partner (same or opposite sex) and children up to the age of 26 for Medical Dental Vision and Voluntary Life If your child is mentally or physically disabled coverage may continue beyond the age of 26 Children may include natural adopted stepchildren or domestic partnerrsquos children
WHEN COVERAGE BEGINSEmployees will be eligible for Medical Dental Vision Life Disability EAP and FSA benefits on the first day of the month following date of hire with CDU and completion of the required paperwork All elections are in effect for the entire plan year and can only be changed during Open Enrollment or if you experience a qualified status change
NOTE If you do not make health benefit elections within 30 days of your eligibility date you will be deemed to have waived coverage until the next open enrollment period
WHEN COVERAGE ENDSIn general your coverage under CDUrsquos Medical Dental and Vision plans ends the last day of the month in which you terminate employment Your coverage under CDUrsquos Life Disability EAP and FSA plans ends on your last day of active employment Covered employees and qualified dependents are permitted to continue certain coverages at their own expense after leaving CDU as provided by federal law (COBRA)
QUALIFIED STATUS CHANGES
You can make some limited changes during the year due to a Qualified Status Change You must notify CDU within 30 days of a qualified status change Some qualified status changes may include
bull Marriage or divorce
bull Birth of a child
bull Spousersquos termination or commencement of employment
bull A reduction or increase in hours of employment by the participant spouse or dependent including a shift between part-time and full-time status or going on or returning from an extended leave of absence
PAGE 2
EMPLOYEE CONTRIBUTIONSYour benefit contributions are automatically payroll deducted each pay period Contributions for Medical Dental Vision and Flexible Spending Accounts are deducted on a pre-tax basis Deductions for certain other benefits are deducted on an after-tax basis in order to receive a tax-free benefit at time of claim
The IRS requires that you pay taxes for domestic partner coverage if your domestic partner and the children of your domestic partner are not considered your IRS tax dependent This impacts you in two ways First your payroll contribution for domestic partner coverage is an after-tax deduction Second CDUrsquos cost of providing domestic partner coverage is added to your taxable income Please contact Human Resources for a detailed description of the domestic partner requirements
CARRIER COVERAGE CATEGORY EMPLOYEESEMI-MONTHLY
COST
CDUSEMI-MONTHLY
COST
Kaiser Medical HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$5250$16848$12805$22239
$24640$48911$40998$70421
Aetna Medical HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$5250$16848$12805$22239
$28670$57765$48249$82918
Aetna Medical OAMCEE Only
EE + SpouseEE + Child(ren)
EE + Family
$10060$29080$22926$39817
$43605$88652$73400$126088
DeltaCareUSA
Dental HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$175$442$421$653
$569$840$934$1434
Delta Dental of CA
Dental PPOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$554$1463$1668$2537
$2058$3729$3820$5917
VSP VisionEE Only
EE + SpouseEE + Child(ren)
EE + Family
$257$411$330$519
$087$278$324$513
CignaBasic Life ADampD
Dependent LifeVoluntary Life Ins
EE OnlyDependentsEE + Family
Employer PaidEmployee PaidEmployee Paid
MHN EAP EE + Family Employer Paid
Cigna STD LTD EE Only Employer Paid
BCC Health Care FSA amp Dependent Care
FSA
Health Care up to $2700yr
Dep Care up to $5000yr
Employee Paid
Unum Supplement Products
EE + Family Employee Paid
PAGE 3
MEDICAL
CDU has three medical plans to choose from Please refer to our Medical Plan Comparison Chart on the next page for more details about these plans or refer to your carrier benefit summaries
LOCATE A PROVIDER
To find participating providers go to httpwwwaetnacomdocfindhomedoor wwwkporg for a local Kaiser Permanente facility
AETNA HMO
AETNA OPEN ACCESS MANAGED CHOICE (OAMC)The Aetna OAMC plan offers more flexibility in selecting providers As a OAMC plan member you may receive health care services from any licensed health care provider However if you choose an in-network provider (a provider who belongs to the Aetna Open Access network) claims will be submitted to Aetna for you and there is a significant cost savings compared to using a non-network OAMC provider When using non-OAMC health care providers members are responsible for any difference between the in-network contracted rate and the actual charges as well as any deductible and coinsurance percentage
KAISER PERMANENTE HMOUnder the Kaiser HMO plan most services are covered in full or require a co-pay through Kaiser You may select a Primary Care Physician from any of the Kaiser Permanente locations but it is not required
You can enroll in the Kaiser Permanente HMO if you live or work within the Kaiser service area Under the plan you must receive non-emergency routine and scheduled services (eg preventive care appointments school physicals) from Kaiser physicians and facilities Emergency care is covered at any hospital facility including non-Kaiser facilities
PRESCRIPTION DRUGSIf you are on a maintenance medication (eg high blood pressure allergies birth control or other daily medications) you can save time and money by having your prescriptions dispensed through the mail order program
Please note that the prescription drug formulary lists are periodically updated by the insurance carriers Based on these updates some drugs will change Rx tier may require step therapypre-authorization or may require an alternative drug These updates generally apply to all of the carrierrsquos plans not just to CDUrsquos plan
PAGE 4
The Aetna HMO plan is designed for you to visit providers that are only contracted with Aetna You will need to choose a Primary Care Physician (PCP) and coordinate care with any Specialists through this PCP Note that services received outside the Aetna HMO network are not covered except for emergency services
MEDICAL PLANS COMPARISON
Each medical plan charges different co-pays and coinsurance for various services The chart below provides a comparison of basic costs and services of the plans CDU offers This chart is only a partial listing of plan features
MEDICAL PLAN OPTIONS
FEATURE OR SERVICE KAISER PERMANENTE HMO AETNA HMO
AETNA OPEN ACCESS MANAGED CHOICE (OAMC)
NETWORK NON-NETWORK
Annual Deductible None None $1000 Member$2000 Family
$2000 Member$4000 Family
Out-of-Pocket MaximumIndividualFamily
$1500$3000
$2000$4000
$3500$7000
$7000$14000
Office Visit $30 per visit $15 per visit (PCP)$30 per visit (Specialist)
$25 per visit (PCP)$50 per visit (Specialist)
40 after deductible
Preventive (physical exams well-baby etc)
No charge No charge No charge(deductible waived)
40 after deductible
Most X-Ray amp Lab No charge No charge 20 after deductible 40 after deductible
Urgent Care $30 copay $35 copay $35 copay 40 after deductible
Emergency Room(copay waived if admitted)
$100 copay $150 copay $150 copay + 20 $150 copay + 20
Chiropractic
Acupuncture
Not covered
$30 per visit for certain services
$15 per visit (20 visitsyear)
$15 per visit(20 visitsyear)
$50 (limited to 20 visitsyear)
$50 (limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
Hospital CoverageInpatient (to avoid addrsquol copays preauthorization is recommended)
Outpatient
$500 per admit
$100 per procedure
$250 per admit
$100 per surgery
20 after deductible
20 after deductible
40 after deductible
40 after deductible
Prescription Drug Retail Day Supply
Preferred GenericPreferred BrandNon-PreferredSpecialty
Up to 30 days$15 copay$30 copay
Not applicable30 up to $150script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Not Covered
Prescription Drug Mail Order Day Supply
Preferred GenericPreferred BrandNon-Preferred
Up to 100 days$30 copay$60 copay
Not applicable
Up to 90 days$20 copay$60 copay$100 copay
Up to 90 days$20 copay$60 copay
$100 copay
Not Applicable
PAGE 5
AETNA PROGRAMS AND SERVICES
AETNA PROGRAMS
Informed Health
Teledoc
Health Connections
Beginning Bright
Simple Steps To a Healthier Life
Discount Programs
Fitness Discounts
Rx Mail Order
247 NURSE LINE ndash INFORMED HEALTH reg | (800) 556-1555 The Informed Health reg program provides members with telephone and e-mail access to registered nurses to help them make informed healthcare decisions Nurses are available 24 hours a day and 7 days a week
BEGINNING RIGHT reg MATERNITY MANAGEMENT | (800) 272-3531Pregnancy can be an exciting time filled with hopes and dreams for your baby The most important thing you can do right now to make those dreams come true is to take good care of yourself This program is designed to help you have a safe delivery and a healthy child The line is staffed by registered nurses 24 hours a day seven days a week
WELLNESS AND DISCOUNT PROGRAMS
bull A toll-free number you can call about pregnancy labor what to expect before and after delivery newborn care and more
bull Some women have health conditions that could affect their pregnancies If you do you can work with a nurse case manager to help you lower those risks
bull Support to quit smoking and help to avoid you going into early labor
Simple Steps To a Healthier Life reg is a road to better health with programs and resources tailored to meet your needs
To locate the discounts that are available to you once yoursquore an Aetna member just log in to your member website at aetnacom You can find a vision hearing or natural therapy professional sign up for a weight-loss program buy health products find a gym and more
PAGE 6
TELEDOC reg | (855) 835-2362 Teladocreg is a convenient and affordable option for a variety of medical services including General Medical Dermatology and Behavioral Health Access quality healthcare from the comfort of home during your lunch break or while traveling You can even get a prescription sent to your local pharmacy when medically necessary
HEALTH CONNECTIONS reg DISEASE MANAGEMENT | (866) 269-4500Health Connections reg is a disease management program that helps members with chronic conditions achieve a healthy outcome through advanced tools techniques and systems Aetna personalizes the condition coaching for members to motivate and empower them to change their behaviors and therefore reduce health risks
KAISER PERMANENTEHEALTHY LIVING PROGRAMS
Kaiser | wwwkporg
bull Manage Your Health
bull Schedule Appointments
bull Refill Prescriptions
bull Email Your Doctor
bull View Test Results
bull Tools and Calculators
bull Health Classes
bull Healthy Lifestyle Programs
As a Kaiser Permanente member you have access to discounts on health products and services through ChooseHealthy As a comprehensive health website offering a directory of complementary health care providers information about complementary health care services and discounts on health and wellness products such as
Visit wwwkporgchoosehealthy and click on ldquocomplementary carerdquo or call American Specialty Health at (877) 335-2746 to learn more about this program sign up or take an online tour
MY HEALTH MANAGER | wwwkporgregister
bull Acupuncturebull Massage therapy servicesbull Fitness club memberships
My Health manager gives you access to powerful online tools designed to help you manage your health You can email your doctorrsquos office order prescription refills view most lab test results request routine appointments check past office visit information look up future appointments and more Once you register you will be able to get connected in a single visit without having to wait for your password to be emailed to you
bull Manage ongoing health conditions ndash When you join HealthMedia Care you will receive a plan for managing your symptoms medication and treatment as well as encouraging reminders for making healthy lifestyle changes
bull Lose Weight ndash HealthMedia Balance gives you personalized strategies for reaching your ideal weight with a program thatrsquos helped thousands of people lose weight and keep it off
bull Eat Right ndash HealthMedia Nourish gives you personalized strategies for making smart and delicious food choices to increase your energy level manage your weight and live a healthier life
bull Quit Smoking ndash This award-winning program can help you create a personalized quitting plan with proven strategies for decreasing your dependency and dealing with cravings
bull Overcome Stress ndash Examine your individual sources and symptoms of stress and develop a customized stress management plan that will help you start living a healthier and more relaxed life
Using the Kaiser Permanente web site you can access the latest healthy lifestyle and medical information right from your own home ndash anytime day or night Whether yoursquod like to quit smoking lose weight control your cholesterol start a fitness program manage your diabetes or reduce stress the Kaiser Permanente website can help
HEALTHY LIFESTYLE PROGRAMSKaiser Permanente has collaborated with HealthMedia to offer you programs such as
bull Chiropractic carebull Herbs vitamins and supplementsbull Health and fitness books and videos
PAGE 7
You and your eligible dependents have the option to enroll in one of two dental plans the Deltacare Dental DHMO plan or the Delta Dental DPPO plan
Under the DeltaCare Dental DHMO there are no deductibles and most dental benefits are unlimited Each family member must select a Primary DentistFacility from the list of Delta Dental dentists when they enroll All services and referrals to specialty care will be coordinated by the Primary DentistFacility
The Delta Dental DPPO allows you the flexibility of seeing a network dentist and receiving benefits at a discounted rate or seeing a non-network dentist and paying the difference between the fee schedule charges and what your dentist bills There is no need to select a dentist at enrollment under the Dental DPPO plan
DENTAL
Using Your Dental Benefits Wisely
bull To pay the least amount out-of-pocket always use in-network dentists under the DPPO
bull Use your preventive benefits and get cleanings for you and your family
bull If your services are estimated to be $350 or more by your dentist be sure to have your dentist get pre-determination of benefits to Delta Dental to ensure services are covered and to get an estimate of what the plan will pay
Fee Schedule Claims incurred outside of the Delta Dental PPO dental network are subject to fee schedule levels Fee schedule represents the maximum dollar amount Delta Dental will pay on certain services The member is responsible for any amounts charged over the fee schedule
DENTAL PLAN OPTIONS
FEATURE OR SERVICE
DELTACAREDHMO
DELTA DENTAL DPPO
NETWORK NON-NETWORK
Deductible None $50 Individual$150 Family
Deductible Waived on PreventiveServices
NA Yes
Annual Calendar Year BenefitMaximum
Unlimited $1500 $1250
Preventive Services copay schedule No charge 80 covered
Basic Services copay schedule 80 covered
Major Services copay schedule 50 covered
Orthodontia copay schedule lifetime max of $1500
PAGE 8
You have the opportunity to participate in the VSP Vision Plan The vision program allows you to utilize VSPrsquos network of eye care providers or see an eye care professional outside the network
VISION
How Long Has It Been Since Your Last Eye Exam
Your eyes provide a clear view of your blood vessels Optometrists and Ophthalmologists can be the first to detect symptoms of illnesses such as cardiovascular disease diabetes and thyroid disorders
Members may be offered discounted fees for extra features added to lenses such as tinting scratch coating and progressive (blended bifocals) lenses when they utilize VSP providers
Members have the choice between lenses or contacts each 12-month interval If you choose contact lenses you will not be eligible for a frame for 12 months following the date contacts were obtained Note the contact lens evaluation fee and fitting costs are separate from the comprehensive vision care exam
VISION PLAN HIGHLIGHTS
FEATURE OR SERVICE NETWORK NON-NETWORK
Deductible for Materials $20
Exams $15 $45 Allowance
LensesSingleLined-BifocalLined-Trifocal
Paid in fullPaid in fullPaid in full
$30 Allowance$50 Allowance$65 Allowance
Frames $120 Retail Allowance (plus 20 off amount over the allowance)
$70 Allowance
Contacts(including fitting amp evaluation)
$120 Retail Allowance $105 Retail Allowance
FrequencyExamsLensesFramesContacts (in lieu of lensesamp frames)
12 Months12 Months12 Months12 Months
NETWORK vs NON-NETWORK COVERAGEDollar for dollar you get the best value from your vision benefit when you visit a VSP in-network doctor If you decide to see a non-network doctor copays still apply and yoursquoll typically receive a lesser benefit When you use a non-network doctor you are required to pay the provider in full at the time of your appointment and submit a claim form to VSP for reimbursement
PAGE 9
LASER VISION CAREVSP has contracted with many of the nationrsquos laser surgery facilities and doctors offering members discounts off laser vision correction surgeries available through contracted laser centers Contact VSP to learn more
Life insurance is an important part of a complete benefits package offered by CDU CDU pays 100 of the cost of a Basic Life and Accidental Death amp Dismemberment (ADampD) for all eligible employees through Cigna
LIFE AND ACCIDENTAL DEATH amp DISMEMBERMENT
Voluntary Life Insurance Features
Accelerated BenefitIf you become terminally ill and are not expected to live beyond a certain period you may request a of your life insurance amount (to a certain maximum) Upon your death the remaining benefit will be paid to the designated beneficiary(ies)
Portability amp ConversionIf you retire reduce your hours or terminate employment you can generally take this coverage with you according to the terms outlined in the contract
VOLUNTARY LIFE PLAN OPTIONS
COVERAGE TYPE COVERAGE AMOUNTS
Employee bull In increments of $10000bull The lesser of $500000 or 5x salarybull Guarantee Issue $100000 (new employees only)
SpouseDomestic Partner bull In increments of $5000bull Maximum 50 of Employee Face Amount not to
exceed $250000bull Guarantee Issue $50000 (new employees only)
Children bull In increments of $2000bull Maximum of $10000bull Birth to 6 months limited to $1000 coverage amount
PAGE 10
The Guarantee Issue amounts apply only when you are first eligible for benefits under the CDU plan If you (andor your dependents) do not elect voluntary life insurance coverage when first eligible the entire amount of life insurance elected will require medical underwriting
BASIC LIFE amp ADampD INSURANCEThe basic life policy will pay a benefit of one times your annual salary to a maximum of $400000 with a minimum benefit of $50000 The benefit amount will reduce to 65 of the original amount when you reach age 65 and to 50 of the original amount at age 70
NOTE To avoid imputed income on the premium for life insurance amounts over $50000 you may opt to reduce your Basic LifeADampD coverage to $50000
OPTIONAL DEPENDENT LIFE COVERAGEYou also have the option to purchase life insurance in the amount of $2000 for your spouse and dependent child(ren)
VOLUNTARY LIFE COVERAGECDU also offers voluntary life insurance You may purchase additional Life insurance for not only yourself but also your dependents The coverage amount will reduce to 65 at age 65 and 45 at age 70 You are eligible to purchase the following amounts
VOLUNTARY LIFE MEDICAL UNDERWRITING
Please note that certain changes during the year (eg salary updates) could result in an adjustment to your payroll deduction amounts
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Slide Number 24
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- Slide Number 26
- Slide Number 27
- Slide Number 28
-
EMPLOYEE CONTRIBUTIONSYour benefit contributions are automatically payroll deducted each pay period Contributions for Medical Dental Vision and Flexible Spending Accounts are deducted on a pre-tax basis Deductions for certain other benefits are deducted on an after-tax basis in order to receive a tax-free benefit at time of claim
The IRS requires that you pay taxes for domestic partner coverage if your domestic partner and the children of your domestic partner are not considered your IRS tax dependent This impacts you in two ways First your payroll contribution for domestic partner coverage is an after-tax deduction Second CDUrsquos cost of providing domestic partner coverage is added to your taxable income Please contact Human Resources for a detailed description of the domestic partner requirements
CARRIER COVERAGE CATEGORY EMPLOYEESEMI-MONTHLY
COST
CDUSEMI-MONTHLY
COST
Kaiser Medical HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$5250$16848$12805$22239
$24640$48911$40998$70421
Aetna Medical HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$5250$16848$12805$22239
$28670$57765$48249$82918
Aetna Medical OAMCEE Only
EE + SpouseEE + Child(ren)
EE + Family
$10060$29080$22926$39817
$43605$88652$73400$126088
DeltaCareUSA
Dental HMOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$175$442$421$653
$569$840$934$1434
Delta Dental of CA
Dental PPOEE Only
EE + SpouseEE + Child(ren)
EE + Family
$554$1463$1668$2537
$2058$3729$3820$5917
VSP VisionEE Only
EE + SpouseEE + Child(ren)
EE + Family
$257$411$330$519
$087$278$324$513
CignaBasic Life ADampD
Dependent LifeVoluntary Life Ins
EE OnlyDependentsEE + Family
Employer PaidEmployee PaidEmployee Paid
MHN EAP EE + Family Employer Paid
Cigna STD LTD EE Only Employer Paid
BCC Health Care FSA amp Dependent Care
FSA
Health Care up to $2700yr
Dep Care up to $5000yr
Employee Paid
Unum Supplement Products
EE + Family Employee Paid
PAGE 3
MEDICAL
CDU has three medical plans to choose from Please refer to our Medical Plan Comparison Chart on the next page for more details about these plans or refer to your carrier benefit summaries
LOCATE A PROVIDER
To find participating providers go to httpwwwaetnacomdocfindhomedoor wwwkporg for a local Kaiser Permanente facility
AETNA HMO
AETNA OPEN ACCESS MANAGED CHOICE (OAMC)The Aetna OAMC plan offers more flexibility in selecting providers As a OAMC plan member you may receive health care services from any licensed health care provider However if you choose an in-network provider (a provider who belongs to the Aetna Open Access network) claims will be submitted to Aetna for you and there is a significant cost savings compared to using a non-network OAMC provider When using non-OAMC health care providers members are responsible for any difference between the in-network contracted rate and the actual charges as well as any deductible and coinsurance percentage
KAISER PERMANENTE HMOUnder the Kaiser HMO plan most services are covered in full or require a co-pay through Kaiser You may select a Primary Care Physician from any of the Kaiser Permanente locations but it is not required
You can enroll in the Kaiser Permanente HMO if you live or work within the Kaiser service area Under the plan you must receive non-emergency routine and scheduled services (eg preventive care appointments school physicals) from Kaiser physicians and facilities Emergency care is covered at any hospital facility including non-Kaiser facilities
PRESCRIPTION DRUGSIf you are on a maintenance medication (eg high blood pressure allergies birth control or other daily medications) you can save time and money by having your prescriptions dispensed through the mail order program
Please note that the prescription drug formulary lists are periodically updated by the insurance carriers Based on these updates some drugs will change Rx tier may require step therapypre-authorization or may require an alternative drug These updates generally apply to all of the carrierrsquos plans not just to CDUrsquos plan
PAGE 4
The Aetna HMO plan is designed for you to visit providers that are only contracted with Aetna You will need to choose a Primary Care Physician (PCP) and coordinate care with any Specialists through this PCP Note that services received outside the Aetna HMO network are not covered except for emergency services
MEDICAL PLANS COMPARISON
Each medical plan charges different co-pays and coinsurance for various services The chart below provides a comparison of basic costs and services of the plans CDU offers This chart is only a partial listing of plan features
MEDICAL PLAN OPTIONS
FEATURE OR SERVICE KAISER PERMANENTE HMO AETNA HMO
AETNA OPEN ACCESS MANAGED CHOICE (OAMC)
NETWORK NON-NETWORK
Annual Deductible None None $1000 Member$2000 Family
$2000 Member$4000 Family
Out-of-Pocket MaximumIndividualFamily
$1500$3000
$2000$4000
$3500$7000
$7000$14000
Office Visit $30 per visit $15 per visit (PCP)$30 per visit (Specialist)
$25 per visit (PCP)$50 per visit (Specialist)
40 after deductible
Preventive (physical exams well-baby etc)
No charge No charge No charge(deductible waived)
40 after deductible
Most X-Ray amp Lab No charge No charge 20 after deductible 40 after deductible
Urgent Care $30 copay $35 copay $35 copay 40 after deductible
Emergency Room(copay waived if admitted)
$100 copay $150 copay $150 copay + 20 $150 copay + 20
Chiropractic
Acupuncture
Not covered
$30 per visit for certain services
$15 per visit (20 visitsyear)
$15 per visit(20 visitsyear)
$50 (limited to 20 visitsyear)
$50 (limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
Hospital CoverageInpatient (to avoid addrsquol copays preauthorization is recommended)
Outpatient
$500 per admit
$100 per procedure
$250 per admit
$100 per surgery
20 after deductible
20 after deductible
40 after deductible
40 after deductible
Prescription Drug Retail Day Supply
Preferred GenericPreferred BrandNon-PreferredSpecialty
Up to 30 days$15 copay$30 copay
Not applicable30 up to $150script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Not Covered
Prescription Drug Mail Order Day Supply
Preferred GenericPreferred BrandNon-Preferred
Up to 100 days$30 copay$60 copay
Not applicable
Up to 90 days$20 copay$60 copay$100 copay
Up to 90 days$20 copay$60 copay
$100 copay
Not Applicable
PAGE 5
AETNA PROGRAMS AND SERVICES
AETNA PROGRAMS
Informed Health
Teledoc
Health Connections
Beginning Bright
Simple Steps To a Healthier Life
Discount Programs
Fitness Discounts
Rx Mail Order
247 NURSE LINE ndash INFORMED HEALTH reg | (800) 556-1555 The Informed Health reg program provides members with telephone and e-mail access to registered nurses to help them make informed healthcare decisions Nurses are available 24 hours a day and 7 days a week
BEGINNING RIGHT reg MATERNITY MANAGEMENT | (800) 272-3531Pregnancy can be an exciting time filled with hopes and dreams for your baby The most important thing you can do right now to make those dreams come true is to take good care of yourself This program is designed to help you have a safe delivery and a healthy child The line is staffed by registered nurses 24 hours a day seven days a week
WELLNESS AND DISCOUNT PROGRAMS
bull A toll-free number you can call about pregnancy labor what to expect before and after delivery newborn care and more
bull Some women have health conditions that could affect their pregnancies If you do you can work with a nurse case manager to help you lower those risks
bull Support to quit smoking and help to avoid you going into early labor
Simple Steps To a Healthier Life reg is a road to better health with programs and resources tailored to meet your needs
To locate the discounts that are available to you once yoursquore an Aetna member just log in to your member website at aetnacom You can find a vision hearing or natural therapy professional sign up for a weight-loss program buy health products find a gym and more
PAGE 6
TELEDOC reg | (855) 835-2362 Teladocreg is a convenient and affordable option for a variety of medical services including General Medical Dermatology and Behavioral Health Access quality healthcare from the comfort of home during your lunch break or while traveling You can even get a prescription sent to your local pharmacy when medically necessary
HEALTH CONNECTIONS reg DISEASE MANAGEMENT | (866) 269-4500Health Connections reg is a disease management program that helps members with chronic conditions achieve a healthy outcome through advanced tools techniques and systems Aetna personalizes the condition coaching for members to motivate and empower them to change their behaviors and therefore reduce health risks
KAISER PERMANENTEHEALTHY LIVING PROGRAMS
Kaiser | wwwkporg
bull Manage Your Health
bull Schedule Appointments
bull Refill Prescriptions
bull Email Your Doctor
bull View Test Results
bull Tools and Calculators
bull Health Classes
bull Healthy Lifestyle Programs
As a Kaiser Permanente member you have access to discounts on health products and services through ChooseHealthy As a comprehensive health website offering a directory of complementary health care providers information about complementary health care services and discounts on health and wellness products such as
Visit wwwkporgchoosehealthy and click on ldquocomplementary carerdquo or call American Specialty Health at (877) 335-2746 to learn more about this program sign up or take an online tour
MY HEALTH MANAGER | wwwkporgregister
bull Acupuncturebull Massage therapy servicesbull Fitness club memberships
My Health manager gives you access to powerful online tools designed to help you manage your health You can email your doctorrsquos office order prescription refills view most lab test results request routine appointments check past office visit information look up future appointments and more Once you register you will be able to get connected in a single visit without having to wait for your password to be emailed to you
bull Manage ongoing health conditions ndash When you join HealthMedia Care you will receive a plan for managing your symptoms medication and treatment as well as encouraging reminders for making healthy lifestyle changes
bull Lose Weight ndash HealthMedia Balance gives you personalized strategies for reaching your ideal weight with a program thatrsquos helped thousands of people lose weight and keep it off
bull Eat Right ndash HealthMedia Nourish gives you personalized strategies for making smart and delicious food choices to increase your energy level manage your weight and live a healthier life
bull Quit Smoking ndash This award-winning program can help you create a personalized quitting plan with proven strategies for decreasing your dependency and dealing with cravings
bull Overcome Stress ndash Examine your individual sources and symptoms of stress and develop a customized stress management plan that will help you start living a healthier and more relaxed life
Using the Kaiser Permanente web site you can access the latest healthy lifestyle and medical information right from your own home ndash anytime day or night Whether yoursquod like to quit smoking lose weight control your cholesterol start a fitness program manage your diabetes or reduce stress the Kaiser Permanente website can help
HEALTHY LIFESTYLE PROGRAMSKaiser Permanente has collaborated with HealthMedia to offer you programs such as
bull Chiropractic carebull Herbs vitamins and supplementsbull Health and fitness books and videos
PAGE 7
You and your eligible dependents have the option to enroll in one of two dental plans the Deltacare Dental DHMO plan or the Delta Dental DPPO plan
Under the DeltaCare Dental DHMO there are no deductibles and most dental benefits are unlimited Each family member must select a Primary DentistFacility from the list of Delta Dental dentists when they enroll All services and referrals to specialty care will be coordinated by the Primary DentistFacility
The Delta Dental DPPO allows you the flexibility of seeing a network dentist and receiving benefits at a discounted rate or seeing a non-network dentist and paying the difference between the fee schedule charges and what your dentist bills There is no need to select a dentist at enrollment under the Dental DPPO plan
DENTAL
Using Your Dental Benefits Wisely
bull To pay the least amount out-of-pocket always use in-network dentists under the DPPO
bull Use your preventive benefits and get cleanings for you and your family
bull If your services are estimated to be $350 or more by your dentist be sure to have your dentist get pre-determination of benefits to Delta Dental to ensure services are covered and to get an estimate of what the plan will pay
Fee Schedule Claims incurred outside of the Delta Dental PPO dental network are subject to fee schedule levels Fee schedule represents the maximum dollar amount Delta Dental will pay on certain services The member is responsible for any amounts charged over the fee schedule
DENTAL PLAN OPTIONS
FEATURE OR SERVICE
DELTACAREDHMO
DELTA DENTAL DPPO
NETWORK NON-NETWORK
Deductible None $50 Individual$150 Family
Deductible Waived on PreventiveServices
NA Yes
Annual Calendar Year BenefitMaximum
Unlimited $1500 $1250
Preventive Services copay schedule No charge 80 covered
Basic Services copay schedule 80 covered
Major Services copay schedule 50 covered
Orthodontia copay schedule lifetime max of $1500
PAGE 8
You have the opportunity to participate in the VSP Vision Plan The vision program allows you to utilize VSPrsquos network of eye care providers or see an eye care professional outside the network
VISION
How Long Has It Been Since Your Last Eye Exam
Your eyes provide a clear view of your blood vessels Optometrists and Ophthalmologists can be the first to detect symptoms of illnesses such as cardiovascular disease diabetes and thyroid disorders
Members may be offered discounted fees for extra features added to lenses such as tinting scratch coating and progressive (blended bifocals) lenses when they utilize VSP providers
Members have the choice between lenses or contacts each 12-month interval If you choose contact lenses you will not be eligible for a frame for 12 months following the date contacts were obtained Note the contact lens evaluation fee and fitting costs are separate from the comprehensive vision care exam
VISION PLAN HIGHLIGHTS
FEATURE OR SERVICE NETWORK NON-NETWORK
Deductible for Materials $20
Exams $15 $45 Allowance
LensesSingleLined-BifocalLined-Trifocal
Paid in fullPaid in fullPaid in full
$30 Allowance$50 Allowance$65 Allowance
Frames $120 Retail Allowance (plus 20 off amount over the allowance)
$70 Allowance
Contacts(including fitting amp evaluation)
$120 Retail Allowance $105 Retail Allowance
FrequencyExamsLensesFramesContacts (in lieu of lensesamp frames)
12 Months12 Months12 Months12 Months
NETWORK vs NON-NETWORK COVERAGEDollar for dollar you get the best value from your vision benefit when you visit a VSP in-network doctor If you decide to see a non-network doctor copays still apply and yoursquoll typically receive a lesser benefit When you use a non-network doctor you are required to pay the provider in full at the time of your appointment and submit a claim form to VSP for reimbursement
PAGE 9
LASER VISION CAREVSP has contracted with many of the nationrsquos laser surgery facilities and doctors offering members discounts off laser vision correction surgeries available through contracted laser centers Contact VSP to learn more
Life insurance is an important part of a complete benefits package offered by CDU CDU pays 100 of the cost of a Basic Life and Accidental Death amp Dismemberment (ADampD) for all eligible employees through Cigna
LIFE AND ACCIDENTAL DEATH amp DISMEMBERMENT
Voluntary Life Insurance Features
Accelerated BenefitIf you become terminally ill and are not expected to live beyond a certain period you may request a of your life insurance amount (to a certain maximum) Upon your death the remaining benefit will be paid to the designated beneficiary(ies)
Portability amp ConversionIf you retire reduce your hours or terminate employment you can generally take this coverage with you according to the terms outlined in the contract
VOLUNTARY LIFE PLAN OPTIONS
COVERAGE TYPE COVERAGE AMOUNTS
Employee bull In increments of $10000bull The lesser of $500000 or 5x salarybull Guarantee Issue $100000 (new employees only)
SpouseDomestic Partner bull In increments of $5000bull Maximum 50 of Employee Face Amount not to
exceed $250000bull Guarantee Issue $50000 (new employees only)
Children bull In increments of $2000bull Maximum of $10000bull Birth to 6 months limited to $1000 coverage amount
PAGE 10
The Guarantee Issue amounts apply only when you are first eligible for benefits under the CDU plan If you (andor your dependents) do not elect voluntary life insurance coverage when first eligible the entire amount of life insurance elected will require medical underwriting
BASIC LIFE amp ADampD INSURANCEThe basic life policy will pay a benefit of one times your annual salary to a maximum of $400000 with a minimum benefit of $50000 The benefit amount will reduce to 65 of the original amount when you reach age 65 and to 50 of the original amount at age 70
NOTE To avoid imputed income on the premium for life insurance amounts over $50000 you may opt to reduce your Basic LifeADampD coverage to $50000
OPTIONAL DEPENDENT LIFE COVERAGEYou also have the option to purchase life insurance in the amount of $2000 for your spouse and dependent child(ren)
VOLUNTARY LIFE COVERAGECDU also offers voluntary life insurance You may purchase additional Life insurance for not only yourself but also your dependents The coverage amount will reduce to 65 at age 65 and 45 at age 70 You are eligible to purchase the following amounts
VOLUNTARY LIFE MEDICAL UNDERWRITING
Please note that certain changes during the year (eg salary updates) could result in an adjustment to your payroll deduction amounts
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
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- Slide Number 26
- Slide Number 27
- Slide Number 28
-
MEDICAL
CDU has three medical plans to choose from Please refer to our Medical Plan Comparison Chart on the next page for more details about these plans or refer to your carrier benefit summaries
LOCATE A PROVIDER
To find participating providers go to httpwwwaetnacomdocfindhomedoor wwwkporg for a local Kaiser Permanente facility
AETNA HMO
AETNA OPEN ACCESS MANAGED CHOICE (OAMC)The Aetna OAMC plan offers more flexibility in selecting providers As a OAMC plan member you may receive health care services from any licensed health care provider However if you choose an in-network provider (a provider who belongs to the Aetna Open Access network) claims will be submitted to Aetna for you and there is a significant cost savings compared to using a non-network OAMC provider When using non-OAMC health care providers members are responsible for any difference between the in-network contracted rate and the actual charges as well as any deductible and coinsurance percentage
KAISER PERMANENTE HMOUnder the Kaiser HMO plan most services are covered in full or require a co-pay through Kaiser You may select a Primary Care Physician from any of the Kaiser Permanente locations but it is not required
You can enroll in the Kaiser Permanente HMO if you live or work within the Kaiser service area Under the plan you must receive non-emergency routine and scheduled services (eg preventive care appointments school physicals) from Kaiser physicians and facilities Emergency care is covered at any hospital facility including non-Kaiser facilities
PRESCRIPTION DRUGSIf you are on a maintenance medication (eg high blood pressure allergies birth control or other daily medications) you can save time and money by having your prescriptions dispensed through the mail order program
Please note that the prescription drug formulary lists are periodically updated by the insurance carriers Based on these updates some drugs will change Rx tier may require step therapypre-authorization or may require an alternative drug These updates generally apply to all of the carrierrsquos plans not just to CDUrsquos plan
PAGE 4
The Aetna HMO plan is designed for you to visit providers that are only contracted with Aetna You will need to choose a Primary Care Physician (PCP) and coordinate care with any Specialists through this PCP Note that services received outside the Aetna HMO network are not covered except for emergency services
MEDICAL PLANS COMPARISON
Each medical plan charges different co-pays and coinsurance for various services The chart below provides a comparison of basic costs and services of the plans CDU offers This chart is only a partial listing of plan features
MEDICAL PLAN OPTIONS
FEATURE OR SERVICE KAISER PERMANENTE HMO AETNA HMO
AETNA OPEN ACCESS MANAGED CHOICE (OAMC)
NETWORK NON-NETWORK
Annual Deductible None None $1000 Member$2000 Family
$2000 Member$4000 Family
Out-of-Pocket MaximumIndividualFamily
$1500$3000
$2000$4000
$3500$7000
$7000$14000
Office Visit $30 per visit $15 per visit (PCP)$30 per visit (Specialist)
$25 per visit (PCP)$50 per visit (Specialist)
40 after deductible
Preventive (physical exams well-baby etc)
No charge No charge No charge(deductible waived)
40 after deductible
Most X-Ray amp Lab No charge No charge 20 after deductible 40 after deductible
Urgent Care $30 copay $35 copay $35 copay 40 after deductible
Emergency Room(copay waived if admitted)
$100 copay $150 copay $150 copay + 20 $150 copay + 20
Chiropractic
Acupuncture
Not covered
$30 per visit for certain services
$15 per visit (20 visitsyear)
$15 per visit(20 visitsyear)
$50 (limited to 20 visitsyear)
$50 (limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
Hospital CoverageInpatient (to avoid addrsquol copays preauthorization is recommended)
Outpatient
$500 per admit
$100 per procedure
$250 per admit
$100 per surgery
20 after deductible
20 after deductible
40 after deductible
40 after deductible
Prescription Drug Retail Day Supply
Preferred GenericPreferred BrandNon-PreferredSpecialty
Up to 30 days$15 copay$30 copay
Not applicable30 up to $150script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Not Covered
Prescription Drug Mail Order Day Supply
Preferred GenericPreferred BrandNon-Preferred
Up to 100 days$30 copay$60 copay
Not applicable
Up to 90 days$20 copay$60 copay$100 copay
Up to 90 days$20 copay$60 copay
$100 copay
Not Applicable
PAGE 5
AETNA PROGRAMS AND SERVICES
AETNA PROGRAMS
Informed Health
Teledoc
Health Connections
Beginning Bright
Simple Steps To a Healthier Life
Discount Programs
Fitness Discounts
Rx Mail Order
247 NURSE LINE ndash INFORMED HEALTH reg | (800) 556-1555 The Informed Health reg program provides members with telephone and e-mail access to registered nurses to help them make informed healthcare decisions Nurses are available 24 hours a day and 7 days a week
BEGINNING RIGHT reg MATERNITY MANAGEMENT | (800) 272-3531Pregnancy can be an exciting time filled with hopes and dreams for your baby The most important thing you can do right now to make those dreams come true is to take good care of yourself This program is designed to help you have a safe delivery and a healthy child The line is staffed by registered nurses 24 hours a day seven days a week
WELLNESS AND DISCOUNT PROGRAMS
bull A toll-free number you can call about pregnancy labor what to expect before and after delivery newborn care and more
bull Some women have health conditions that could affect their pregnancies If you do you can work with a nurse case manager to help you lower those risks
bull Support to quit smoking and help to avoid you going into early labor
Simple Steps To a Healthier Life reg is a road to better health with programs and resources tailored to meet your needs
To locate the discounts that are available to you once yoursquore an Aetna member just log in to your member website at aetnacom You can find a vision hearing or natural therapy professional sign up for a weight-loss program buy health products find a gym and more
PAGE 6
TELEDOC reg | (855) 835-2362 Teladocreg is a convenient and affordable option for a variety of medical services including General Medical Dermatology and Behavioral Health Access quality healthcare from the comfort of home during your lunch break or while traveling You can even get a prescription sent to your local pharmacy when medically necessary
HEALTH CONNECTIONS reg DISEASE MANAGEMENT | (866) 269-4500Health Connections reg is a disease management program that helps members with chronic conditions achieve a healthy outcome through advanced tools techniques and systems Aetna personalizes the condition coaching for members to motivate and empower them to change their behaviors and therefore reduce health risks
KAISER PERMANENTEHEALTHY LIVING PROGRAMS
Kaiser | wwwkporg
bull Manage Your Health
bull Schedule Appointments
bull Refill Prescriptions
bull Email Your Doctor
bull View Test Results
bull Tools and Calculators
bull Health Classes
bull Healthy Lifestyle Programs
As a Kaiser Permanente member you have access to discounts on health products and services through ChooseHealthy As a comprehensive health website offering a directory of complementary health care providers information about complementary health care services and discounts on health and wellness products such as
Visit wwwkporgchoosehealthy and click on ldquocomplementary carerdquo or call American Specialty Health at (877) 335-2746 to learn more about this program sign up or take an online tour
MY HEALTH MANAGER | wwwkporgregister
bull Acupuncturebull Massage therapy servicesbull Fitness club memberships
My Health manager gives you access to powerful online tools designed to help you manage your health You can email your doctorrsquos office order prescription refills view most lab test results request routine appointments check past office visit information look up future appointments and more Once you register you will be able to get connected in a single visit without having to wait for your password to be emailed to you
bull Manage ongoing health conditions ndash When you join HealthMedia Care you will receive a plan for managing your symptoms medication and treatment as well as encouraging reminders for making healthy lifestyle changes
bull Lose Weight ndash HealthMedia Balance gives you personalized strategies for reaching your ideal weight with a program thatrsquos helped thousands of people lose weight and keep it off
bull Eat Right ndash HealthMedia Nourish gives you personalized strategies for making smart and delicious food choices to increase your energy level manage your weight and live a healthier life
bull Quit Smoking ndash This award-winning program can help you create a personalized quitting plan with proven strategies for decreasing your dependency and dealing with cravings
bull Overcome Stress ndash Examine your individual sources and symptoms of stress and develop a customized stress management plan that will help you start living a healthier and more relaxed life
Using the Kaiser Permanente web site you can access the latest healthy lifestyle and medical information right from your own home ndash anytime day or night Whether yoursquod like to quit smoking lose weight control your cholesterol start a fitness program manage your diabetes or reduce stress the Kaiser Permanente website can help
HEALTHY LIFESTYLE PROGRAMSKaiser Permanente has collaborated with HealthMedia to offer you programs such as
bull Chiropractic carebull Herbs vitamins and supplementsbull Health and fitness books and videos
PAGE 7
You and your eligible dependents have the option to enroll in one of two dental plans the Deltacare Dental DHMO plan or the Delta Dental DPPO plan
Under the DeltaCare Dental DHMO there are no deductibles and most dental benefits are unlimited Each family member must select a Primary DentistFacility from the list of Delta Dental dentists when they enroll All services and referrals to specialty care will be coordinated by the Primary DentistFacility
The Delta Dental DPPO allows you the flexibility of seeing a network dentist and receiving benefits at a discounted rate or seeing a non-network dentist and paying the difference between the fee schedule charges and what your dentist bills There is no need to select a dentist at enrollment under the Dental DPPO plan
DENTAL
Using Your Dental Benefits Wisely
bull To pay the least amount out-of-pocket always use in-network dentists under the DPPO
bull Use your preventive benefits and get cleanings for you and your family
bull If your services are estimated to be $350 or more by your dentist be sure to have your dentist get pre-determination of benefits to Delta Dental to ensure services are covered and to get an estimate of what the plan will pay
Fee Schedule Claims incurred outside of the Delta Dental PPO dental network are subject to fee schedule levels Fee schedule represents the maximum dollar amount Delta Dental will pay on certain services The member is responsible for any amounts charged over the fee schedule
DENTAL PLAN OPTIONS
FEATURE OR SERVICE
DELTACAREDHMO
DELTA DENTAL DPPO
NETWORK NON-NETWORK
Deductible None $50 Individual$150 Family
Deductible Waived on PreventiveServices
NA Yes
Annual Calendar Year BenefitMaximum
Unlimited $1500 $1250
Preventive Services copay schedule No charge 80 covered
Basic Services copay schedule 80 covered
Major Services copay schedule 50 covered
Orthodontia copay schedule lifetime max of $1500
PAGE 8
You have the opportunity to participate in the VSP Vision Plan The vision program allows you to utilize VSPrsquos network of eye care providers or see an eye care professional outside the network
VISION
How Long Has It Been Since Your Last Eye Exam
Your eyes provide a clear view of your blood vessels Optometrists and Ophthalmologists can be the first to detect symptoms of illnesses such as cardiovascular disease diabetes and thyroid disorders
Members may be offered discounted fees for extra features added to lenses such as tinting scratch coating and progressive (blended bifocals) lenses when they utilize VSP providers
Members have the choice between lenses or contacts each 12-month interval If you choose contact lenses you will not be eligible for a frame for 12 months following the date contacts were obtained Note the contact lens evaluation fee and fitting costs are separate from the comprehensive vision care exam
VISION PLAN HIGHLIGHTS
FEATURE OR SERVICE NETWORK NON-NETWORK
Deductible for Materials $20
Exams $15 $45 Allowance
LensesSingleLined-BifocalLined-Trifocal
Paid in fullPaid in fullPaid in full
$30 Allowance$50 Allowance$65 Allowance
Frames $120 Retail Allowance (plus 20 off amount over the allowance)
$70 Allowance
Contacts(including fitting amp evaluation)
$120 Retail Allowance $105 Retail Allowance
FrequencyExamsLensesFramesContacts (in lieu of lensesamp frames)
12 Months12 Months12 Months12 Months
NETWORK vs NON-NETWORK COVERAGEDollar for dollar you get the best value from your vision benefit when you visit a VSP in-network doctor If you decide to see a non-network doctor copays still apply and yoursquoll typically receive a lesser benefit When you use a non-network doctor you are required to pay the provider in full at the time of your appointment and submit a claim form to VSP for reimbursement
PAGE 9
LASER VISION CAREVSP has contracted with many of the nationrsquos laser surgery facilities and doctors offering members discounts off laser vision correction surgeries available through contracted laser centers Contact VSP to learn more
Life insurance is an important part of a complete benefits package offered by CDU CDU pays 100 of the cost of a Basic Life and Accidental Death amp Dismemberment (ADampD) for all eligible employees through Cigna
LIFE AND ACCIDENTAL DEATH amp DISMEMBERMENT
Voluntary Life Insurance Features
Accelerated BenefitIf you become terminally ill and are not expected to live beyond a certain period you may request a of your life insurance amount (to a certain maximum) Upon your death the remaining benefit will be paid to the designated beneficiary(ies)
Portability amp ConversionIf you retire reduce your hours or terminate employment you can generally take this coverage with you according to the terms outlined in the contract
VOLUNTARY LIFE PLAN OPTIONS
COVERAGE TYPE COVERAGE AMOUNTS
Employee bull In increments of $10000bull The lesser of $500000 or 5x salarybull Guarantee Issue $100000 (new employees only)
SpouseDomestic Partner bull In increments of $5000bull Maximum 50 of Employee Face Amount not to
exceed $250000bull Guarantee Issue $50000 (new employees only)
Children bull In increments of $2000bull Maximum of $10000bull Birth to 6 months limited to $1000 coverage amount
PAGE 10
The Guarantee Issue amounts apply only when you are first eligible for benefits under the CDU plan If you (andor your dependents) do not elect voluntary life insurance coverage when first eligible the entire amount of life insurance elected will require medical underwriting
BASIC LIFE amp ADampD INSURANCEThe basic life policy will pay a benefit of one times your annual salary to a maximum of $400000 with a minimum benefit of $50000 The benefit amount will reduce to 65 of the original amount when you reach age 65 and to 50 of the original amount at age 70
NOTE To avoid imputed income on the premium for life insurance amounts over $50000 you may opt to reduce your Basic LifeADampD coverage to $50000
OPTIONAL DEPENDENT LIFE COVERAGEYou also have the option to purchase life insurance in the amount of $2000 for your spouse and dependent child(ren)
VOLUNTARY LIFE COVERAGECDU also offers voluntary life insurance You may purchase additional Life insurance for not only yourself but also your dependents The coverage amount will reduce to 65 at age 65 and 45 at age 70 You are eligible to purchase the following amounts
VOLUNTARY LIFE MEDICAL UNDERWRITING
Please note that certain changes during the year (eg salary updates) could result in an adjustment to your payroll deduction amounts
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
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-
MEDICAL PLANS COMPARISON
Each medical plan charges different co-pays and coinsurance for various services The chart below provides a comparison of basic costs and services of the plans CDU offers This chart is only a partial listing of plan features
MEDICAL PLAN OPTIONS
FEATURE OR SERVICE KAISER PERMANENTE HMO AETNA HMO
AETNA OPEN ACCESS MANAGED CHOICE (OAMC)
NETWORK NON-NETWORK
Annual Deductible None None $1000 Member$2000 Family
$2000 Member$4000 Family
Out-of-Pocket MaximumIndividualFamily
$1500$3000
$2000$4000
$3500$7000
$7000$14000
Office Visit $30 per visit $15 per visit (PCP)$30 per visit (Specialist)
$25 per visit (PCP)$50 per visit (Specialist)
40 after deductible
Preventive (physical exams well-baby etc)
No charge No charge No charge(deductible waived)
40 after deductible
Most X-Ray amp Lab No charge No charge 20 after deductible 40 after deductible
Urgent Care $30 copay $35 copay $35 copay 40 after deductible
Emergency Room(copay waived if admitted)
$100 copay $150 copay $150 copay + 20 $150 copay + 20
Chiropractic
Acupuncture
Not covered
$30 per visit for certain services
$15 per visit (20 visitsyear)
$15 per visit(20 visitsyear)
$50 (limited to 20 visitsyear)
$50 (limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
40 after deductible(limited to 20 visitsyear)
Hospital CoverageInpatient (to avoid addrsquol copays preauthorization is recommended)
Outpatient
$500 per admit
$100 per procedure
$250 per admit
$100 per surgery
20 after deductible
20 after deductible
40 after deductible
40 after deductible
Prescription Drug Retail Day Supply
Preferred GenericPreferred BrandNon-PreferredSpecialty
Up to 30 days$15 copay$30 copay
Not applicable30 up to $150script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Up to 30 days$10 copay$30 copay$50 copay
20 up to $200script
Not Covered
Prescription Drug Mail Order Day Supply
Preferred GenericPreferred BrandNon-Preferred
Up to 100 days$30 copay$60 copay
Not applicable
Up to 90 days$20 copay$60 copay$100 copay
Up to 90 days$20 copay$60 copay
$100 copay
Not Applicable
PAGE 5
AETNA PROGRAMS AND SERVICES
AETNA PROGRAMS
Informed Health
Teledoc
Health Connections
Beginning Bright
Simple Steps To a Healthier Life
Discount Programs
Fitness Discounts
Rx Mail Order
247 NURSE LINE ndash INFORMED HEALTH reg | (800) 556-1555 The Informed Health reg program provides members with telephone and e-mail access to registered nurses to help them make informed healthcare decisions Nurses are available 24 hours a day and 7 days a week
BEGINNING RIGHT reg MATERNITY MANAGEMENT | (800) 272-3531Pregnancy can be an exciting time filled with hopes and dreams for your baby The most important thing you can do right now to make those dreams come true is to take good care of yourself This program is designed to help you have a safe delivery and a healthy child The line is staffed by registered nurses 24 hours a day seven days a week
WELLNESS AND DISCOUNT PROGRAMS
bull A toll-free number you can call about pregnancy labor what to expect before and after delivery newborn care and more
bull Some women have health conditions that could affect their pregnancies If you do you can work with a nurse case manager to help you lower those risks
bull Support to quit smoking and help to avoid you going into early labor
Simple Steps To a Healthier Life reg is a road to better health with programs and resources tailored to meet your needs
To locate the discounts that are available to you once yoursquore an Aetna member just log in to your member website at aetnacom You can find a vision hearing or natural therapy professional sign up for a weight-loss program buy health products find a gym and more
PAGE 6
TELEDOC reg | (855) 835-2362 Teladocreg is a convenient and affordable option for a variety of medical services including General Medical Dermatology and Behavioral Health Access quality healthcare from the comfort of home during your lunch break or while traveling You can even get a prescription sent to your local pharmacy when medically necessary
HEALTH CONNECTIONS reg DISEASE MANAGEMENT | (866) 269-4500Health Connections reg is a disease management program that helps members with chronic conditions achieve a healthy outcome through advanced tools techniques and systems Aetna personalizes the condition coaching for members to motivate and empower them to change their behaviors and therefore reduce health risks
KAISER PERMANENTEHEALTHY LIVING PROGRAMS
Kaiser | wwwkporg
bull Manage Your Health
bull Schedule Appointments
bull Refill Prescriptions
bull Email Your Doctor
bull View Test Results
bull Tools and Calculators
bull Health Classes
bull Healthy Lifestyle Programs
As a Kaiser Permanente member you have access to discounts on health products and services through ChooseHealthy As a comprehensive health website offering a directory of complementary health care providers information about complementary health care services and discounts on health and wellness products such as
Visit wwwkporgchoosehealthy and click on ldquocomplementary carerdquo or call American Specialty Health at (877) 335-2746 to learn more about this program sign up or take an online tour
MY HEALTH MANAGER | wwwkporgregister
bull Acupuncturebull Massage therapy servicesbull Fitness club memberships
My Health manager gives you access to powerful online tools designed to help you manage your health You can email your doctorrsquos office order prescription refills view most lab test results request routine appointments check past office visit information look up future appointments and more Once you register you will be able to get connected in a single visit without having to wait for your password to be emailed to you
bull Manage ongoing health conditions ndash When you join HealthMedia Care you will receive a plan for managing your symptoms medication and treatment as well as encouraging reminders for making healthy lifestyle changes
bull Lose Weight ndash HealthMedia Balance gives you personalized strategies for reaching your ideal weight with a program thatrsquos helped thousands of people lose weight and keep it off
bull Eat Right ndash HealthMedia Nourish gives you personalized strategies for making smart and delicious food choices to increase your energy level manage your weight and live a healthier life
bull Quit Smoking ndash This award-winning program can help you create a personalized quitting plan with proven strategies for decreasing your dependency and dealing with cravings
bull Overcome Stress ndash Examine your individual sources and symptoms of stress and develop a customized stress management plan that will help you start living a healthier and more relaxed life
Using the Kaiser Permanente web site you can access the latest healthy lifestyle and medical information right from your own home ndash anytime day or night Whether yoursquod like to quit smoking lose weight control your cholesterol start a fitness program manage your diabetes or reduce stress the Kaiser Permanente website can help
HEALTHY LIFESTYLE PROGRAMSKaiser Permanente has collaborated with HealthMedia to offer you programs such as
bull Chiropractic carebull Herbs vitamins and supplementsbull Health and fitness books and videos
PAGE 7
You and your eligible dependents have the option to enroll in one of two dental plans the Deltacare Dental DHMO plan or the Delta Dental DPPO plan
Under the DeltaCare Dental DHMO there are no deductibles and most dental benefits are unlimited Each family member must select a Primary DentistFacility from the list of Delta Dental dentists when they enroll All services and referrals to specialty care will be coordinated by the Primary DentistFacility
The Delta Dental DPPO allows you the flexibility of seeing a network dentist and receiving benefits at a discounted rate or seeing a non-network dentist and paying the difference between the fee schedule charges and what your dentist bills There is no need to select a dentist at enrollment under the Dental DPPO plan
DENTAL
Using Your Dental Benefits Wisely
bull To pay the least amount out-of-pocket always use in-network dentists under the DPPO
bull Use your preventive benefits and get cleanings for you and your family
bull If your services are estimated to be $350 or more by your dentist be sure to have your dentist get pre-determination of benefits to Delta Dental to ensure services are covered and to get an estimate of what the plan will pay
Fee Schedule Claims incurred outside of the Delta Dental PPO dental network are subject to fee schedule levels Fee schedule represents the maximum dollar amount Delta Dental will pay on certain services The member is responsible for any amounts charged over the fee schedule
DENTAL PLAN OPTIONS
FEATURE OR SERVICE
DELTACAREDHMO
DELTA DENTAL DPPO
NETWORK NON-NETWORK
Deductible None $50 Individual$150 Family
Deductible Waived on PreventiveServices
NA Yes
Annual Calendar Year BenefitMaximum
Unlimited $1500 $1250
Preventive Services copay schedule No charge 80 covered
Basic Services copay schedule 80 covered
Major Services copay schedule 50 covered
Orthodontia copay schedule lifetime max of $1500
PAGE 8
You have the opportunity to participate in the VSP Vision Plan The vision program allows you to utilize VSPrsquos network of eye care providers or see an eye care professional outside the network
VISION
How Long Has It Been Since Your Last Eye Exam
Your eyes provide a clear view of your blood vessels Optometrists and Ophthalmologists can be the first to detect symptoms of illnesses such as cardiovascular disease diabetes and thyroid disorders
Members may be offered discounted fees for extra features added to lenses such as tinting scratch coating and progressive (blended bifocals) lenses when they utilize VSP providers
Members have the choice between lenses or contacts each 12-month interval If you choose contact lenses you will not be eligible for a frame for 12 months following the date contacts were obtained Note the contact lens evaluation fee and fitting costs are separate from the comprehensive vision care exam
VISION PLAN HIGHLIGHTS
FEATURE OR SERVICE NETWORK NON-NETWORK
Deductible for Materials $20
Exams $15 $45 Allowance
LensesSingleLined-BifocalLined-Trifocal
Paid in fullPaid in fullPaid in full
$30 Allowance$50 Allowance$65 Allowance
Frames $120 Retail Allowance (plus 20 off amount over the allowance)
$70 Allowance
Contacts(including fitting amp evaluation)
$120 Retail Allowance $105 Retail Allowance
FrequencyExamsLensesFramesContacts (in lieu of lensesamp frames)
12 Months12 Months12 Months12 Months
NETWORK vs NON-NETWORK COVERAGEDollar for dollar you get the best value from your vision benefit when you visit a VSP in-network doctor If you decide to see a non-network doctor copays still apply and yoursquoll typically receive a lesser benefit When you use a non-network doctor you are required to pay the provider in full at the time of your appointment and submit a claim form to VSP for reimbursement
PAGE 9
LASER VISION CAREVSP has contracted with many of the nationrsquos laser surgery facilities and doctors offering members discounts off laser vision correction surgeries available through contracted laser centers Contact VSP to learn more
Life insurance is an important part of a complete benefits package offered by CDU CDU pays 100 of the cost of a Basic Life and Accidental Death amp Dismemberment (ADampD) for all eligible employees through Cigna
LIFE AND ACCIDENTAL DEATH amp DISMEMBERMENT
Voluntary Life Insurance Features
Accelerated BenefitIf you become terminally ill and are not expected to live beyond a certain period you may request a of your life insurance amount (to a certain maximum) Upon your death the remaining benefit will be paid to the designated beneficiary(ies)
Portability amp ConversionIf you retire reduce your hours or terminate employment you can generally take this coverage with you according to the terms outlined in the contract
VOLUNTARY LIFE PLAN OPTIONS
COVERAGE TYPE COVERAGE AMOUNTS
Employee bull In increments of $10000bull The lesser of $500000 or 5x salarybull Guarantee Issue $100000 (new employees only)
SpouseDomestic Partner bull In increments of $5000bull Maximum 50 of Employee Face Amount not to
exceed $250000bull Guarantee Issue $50000 (new employees only)
Children bull In increments of $2000bull Maximum of $10000bull Birth to 6 months limited to $1000 coverage amount
PAGE 10
The Guarantee Issue amounts apply only when you are first eligible for benefits under the CDU plan If you (andor your dependents) do not elect voluntary life insurance coverage when first eligible the entire amount of life insurance elected will require medical underwriting
BASIC LIFE amp ADampD INSURANCEThe basic life policy will pay a benefit of one times your annual salary to a maximum of $400000 with a minimum benefit of $50000 The benefit amount will reduce to 65 of the original amount when you reach age 65 and to 50 of the original amount at age 70
NOTE To avoid imputed income on the premium for life insurance amounts over $50000 you may opt to reduce your Basic LifeADampD coverage to $50000
OPTIONAL DEPENDENT LIFE COVERAGEYou also have the option to purchase life insurance in the amount of $2000 for your spouse and dependent child(ren)
VOLUNTARY LIFE COVERAGECDU also offers voluntary life insurance You may purchase additional Life insurance for not only yourself but also your dependents The coverage amount will reduce to 65 at age 65 and 45 at age 70 You are eligible to purchase the following amounts
VOLUNTARY LIFE MEDICAL UNDERWRITING
Please note that certain changes during the year (eg salary updates) could result in an adjustment to your payroll deduction amounts
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
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-
AETNA PROGRAMS AND SERVICES
AETNA PROGRAMS
Informed Health
Teledoc
Health Connections
Beginning Bright
Simple Steps To a Healthier Life
Discount Programs
Fitness Discounts
Rx Mail Order
247 NURSE LINE ndash INFORMED HEALTH reg | (800) 556-1555 The Informed Health reg program provides members with telephone and e-mail access to registered nurses to help them make informed healthcare decisions Nurses are available 24 hours a day and 7 days a week
BEGINNING RIGHT reg MATERNITY MANAGEMENT | (800) 272-3531Pregnancy can be an exciting time filled with hopes and dreams for your baby The most important thing you can do right now to make those dreams come true is to take good care of yourself This program is designed to help you have a safe delivery and a healthy child The line is staffed by registered nurses 24 hours a day seven days a week
WELLNESS AND DISCOUNT PROGRAMS
bull A toll-free number you can call about pregnancy labor what to expect before and after delivery newborn care and more
bull Some women have health conditions that could affect their pregnancies If you do you can work with a nurse case manager to help you lower those risks
bull Support to quit smoking and help to avoid you going into early labor
Simple Steps To a Healthier Life reg is a road to better health with programs and resources tailored to meet your needs
To locate the discounts that are available to you once yoursquore an Aetna member just log in to your member website at aetnacom You can find a vision hearing or natural therapy professional sign up for a weight-loss program buy health products find a gym and more
PAGE 6
TELEDOC reg | (855) 835-2362 Teladocreg is a convenient and affordable option for a variety of medical services including General Medical Dermatology and Behavioral Health Access quality healthcare from the comfort of home during your lunch break or while traveling You can even get a prescription sent to your local pharmacy when medically necessary
HEALTH CONNECTIONS reg DISEASE MANAGEMENT | (866) 269-4500Health Connections reg is a disease management program that helps members with chronic conditions achieve a healthy outcome through advanced tools techniques and systems Aetna personalizes the condition coaching for members to motivate and empower them to change their behaviors and therefore reduce health risks
KAISER PERMANENTEHEALTHY LIVING PROGRAMS
Kaiser | wwwkporg
bull Manage Your Health
bull Schedule Appointments
bull Refill Prescriptions
bull Email Your Doctor
bull View Test Results
bull Tools and Calculators
bull Health Classes
bull Healthy Lifestyle Programs
As a Kaiser Permanente member you have access to discounts on health products and services through ChooseHealthy As a comprehensive health website offering a directory of complementary health care providers information about complementary health care services and discounts on health and wellness products such as
Visit wwwkporgchoosehealthy and click on ldquocomplementary carerdquo or call American Specialty Health at (877) 335-2746 to learn more about this program sign up or take an online tour
MY HEALTH MANAGER | wwwkporgregister
bull Acupuncturebull Massage therapy servicesbull Fitness club memberships
My Health manager gives you access to powerful online tools designed to help you manage your health You can email your doctorrsquos office order prescription refills view most lab test results request routine appointments check past office visit information look up future appointments and more Once you register you will be able to get connected in a single visit without having to wait for your password to be emailed to you
bull Manage ongoing health conditions ndash When you join HealthMedia Care you will receive a plan for managing your symptoms medication and treatment as well as encouraging reminders for making healthy lifestyle changes
bull Lose Weight ndash HealthMedia Balance gives you personalized strategies for reaching your ideal weight with a program thatrsquos helped thousands of people lose weight and keep it off
bull Eat Right ndash HealthMedia Nourish gives you personalized strategies for making smart and delicious food choices to increase your energy level manage your weight and live a healthier life
bull Quit Smoking ndash This award-winning program can help you create a personalized quitting plan with proven strategies for decreasing your dependency and dealing with cravings
bull Overcome Stress ndash Examine your individual sources and symptoms of stress and develop a customized stress management plan that will help you start living a healthier and more relaxed life
Using the Kaiser Permanente web site you can access the latest healthy lifestyle and medical information right from your own home ndash anytime day or night Whether yoursquod like to quit smoking lose weight control your cholesterol start a fitness program manage your diabetes or reduce stress the Kaiser Permanente website can help
HEALTHY LIFESTYLE PROGRAMSKaiser Permanente has collaborated with HealthMedia to offer you programs such as
bull Chiropractic carebull Herbs vitamins and supplementsbull Health and fitness books and videos
PAGE 7
You and your eligible dependents have the option to enroll in one of two dental plans the Deltacare Dental DHMO plan or the Delta Dental DPPO plan
Under the DeltaCare Dental DHMO there are no deductibles and most dental benefits are unlimited Each family member must select a Primary DentistFacility from the list of Delta Dental dentists when they enroll All services and referrals to specialty care will be coordinated by the Primary DentistFacility
The Delta Dental DPPO allows you the flexibility of seeing a network dentist and receiving benefits at a discounted rate or seeing a non-network dentist and paying the difference between the fee schedule charges and what your dentist bills There is no need to select a dentist at enrollment under the Dental DPPO plan
DENTAL
Using Your Dental Benefits Wisely
bull To pay the least amount out-of-pocket always use in-network dentists under the DPPO
bull Use your preventive benefits and get cleanings for you and your family
bull If your services are estimated to be $350 or more by your dentist be sure to have your dentist get pre-determination of benefits to Delta Dental to ensure services are covered and to get an estimate of what the plan will pay
Fee Schedule Claims incurred outside of the Delta Dental PPO dental network are subject to fee schedule levels Fee schedule represents the maximum dollar amount Delta Dental will pay on certain services The member is responsible for any amounts charged over the fee schedule
DENTAL PLAN OPTIONS
FEATURE OR SERVICE
DELTACAREDHMO
DELTA DENTAL DPPO
NETWORK NON-NETWORK
Deductible None $50 Individual$150 Family
Deductible Waived on PreventiveServices
NA Yes
Annual Calendar Year BenefitMaximum
Unlimited $1500 $1250
Preventive Services copay schedule No charge 80 covered
Basic Services copay schedule 80 covered
Major Services copay schedule 50 covered
Orthodontia copay schedule lifetime max of $1500
PAGE 8
You have the opportunity to participate in the VSP Vision Plan The vision program allows you to utilize VSPrsquos network of eye care providers or see an eye care professional outside the network
VISION
How Long Has It Been Since Your Last Eye Exam
Your eyes provide a clear view of your blood vessels Optometrists and Ophthalmologists can be the first to detect symptoms of illnesses such as cardiovascular disease diabetes and thyroid disorders
Members may be offered discounted fees for extra features added to lenses such as tinting scratch coating and progressive (blended bifocals) lenses when they utilize VSP providers
Members have the choice between lenses or contacts each 12-month interval If you choose contact lenses you will not be eligible for a frame for 12 months following the date contacts were obtained Note the contact lens evaluation fee and fitting costs are separate from the comprehensive vision care exam
VISION PLAN HIGHLIGHTS
FEATURE OR SERVICE NETWORK NON-NETWORK
Deductible for Materials $20
Exams $15 $45 Allowance
LensesSingleLined-BifocalLined-Trifocal
Paid in fullPaid in fullPaid in full
$30 Allowance$50 Allowance$65 Allowance
Frames $120 Retail Allowance (plus 20 off amount over the allowance)
$70 Allowance
Contacts(including fitting amp evaluation)
$120 Retail Allowance $105 Retail Allowance
FrequencyExamsLensesFramesContacts (in lieu of lensesamp frames)
12 Months12 Months12 Months12 Months
NETWORK vs NON-NETWORK COVERAGEDollar for dollar you get the best value from your vision benefit when you visit a VSP in-network doctor If you decide to see a non-network doctor copays still apply and yoursquoll typically receive a lesser benefit When you use a non-network doctor you are required to pay the provider in full at the time of your appointment and submit a claim form to VSP for reimbursement
PAGE 9
LASER VISION CAREVSP has contracted with many of the nationrsquos laser surgery facilities and doctors offering members discounts off laser vision correction surgeries available through contracted laser centers Contact VSP to learn more
Life insurance is an important part of a complete benefits package offered by CDU CDU pays 100 of the cost of a Basic Life and Accidental Death amp Dismemberment (ADampD) for all eligible employees through Cigna
LIFE AND ACCIDENTAL DEATH amp DISMEMBERMENT
Voluntary Life Insurance Features
Accelerated BenefitIf you become terminally ill and are not expected to live beyond a certain period you may request a of your life insurance amount (to a certain maximum) Upon your death the remaining benefit will be paid to the designated beneficiary(ies)
Portability amp ConversionIf you retire reduce your hours or terminate employment you can generally take this coverage with you according to the terms outlined in the contract
VOLUNTARY LIFE PLAN OPTIONS
COVERAGE TYPE COVERAGE AMOUNTS
Employee bull In increments of $10000bull The lesser of $500000 or 5x salarybull Guarantee Issue $100000 (new employees only)
SpouseDomestic Partner bull In increments of $5000bull Maximum 50 of Employee Face Amount not to
exceed $250000bull Guarantee Issue $50000 (new employees only)
Children bull In increments of $2000bull Maximum of $10000bull Birth to 6 months limited to $1000 coverage amount
PAGE 10
The Guarantee Issue amounts apply only when you are first eligible for benefits under the CDU plan If you (andor your dependents) do not elect voluntary life insurance coverage when first eligible the entire amount of life insurance elected will require medical underwriting
BASIC LIFE amp ADampD INSURANCEThe basic life policy will pay a benefit of one times your annual salary to a maximum of $400000 with a minimum benefit of $50000 The benefit amount will reduce to 65 of the original amount when you reach age 65 and to 50 of the original amount at age 70
NOTE To avoid imputed income on the premium for life insurance amounts over $50000 you may opt to reduce your Basic LifeADampD coverage to $50000
OPTIONAL DEPENDENT LIFE COVERAGEYou also have the option to purchase life insurance in the amount of $2000 for your spouse and dependent child(ren)
VOLUNTARY LIFE COVERAGECDU also offers voluntary life insurance You may purchase additional Life insurance for not only yourself but also your dependents The coverage amount will reduce to 65 at age 65 and 45 at age 70 You are eligible to purchase the following amounts
VOLUNTARY LIFE MEDICAL UNDERWRITING
Please note that certain changes during the year (eg salary updates) could result in an adjustment to your payroll deduction amounts
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
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-
KAISER PERMANENTEHEALTHY LIVING PROGRAMS
Kaiser | wwwkporg
bull Manage Your Health
bull Schedule Appointments
bull Refill Prescriptions
bull Email Your Doctor
bull View Test Results
bull Tools and Calculators
bull Health Classes
bull Healthy Lifestyle Programs
As a Kaiser Permanente member you have access to discounts on health products and services through ChooseHealthy As a comprehensive health website offering a directory of complementary health care providers information about complementary health care services and discounts on health and wellness products such as
Visit wwwkporgchoosehealthy and click on ldquocomplementary carerdquo or call American Specialty Health at (877) 335-2746 to learn more about this program sign up or take an online tour
MY HEALTH MANAGER | wwwkporgregister
bull Acupuncturebull Massage therapy servicesbull Fitness club memberships
My Health manager gives you access to powerful online tools designed to help you manage your health You can email your doctorrsquos office order prescription refills view most lab test results request routine appointments check past office visit information look up future appointments and more Once you register you will be able to get connected in a single visit without having to wait for your password to be emailed to you
bull Manage ongoing health conditions ndash When you join HealthMedia Care you will receive a plan for managing your symptoms medication and treatment as well as encouraging reminders for making healthy lifestyle changes
bull Lose Weight ndash HealthMedia Balance gives you personalized strategies for reaching your ideal weight with a program thatrsquos helped thousands of people lose weight and keep it off
bull Eat Right ndash HealthMedia Nourish gives you personalized strategies for making smart and delicious food choices to increase your energy level manage your weight and live a healthier life
bull Quit Smoking ndash This award-winning program can help you create a personalized quitting plan with proven strategies for decreasing your dependency and dealing with cravings
bull Overcome Stress ndash Examine your individual sources and symptoms of stress and develop a customized stress management plan that will help you start living a healthier and more relaxed life
Using the Kaiser Permanente web site you can access the latest healthy lifestyle and medical information right from your own home ndash anytime day or night Whether yoursquod like to quit smoking lose weight control your cholesterol start a fitness program manage your diabetes or reduce stress the Kaiser Permanente website can help
HEALTHY LIFESTYLE PROGRAMSKaiser Permanente has collaborated with HealthMedia to offer you programs such as
bull Chiropractic carebull Herbs vitamins and supplementsbull Health and fitness books and videos
PAGE 7
You and your eligible dependents have the option to enroll in one of two dental plans the Deltacare Dental DHMO plan or the Delta Dental DPPO plan
Under the DeltaCare Dental DHMO there are no deductibles and most dental benefits are unlimited Each family member must select a Primary DentistFacility from the list of Delta Dental dentists when they enroll All services and referrals to specialty care will be coordinated by the Primary DentistFacility
The Delta Dental DPPO allows you the flexibility of seeing a network dentist and receiving benefits at a discounted rate or seeing a non-network dentist and paying the difference between the fee schedule charges and what your dentist bills There is no need to select a dentist at enrollment under the Dental DPPO plan
DENTAL
Using Your Dental Benefits Wisely
bull To pay the least amount out-of-pocket always use in-network dentists under the DPPO
bull Use your preventive benefits and get cleanings for you and your family
bull If your services are estimated to be $350 or more by your dentist be sure to have your dentist get pre-determination of benefits to Delta Dental to ensure services are covered and to get an estimate of what the plan will pay
Fee Schedule Claims incurred outside of the Delta Dental PPO dental network are subject to fee schedule levels Fee schedule represents the maximum dollar amount Delta Dental will pay on certain services The member is responsible for any amounts charged over the fee schedule
DENTAL PLAN OPTIONS
FEATURE OR SERVICE
DELTACAREDHMO
DELTA DENTAL DPPO
NETWORK NON-NETWORK
Deductible None $50 Individual$150 Family
Deductible Waived on PreventiveServices
NA Yes
Annual Calendar Year BenefitMaximum
Unlimited $1500 $1250
Preventive Services copay schedule No charge 80 covered
Basic Services copay schedule 80 covered
Major Services copay schedule 50 covered
Orthodontia copay schedule lifetime max of $1500
PAGE 8
You have the opportunity to participate in the VSP Vision Plan The vision program allows you to utilize VSPrsquos network of eye care providers or see an eye care professional outside the network
VISION
How Long Has It Been Since Your Last Eye Exam
Your eyes provide a clear view of your blood vessels Optometrists and Ophthalmologists can be the first to detect symptoms of illnesses such as cardiovascular disease diabetes and thyroid disorders
Members may be offered discounted fees for extra features added to lenses such as tinting scratch coating and progressive (blended bifocals) lenses when they utilize VSP providers
Members have the choice between lenses or contacts each 12-month interval If you choose contact lenses you will not be eligible for a frame for 12 months following the date contacts were obtained Note the contact lens evaluation fee and fitting costs are separate from the comprehensive vision care exam
VISION PLAN HIGHLIGHTS
FEATURE OR SERVICE NETWORK NON-NETWORK
Deductible for Materials $20
Exams $15 $45 Allowance
LensesSingleLined-BifocalLined-Trifocal
Paid in fullPaid in fullPaid in full
$30 Allowance$50 Allowance$65 Allowance
Frames $120 Retail Allowance (plus 20 off amount over the allowance)
$70 Allowance
Contacts(including fitting amp evaluation)
$120 Retail Allowance $105 Retail Allowance
FrequencyExamsLensesFramesContacts (in lieu of lensesamp frames)
12 Months12 Months12 Months12 Months
NETWORK vs NON-NETWORK COVERAGEDollar for dollar you get the best value from your vision benefit when you visit a VSP in-network doctor If you decide to see a non-network doctor copays still apply and yoursquoll typically receive a lesser benefit When you use a non-network doctor you are required to pay the provider in full at the time of your appointment and submit a claim form to VSP for reimbursement
PAGE 9
LASER VISION CAREVSP has contracted with many of the nationrsquos laser surgery facilities and doctors offering members discounts off laser vision correction surgeries available through contracted laser centers Contact VSP to learn more
Life insurance is an important part of a complete benefits package offered by CDU CDU pays 100 of the cost of a Basic Life and Accidental Death amp Dismemberment (ADampD) for all eligible employees through Cigna
LIFE AND ACCIDENTAL DEATH amp DISMEMBERMENT
Voluntary Life Insurance Features
Accelerated BenefitIf you become terminally ill and are not expected to live beyond a certain period you may request a of your life insurance amount (to a certain maximum) Upon your death the remaining benefit will be paid to the designated beneficiary(ies)
Portability amp ConversionIf you retire reduce your hours or terminate employment you can generally take this coverage with you according to the terms outlined in the contract
VOLUNTARY LIFE PLAN OPTIONS
COVERAGE TYPE COVERAGE AMOUNTS
Employee bull In increments of $10000bull The lesser of $500000 or 5x salarybull Guarantee Issue $100000 (new employees only)
SpouseDomestic Partner bull In increments of $5000bull Maximum 50 of Employee Face Amount not to
exceed $250000bull Guarantee Issue $50000 (new employees only)
Children bull In increments of $2000bull Maximum of $10000bull Birth to 6 months limited to $1000 coverage amount
PAGE 10
The Guarantee Issue amounts apply only when you are first eligible for benefits under the CDU plan If you (andor your dependents) do not elect voluntary life insurance coverage when first eligible the entire amount of life insurance elected will require medical underwriting
BASIC LIFE amp ADampD INSURANCEThe basic life policy will pay a benefit of one times your annual salary to a maximum of $400000 with a minimum benefit of $50000 The benefit amount will reduce to 65 of the original amount when you reach age 65 and to 50 of the original amount at age 70
NOTE To avoid imputed income on the premium for life insurance amounts over $50000 you may opt to reduce your Basic LifeADampD coverage to $50000
OPTIONAL DEPENDENT LIFE COVERAGEYou also have the option to purchase life insurance in the amount of $2000 for your spouse and dependent child(ren)
VOLUNTARY LIFE COVERAGECDU also offers voluntary life insurance You may purchase additional Life insurance for not only yourself but also your dependents The coverage amount will reduce to 65 at age 65 and 45 at age 70 You are eligible to purchase the following amounts
VOLUNTARY LIFE MEDICAL UNDERWRITING
Please note that certain changes during the year (eg salary updates) could result in an adjustment to your payroll deduction amounts
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
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-
You and your eligible dependents have the option to enroll in one of two dental plans the Deltacare Dental DHMO plan or the Delta Dental DPPO plan
Under the DeltaCare Dental DHMO there are no deductibles and most dental benefits are unlimited Each family member must select a Primary DentistFacility from the list of Delta Dental dentists when they enroll All services and referrals to specialty care will be coordinated by the Primary DentistFacility
The Delta Dental DPPO allows you the flexibility of seeing a network dentist and receiving benefits at a discounted rate or seeing a non-network dentist and paying the difference between the fee schedule charges and what your dentist bills There is no need to select a dentist at enrollment under the Dental DPPO plan
DENTAL
Using Your Dental Benefits Wisely
bull To pay the least amount out-of-pocket always use in-network dentists under the DPPO
bull Use your preventive benefits and get cleanings for you and your family
bull If your services are estimated to be $350 or more by your dentist be sure to have your dentist get pre-determination of benefits to Delta Dental to ensure services are covered and to get an estimate of what the plan will pay
Fee Schedule Claims incurred outside of the Delta Dental PPO dental network are subject to fee schedule levels Fee schedule represents the maximum dollar amount Delta Dental will pay on certain services The member is responsible for any amounts charged over the fee schedule
DENTAL PLAN OPTIONS
FEATURE OR SERVICE
DELTACAREDHMO
DELTA DENTAL DPPO
NETWORK NON-NETWORK
Deductible None $50 Individual$150 Family
Deductible Waived on PreventiveServices
NA Yes
Annual Calendar Year BenefitMaximum
Unlimited $1500 $1250
Preventive Services copay schedule No charge 80 covered
Basic Services copay schedule 80 covered
Major Services copay schedule 50 covered
Orthodontia copay schedule lifetime max of $1500
PAGE 8
You have the opportunity to participate in the VSP Vision Plan The vision program allows you to utilize VSPrsquos network of eye care providers or see an eye care professional outside the network
VISION
How Long Has It Been Since Your Last Eye Exam
Your eyes provide a clear view of your blood vessels Optometrists and Ophthalmologists can be the first to detect symptoms of illnesses such as cardiovascular disease diabetes and thyroid disorders
Members may be offered discounted fees for extra features added to lenses such as tinting scratch coating and progressive (blended bifocals) lenses when they utilize VSP providers
Members have the choice between lenses or contacts each 12-month interval If you choose contact lenses you will not be eligible for a frame for 12 months following the date contacts were obtained Note the contact lens evaluation fee and fitting costs are separate from the comprehensive vision care exam
VISION PLAN HIGHLIGHTS
FEATURE OR SERVICE NETWORK NON-NETWORK
Deductible for Materials $20
Exams $15 $45 Allowance
LensesSingleLined-BifocalLined-Trifocal
Paid in fullPaid in fullPaid in full
$30 Allowance$50 Allowance$65 Allowance
Frames $120 Retail Allowance (plus 20 off amount over the allowance)
$70 Allowance
Contacts(including fitting amp evaluation)
$120 Retail Allowance $105 Retail Allowance
FrequencyExamsLensesFramesContacts (in lieu of lensesamp frames)
12 Months12 Months12 Months12 Months
NETWORK vs NON-NETWORK COVERAGEDollar for dollar you get the best value from your vision benefit when you visit a VSP in-network doctor If you decide to see a non-network doctor copays still apply and yoursquoll typically receive a lesser benefit When you use a non-network doctor you are required to pay the provider in full at the time of your appointment and submit a claim form to VSP for reimbursement
PAGE 9
LASER VISION CAREVSP has contracted with many of the nationrsquos laser surgery facilities and doctors offering members discounts off laser vision correction surgeries available through contracted laser centers Contact VSP to learn more
Life insurance is an important part of a complete benefits package offered by CDU CDU pays 100 of the cost of a Basic Life and Accidental Death amp Dismemberment (ADampD) for all eligible employees through Cigna
LIFE AND ACCIDENTAL DEATH amp DISMEMBERMENT
Voluntary Life Insurance Features
Accelerated BenefitIf you become terminally ill and are not expected to live beyond a certain period you may request a of your life insurance amount (to a certain maximum) Upon your death the remaining benefit will be paid to the designated beneficiary(ies)
Portability amp ConversionIf you retire reduce your hours or terminate employment you can generally take this coverage with you according to the terms outlined in the contract
VOLUNTARY LIFE PLAN OPTIONS
COVERAGE TYPE COVERAGE AMOUNTS
Employee bull In increments of $10000bull The lesser of $500000 or 5x salarybull Guarantee Issue $100000 (new employees only)
SpouseDomestic Partner bull In increments of $5000bull Maximum 50 of Employee Face Amount not to
exceed $250000bull Guarantee Issue $50000 (new employees only)
Children bull In increments of $2000bull Maximum of $10000bull Birth to 6 months limited to $1000 coverage amount
PAGE 10
The Guarantee Issue amounts apply only when you are first eligible for benefits under the CDU plan If you (andor your dependents) do not elect voluntary life insurance coverage when first eligible the entire amount of life insurance elected will require medical underwriting
BASIC LIFE amp ADampD INSURANCEThe basic life policy will pay a benefit of one times your annual salary to a maximum of $400000 with a minimum benefit of $50000 The benefit amount will reduce to 65 of the original amount when you reach age 65 and to 50 of the original amount at age 70
NOTE To avoid imputed income on the premium for life insurance amounts over $50000 you may opt to reduce your Basic LifeADampD coverage to $50000
OPTIONAL DEPENDENT LIFE COVERAGEYou also have the option to purchase life insurance in the amount of $2000 for your spouse and dependent child(ren)
VOLUNTARY LIFE COVERAGECDU also offers voluntary life insurance You may purchase additional Life insurance for not only yourself but also your dependents The coverage amount will reduce to 65 at age 65 and 45 at age 70 You are eligible to purchase the following amounts
VOLUNTARY LIFE MEDICAL UNDERWRITING
Please note that certain changes during the year (eg salary updates) could result in an adjustment to your payroll deduction amounts
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
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-
You have the opportunity to participate in the VSP Vision Plan The vision program allows you to utilize VSPrsquos network of eye care providers or see an eye care professional outside the network
VISION
How Long Has It Been Since Your Last Eye Exam
Your eyes provide a clear view of your blood vessels Optometrists and Ophthalmologists can be the first to detect symptoms of illnesses such as cardiovascular disease diabetes and thyroid disorders
Members may be offered discounted fees for extra features added to lenses such as tinting scratch coating and progressive (blended bifocals) lenses when they utilize VSP providers
Members have the choice between lenses or contacts each 12-month interval If you choose contact lenses you will not be eligible for a frame for 12 months following the date contacts were obtained Note the contact lens evaluation fee and fitting costs are separate from the comprehensive vision care exam
VISION PLAN HIGHLIGHTS
FEATURE OR SERVICE NETWORK NON-NETWORK
Deductible for Materials $20
Exams $15 $45 Allowance
LensesSingleLined-BifocalLined-Trifocal
Paid in fullPaid in fullPaid in full
$30 Allowance$50 Allowance$65 Allowance
Frames $120 Retail Allowance (plus 20 off amount over the allowance)
$70 Allowance
Contacts(including fitting amp evaluation)
$120 Retail Allowance $105 Retail Allowance
FrequencyExamsLensesFramesContacts (in lieu of lensesamp frames)
12 Months12 Months12 Months12 Months
NETWORK vs NON-NETWORK COVERAGEDollar for dollar you get the best value from your vision benefit when you visit a VSP in-network doctor If you decide to see a non-network doctor copays still apply and yoursquoll typically receive a lesser benefit When you use a non-network doctor you are required to pay the provider in full at the time of your appointment and submit a claim form to VSP for reimbursement
PAGE 9
LASER VISION CAREVSP has contracted with many of the nationrsquos laser surgery facilities and doctors offering members discounts off laser vision correction surgeries available through contracted laser centers Contact VSP to learn more
Life insurance is an important part of a complete benefits package offered by CDU CDU pays 100 of the cost of a Basic Life and Accidental Death amp Dismemberment (ADampD) for all eligible employees through Cigna
LIFE AND ACCIDENTAL DEATH amp DISMEMBERMENT
Voluntary Life Insurance Features
Accelerated BenefitIf you become terminally ill and are not expected to live beyond a certain period you may request a of your life insurance amount (to a certain maximum) Upon your death the remaining benefit will be paid to the designated beneficiary(ies)
Portability amp ConversionIf you retire reduce your hours or terminate employment you can generally take this coverage with you according to the terms outlined in the contract
VOLUNTARY LIFE PLAN OPTIONS
COVERAGE TYPE COVERAGE AMOUNTS
Employee bull In increments of $10000bull The lesser of $500000 or 5x salarybull Guarantee Issue $100000 (new employees only)
SpouseDomestic Partner bull In increments of $5000bull Maximum 50 of Employee Face Amount not to
exceed $250000bull Guarantee Issue $50000 (new employees only)
Children bull In increments of $2000bull Maximum of $10000bull Birth to 6 months limited to $1000 coverage amount
PAGE 10
The Guarantee Issue amounts apply only when you are first eligible for benefits under the CDU plan If you (andor your dependents) do not elect voluntary life insurance coverage when first eligible the entire amount of life insurance elected will require medical underwriting
BASIC LIFE amp ADampD INSURANCEThe basic life policy will pay a benefit of one times your annual salary to a maximum of $400000 with a minimum benefit of $50000 The benefit amount will reduce to 65 of the original amount when you reach age 65 and to 50 of the original amount at age 70
NOTE To avoid imputed income on the premium for life insurance amounts over $50000 you may opt to reduce your Basic LifeADampD coverage to $50000
OPTIONAL DEPENDENT LIFE COVERAGEYou also have the option to purchase life insurance in the amount of $2000 for your spouse and dependent child(ren)
VOLUNTARY LIFE COVERAGECDU also offers voluntary life insurance You may purchase additional Life insurance for not only yourself but also your dependents The coverage amount will reduce to 65 at age 65 and 45 at age 70 You are eligible to purchase the following amounts
VOLUNTARY LIFE MEDICAL UNDERWRITING
Please note that certain changes during the year (eg salary updates) could result in an adjustment to your payroll deduction amounts
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
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-
Life insurance is an important part of a complete benefits package offered by CDU CDU pays 100 of the cost of a Basic Life and Accidental Death amp Dismemberment (ADampD) for all eligible employees through Cigna
LIFE AND ACCIDENTAL DEATH amp DISMEMBERMENT
Voluntary Life Insurance Features
Accelerated BenefitIf you become terminally ill and are not expected to live beyond a certain period you may request a of your life insurance amount (to a certain maximum) Upon your death the remaining benefit will be paid to the designated beneficiary(ies)
Portability amp ConversionIf you retire reduce your hours or terminate employment you can generally take this coverage with you according to the terms outlined in the contract
VOLUNTARY LIFE PLAN OPTIONS
COVERAGE TYPE COVERAGE AMOUNTS
Employee bull In increments of $10000bull The lesser of $500000 or 5x salarybull Guarantee Issue $100000 (new employees only)
SpouseDomestic Partner bull In increments of $5000bull Maximum 50 of Employee Face Amount not to
exceed $250000bull Guarantee Issue $50000 (new employees only)
Children bull In increments of $2000bull Maximum of $10000bull Birth to 6 months limited to $1000 coverage amount
PAGE 10
The Guarantee Issue amounts apply only when you are first eligible for benefits under the CDU plan If you (andor your dependents) do not elect voluntary life insurance coverage when first eligible the entire amount of life insurance elected will require medical underwriting
BASIC LIFE amp ADampD INSURANCEThe basic life policy will pay a benefit of one times your annual salary to a maximum of $400000 with a minimum benefit of $50000 The benefit amount will reduce to 65 of the original amount when you reach age 65 and to 50 of the original amount at age 70
NOTE To avoid imputed income on the premium for life insurance amounts over $50000 you may opt to reduce your Basic LifeADampD coverage to $50000
OPTIONAL DEPENDENT LIFE COVERAGEYou also have the option to purchase life insurance in the amount of $2000 for your spouse and dependent child(ren)
VOLUNTARY LIFE COVERAGECDU also offers voluntary life insurance You may purchase additional Life insurance for not only yourself but also your dependents The coverage amount will reduce to 65 at age 65 and 45 at age 70 You are eligible to purchase the following amounts
VOLUNTARY LIFE MEDICAL UNDERWRITING
Please note that certain changes during the year (eg salary updates) could result in an adjustment to your payroll deduction amounts
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
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- Slide Number 28
-
CDU has purchased Short Term Disability (STD) on your behalf Our short term disability program provides a source of weekly income should you become disabled and you are unable to work
Benefits are paid for any non-occupational illness or injury that causes disability including pregnancy and pre-existing conditions The amount of your benefit equals 60 of your pay up to a weekly maximum benefit of $1750
SHORT TERM DISABILITY
Why are Short Term Disability benefits important
bull 23 of disabilities are non-work related and therefore are not covered by workerrsquos compensation
bull Managing treatment early especially for disabilities that could become long-term can mean better outcomes
PLEASE NOTE
Benefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
SHORT TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Weekly Maximum $1750
Benefit Waiting Period 60 days for accident60 days for sickness
Maximum Benefit Period 26 weeks (includes Benefit Waiting Period)
PAGE 11
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
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- Slide Number 16
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- Slide Number 26
- Slide Number 27
- Slide Number 28
-
Long-Term Disability insurance is an essential part of a complete benefits package offered by CDU New for 2020 CDU pays 100 of the cost of Long-Term Disability coverage for all eligible employees through Cigna This program covers disabling injuries or sicknesses that last beyond the 180 day elimination period
The benefits under this plan are paid out at the following level
LONG TERM DISABILITY ndash NEW BENEFIT FOR 2020
Did You KnowOnly 5 of baby boomers realize they have a one-in-three chance of becoming disabled during their working years
And
Without a paycheck the typical employeersquos savings lasts less than 5 weeks
PLEASE NOTEBenefits are integrated with any amount you receive or are entitled to receive under such things as any state compulsory benefit act or law or Social Security disability
LONG TERM DISABILITY BENEFITS
FEATURE BENEFIT
Income Replacement 60
Monthly Maximum $12500
Elimination Period 180 days
Maximum Benefit Period Generally Social Security Normal Retirement Age
Pre-existing Condition Limitation
Benefits are not payable for medical conditions for which you incurred expenses took prescription drugs receivedmedical treatment care or services (including diagnostic measures) during the 12 months just prior to the most recent effective date of insurance Benefits are not payable for any disability resulting from a pre-existing condition unless the disability occurs after a continuous period of 12 months without any medical treatment care of services in connection with the pre-existing conditions and you have been insured under this plan for at least 24 months after your most recent effective date of insurance
PAGE 12
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
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- Slide Number 12
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- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
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- Slide Number 21
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
-
To help cover health events from accidents to critical illness CDU offers you the opportunity to purchase additional policies through Unum Should you become injured or sick these policies will help offset out-of-pocket medical and indirect non-medical expenses
UNUM VOLUNTARY INSURANCE
HOW TO ENROLL
These plans are only offered during Open Enrollment
If you are interested in enrolling in any of these plans or desire more information about one or more of the plans you will need to call
Unumrsquos Enrollment Line(866) 961-1475(M-F 5am ndash 5pm PST)
PAGE 13
VOLUNTARY ACCIDENT (wOPTIONAL HOSPITAL RIDER)
The accident plan provides supplemental coverage to your current medical plan and helps with the out-of-pocket expenses associated with accidents and injuries including copays deductibles co-insurances and other out-of-pocket expenses Coverage is available for dependents and families as well The Optional Hospital Rider helps with expenses due to hospitalization
SPECIFIED CRITICAL ILLNESS (wOPTIONAL CANCER RIDER)
Specified critical illness insurance pays a lump sum benefit up to 100 of the face amount if you or a covered family member is diagnosed with a covered critical illness including heart attack stroke major organ transplant permanent paralysis cancer end-stage renal failure and coronary bypass surgery The benefit can be used any way you choose and you donrsquot have to be disabled or terminally ill to receive benefits The Optional Cancer Rider helps with cancer treatment related expenses
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
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- Slide Number 15
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- Slide Number 18
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- Slide Number 26
- Slide Number 27
- Slide Number 28
-
The reimbursement accounts offer you a great way to save money Theseaccounts allow you to set aside pre-tax money from each paycheck to pay for eligible out-of-pocket health care or dependent care expenses that you and your dependents incur throughout the plan year Budget carefully Unused funds are forfeited at the end of the plan year
Since the deduction comes out of your paycheck before taxes are computed your taxable income is reduced This means you pay less income tax
FLEXIBLE SPENDING ACCOUNTS
ENROLL EVERY YEARYou must re-enroll in the FSA plan every year at Open Enrollment to continue your FSA benefits ndash elections will NOT roll over year-to-year
USE IT OR LOSE ITYou must use all of the money in your FSA for eligible expenses incurred during the plan year or forfeit it
HEALTH CARE REIMBURSEMENT ACCOUNT REMINDEROver-the-counter medicines are not eligible for reimbursement without a prescription
PAGE 14
You have a 2frac12 month grace period after the end of the plan year to incur additional expenses This means you may incur expenses through March 15 2020
For the 2020 plan year you have until March 31 2021 to submit claims to BCC for expenses incurred between January 1 2020 and March 15 2021
After March 31 2021 any unused money in either reimbursement account will be forfeited as required by the IRS
ITrsquoS EASYYou determine how much money to set aside in your account(s) for the plan year The amount is then subtracted in equal amounts from each paycheck BEFORE taxes are deducted The per-pay-period amount is then deposited into your personal reimbursement account(s)
Claims are paid once a week When you have a health care expense not covered by our medical dental or vision plans you pay the bill using your FSA debit card You can also submit a claim for reimbursement manually by filling out a claim form and submitting it to our plan administrator BCC Claim forms are available via the BCC benefits portal
MAXIMUM CONTRIBUTIONSThe maximum amount you can contribute to an FSA during the plan year isbull Health Care Reimbursement Account $2750bull Dependent Care Reimbursement Account $5000
Please note If your spouse participates in a separate Dependent Care Reimbursement Account the total combined amount between both accounts cannot exceed $5000
CLAIMS SUBMISSION DEADLINE
bull Child care services provided inside or outside your home but not by someone who is your minor child or dependent for income tax purposes (for example an older child)
bull The child must be up to 13 years of age and must be your dependent under federal tax rules
DEPENDENT CARE ELIGIBLE EXPENSES
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
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- Slide Number 7
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- Slide Number 28
-
Our Employee Assistance Program (EAP) through MHN will help you with a wide spectrum of resources including Community Referrals Legal Services Online Tools and Counseling
Community Referralsbull Child Carebull 12-Step Groupsbull Elder Carebull Academicsbull Attorney Servicebull Free 30-minute Phone Consultationbull Discount for services beyond the free phone consultationbull Financial Counseling
Occasionally personal problems may arise or situations may develop that interfere with your ability to perform your job effectively When this occurs it is important to have an understanding person accessible who can offer professional assistance MHN is available to help you or an eligible dependentaddress life stressors that may include
bull Family or Marital Conflictbull ChildAdolescent Behavioral Problemsbull Major Life Changesbull Work performance making it hard to concentrate due to alcoholdrug
abuse prescription drug abuse depression andor financial difficulties
Benefits also include up to three face-to-face confidential sessions per family member per problem each year ndash at no charge If further help past the initial sessions is necessary the EAP can assist you in coordinating additional treatment through your medical plan
EMPLOYEE ASSISTANCE PROGRAM
Confidentiality
When you call and refer yourself into the program it is absolutely confidential
The success of the EAP depends on confidentiality
Participation in the program is not documented in your employee medical or personnel records and will not affect job security or career mobility
EMPLOYEE ASSISTANCE PROGRAM
FREE Face-to-face Counseling Sessions
Up to 3 face-to-face sessions per family member per problem each year
24-Hour Hotline (800) 227-1060
Website httpsmembersmhncomCompany Code charlesdrew
PAGE 15
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
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-
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
PAGE 16
RETIREMENT PLANSThe University offers a Group Retirement Plan and a Supplemental Retirement Plan The group retirement plan is a defined contribution plan fully funded by the University at the rate of 7 of the employeersquos earning Eligible employee must be at least 18-years old completed one year of continuous services with the University and worked at least 1000 hours
The supplemental retirement plan is solely funded by the employee through pre-tax payroll deduction Employees are invited to join the supplemental retirement plan quarterly (January 1 April 1 July 1 and October 1) Based on IRS guideline the maximum contribution for year 2020 is $19500 Catch-up contribution for age 50 or older is $6500
EMPLOYEE ASSISTANCE PROGRAMThe Employee Assistance Program through MHN (Managed Health Network a Health Net Company) provides resources to help employees and their family members address both everyday issues as well as more serious matters confidentially This plan includes 24-hours Hotline assistance and 3 face-to-face counseling sessions per year In addition MHN provides resources on childcare and eldercare assistance financial legal identity theft recovery and daily living services Benefit eligible employees are automatically enrolled
HOLIDAYSThe University provides paid holidays Employees with a Regular or Conditional status are eligible for holiday pay The following holidays will be observed for 2020 New Yearrsquos Day Martin Luther King Jr Birthday Presidentrsquos Day Cesar E Chavez Day Memorial Day Independence Day Labor Day Veteranrsquos Day Thanksgiving Day Friday after Thanksgiving Day and University Holiday Closure (Christmas Eve through New Yearrsquos Eve)
VACATIONThe University provides vacation time to all eligible employees The vacation year shall coincide with the employeersquos anniversary date Vacation benefits will begin to accrue day one of hire The vacation accrual schedule and accrued maximum for a full-time employee is as follows
0-months to 5-years 1000 hours per month up to Maximum 180 hours5-years and 1-month to 14-years 1333 hours per month up to Maximum 240 hours14-years and 1-month and above 1666 hours per month up to Maximum 300 hours
SICK TIMEBeginning the first day of employment sick leave accrues at a rate of 8-hours per month to a maximum of 480-hours (60 days) Sick Leave can be used as it is accrued and can be used for the illness of the employee or to care for a sick family member (child spouse or parent) It may also be used for medical or dental appointments including routine checkups or treatment Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
COMMUNITY SERVICE LEAVE Community Service Leave (CSL) is provided each calendar year to all benefits-eligible employees working twenty (20) hours or more a week CDU allows employees to take up to sixteen (16) hours of leave time each calendar year with approval of your supervisor to participate in specific approved community volunteer activities or programs
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
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-
OTHER BENEFITS
THIS REPRESENTS ONLY A SUMMARY OF BENEFITS
DETAILS AND PLAN DESCRIPTIONS ARE AVAILABLE IN THE HUMAN RESOURCES DEPARTMENT
LEAVE DONATION PROGRAMThe Leave Donation Program provides salary and benefits continuation for eligible employees who have exhausted all paid leave due to their own serious illness or injury or due to the need to care for an immediate family member who has experienced a catastrophic illness or injury
LEAVES OF ABSENCEThe University complies with the State and Federal laws for provision of leaves of absence These include Pregnancy Disability Leave (PDL) Family and Medical Leave Act (FMLA) California Family Rights Act (CFRA) Paid Family Leave Parent Time Off for School Activities and Military Leave For specific information regarding eligibility for leaves of absence please contact the Human Resources Department Sick leave will be integrated with state disability insurance and CDU provided short amp long term disability as appropriate
EDUCATION Upon completion of 6-month introductory period educational leave may be used to pursue course work at an academic institution for up to 4 hours per week Educational leave is unpaid Approval of educational leave is at the discretion of the supervisor
JURY DUTYThe University encourages employees to fulfill their civic responsibilities by serving jury duty when required All employees will receive their usual compensation for up to 10 days while excused from hisher work in order to satisfy jury duty obligations
BEREAVEMENTBereavement leave is offered in the event of a death in the employeersquos immediate family The paid leave is granted for three days For services that are more than 200 miles from the employeersquos home one (1) additional day will be authorized If out of state travel is required to attend services two (2) additional days will be authorized
LIBRARYA free library card is available to any regular full-time employee An employee may use the services of the campus library during campus hours
WORKING ADVANTAGEA 10 million member employee shopping network allows subscribers to save up to 60 on purchases such as Movie Passes Broadway Shows Theme Parks Ski Tickets Sports Events Hotels and Travel Health and Fitness Museums and City Passes Merchant Gift Certificates Online Shoppinghellipand much more
PARKINGParking is free and available on the 118th street side of the Cobb Building A Parking Permit will be issued by the Campus Safety Office
PAGE 17
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
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- Slide Number 5
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- Slide Number 7
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-
UNIVERSITY HOLIDAYS 2020
PAGE 18
New Yearrsquos Day Wednesday January 1 2020
Martin Luther King Jr Birthday Monday January 20 2020(Observed)
Presidentsrsquo Day Monday February 17 2020
Ceacutesar E Chaacutevez Day Monday March 30 2020 (Observed)
Memorial Day Monday May 25 2020
Independence Day Friday July 3 2020 (Observed)
Labor Day Monday September 7 2020
Veteranrsquos Day Wednesday November 11 2020
Thanksgiving Day Thursday November 26 2020
Friday after Thanksgiving Day Friday November 27 2020
Winter Holiday Closure Thursday December 24 2020 - Friday January 1 2021
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
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- Slide Number 11
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- Slide Number 15
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- Slide Number 18
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- Slide Number 20
- Slide Number 21
- Slide Number 22
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- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
-
CARRIERVENDOR CONTACTS
QUESTIONSThis guide summarizes the benefits that are available to you as an employee of CDU
For specific questions please contact the Benefits Call Center (BCC) or the benefits providers at the phone numbers listed on this page
BENEFIT PROVIDER GROUP ID PHONEWEBSITE
Medical HMO amp OAMC Aetna 120209 - HMO amp OAMC (800) 445-5299 (HMO)(877) 204-9186 (OAMC)wwwaetnacom
Medical HMO Kaiser 227461 (800) 464-4000wwwkporg
Dental DHMO DeltaCare USA 75418 (800) 422-4234wwwdeltadentalinscom
Dental DPPO Delta Dental of CA 02642 (800) 765-6003wwwdeltadentalinscom
Vision VSP 00112813 (800) 877-7195wwwvspcom
Basic Life and ADampD Insurance
Cigna FLX969287 - Life OK970729 - ADampD
(800) 362-4462wwwcignacom
Voluntary Life Insurance Cigna FLX969287 (800) 362-4462wwwcignacom
Disability Insurance Cigna LK752614 - STD LK966172 - LTD
(800) 362-4462wwwcignacom
Unum Voluntary Insurancebull Accidentbull Critical Illness
Unum NA To enroll please contact Unumrsquos Enrollment Line at (866) 961-1465(Available only during open enrollment)
Flexible Spending Accounts BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
Employee Assistance Program
MHN NA (800) 227-1060httpsmembersmhncomCompany Code charlesdrew
Discount Program Working Advantage 80566247 (800) 565-3712wwwworkingadvantagecom
Discount Program Employee Savings Tickets
Charles R Drew University (310) 316-3384wwwestuscom Access code ETF72G
Retirement Account TIAA-CREF 151047 (800) 842-2252wwwtiaa-crefcom
Retirement Services amp Education
PensionmarkRetirement Group
Charles R Drew University (888) 201-5488wwwpensionmarkcom
Benefits Call Center BCC CDU (855) 230-0745 extension 6412httpswwwbenxcelcomcduhtm
PAGE 19
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
-
WOMENrsquoS HEALTH AND CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Womenrsquos 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 forAll states of reconstruction of the breast on which the mastectomy was performedSurgery and reconstruction of the other breast to produce a symmetrical appearanceProstheses and Treatment of physical complications of the mastectomy including lymphedemaThese benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this planIf you would like more information on WHCRA benefits call Human Resources
INITIAL NOTICE OF YOUR HIPAA SPECIAL ENROLLMENT RIGHTS Our records show you are eligible to participate in the Charles R Drew University of Medicine and Science Group Health Plan (to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction) A federal law called HIPAA requires that we notify you about an important provision in the plan - your right to enroll in the plan under itsrsquo ldquospecial enrollment provisionrdquo if you acquire a new dependent or if you decline coverage underthis plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons
Loss of Other Coverage (Excluding Medicaid or a State Childrenrsquos Health Insurance Program) If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect 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 dependentsrsquo other coverage) However you must request enrollment within 30 days after your or your dependentsrsquo other coverage ends (or after the employer stops contributing toward the other coverage)
Loss of Coverage for Medicaid or a State Childrenrsquos Health Insurance Program If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state childrenrsquos health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependentsrsquo coverage ends under Medicaid or a State Childrenrsquos Health Insurance Program
New Dependent by Marriage Birth Adoption or Placement for Adoption 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 new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption
Eligibility for Medicaid or a State Childrenrsquos Health Insurance Program If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a State Childrenrsquos Health Insurance Program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependentsrsquo determination of eligibility for such assistance
To request special enrollment or to obtain more information about the planrsquos special enrollment provisions contact the Human Resources Department
NEWBORNSrsquo AND MOTHERS HEALTH PROTECTION ACT (NMHPA)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 motherrsquos or newbornrsquos 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)
Required Notices
PAGE 20
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
-
PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDRENrsquoS HEALTH INSURANCE PROGRAM
If you or your children are eligible for Medicaid or CHIP and yoursquore eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children arenrsquot eligible for Medicaid or CHIP you wonrsquot be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit wwwhealthcaregov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available
If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or wwwinsurekidsnowgov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan
If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you arenrsquot already enrolled This is called a ldquospecial enrollmentrdquo opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at wwwaskebsadolgov or call 1-866-444-EBSA (3272)
If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of July 31 2019 Contact your State for more information on eligibility
ALABAMA ndash Medicaid FLORIDA ndash Medicaid Website httpmyalhippcomPhone 1-855-692-5447
Website httpflmedicaidtplrecoverycomhippPhone 1-877-357-3268
ALASKA ndash Medicaid GEORGIA ndash Medicaid The AK Health Insurance Premium Payment Program Website httpmyakhippcomPhone 1-866-251-4861Email CustomerServiceMyAKHIPPcomMedicaid Eligibility httpdhssalaskagovdpaPagesmedicaiddefaultaspx
Website httpsmedicaidgeorgiagovhealthinsurance-premium-payment-program-hippPhone 678-564-1162 ext 2131
ARKANSAS ndash Medicaid INDIANA ndash Medicaid Website httpmyarhippcomPhone 1-855-MyARHIPP (855-692-7447)
Healthy Indiana Plan for low-income adults 19-64 Website httpwwwingovfssahipPhone 1-877-438-4479 All other Medicaid Website httpwwwindianamedicaidcomPhone 1-800-403-0864
COLORADO ndash Health First Colorado (Coloradorsquos Medicaid Program) amp Child Health Plan Plus
(CHP+)
IOWA ndash Medicaid
Health First Colorado Website httpswwwhealthfirstcoloradocomHealth First Colorado Member Contact Center 1-800-221-3943 State Relay 711 CHP+ httpswwwcoloradogovpacifichcpfchild-healthplan-plusCHP+ Customer Service 1-800-359-1991 State Relay 711
Website httpdhsiowagovHawkiPhone 1-800-257-8563
PAGE 21
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
-
KANSAS ndash Medicaid NEW HAMPSHIRE ndash Medicaid Website httpwwwkdheksgovhcfPhone 1-785-296-3512
Website httpswwwdhhsnhgovoiihipphtmPhone 603-271-5218 Toll free number for the HIPP program1-800-852-3345 ext 5218
KENTUCKY ndash Medicaid NEW JERSEY ndash Medicaid and CHIP Website httpschfskygovPhone 1-800-635-2570
Medicaid Website httpwwwstatenjushumanservicesdmahsclientsmedicaid Medicaid Phone 609-631-2392 CHIP Website httpwwwnjfamilycareorgindexhtmlCHIP Phone 1-800-701-0710
LOUISIANA ndash Medicaid NEW YORK ndash MedicaidWebsite httpdhhlouisianagovindexcfmsubhome1n331Phone 1-888-695-2447
Website httpswwwhealthnygovhealth_caremedicaidPhone 1-800-541-2831
MAINE ndash Medicaid NORTH CAROLINA ndash Medicaid WebsitehttpwwwmainegovdhhsofipublicassistanceindexhtmlPhone 1-800-442-6003TTY Maine relay 711
Website httpsmedicaidncdhhsgovPhone 919-855-4100
MASSACHUSETTS ndash Medicaid and CHIP NORTH DAKOTA ndash Medicaid Website httpwwwmassgoveohhsgovdepartmentsmasshe althPhone 1-800-862-4840
Website httpwwwndgovdhsservicesmedicalservmedicaidPhone 1-844-854-4825
MINNESOTA ndash Medicaid OKLAHOMA ndash Medicaid and CHIP Website httpsmngovdhspeople-we-serveseniorshealthcarehealth-care-programsprograms-andservicesother-insurancejspPhone 1-800-657-3739
Website httpwwwinsureoklahomaorgPhone 1-888-365-3742
MISSOURI ndash Medicaid OREGON ndash Medicaid
Website httpwwwdssmogovmhdparticipantspageshipphtmPhone 573-751-2005
Website httphealthcareoregongovPagesindexaspxhttpwwworegonhealthcaregovindex-eshtmlPhone 1-800-699-9075
MONTANA ndash Medicaid PENNSYLVANIA ndash Medicaid Website httpdphhsmtgovMontanaHealthcareProgramsHIPPPhone 1-800-694-3084
Website httpwwwdhspagovprovidermedicalassistancehe althinsurancepremiumpaymenthippprogramindexhtmPhone 1-800-692-7462
NEBRASKA ndash Medicaid RHODE ISLAND ndash Medicaid and CHIP Website httpwwwACCESSNebraskanegovPhone (855) 632-7633 Lincoln (402) 473-7000 Omaha (402) 595-1178
Website httpwwweohhsrigovPhone 855-697-4347 or 401-462-0311 (Direct RIte Share Line)
PAGE 22
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
-
SOUTH DAKOTA - Medicaid WASHINGTON ndash Medicaid Website httpdsssdgovPhone 1-888-828-0059
Website httpswwwhcawagovPhone 1-800-562-3022 ext 15473
TEXAS ndash Medicaid WEST VIRGINIA ndash Medicaid Website httpgethipptexascomPhone 1-800-440-0493
Website httpmywvhippcomToll-free phone 1-855-MyWVHIPP (1-855-699-8447)
UTAH ndash Medicaid and CHIP WISCONSIN ndash Medicaid and CHIP Medicaid Website httpsmedicaidutahgovCHIP Website httphealthutahgovchipPhone 1-877-543-7669
Website httpswwwdhswisconsingovpublicationsp1p10095 pdfPhone 1-800-362-3002
VERMONTndash Medicaid WYOMING ndash Medicaid Website httpwwwgreenmountaincareorgPhone 1-800-250-8427
Website httpswyequalitycareacs-inccomPhone 307-777-7531
VIRGINIA ndash Medicaid and CHIP Medicaid Website httpwwwcovervaorgprograms_premium_assistance cfmMedicaid Phone 1-800-432-5924CHIP Websitehttpwwwcovervaorgprograms_premium_assistance cfmCHIP Phone 1-855-242-8282
To see if any other states have added a premium assistance program since July 31 2019 or for more information on special enrollment rights contact either
US Department of Labor US Department of Health and Human ServicesEmployee Benefits Security Administration Centers for Medicare amp Medicaid Serviceswwwdolgovagenciesebsa wwwcmshhsgov1-866-444-EBSA (3272) 1-877-267-2323 Menu Option 4 Ext 61565
PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995 (Pub L 104-13) (PRA) no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 USC 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection ofinformation if the collection of information does not display a currently valid OMB control number See 44 USC 3512
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the US Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue NW Room N-5718 Washington DC 20210 or email ebsaoprdolgov and reference the OMB Control Number 1210-0137
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Yoursquore getting this notice because you recently gained coverage under a group health plan (the Plan) This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage
PAGE 23
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
-
The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federallaw you should review the Planrsquos Summary Plan Description or contact the Plan Administrator
You may have other options available to you when you lose group health coverageFor example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs Additionally you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spousersquos plan) even if that plan generally doesnrsquot accept late enrollees
What is COBRA continuation coverageCOBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a ldquoqualifying eventrdquo Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a ldquoqualified beneficiaryrdquo You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If yoursquore an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour hours of employment are reduced orYour employment ends for any reason other than your gross misconductIf yoursquore the spouse of an employee yoursquoll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying eventsYour spouse diesYour spousersquos hours of employment are reducedYour spousersquos employment ends for any reason other than his or her gross misconductYour spouse becomes entitled to Medicare benefits (under Part A Part B or both) orYou become divorced or legally separated from your spouseYour dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying eventsThe parent-employee diesThe parent-employeersquos hours of employment are reducedThe parent-employeersquos employment ends for any reason other than his or her gross misconductThe parent-employee becomes entitled to Medicare benefits (Part A Part B or both)The parents become divorced or legally separated orThe child stops being eligible for coverage under the Plan as a ldquodependent childrdquo
When is COBRA continuation coverage availableThe Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying eventsThe end of employment or reduction of hours of employment Death of the employee The employeersquos becoming entitled to Medicare benefits (under Part A Part B or both)
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent childrsquos losing eligibility for coverage as a dependent child) you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Human Resources
How is COBRA continuation coverage providedOnce the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offeredto each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage
PAGE 24
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
-
There are also ways in which this 18-month period of COBRA continuation coverage can be extended
Disability extension of 18-month period of COBRA continuation coverageIf you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage
Second qualifying event extension of 18-month period of continuation coverageIf your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits (under Part A Part B or both) gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred
Are there other coverage options besides COBRA Continuation CoverageYes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicaid or other group health plan coverage options (such as a spousersquos plan) through what is called a ldquospecial enrollment periodrdquo Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at wwwhealthcaregovIf you have questionsQuestions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act (ERISA) includingCOBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the US Department of Laborrsquos Employee Benefits Security Administration (EBSA) in your area or visit wwwdolgovebsa (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSArsquos website) For more information about the Marketplace visit wwwHealthCaregov
Keep your Plan informed of address changesTo protect your familyrsquos rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan AdministratorPlan contact information
Charles R Drew University of Medicine and ScienceCharles Bugarin1731 E 120th StreetLos Angeles California 90059323-563-5834
MEDICARE PART D NOTICE
Important Notice from Charles R Drew University of Medicine and Science About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it This notice has information about your current prescriptiondrug coverage with Charles R Drew University of Medicine and Science and about your options under Medicarersquos 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 Medicarersquos prescription drug coverage1 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
PAGE 25
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
- Slide Number 20
- Slide Number 21
- Slide Number 22
- Slide Number 23
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
-
2 Charles R Drew University of Medicine and Science has determined that the prescription drug coverage offered by theCharles R Drew University of Medicine and Science Aetna Inc Medical 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 PlanYou 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 also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug PlanIf you decide to join a Medicare drug plan your current Charles R Drew University of Medicine and Science coverage will notbe affected You can keep this coverage if you elect Part D but the group health plan will not coordinate with Part D coverageIf you do decide to join a Medicare drug plan and drop your current Charles R Drew University of Medicine and Science coverage be aware that you and your dependents will be able to get this coverage back only during open enrollment or a special enrollment event
When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug PlanYou should also know that if you drop or lose your current coverage with Charles R Drew University of Medicine and Science and donrsquot 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 Current Prescription Drug CoveragehellipContact the person listed below for further information NOTE Yoursquoll 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 Charles R Drew University of Medicine and Science changes You also may request a copy of this notice at any time
For More Information About Your Options Under Medicare Prescription Drug CoveragehellipMore detailed information about Medicare plans that offer prescription drug coverage is in the ldquoMedicare amp Yourdquo handbook Yoursquoll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plansFor more information about Medicare prescription drug coverageVisit wwwmedicaregovCall your State Health Insurance Assistance Program (see the inside back cover of your copy of the ldquoMedicare amp Yourdquo handbook for their telephone number) for personalized helpCall 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 wwwsocialsecuritygov 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 January 1 2020Name of EntitySender Charles R Drew University of Medicine and ScienceContact-PositionOffice Charles BugarinAddress 1731 E 120th Street
Los Angeles California 90059Phone 323-563-5834
PAGE 26
ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
- Slide Number 1
- Slide Number 2
- Slide Number 3
- Slide Number 4
- Slide Number 5
- Slide Number 6
- Slide Number 7
- Slide Number 8
- Slide Number 9
- Slide Number 10
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- Slide Number 15
- Slide Number 16
- Slide Number 17
- Slide Number 18
- Slide Number 19
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ContributorsCharles R Drew University of Medicine and Science Human Resources DeptGallagher Benefit Services
Restricted Rights
The information contained in this document is proprietary and confidential to Charles R Drew University of Medicine and Science (ldquoCDUrdquo)
No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of CDU
This document is subject to change without notice CDU does not warrant that the material contained in this document is error-free If you find any problems with this document please report them to CDU Human Resources in writing
CDU reserves the right to terminate suspend withdraw or modify the benefits described in this document in whole or in part at any time for any reason No statement in this or any other document and no oral representation should be construed as a waiver of this right
This is not a legal document Please refer to the Summary Plan Descriptions for detailed information This document is not intended to cover every option in detail Complete details are in the legal documents contracts and administrative policies that govern benefit operation and administration
If there should ever be any differences between the summaries in this guide and the legal documents contracts and policies the legal documents contracts and policies will be the final authority
Neither the Plan the Summary Plan Descriptions nor your coverage under the Plan give you any right to continue your employment with CDU nor will they interfere in any way with your right or CDUrsquos right to terminate your employment at any time for any reason which right is hereby expressly reserved
Copyright 2020 copy Charles R Drew University of Medicine and Science All Rights Reserved
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