otice rivacy olicy nd rocedures · iv out-of-pocket maximum . . . . . . . . . . . . . . . . . . . ....

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FY12 BeneFits HandBook

taBle oF Contents

CompreHensive notiCe oF privaCY poliCY and proCedures . . . . . . . . . . . . . . . . . . . . . . . . . . .1The Plan’s Duty to Safeguard Your Protected Health Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1How the Plan May Use and Disclose Your Protected Health Information . . . . . . . . . . . . . . . . . . . . . . . . . .1

Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations . . . . . . . . . . . . . . . .1Other Uses and Disclosures of Your PHI Not Requiring Authorization . . . . . . . . . . . . . . . . . . . . . . . . . .2

Your Rights Regarding Your Protected Health Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3How to Complain about the Plan’s Privacy Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Contact Person for Information, or to Submit a Complaint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4Organized Health Care Arrangement Designation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

aBout tHis HandBook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

BeneFits in BrieF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6UA Choice Health Care Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Flexible Spending Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Life Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Retirement Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Other Benefits * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9Other Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

introduCtion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Your Benefit Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Benefit Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Notice Under the Women’s Health and Cancer Rights Act of 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Campus Human Resources Office Locations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Your role in ControllinG Your HealtH plan Costs . . . . . . . . . . . . . . . . . . .13

eliGiBilitY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Employee Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Enrollment Waiting Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Dependent Enrollment Time Frames . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Dependent Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15Evidence of Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15Continued Eligibility for a Disabled Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Major Life Event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Involuntary Loss of Other Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Open Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Re-enrollment After a Lapse in Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Cost for Employee Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Cost for Dependent Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

pre-eXistinG Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18Credit for Prior Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

plan Year deduCtiBle—mediCal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19Individual Deductible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19Family Deductible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

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Common Accident Deductible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19Fourth Quarter Deductible Carry Forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19Benefits Not Subject to the Medical Deductible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

sCHedule oF BeneFits—mediCal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Anchorage, Fairbanks and Juneau . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Outside Anchorage, Fairbanks and Juneau . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20When You Are Outside Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Emergency Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Benefit Level Exception for Non-Emergent Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Waived Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22Provider Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

out-oF-poCket maXimums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23Individual Medical Out-of-Pocket Maximum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23Family Medical Out-of-Pocket Maximum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23Out-of-Pocket Maximums By Plan Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24Maximum Lifetime Benefit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

preventive (Wellness) BeneFit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25Wellness Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Care manaGement / HealtHCare utiliZation . . . . . . . . . . . . . . . . . . . . . . . . . .26Individual Case Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26Appeals Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26BestBeginnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

tHe BlueCard proGram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Here’s How BlueCard helps keep costs down . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Clark County Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27Non-BlueCard Claim Submission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28BlueCard Worldwide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28Further Questions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Covered serviCes and supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29Hospital Inpatient Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

Hospital Inpatient Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29Hospital Outpatient Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29Skilled Nursing Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Skilled Nursing Care Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30Ambulatory Surgical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30Physicians’ Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30Assistant Surgeon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30Multiple Surgical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30Mental Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Mental Health Care Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Chemical Dependency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Chemical Dependency Treatment Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Therapeutic Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Diagnostic Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Diagnostic and Screening Mammography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32Contraceptive Management and Sterilization Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

Prescription Contraceptives Dispensed by a Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32Contraceptive Management and Sterilization Services Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

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Mastectomy and Breast Reconstruction Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32Transplants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

Covered Transplants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33Transplant Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33Transplant Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Rehabilitation Therapy, Chronic Pain Care, and Neurodevelopmental Therapy . . . . . . . . . . . . . . . . . . . .34Rehabilitation Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Inpatient Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35Outpatient Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35Chronic Pain Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35Neurodevelopmental Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35

Rehabilitation Therapy, Chronic Pain Care, and Neurodevelopmental Therapy Limitations . . . . . . . . .35Home Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

Home Health Care Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36Hospice Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

Hospice Care Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37Licensed Ambulance Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38Special Transport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38Home Medical and Respiratory Equipment/Medical Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

Home Medical and Respiratory Equipment/Medical Supplies Limitations . . . . . . . . . . . . . . . . . . . . . .38Prosthetic Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39

Prosthetic Devices Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39Blood Transfusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39PKU Dietary Formula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39Obstetric Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39Routine Newborn Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40Newborn Hearing Exams and Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40Acupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40Chiropractors’ Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41Health Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Health Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41Nicotine Dependency Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Nutritional Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41Skilled Nursing Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Skilled Nursing Care Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41Temporomandibular Joint (TMJ) Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42Orthognathic Surgery (Jaw Augmentation or Reduction) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42Obesity Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

Non-Surgical Weight Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42Surgical Treatment of Morbid Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42Obesity Treatment Benefit Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43

disease manaGement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44

pHarmaCY proGram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45Maximum Medication Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45Special Features of the Pharmacy Network Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45Drug Utilization Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45Generic Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46High Performance Step Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46Approved Drug List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47Prescription Drug Copayment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47Refills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47Maintenance Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

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Out-of-Pocket Maximum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48Pharmacies Outside Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48Non-Participating Retail Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48Coordination of Benefits for Prescription Drug Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48Ordering From CVS Caremark Mail Service Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49CVS Caremark Specialty Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

Pharmacy Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

dental Care BeneFits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51Estimate of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51Alternative Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52Plan Year Deductible (750 and High Deductible Health Plans only) . . . . . . . . . . . . . . . . . . . . . . . . . . . .52Covered Dental Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52Type A—Preventive Care Expenses (not subject to dental deductible) . . . . . . . . . . . . . . . . . . . . . . . . . . .52Type B—Basic Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53Type C—Major Dental Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53

Dental Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54Orthodontia (Available on 500 Plan Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

Orthodontia Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

vision Care BeneFits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56Covered Vision Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56Extra Discounts and Savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56Using Non-VSP Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57Coordination of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

Vision Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

audio Care BeneFits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59Covered Services and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

Audio Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

HoW to suBmit a Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60Automatic Claims Submission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60Manual Claims Filing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60Air or Surface Transportation Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61Submission of Pharmacy Drug Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61Claims Filing Timelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62Claims Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62Denied Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62Your Questions, Complaints and Appeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

When You Have Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62When You Have a Complaint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63When You Have an Appeal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63Appeals Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63

Coordination oF BeneFits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65Terms You Should Know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65Order of Claim Filing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66Right of Recovery/Facility of Payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66Third Party Liability (Subrogation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

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termination oF BeneFits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68Termination of Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68Certificate of Group Health Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68Plan Termination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

CoveraGe Continuation (CoBra) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69Leave of Absence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70Medicare Supplement Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70

eXtended BeneFits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71Continued Eligibility for a Disabled Enrollee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71Surviving Dependents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72

General limitations and eXClusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73What Your Program Does Not Cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

General provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76Enrollee Cooperation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76Notice of Other Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76Evidence of Medical Necessity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76Notice of Information Use and Disclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76Right to and Payment of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77Right of Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77Venue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77Workers’ Compensation Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77Intentionally False or Misleading Statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77Limitations of Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78

FleXiBle spendinG aCCounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79Plan Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79Major Life Event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80Termination of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80Use It or Lose It Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80Medical Flexible Spending Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81Eligible Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81Dependent Care Flexible Spending Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82How to Submit a Claim for Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

Medical FSA Claim Submissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83Dependent Care FSA Claim Submissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

Questions Regarding Your Plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83COBRA Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

emploYee assistanCe proGram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84How to Use the Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84

disaBilitY BeneFits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85Definition of Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85

vi

Monthly Benefit Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86Monthly Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86Benefit Offsets (Income from Other Sources) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86Rehabilitation/Return to Work Incentive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87Limitation of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87Long Term Disability Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88Long Term Disability Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88Termination of Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88Conversion Privilege . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88

liFe insuranCe BeneFits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89

BasiC liFe insuranCe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90Beneficiaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90Termination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90Travel Accident Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90Disability Waiver of Premium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91Portability or Conversion Privilege . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91

supplemental liFe insuranCe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92Payment of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93Termination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93Disability Waiver of Premium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93Portability or Conversion Privilege . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93

aCCidental deatH and dismemBerment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94Beneficiaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95AD&D Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95

retirement plans and options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96Social Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96

universitY oF alaska optional retirement plan . . . . . . . . . . . . . . . . . . . . . .97Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97Contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97Vesting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97Your Investment Decision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97Forms of Payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98

vii

Your Choices Of Investment Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98Fidelity Investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98Lincoln National . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98TIAA-CREF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98VALIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99Default Investment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99

Choosing a Fund Sponsor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99Distributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99

universitY oF alaska pension plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100Vesting and Distributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100Investment Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100

state retirement plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101

TRS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101PERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101

Contribution Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101TRS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101PERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101

Vesting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102

Defined Contribution Plan Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102Defined Benefits Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102

Termination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102Additional Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102

taX-deFerred annuitY (tda) plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103Disclaimer Of Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103Contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103Payment of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104

otHer BeneFits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105Educational Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105Holidays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105Annual Leave . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106Sick Leave . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106Leave of Absence Without Pay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107Other Leaves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107Medical Leave . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107Family Medical Leave (FML) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107Leave Share Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108Parental Leave . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108Jury Duty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108Military Leave . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109

GlossarY oF terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110

viii

NOTES

1

Comprehensive Notice Of Privacy Policy And Procedures

THIS NOTICE IS REQUIRED BY FEDERAL REGULATIONS AND DESCRIBES HOW MEDICAL INFORMA-TION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFOR-MATION. PLEASE REVIEW IT CAREFULLY.

This Notice is provided to you on behalf of:

• UniversityofAlaskaHealthCarePlan• UniversityofAlaskaPharmacyPlan• UniversityofAlaskaVisionPlan• UniversityofAlaskaMedicalFlexibleSpendingAccount

Theseplanscomprisewhatiscalledan“AffiliatedCoveredEntity,”andaretreatedasasingleplanforpurposesofthisNoticeandtheprivacyrulesthatrequireit.ForpurposesofthisNotice,we’llrefertotheseplansasasingle“Plan.”

tHe plan’s dutY to saFeGuard Your proteCted HealtH inFormation

Individuallyidentifiableinformationaboutyourpast,present,orfuturehealthorcondition,theprovisionofhealthcaretoyou,orpaymentforthehealthcareisconsidered“ProtectedHealthInformation”(“PHI”).ThePlanisre-quiredtoextendcertainprotectionstoyourPHI,andtogiveyouthisNoticeaboutitsprivacypracticesthatexplainshow,whenandwhythePlanmayuseordiscloseyourPHI.Exceptinspecifiedcircumstances,thePlanmayuseordiscloseonlytheminimumnecessaryPHItoaccomplishthepurposeoftheuseordisclosure.

ThePlanisrequiredtofollowtheprivacypracticesdescribedinthisNotice,thoughitreservestherighttochangethosepracticesandthetermsofthisNoticeatanytime.Ifitdoesso,andthechangeismaterial,youwillreceivearevisedversionofthisNoticeeitherbyhanddelivery,e-maildelivery,maildeliverytoyourlastknownaddress,orsomeotherfashion.ThisNotice,andanymaterialrevisionsofit,willalsobeprovidedtoyouinwritinguponyourrequest(askyourHumanResourcesrepresentative,orcontactthePlan’sPrivacyOfficial,describedbelow),andwillbepostedontheUniversityofAlaska’sbenefitswebsite.

Youwillalsoreceiveotherprivacynotices,fromcompaniesthatprovidebenefitplanservicestotheUniversityofAlaska.ThosenoticeswilldescribehowtheyuseanddisclosePHI,andyourrightswithrespecttothePHItheymaintain.

HoW tHe plan maY use and disClose Your proteCted HealtH inFormation

The Plan uses and discloses PHI for a variety of reasons. For its routine uses and disclosures it does not require your authorization,butforotherusesanddisclosures,yourauthorization(ortheauthorizationofyourpersonalrepresen-tative,e.g.apersonwhoisyourcustodian,guardian,orhasyourpower-of-attorney)mayberequired.ThefollowingoffersmoredescriptionandexamplesofthePlan’susesanddisclosuresofyourPHI.

uses and disClosures relatinG to treatment, paYment, or HealtH Care operations

• Treatment:ThePlanispermittedtodiscloseyourPHIforpurposesofyourmedicaltreatment.Thus,itmaydis-closeyourPHItodoctors,nurses,hospitals,emergencymedicaltechnicians,pharmacistsandotherhealthcareprofessionalswherethedisclosureisforyourmedicaltreatment.

2

• Payment:ThePlanispermittedtodiscloseyourPHIforpurposesofpaymentofyourclaims.Thus,itmaydiscloseyourPHItodoctors,nurses,hospitals,emergencymedicaltechnicians,pharmacistsandotherhealthcareprofessionalswherethedisclosureisforpaymentfunctions.ThePlanmayalsoshareyourPHIwithotherplans,incertaincases.Forexample,ifyouarecoveredbymorethanonehealthcareplan,wemayshareyourPHIwiththeotherplanstocoordinatepaymentofyourclaims.

• Healthcareoperations:ThePlanmayuseanddiscloseyourPHIinthecourseofits“healthcareoperations.”Forexample,itmayuseyourPHIinevaluatingthequalityofservicesyoureceived,ordiscloseyourPHItoanaccountantorattorneyforauditpurposes.Insomecases,thePlanmaydiscloseyourPHItoinsurancecompa-niesforpurposesofobtainingvariousinsurancecoverage.

otHer uses and disClosures oF Your pHi not requirinG autHoriZation

ThelawprovidesthatthePlanmayuseanddiscloseyourPHIwithoutauthorizationinthefollowingcircumstances:

• TothePlanSponsor:ThePlanmaydisclosePHItotheemployer(suchasUniversityofAlaska)whosponsorsormaintainsthePlanforthebenefitofemployeesanddependents.However,thePHImayonlybeusedforlimitedpurposes,andmaynotbeusedforpurposesofemployment-relatedactionsordecisionsorinconnectionwithanyotherbenefitoremployeebenefitplanoftheemployer.PHImaybedisclosedto:thehumanresourcesoremployeebenefitsdepartmentforpurposesofenrollmentsanddisenrollments,census,claimresolutions,andothermattersrelatedtoPlanadministration;payrolldepartmentforpurposesofensuringappropriatepayrolldeductionsandotherpaymentsbycoveredpersonsfortheircoverage;informationtechnologydepartment,asneededforpreparationofdatacompilationsandreportsrelatedtoPlanadministration;financedepartmentforpurposesofreconcilingappropriatepaymentsofpremiumtoandbenefitsfromthePlan,andothermattersre-latedtoPlanadministration;internallegalcounseltoassistwithresolutionofclaim,coverageandotherdisputesrelatedtothePlan’sprovisionofbenefits.

• Requiredbylaw:ThePlanmaydisclosePHIwhenalawrequiresthatitreportinformationaboutsuspectedabuse,neglectordomesticviolence,orrelatingtosuspectedcriminalactivity,orinresponsetoacourtorder.ItmustalsodisclosePHItoauthoritiesthatmonitorcompliancewiththeseprivacyrequirements.

• Forpublichealthactivities:ThePlanmaydisclosePHIwhenrequiredtocollectinformationaboutdiseaseorinjury,ortoreportvitalstatisticstothepublichealthauthority.

• Forhealthoversightactivities:ThePlanmaydisclosePHItoagenciesordepartmentsresponsibleformonitor-ingthehealthcaresystemforsuchpurposesasreportingorinvestigationofunusualincidents.

• Relatingtodecedents:ThePlanmaydisclosePHIrelatingtoanindividual’sdeathtocoroners,medicalexamin-ersorfuneraldirectors,andtoorganprocurementorganizationsrelatingtoorgan,eye,ortissuedonationsortransplants.

• Forresearchpurposes:Incertaincircumstances,andunderstrictsupervisionofaprivacyboard,thePlanmaydisclosePHItoassistmedicalandpsychiatricresearch.

• Toavertthreattohealthorsafety:Inordertoavoidaseriousthreattohealthorsafety,thePlanmaydisclosePHIasnecessarytolawenforcementorotherpersonswhocanreasonablypreventorlessenthethreatofharm.

• Forspecificgovernmentfunctions:ThePlanmaydisclosePHIofmilitarypersonnelandveteransincertainsituations,tocorrectionalfacilitiesincertainsituations,togovernmentprogramsrelatingtoeligibilityanden-rollment,andfornationalsecurityreasons.

• UsesandDisclosuresRequiringAuthorization:Forusesanddisclosuresbeyondtreatment,paymentandopera-tionspurposes,andforreasonsnotincludedinoneoftheexceptionsdescribedabove,thePlanisrequiredtohaveyourwrittenauthorization.Yourauthorizationscanberevokedatanytimetostopfutureusesanddisclo-sures,excepttotheextentthatthePlanhasalreadyundertakenanactioninrelianceuponyourauthorization.

• UsesandDisclosuresRequiringYoutohaveanOpportunitytoObject:ThePlanmaysharePHIwithyourfam-ily,friendorotherpersoninvolvedinyourcare,orpaymentforyourcare.ThePlanmayalsosharePHIwiththesepeopletonotifythemaboutyourlocation,generalcondition,ordeath.However,thePlanmaydiscloseyourPHIonlyifitinformsyouaboutthedisclosureinadvanceandyoudonotobject(butifthereisanemer-gencysituationandyoucannotbegivenyouropportunitytoobject,disclosuremaybemadeifitisconsistent

3

withanypriorexpressedwishesanddisclosureisdeterminedtobeinyourbestinterests;youmustbeinformedandgivenanopportunitytoobjecttofurtherdisclosureassoonasyouareabletodoso).

Your riGHts reGardinG Your proteCted HealtH inFormation

Youhavethefollowingrightsrelatingtoyourprotectedhealthinformation:

• Torequestrestrictionsonusesanddisclosures:YouhavetherighttoaskthatthePlanlimithowitusesordisclosesyourPHI.ThePlanwillconsideryourrequest,butisnotlegallyboundtoagreetotherestriction.TotheextentthatitagreestoanyrestrictionsonitsuseordisclosureofyourPHI,itwillputtheagreementinwrit-ingandabidebyitexceptinemergencysituations.ThePlancannotagreetolimitusesordisclosuresthatarerequiredbylaw.

• TochoosehowthePlancontactsyou:YouhavetherighttoaskthatthePlansendyouinformationatanalterna-tiveaddressorbyanalternativemeans.ThePlanmustagreetoyourrequestaslongasitisreasonablyeasyforittoaccommodatetherequest.

• ToinspectandcopyyourPHI:Unlessyouraccessisrestrictedforclearanddocumentedtreatmentreasons,youhavearighttoseeyourPHIinthepossessionofthePlanoritsvendorsifyouputyourrequestinwriting.ThePlan,orsomeoneonbehalfofthePlan,willrespondtoyourrequest,normallywithin30days.Ifyourrequestisdenied,youwillreceivewrittenreasonsforthedenialandanexplanationofanyrighttohavethedenialre-viewed.IfyouwantcopiesofyourPHI,achargeforcopyingmaybeimposeddependingonyourcircumstanc-es.Youhavearighttochoosewhatportionsofyourinformationyouwantcopiedandtoreceive,uponrequest,priorinformationonthecostofcopying.

• TorequestamendmentofyourPHI:IfyoubelievethatthereisamistakeormissinginformationinarecordofyourPHIheldbythePlanoroneofitsvendors,youmayrequest,inwriting,thattherecordbecorrectedorsupplemented.ThePlanorsomeoneonitsbehalfwillrespond,normallywithin60daysofreceivingyourre-quest.ThePlanmaydenytherequestifitisdeterminedthatthePHIis:(i)correctandcomplete;(ii)notcreatedbythePlanoritsvendorand/ornotpartofthePlan’sorvendor’srecords;or(iii)notpermittedtobedisclosed.Anydenialwillstatethereasonsfordenialandexplainyourrightstohavetherequestanddenial,alongwithanystatementinresponsethatyouprovide,appendedtoyourPHI.Iftherequestforamendmentisapproved,thePlanorvendor,asthecasemaybe,willchangethePHIandsoinformyou,andwillattempttotellothersthatneedtoknowaboutthechangeinthePHI.

• Tofindoutwhatdisclosureshavebeenmade:Youhavearighttogetalistofwhen,towhom,forwhatpurpose,andwhatportionofyourPHIhasbeenreleasedbythePlananditsvendors,otherthaninstancesofdisclosureforwhichyougaveauthorization,orinstanceswherethedisclosurewasmadetoyouoryourfamily.Inad-dition,thedisclosurelistwillnotincludedisclosuresfortreatment,payment,orhealthcareoperations.Thelistalsowillnotincludeanydisclosuresmadefornationalsecuritypurposes,tolawenforcementofficialsorcorrectionalfacilities,orbeforethedatethefederalprivacyrulesappliedtothePlan.Youwillnormallyreceivearesponsetoyourwrittenrequestforsuchalistwithin60daysafteryoumaketherequestinwriting.Yourre-questcanrelatetodisclosuresgoingasfarbackassixyears.Therewillbenochargeforuptoonesuchlisteachyear.Theremaybeachargeformorefrequentrequests.

HoW to Complain aBout tHe plan’s privaCY praCtiCes

IfyouthinkthePlanoroneofitsvendorsmayhaveviolatedyourprivacyrights,orifyoudisagreewithadecisionmadebythePlanoravendoraboutaccesstoyourPHI,youmayfileacomplaintwiththepersonlistedinthesectionimmediatelybelow.YoualsomayfileawrittencomplaintwiththeSecretaryoftheU.S.DepartmentofHealthandHumanServices.Thelawdoesnotpermitanyonetotakeretaliatoryactionagainstyouifyoumakesuchcomplaints.

4

ContaCt person For inFormation, or to suBmit a Complaint

IfyouhavequestionsaboutthisNoticepleasecontactthePlan’sPrivacyOfficialorDeputyPrivacyOfficial(s)(seebelow).IfyouhaveanycomplaintsaboutthePlan’sprivacypracticesorhandlingofyourPHI,pleasecontactthePrivacyOfficialoranauthorizedDeputyPrivacyOfficial.

Privacy Official

ThePlan’sPrivacyOfficial,thepersonresponsibleforensuringcompliancewiththisNotice,is:

DonaldSmithChiefHumanResourceOfficer(Interim)

(907)450-8200

ThePlan’sDeputyPrivacyOfficialis:

ErikaVanFleinDirectorofBenefits(907)450-8227

orGaniZed HealtH Care arranGement desiGnation

ThePlanparticipatesinwhatthefederalprivacyrulescallan“OrganizedHealthCareArrangement.”ThepurposeofthatparticipationisthatitallowsPHItobesharedbetweenthemembersoftheArrangement,withoutauthoriza-tionbythepersonswhosePHIisshared,forhealthcareoperations.Primarily,thedesignationisusefultothePlanbecauseitallowstheinsurerswhoparticipateintheArrangementtosharePHIwiththePlanforpurposessuchasshoppingforotherinsurancebids.

ThemembersoftheOrganizedHealthCareArrangementare:

• UniversityofAlaska• PremeraBlueCrossBlueShieldofAlaska• CVSCaremark• FringeBenefitsManagementCompany,adivisionofWageWorks• VSP

Effective Date

TheeffectivedateofthisNoticeis:December1,2011.

5

ABOUT THIS HANDBOOK

ThishandbooksummarizesbenefitprogramscurrentlyprovidedbytheUniversityofAlaska.Formalagreementsandrules,includingbutnotlimitedtoplandocuments,Regents’PolicyandUniversityRegulation,determinetheactualbenefitsthatwillbeprovidedtoemployees.Iftheprovisionsofthissummaryconflictwithsuchdocuments,theformalagreementsandruleswillgovern.

Themethodofdeliveryorthecompanythroughwhichabenefitprogramisprovidedmaychangefromtimetotime.Specificservicesmaynotbeduplicatedorofferedbythenewbenefitvendor.

Alaskainsuranceregulationsalsoplacecertainstipulationsonthemannerinwhichinsurance-relateddisputesmaybeaddressedandsettled.Asaresult,eachvendorhasanestablisheddisputeresolutionprocedure.Inaddition,be-causesomeproductsarefullyunderwrittenand/orinsuredbyavendor,thesoleremedyforanyandalldisputeswillrestexclusivelywiththatbenefitvendor.

ThisHandbookiscurrentasofJuly1,2011.UpdatestotheHandbookaremadeasneededtoclarifyorcorrectinfor-mation.ThemostrecentversionoftheHandbookcanbefoundontheUniversityofAlaska’sbenefitswebsiteatthefollowingaddress:

http://www.alaska.edu/benefits/

YourHandbookcontainsthefollowingsections:

Benefits in Brief Chart—aquickoverviewofyourvariousbenefitsandhowtheyinterrelate.

Introduction—basicinformationaboutthebenefitprogramsoftheUniversity.

Health Care—descriptionofyourcomprehensiveMedical,Dental,PharmacyandAudiobenefits,includinginfor-mationabouteligibilityandenrollment.

Pharmacy—descriptionofyourprescriptiondrugbenefit,includingretail,mailorderandspecialtypharmacy.

Vision Care—description of the Vision Care Plan as provided by VSP

Employee Assistance Program (EAP)—descriptionofthebenefitsavailabletoemployeesandtheirdependents.

Disability—explainshowtheLongTermDisabilityplancanreplaceapercentageofyourincomeintheeventyoucannotworkbecauseofamedicaldisability.

Life Insurance Benefits—summarizesLifeInsurancecoverage,optionalSupplementalLifeInsurancebenefits,andvoluntaryAccidentalDeathandDismembermentbenefits.

Retirement Benefits—outlinesthestate-affiliatedretirementplans-TheTeachers’RetirementSystem(TRS),andPublicEmployees’RetirementSystem(PERS).AlsooutlinestheUniversityofAlaskaOptionalRetirementPlan(ORP),theUniversityofAlaskaPensionPlan,andvoluntaryTax-DeferredAnnuities.

Other Benefits—providesinformationabouttheUniversity’sregulationsandproceduresconcerningleaves,sabbati-cals,holidays,andeducationalbenefits.

If you have any questions about your benefits, please contact the human resources office at your local campus.

6

BENEFITS IN BRIEF

Medical Care Deductible

Coinsurance (afterthedeductible)

Out-of-PocketMaximum(afterthedeductible)

Dental Care ($2,000maxi-mumbenefitper covered individual per year)

Preventiveservices100%Basicexpenses 80%Majorexpenses 50%$25annualdeductibleonbasicandmajorexpenses

Pharmacy Local retail andmailorderbenefits;non-networkbenefitsalsoavailable

Vision Care $10copayforexam,$25copayforglasses(lensesandframes),nocopayforcontacts.Examevery12months,lensesandframesORcontactsevery24months.Non-VSPproviderbenefitslimitedtoallowances.

$1,250perindividual$3,000perfamily

80%forin-networkservices,60%forout-of-network

$3,750perperson,$8,000perfamilyforin-networkservices;Out-of-NetworkServicesdonotapplytothemaximumout-of-pocketlimit.

Preventiveservices 80%Basicexpenses 80%Majorexpenses 50%$50annualdeductibleonbasicandmajorexpenses

Preventiveservices100%Basicexpenses 80%Majorexpenses 50%No deductibleOrthodontiaat50%upto$1,500lifetimemaximum

ua CHoiCe HealtH Care proGram

Regularemployees(andtheirdependents,ifenrolled)areeligibleafterawaitingperiodofapproximately30daysfromhiredate.Employeesmaywaivecoveragewithproofofotherinsurance.TheUniversityofAlaskaandemployeesbothcontributetothecostofthisprogram.

$750perindividual$2,250perfamily



$500perindividual$1,500perfamily



Plan High Deductible Plan 750 Plan 500 Plan

LocalNetworkPharmacy MailOrderPharmacy(30daysupply) (Upto90daysupply)GenericDrugs $5copay $10copayBrandName $25copay $50copayNon-preferred $50copay $100copay

Thereisa$1,000annualout-of-pocketmaximumperenrolleeforpharmacybenefits

7

FleXiBle spendinG aCCounts

Program WhoPays Eligibility BenefitsHealth Care FlexibleSpendingAccount

You Anoptionalprogramthatprovidesem-ployeestheopportunitytobereimbursedwiththeirowntax-freecontributionsforhealthcareexpensesthatarenotcoveredbythehealthcareprogram.Accountbal-ancesmustbeusedduringtheplanyear,orthemoneyisforfeited.

Regularemployeesuponenrollment(atthetimeofhire,duringopenenroll-ment,orwith“lifeevent”).

Dependent CareFlexibleSpendingAccount

You Regularemployeesuponenrollment(atthetimeofhire,duringopenenroll-ment,orwith“lifeevent”).

Anoptionalprogramthatprovidesem-ployeestheopportunitytobereimbursedwiththeirowntax-freecontributionsfordependentcareexpensesthatareneces-sarytoallowtheemployee(andhis/herspouse,ifmarried)toseekorretainemployment.Accountbalancesmustbeusedduringtheplanyear,orthemoneyisforfeited.

liFe insuranCe

Program WhoPays Eligibility BenefitsBasic Life Insurance

SupplementalLife

The University Regularemployeesfromtheinitialdayofemployment

$50,000ofgrouplifeinsurancecoverageisprovidedtoallemployees.


Availableinamountsfrom$25,000to$400,000,inincrementsof$25,000,ben-efitsarepaidinalumpsumorinmonthlyinstallments.EvidenceofInsurabilityrequiredforamountsover$200,000.Foremployeesage65andover,themaxi-mumamountoflifeinsurancethattheymayelectis$25,000.Participation is optional.

Accidental Death and Dismember-ment


Paysbenefitsforaccidentallossoflifeorlimb.Coverageisalsoavailablefordependents. Participation is optional.

Travel Accident

The University Regularemployeesfromtheinitialdayofemployment.

PaysbenefitsforaccidentaldeathwhiletravelingonUniversitybusiness.Cover-ageis$250,000.

8

Program WhoPays Eligibility Benefits

retirement BeneFits

PublicEmployees’RetirementSystem(PERS)and Teachers’RetirementSystem(TRS)

You contribute a percent of your salary before taxes.Contribu-tion rate is deter-minedbydateofhire. University contribution can changeannuallyasdeterminedby the State of AlaskaDivisionofRetirement.

Eligibleregularemploy-eesfrominitialdayofemployment.EmployeeshiredonorafterJuly1,2006participateinadefinedcontribution(DC)plan.Employeeshiredbe-foreJuly1,2006partici-pateinadefinedbenefitplan(DB).

RetirementbenefitbasedondateofhirewithDCmembershavingacashaccountandDBmembersgettingcreditforsalaryand service. CompletedetailsonallfeaturesofPERSand TRS are available at the State of AlaskaDivisionofRetirementandBen-efitsWebsiteatwww.state.ak.us/local/akpages/ADMIN/drb/home.htm

Optional RetirementProgram(ORP)

You contribute apercentageofyourpre-taxsalary. Univer-sity contribution is a three-year averageofTRSemployerrateifhiredbeforeJuly1,2005.IfhiredafterJuly1,2005youremployercontribution rate is12%.

Regularfull-timeandpart-timeemployeesmustchoosebetweentheORPandthestate’sretirementsystemprogramswithin30daysofbeingnoti-fiedtheyareeligibletoparticipate.

Retirementbenefitbasedontotalcon-tributionsandearnings.Contributionsareplacedinanindividualtax-deferredaccount,chosenfromawidevarietyofinvestmentoptionsprovidedbyfourfundsponsors. Participants are fully vested in theemployercontributionaccountafterthreeyears;vestingintheemployeecon-tributionaccountisimmediate.VestedaccountbalancesmayberolledovertoanotherqualifiedplanorIRAatterminationaftera45-daywaitingperiod.Youmaynottakealump-sumcashdistri-butionfromthisplan.PleaseseetheUARetirementDecisionGuideformoreinformation.

University ofAlaskaPension Plan

The University contributes7.65%ofyourfirst$42,000ingrosswages.

Eligibleemployeesfrominitialdayofemployment.Employeeshiredonoraf-terJuly1,2006mustelecttheORPtobeeligibleforUA Pension.

Retirementbenefitbasedonamountcon-tributedandinvestmentoptionselected.VestingisimmediateifhiredbeforeJuly1,2006;3-yearvestingifhiredonorafterJuly1,2006.Accountbalancemaybewithdrawnatterminationaftera45-daywaitingperiod.

Medicare You and the University.

AllemployeeshiredafterMarch31,1986.

Medicarebenefitsfordisabledemployeesandforthoseage65andover.

TaxDeferredAnnuity Plans (TDAs)

You. Allemployeesuponen-rollment.

Supplementalsavingsforretirementanddefertaxesoncurrentincome.Participa-tion is optional.

9

otHer BeneFits *Program WhoPays Eligibility BenefitsSickLeave The University Regularemployeesfrom

initialdayofemploymentPaidleaveforillness,medicalconditions,ordoctorsappointment.Leaveaccruesat4.62hoursperpayperiodforfull-timeemployees.SeetheFamilyMedicalLeave(FML)sectionformoreinforma-tion.

Leave Share Program

FellowUniver-sityEmployeesDonatefromTheir Accrued SickLeave

Regularemployeesfrominitialdayofemployment

Ifanemployeehasexhaustedalloftheirannualleaveandsickleaveasaresultofacatastrophicmedicalcrisis,theymayapplytotheleaveshareprogramiftheystillqualifyforFamilyMedicalLeave.Underthisprogramotheremployeesareallowedtodonateaportionoftheirsickleavetotheemployeeapplyingforleaveshare.

FamilyMedical Leave(ParentalLeave)

You and the University,dependingonwhetheryouusesickleave,annualleave,leavewithoutpay,orcombi-nations of the above.

Allregularemployeesmeet-inglengthofemploymentandhoursworkedrequire-ments.

Leave for serious health care condition ofyouorafamilymember,tocarefornewborninfantornewlyadoptedchildorforplacementofafosterchild,ortocareforaninjuredservicememberorforaqualifyingexigencyrelatedtoacoveredservicemember.SeetheFamilyMedicalLeave(FML)sectionformoreinforma-tion.

Annual Leave The University Regularemployees,exceptfaculty.

Vacationtimebaseduponyearsofser-viceandpart-time/full-timeemploymentstatus.Accrualforafull-timeemployeeis: First5years: 5.54hrsperpayperiod 6-10years: 6.46hrsperpayperiod Over10years: 7.38hrsperpayperiod

Holidays The University Regularemployees,exceptfaculty. Based on part/full-timeemploymentstatus.

Upto12paidholidayseachcalendaryear. One additional personal holiday is grantedtoregularclassifiedemployees.

*Ifyouareamemberofacollectivebargainingunit,yourbenefitsmaydiffer.Pleasecheckyourcollectivebargainingagreement(CBA).

10

Educational Benefits

The University

Regularemployeesandtheir dependents.

Employeesareeligibleforupto12tuition-freecoursecreditsperacademicyear.Notuitionfeeischargedforcoursestakenbyeligibledependents.(Graduatecredits,however,aretaxable.Self-supportingclassesarenotcovered.)

Leaveforuptooneyear,withthepos-sibilitytoextendtoasecondyear.

YouLeave of Absence

AllemployeeswhoaregrantedleavebytheUni-versity.

otHer BeneFits

Program WhoPays Eligibility Benefits

Long-termDisability

The University

Ifyouarehiredandactivelyatworkonthefirstdayofthemonthcoveragebeginson that day. If you are hired and actively atworkonanyotherdayofthemonth,itstartsthefirstofthefollowingmonth.Inconjunctionwithotheravailableben-efits,theprogrampays60%ofyourbasesalary,toamaximumof$3,000/month.Priortobeingeligibleforthisprogram,anemployeemusthaveexhaustedalloftheirsickleaveand/orcompletedthe90-daywaitingperiod,whicheverisgreater.

Regularemployees.

Worker’sCompensation

The University Allemployeesfrominitialdayofemployment.

Compensationforon-the-jobinjuryorillness.Providescoverageformedi-calexpenseandlossofcompensation.Injury/illnessformmustbecompletedwithin10daysaftertheinitialinjuryofillness.

11

INTRODUCTION

Your BeneFit proGram

Inrecognitionofthediversityoftheemployeepopulation,theUniversityofAlaskahasdevelopedabenefitprogramthatallowsflexibilityandchoice.Thehealthbenefitprogramprovidescoverageforyouandyourfamilynotonlyincaseofillness,butalsoincludesseveralprovisionsthatfocusonpreventivecare.TheUA Choice health care plan offersyouthreeoptions:the500Plan,the750PlanortheHighDeductibleHealthPlan(HDHP),atthreedifferentcoststoyou.Alternatively,ifyouhaveothermedicalcoverageanddon’tneedcoveragethroughtheUniversity,youcanoptout(withproofofothercoverage)andavoidpayrolldeductionsforhealthcare.

YoumayenhancewhicheverUA Choiceplanyouchoosebyselectingamedicalflexiblespendingaccount.Thebasiclifeinsurancebenefitmaybesupplementedbypurchasingtheoptionalsupplementallifeinsuranceand/oraccidentaldeathanddismembermentcoverage.Themedicalanddependentcareflexiblespendingaccountsandlifeinsuranceplansaredesignedtoallowemployeestheabilitytoincreasetheirtotalbenefitcoverage.Pleasenotethatalloptionalplansarepaidforbytheemployeeandratesaresetannually.

EmployeesmayalsoaugmenttheUniversityretirementprogrambyselectingfromanumberofTax-DeferredAn-nuityplansinwhichtheysetasidetax-deferredfundsfromtheirsalaryforincomeduringretirement.Thesefundswouldbeinadditiontoanybenefitsfromthestate-affiliatedretirementplans,theUniversity’sPensionPlanorOptionalRetirementPlan(ORP).

BeneFit Considerations

ItisimportantthatyoucarefullyevaluateeachoftheUA Choiceplansandtheoptionalplansafterconsideringyourparticularneeds.Age,familystatus,healthcarerequirements,careergoals,yearsofservice,pay,andfinancialobjec-tivesarefactorsthatneedtobeconsideredinselectingyouroptionalbenefits.

Eachyearduringtheannualopenenrollmentperiodemployeescanmakenewbenefitelectionstoreflectchangesintheirbenefitneeds.Exceptincasesofamajorlifeevent,theperioddesignatedforopenenrollmentistheonlytimethatemployeesmaymakebenefitelections.If,however,duringtheplanyearanemployeeexperiencesamajorlifeeventsuchasmarriage,divorce,birth,adoption,deathofaspouseorchild,etc.,theymaybeeligibletomakeachangeintheirbenefitelectionsaslongasthechangeisconsistentwiththelifeevent.Pleaseconsultyourregionalcampushumanresourcesofficeifyouexperienceamajorlifeeventduringtheplanyear.

12

Campus Human resourCes oFFiCe loCations

Contactyourregionalcampushumanresourcesofficeatthefollowingaddressesforquestionsaboutspecificpro-grams:

University of Alaska FairbanksHumanResources

UniversityofAlaskaFairbanksUAFAdministrativeServicesCenter

P.O.Box7578603295CollegeRoad

Fairbanks,AK99775-7860907/474-7700

University of Alaska AnchorageHumanResourceServices

101UniversityLakeBuilding3890UniversityLakeDriveAnchorage,AK99508

907/786-4608

University of Alaska SoutheastHumanResources

UniversityofAlaskaSoutheast11120GlacierHighwayJuneau,AK99801907/796-6473

Statewide AdministrationStatewideOfficeofHumanResources

UniversityofAlaskaP.O.Box755140

212ButrovichBuildingFairbanks,AK99775-5140

907/450-8200

notiCe under tHe Women’s HealtH and CanCer riGHts aCt oF 1998

Afederallawrequireshealthplansthatprovidemastectomybenefitstoalsoprovidecertainrelatedbenefitsandtotellparticipantsthattheyareavailable.EffectiveJanuary1,1999,benefitsavailableundertheUniversityofAlaska’sHealthCarePlanforcoveredindividualswhoarereceivingbenefitsforamastectomyandelectbreastreconstructioninconnectionwiththemastectomyinamannerdeterminedinconsultationwiththepatientandat-tendingphysicianinclude:

• reconstructionofthebreastonwhichthemastectomywasperformed;• surgeryandreconstructionoftheotherbreasttoproduceasymmetricalappearance;and• prosthesesandtreatmentofphysicalcomplicationsofallstagesofmastectomy,includinglymphedemas.

Thesereconstructivebenefitsaresubjecttothesameannualdeductibleandcoinsuranceprovisionsasotherplanmedicalandsurgicalbenefits(seeMastectomyandBreastReconstructionServicesunderCoveredServicesandSup-plies).

13

YOUR ROLE IN CONTROLLING YOUR HEALTH PLAN COSTS

TheUniversity’shealthcareprogramhasmanyfeaturesthathavebeendesignedtoprovideforyourhealthcareprotection.However,yourwiseandcarefuluseoftheprogramiskeytotheUniversity’sabilitytocontinuetoofferacomprehensivehealthcareprogram.

Thecostofthehealthcareplanissharedbetweenemployeesandtheuniversity,withtheuniversitycurrentlypaying83%ofthenetcost.FortheFY12planyear,theuniversity’scontributionisapproximately$59.4million,or$13,919peremployee.

Oneofthemosteffectivemeasuresthatyoucantakeinyourpersonaleffortstoassistincontrollingthecostofthehealthcareprogramistodevelopahealthylifestyle.Unlessyouareoneofthefewreallyhealth-consciousindividu-als,yourcurrentlifestyleisalmostcertainlylesshealthythanitcouldbe.Nowisthetimetomodifyit.Youwillbenefitfirstofallbyloweringyourriskofdevelopingapreventableillness.Heartdisease,cardiovasculardisease,andcanceraremajorcoststoyourhealthcareprogramandaremoreeasilypreventedthancured.Second,asyoubecomeincreasinglyfit,youwillfeelbetterandwillfindthatyouaremoreabletoenjoylife.Basicguidelinesforhealthylivingaresimple,andmedicalresearchshowsconvincinglythatfollowingtheseguidelineswillimproveyourchancesforalonger,healthierlife:

• Ifyousmokeorusetobacco,quit.Tobaccocessationprogramsareavailabletohelpyouquit.• Ifyoudrink,drinkinmoderation.• Getsomeaerobicexercise,preferablythreetofivetimeseachweek.• Eatawell-balanceddiet.• Getplentyofrest,andtrytoscheduletimeforyourself.

Tohelpemployeesimprovetheirhealthbyadoptingamorehealthylifestyle,theUniversityofAlaskahaspartneredwithWINforAlaskatoprovideonsiteandonlineseminars,information,screeningtoolsandparticipant-basedac-tivities.Thispartnershipgoesbeyondthehealthplantohelpemployeesandtheirfamiliesdevelopahealthylifestyleplanthatmeetstheirneeds.

TheUniversityhascontractedwithPremeraBlueCrossBlueShieldofAlaska,alsoreferredtoasBlueCrossinthisHandbook,forclaims processing and paymentofthemedicalanddentalplanbenefits.PharmacybenefitsareprovidedbyCVSCaremark.VisioncarebenefitsareprovidedbyVSP.PleasecontactStatewideHumanResourcesat450-8200,BlueCrossat(800)364-2982,CVSCaremarkatCaremark.comor(800)596-2178,orVSPatwww.vsp.comor(800)877-7195ifyouhaveanyquestionsregardingyourbenefitplan.

Thisplancomplieswiththe2010federalhealthcarereformlaw,calledtheAffordableCareAct(seeGlossaryofTerms).IfCongress,federalorstateregulators,orthecourtsmakefurtherchangesorclarificationsregardingtheAffordableCareActandit’simplementingregulations,thisplanwillcomplywiththemeveniftheyarenotstatedinthisHandbookoriftheyconflictwithstatementsmadeinthisHandbook.

14

ELIGIBILITY

emploYee eliGiBilitY

Regularfull-time,regularpart-time,andextendedtemporaryemployeesoftheUniversityofAlaskamayelecteitherthe500Plan,the750PlanortheHighDeductibleHealthPlanoptionsundertheUAChoiceHealthPlan,ormayelecttowaivecoveragewithverificationofothercoverage.

enrollment WaitinG period

Eligibleemployeeshavea30-dayelectionperiodinwhichtochoosetheirpreferredhealthplananddependentcoverageoptions.Thehealthplanrequiresawaitingperiodofapproximately30daysfromyourdateofhireintoabenefits-eligibleposition,orattainingextendedtemporarystatus,beforecoverageiseffective.Thiswaitingperiodisdeterminedasfollows:

Ifyousubmityourcompletedandsignedenrollmentform,showingplanelectionandeligibledependentstobeenrolled,onorbeforethe25thofthemonthduringyour30-dayelectionperiod,yourcoveragewillbeeffectivethesamedayasyourdateofhireinthefollowingmonth.Forexample,ifyouwerehiredonJanuary13,andsubmityoursignedenrollmentformstoyourregionalhumanresourcesofficebyJanuary25th,yourcoveragewouldbeef-fectiveonFebruary13.

Ifyousubmityourenrollmentformafterthe25thofthemonth,butwithinyour30-dayelectionperiod,yourcover-agewillbeeffectivethefirstofthemonthfollowingyour30-dayelectionperiod.Forexample,ifyouwerehiredonJanuary13,andsubmittedyoursignedenrollmentformstoHRonFebruary5,yourcoveragewillbeeffectiveonMarch1.

Ifyoudonotsubmitanenrollmentformand/orifyoudonotoptout(waivecoverage)withinyour30-dayelectionperiod,youwillautomaticallybeenrolledintheStandardPlanwithemployee-onlycoverage,effectivethefirstofthemonthfollowingtheendofyourelectionperiod.

Please Note:tosubmityourenrollmentformmeansithasbeenreceivedbyyourregionalhumanresourcesoffice.

Employeesrehiredafterabreakinserviceoflessthan10workingdaysfromabenefits-eligiblepositionwillbecoveredasofthedateofrehireintoabenefits-eligibleposition,withnoadditionalwaitingperiod.Breaksinserviceof10workingdaysorlongerrequirethewaitingperiodtobesatisfiedagain.

Enrollmentsbasedonalifeeventareeffectiveonthedayofthelifeevent,aslongastheenrollmentformisturnedinwithintheappropriatetimeframe.

dependent enrollment time Frames

Eligibleemployeesarenotrequiredtoenrolltheireligibledependents,butmaychoosetodosoatthetimeofinitialeligibility,openenrollmentorinthecaseofamajorlifeeventasexplainedbelow.Coveragefordependentscanonlybeelectedwithinthirty(30)daysofhire,withinthirty(30)daysafteramajorlifeevent,orduringopenenrollment,withtheexceptionofnewbornornewlyadoptedchildren,inwhichcaseyouareallowed60days.

Inthecaseofamajorlifeevent,coveragebeginsonthedateofthemajorlifeevent.CoverageforadependentelectedatopenenrollmentwillbecomeeffectiveonJuly1.

15

dependent eliGiBilitY

Employees are required to notify their regional human resources office as soon as a dependent loses eligibility status.

Tobeeligibleforcoverageasadependentunderthisprogram,thefamilymembermustfitoneofthefollowingdescriptions:

• Thelawfulspouseoftheemployee,unlesslegallyseparated Please note: ProvidedallrequirementsaremetasspecifiedbytheUniversityofAlaska,wherever“spouse”is

statedinthehealthcareplan,afinanciallyinterdependentpartnerwouldalsobeincluded.Pleasecontactyourregionalhumanresourcesofficefordetailsconcerningfinanciallyinterdependentrelationships.

• A“child”26yearsofageoryounger.However,ifachildisanemployeeoftheUniversityofAlaskawhomeetstherequirementsin“EmployeeEligibility”earlierinthissection,thechildcanonlyenrollasanemployee.Achildisconsideredoneofthefollowing:• Anaturaloffspringofeitherorboththeemployeeorspouse• Alegallyadoptedchildofeitherorboththeemployeeorspouse• Achildforwhomtheemployeehasbeengrantedcourt-appointedlegalguardianship;theremustbeacourt

ordersignedbyajudge,whichgrantsguardianshipofthechildtotheemployeeorspouseoftheemployeeasofaspecificdate.Whenthecourtorderterminatesorexpires,thechildisnolongeraneligiblechild

• Achildforwhomtheemployeeorspouseisunderadomesticrelationsordertoprovidemedicalbenefitsasdirectedbyadivorcedecree,amedicalchildsupportorderorothercourt-ordereddependentcoverage

• Afosterchildlivingwiththeemployee• Achild“placed”withtheemployeeforthepurposeoflegaladoptioninaccordancewithstatelaw;placed

foradoptionmeansassumptionandretentionbytheemployeeofalegalobligationfortotalorpartialsup-port of a child in anticipation of adoption of such child.

evidenCe oF eliGiBilitY

TheUniversityofAlaskarequiresevidenceofeligibilityforallenrolleddependents.Supportingdocumentsincludebirthcertificate,marriagelicense,finaladoptionpaperwork,taxreturnsshowingclaimeddependents,qualifiedmedicalchildsupportorders,legalguardianshippapers,etc.Seeyourregionalhumanresourcesofficeformoreinformationonsupportingdocumentation.

Continued eliGiBilitY For a disaBled CHild

Coveragemaycontinuepastthelimitingageof26foradependentchildwhocannotsupporthimselforherselfbecauseofadevelopmentalorphysicaldisability.Thechildwillcontinuetobeeligibleifallthefollowingrequire-mentsaremet:

• Thechildbecamedisabledbeforereachingthelimitingageof26.• Thechildisincapableofself-sustainingemploymentbyreasonofdevelopmentaldisabilityorphysicalhandi-

cap,andischieflydependentupontheemployeeforeconomicsupportandmaintenance.• Theemployeeremainscoveredunderthisprogram.• Theemployee’scostfordependentcoveragecontinuestobepaid.• Within30daysofthechildreachingthelimitingage,theemployeemusthavecompletedandhaveonfilewith

BlueCrossa“RequestforCertificationofHandicappedDependent”statusform.• TheemployeehascontinuedtoprovideBlueCrosswithproofofthechild’sdisabilityanddependentstatus

whenrequested.BlueCrosswillnotaskforproofmoreoftenthanonceayearafterthetwo-yearperiodfollow-ingthechild’sattainmentofthelimitingage.

Blue Cross must approve the request for certification before coverage can continue.

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major liFe event

Outsideoftheannualopenenrollmentperiod,anemployeemaychangeanenrollmentelection(i.e.,addordeletedependents,changelevelofcoverage)onlyiftherehasbeenamajorlifeevent.Thefollowingareconsideredmajorlife events:

• Marriageordivorceoftheemployee• Deathoftheemployee’sspouseoradependent• Birthoradoptionofachildbytheemployee• Terminationofemployment(orthecommencementofemployment)oftheemployee’sspouse• Switchingfrompart-timetofull-timeemploymentstatusorfromfull-timetopart-timestatusbytheemployee

ortheemployee’sspouse• Takingofanunpaidleaveofabsencebytheemployeeortheemployee’sspouse• Asignificantchangeinthehealthcoverageoftheemployeeortheemployee’sspouseattributabletothe

spouse’semployment• Gainorinvoluntarylossofhealthcarecoverageofyourdependent

Changes(additionordeletionofdependents)willbelimitedtothosethatarebothonaccountofamajorlifeeventandareconsistentwiththatmajorlifeevent.Enrollmentchangesaresubjecttotheothertermsandlimitationsofthisprogram.

Aneligibleemployeewhopreviouslyelectednottoenrolladependent(s)intheplanwhensuchcoveragewasprevi-ouslyoffered,mayenrollthedependent(s)intheplanatthesametimeanewlyacquireddependentisenrolled.

involuntarY loss oF otHer CoveraGe

Ifadependentdidnotenrollinthisprogramwhenfirsteligible,thedependentmaylaterenrolloutsideoftheannualopenenrollmentperiodifeachofthefollowingrequirementsaremet:

• yourdependentwascoveredundergrouphealthcoverageorahealthinsuranceprogramatthetimecoverageundertheUniversityofAlaska’sprogramwaspreviouslyoffered;

• youdeclinedcoverageforyourdependentunderthisprogramatthetimethiscoveragewasoffered,and• yourdependent’scoverageundertheothergrouphealthcoverageorhealthprogramwasterminatedasaresult

of:• lossofeligibilityforthecoverage(including,butnotlimitedto,asaresultoflegalseparation,divorce,

death,takinganunpaidleaveofabsence,terminationofemployment,orreductioninhoursofemploy-ment);

• terminationofemployercontributionstowardsuchcoverage,or• yourdependentwascoveredunderCOBRAatthetimecoverageunderthisprogramwaspreviouslyoffered

andCOBRAcoveragehasbeenexhausted.• thereisasignificantchangeinthehealthcoverageofyourspouseattributabletotheiremployment.

WhentheUniversityofAlaskareceivesyourcompletedenrollmentformandanyrequiredcontributionswithin30daysofthedatesuchothercoverageended,coverageunderthisprogramwillbecomeeffectiveonthedayaftertheothercoverageended.IftheUniversityofAlaskadoesnotreceiveyourcompletedenrollmentformwithin30daysofthedatepriorcoverageended,referto“OpenEnrollment”below.

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enrollment

Aftertimelyenrollment,coveragewillbecomeeffectiveonthefollowingdates:

• Fortheemployeeandenrolledfamilymembers,seethesectiononEnrollmentWaitingPeriod• Foraspouseandeligiblechildrenacquiredthroughmarriage,onthedateofmarriage• Foraspouseandeligiblechildrenwhohavehadalossofothercoverage,thedayafterothercoverageended• Foranewbornchild,onthechild’sdateofbirth• Foranadoptedchild,onthedatethechildisplacedwiththeemployeeforthepurposeoflegaladoption• Forachildcoveredunderacourt-appointedlegalguardianshiporder,thedatethecourtgrantslegalguardian-

shiptotheemployeeorspouse• Forachildcoveredunderadomesticrelationsordertoprovidemedicalbenefitsasdirectedbyadivorcedecree,

the date of the order• Forafosterchild,onthedatethechildisplacedintheemployee’shome

open enrollment

Aneligibledependentwhoisnotenrolledwhenfirsteligibleorwhofailstomaintaincontinuouscoveragemayen-rollonlyduringtheUniversity’sannualopenenrollmentperiod.Toenroll,properapplicationmustbemadeduringtheopenenrollmentperiodandcoveragewillbecomeeffectiveatthebeginningofthenewplanyear(July1).

re-enrollment aFter a lapse in CoveraGe

Ifyourcoverageisreinstatedafteralapseoftime,thedateyourcoveragebeginsagainbecomesyoureffectivedate.Alltermsandconditionsofthehealthcareprogram,includingpre-existingconditions,willapplyatthetimeofrein-statement.PleaseseethesectiononEnrollmentWaitingPeriodformoreinformation.

Cost For emploYee CoveraGe

Employeesarerequiredtoshareinthecostoftheirhealthcarecoverage.Thecostforemployeecoverageisdeter-minedannually.

Cost For dependent CoveraGe

Employeesarerequiredtoshareinthecostofcoveringdependentsonthehealthcareplan.Thecostfordependentcoverageisdeterminedannually.Ifyouhavequestionsastothecurrentcostofdependentcoverage,pleasecontactyourregionalhumanresourcesoffice.

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PRE-EXISTING CONDITIONS

Apre-existingconditionisanycondition,regardlessofcause,forwhichanymedicaladvice,diagnosis,care,medication,ortreatmentwasrecommendedorreceivedwithinthe90dayspriortothedatetheenrollee’scoveragebecomeseffective.However,thehealthcareplanwillprovideupto$1,000inbenefits,afteranyrequireddeductiblehasbeensatisfied,foreachconditionthatwouldotherwisebeexcludedbythispre-existingconditionslimitation.

Thereisnopre-existingconditionsexclusionforchildrenundertheageof19.

Aconditionisnolongerconsideredpre-existingifanenrolleehasbeencoveredbytheprogramfor90days,andnomedicalservicesfortheconditionhavebeenincurredorrecommendedduringthattime.

However,ifanenrolleehas incurredexpensesforaconditionduringthefirst90daysofcoverage,thentheconditionwillnolongerbeconsideredpre-existingoncethefollowingissatisfied:

• Fortheemployee,onceheorshehasbeencoveredunderthisprogramforaperiodof6consecutivemonths• Forthedependentage19orolder,onceheorshehasbeencoveredunderthisprogramforaperiodof12con-

secutivemonths

Thiswaitingperiodlimitationforpre-existingconditionsdoesnotapplyinthefollowingcases:

• Membersundertheageof19• Pregnancy• Childwhoiscoveredunderlegalguardianship,providedthechildhasbeencoveredunderthisprogramsince

thedatethecourtgrantedlegalguardianshiptotheemployeeorspouse• Fosterchild,providedthechildhasbeencoveredunderthisprogramsincethedatethechildwasplacedinthe

employee’shome• Childcoveredunderadomesticrelationsorder,providedthechildhasbeencoveredunderthisprogramsince

the date of the order• CoverageforPKUformulaforenrolleeswithPhenylketonuria• Geneticinformationinabsenceofadiagnosis

Credit For prior CoveraGe

Thewaitingperiodforpre-existingconditionsmaybereducedbyperiodsofcreditablecoverageyou’veaccruedun-derotherhealthcareprogramspriortoyoureffectivedateforthisplan.Mostmedicalhealthcarecoverageisconsid-eredcreditablecoverage.Youwillreceivecreditforpriorcreditablecoveragethatoccurredwithoutabreakincover-ageofmorethan90days.Anycoverageyouhadbeforeabreakincoveragewhichexceeds90daysisnotcreditedtowardyourwaitingperiodforpre-existingconditions.Eligibilitywaitingperiodswillnotbeconsideredcreditablecoverageorabreakincoverage.Yourprioremployerorhealthinsurancecarrierwillprovideyouwithacertificateofhealthcoverage.Ifyouhavenotreceivedacertificate,orhavemisplacedit,youhavetherighttorequestonefromaprioremployerorhealthcarrierwithin24monthsofthedateyourcoverageunderthatplanterminated.

Certificatesofpriorhealthcarecoverageshouldbesubmittedtoyourregionalhumanresourcesoffice.

19

PLAN YEAR DEDUCTIBLE—MEDICAL

individual deduCtiBle

EachplanyearyoumustsatisfyadeductiblebeforeyourComprehensiveMedicalBenefitsarepayable.DeductibleamountsforeachplaninUA Choicearelistedbelow.

Whilesomebenefitshavedollarmaximums,othershavedifferentkindsofmaximums,suchasamaximumnumberofvisitsordaysofcarethatcanbecovered.Allowablechargesthatapplytoyourindividualplanyeardeductibledon’tcounttowarddollarbenefitmaximums.Butifyoureceiveservicesorsuppliescoveredbyabenefitthathasanyotherkindofmaximum,chargesforthoseservicesorsuppliesthatapplytoyourdeductiblearealsoappliedtothatbenefit’smaximum.

FamilY deduCtiBle

ThisprogramhasaComprehensiveMedicalPlanYearDeductiblelimitforfamilies.Ifthetotaldeductibleforyouandyourfamilyreachesacertainamountwithinoneplanyear,youwillnotbesubjecttoanyfurtherdeductibleforthatyear.Familydeductiblelimitsareshownbelow.Onlytheamountsusedtosatisfyeachenrolledfamilymem-ber’sdeductiblewillcontributetowardthefamily’stotaldeductible.

Plan Option Individual Deductible Family Deductible

HighDeductibleHealthPlan $1,250 $3,000750Plan $750 $2,250500Plan $500 $1,500

Common aCCident deduCtiBle

Ifyouandoneormoreofyourinsureddependents,ortwoormoreofyourinsureddependents,incurcoveredmedicalexpensesasaresultofthesameaccident,thedeductiblewillbeappliedonlyonceduringtheplanyearinwhichtheaccidentoccursandthefollowingplanyear.Inotherwords,nomatterhowmanyinsuredfamilymembersreceivetreatmentforinjuriesfromanaccident,thedeductibleistheapplicableindividualdeductible.

FourtH quarter deduCtiBle CarrY ForWard

Coveredchargesthatareappliedtowardadeductibleforservicesincurredduringthelastthreemonthsofaplanyearmaybecarriedovertoreducethedeductibleforthenextplanyear.Thisisalsotrueforthefamilydeductible.

BeneFits not suBjeCt to tHe mediCal deduCtiBle

Thefollowingbenefitsarenotsubjecttothecomprehensivemedicalplanyeardeductible:

• DiagnosticandScreeningMammography • PharmacyBenefits• WellnessProvisions(PreventiveBenefit) • AudioCare• DentalCare(seetheDentalBenefitssectionforinformationondentaldeductibles)

20

SCHEDULE OF BENEFITS—MEDICAL

Thebenefitsofyourhealthcareplanarebasedonallowablechargesforcoveredservicesandsupplies.PleaserefertothedefinitionofAllowableChargeintheGlossaryofTermsatthebackofthisHandbook.

PremeraBlueCrossBlueShieldofAlaskahasdevelopedabroadnetworkofprovidersinthestateofAlaskacalledthe Alaska Heritage Network.Youmayseekcoveredservicesfromanyproviderlicensedtoprovidetheservice.However,withinAlaska,inordertoreceivethehigherlevelofbenefitsavailableunderthisprogramforcertainser-vices,youmustuseaphysician,hospitalorhospital-basedchemicaldependencytreatmentfacilityintheNetwork.Forthispurpose,a“physician”meansaproviderwhoislicensedbythestateasaDoctorofMedicineandSurgery(M.D.),DoctorofOsteopathyandSurgery(D.O.)orPodiatrist(D.P.M.).

Whenyouuseaphysician,hospital,orhospital-basedchemicaldependencytreatmentfacilityintheNetwork,youwillberesponsibleonlyforanyapplicabledeductibles,copayments,coinsurance,out-of-pocketmaximums,chargesinexcessofthestatedbenefitmaximums,andchargesforservicesandsuppliesnotcoveredunderthehealthcareprogram.Inaddition,networkproviderswillbillBlueCrossdirectlywhentheyfurnishcoveredservicestoyou.

Ifyouuseaproviderthatdoesn’thaveanetworkagreementwithBlueCross,you’llberesponsibleforamountsovertheallowablecharge.Amountsinexcessoftheallowablechargealsodon’tcounttowardtheplanyeardeductibleoras coinsurance.

anCHoraGe, FairBanks and juneau

IfyouliveinthegreaterAnchorage,FairbanksorJuneauareas,thefullnetworkofAlaskaHeritageprovidersisavailable(AlaskaHeritagePlusnetwork).Fornon-emergencyphysicianservices,hospitalservicesandhospital-basedchemicaldependencyservicesreceivedinAlaska,youmustuseAlaskaHeritagePlusnetworkproviderstoreceivethehigherlevelofbenefitsprovidedunderthisprogram.AfteryousatisfyyourPlanYearMedicalDeduct-ible,thePlanwillprovidebenefitsforcoveredservicesasfollows:

• In-networkBenefitLevel:benefitswillbeprovidedat80percentofallowablechargesforcoveredservicesandsupplies.Thisbenefitlevelisalsoprovidedfornon-networkproviderswhenBlueCrosshasgrantedabenefitlevelexceptionfornon-emergentcareasexplainedbelow.

• Out-of-networkBenefitLevel:benefitswillbeprovidedataconstant60percentofallowablecharges;out-of-pocketexpensesdonotaccruetowardsanyout-of-pocketmaximum.

Tolocateanetworkproviderinyourarea,pleaserefertotheBlueCrossHeritageNetworkDirectory of Alaska Phy-sicians and Other Providers.Ifyouhavequestions,pleasecontactBlueCrossCustomerServiceat(800)364-2982,yourregionalhumanresourcesoffice,orchecktheUniversityofAlaska’sbenefitswebsiteatwww.alaska.edu/ben-efitsorPremera.com.

outside anCHoraGe, FairBanks and juneau

IfyouliveoutsideofthegreaterAnchorage,FairbanksorJuneauareas,thenetworkproviderrequirementinthestateofAlaskaappliestohospitalsandhospital-basedchemicaldependencyprogramsinAnchorageonly.However,ifyoureceivecareoutsideofAlaska,youmustusenetworkproviderstoreceivethehigherlevelofbenefits.

21

WHen You are outside alaska

Fornon-emergencyphysician,hospitalandhospital-basedchemicaldependencyservicesreceivedinWashington,you’llreceivethehigherlevelofbenefitswhenyouuseHeritagenetworkproviders.ForthesameservicesoutsideofAlaskaandWashington,seekcarefromproviderswithpreferredagreementswiththelocalBlueCrossand/orBlueShield Licensee.

WhentravelingorifeligibledependentsareattendingschooloutsidethestateofAlaska,itisimperativethatyouusepreferredproviderstoobtainthehigherlevelofbenefitsfromyourhealthcareplan.SeeTheBlueCardProgramsectionofthisHandbookformoreinformation.

emerGenCY serviCes

Benefitsformedicalemergenciesandaccidentalinjurieswillbeprovidedatthehigherlevelwhenyouseeanycov-eredprovider.PremeraBlueCrossBlueShieldofAlaskawillpaytheallowablechargefortheseservicesandyou’llonlypayyourapplicabledeductibles,coinsurance,copays,amountsthatexceedthebenefitmaximums,amountsabovetheallowablechargefornon-networkprovidersandchargesfornon-coveredservices.

BeneFit level eXCeption For non-emerGent Care

PremeraBlueCrossBlueShieldofAlaskacurrentlyhasanextensivenetworkofprovidersintheAnchorage,Fair-banksandJuneaucommunities.However,ineachcommunitytherearespecialtieswherethenetworkisincomplete.

IfyourequiretheservicesofaphysicianorhospitalthatisnotintheAlaskaHeritagenetwork,youmustcallBlueCrossforareferral,or“benefitlevelexceptionfornon-emergencycare,”toreceivethehigherlevelofbenefits.AbenefitlevelexceptionisadeterminationbyBlueCrosstoprovidein-networkbenefitsforcoveredservicesfromanon-networkprovider.

You,yourproviderormedicalfacilitymayrequestabenefitlevelexception,butitmustbedonebeforeyoureceivetheserviceorsupply.IfyourrequestisapprovedbyBlueCross,benefitsforcoveredservicesandsupplieswillbeprovidedatthein-networkbenefitlevel.Paymentofyourclaimwillbebasedonyoureligibilityandbenefitsavailableatthetimeyougettheserviceorsupply.Youwillberesponsibleforamountsappliedtowardsyourplanyeardeductible,coinsurance,amountsthatexceedthebenefitmaximums,amountsabovetheallowablecharge,andchargesfornon-coveredservices.Ifyourrequestisdenied,in-networkbenefitswon’tbeprovided.

PleasecallPremeraBlueCrossBlueShieldofAlaskaCustomerServiceat(800)364-2982torequestabenefitlevelexceptionfornon-emergencycare.

BlueCrosswilldeterminewhetherthebenefitlevelexceptionwillbeauthorizedordenied.IfyoudonotcallBlueCrossforabenefitlevelexceptionbeforehand,orifabenefitlevelexceptionisdenied,benefitswillbeprovidedataconstant60percentofallowablechargesafteryouhavemetyourdeductible,withnomaximumout-of-pocketlimit.

PremeraBlueCrossBlueShieldofAlaska’sbenefitlevelexceptionshouldnotbeconsideredaguaranteeofpay-ment.Paymentofanyservicewillbebasedonyoureligibilityandbenefitsavailableatthetimeservicesareren-dered.

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Waived serviCes

PremeraBlueCrossBlueShieldofAlaskamayfromtimetotimeidentifyprovidersthattheydon’thaveagreementswithwhoprovidespecificservicesforwhichyou’llalwaysreceivethehigherlevelofbenefitsundertheStandardorEconomyPlanoptions.Waivedserviceswon’trequireabenefitlevelexception.Ifyou’dlikemoreinformationonwaivedservices,pleasecallCustomerServiceat(800)364-2982.

provider status

Sinceaprovider’sagreementwithPremeraBlueCrossBlueShieldofAlaskaissubjecttochangeatanytime,itisimportanttoverifyaprovider’sstatus.Thismayhelpyouavoidadditionalout-of-pocketexpenses.PleasecallCus-tomerServiceat(800)364-2982toverifyaprovider’sstatus.IfyouareoutsideAlaskaandWashington,orinClarkCounty,Washington,call(800)810-BLUE(2583)tolocateorverifythestatusofaprovider.

IfyouareseeingaproviderandtheirwrittenagreementwithBlueCrossisterminatedwhileyouarereceivingpreg-nancycareorotheractivetreatment,BlueCrosswillconsidertheproviderasiftheystillhaveanactiveagreementwithBlueCrossforthepurposeofthatcareuntiloneofthefollowingoccurs:

• Thisprogramisterminated.• Theprovider’sstatuswillchangeonthedatetheprovider’smedicallynecessarytreatmentofaterminalcondi-

tionends.“Terminal”meansthatthepatientisexpectedtolivelessthanoneyearfromthedatetheprovider’sagreementisterminated.

• Inallothercases,theprovider’sstatuswillchangeonthelastofthreedatestooccur:• Theninetiethdayafterthedatetheprovider’sagreementisterminated;• Thedatethecurrentplanyearends;or• Thedatepostpartumcareiscompleted.

23

OUT-OF-POCKET MAXIMUMS

Thisprovisionoffersextendedprotectionforyouandyourfamilybyplacingmaximumlimitsonyourout-of-pocketcostsformedicalservices(personalexpensesforcoveredandallowablecharges)whenyouuseAlaskaHeritagenetworkproviders.Onceyouhavereachedyourout-of-pocketlimit,benefitswillbeprovidedat100percentofal-lowablechargesforcoveredservicesreceivedbyyoufromnetworkprovidersduringtheremainderofthatplanyear.

IfyouliveinthegreaterAnchorage,FairbanksorJuneauareaswherethefullAlaskaHeritageprovidernetworkapplies,andyoudonotuseanetworkproviderordonotobtainabenefitlevelexceptionfornon-emergentcareforanon-networkprovider,yourout-of-pocketexpenseswillnotapplytoanymaximumout-of-pocketlimit.PleaseseetheBenefitLevelExceptionforNon-EmergentCaresectionofthisHandbook.

Please Note: The100percentbenefitleveldoesnotapplytothefollowingbenefits,whichhavetheirownspecificbenefitlevels.Expensesincurredforthesebenefitsdonotaccruetowardyourmedicalout-of-pocketmaximums,withtheexceptionofanyplanyeardeductibles:

• DentalCareBenefit• OrthognathicSurgeryServices• VisionCareBenefitthroughVSP• PharmacyDrugProgramthroughCaremark• AudioCareBenefit

Inaddition,planyeardeductibles,amountsthatexceedthebenefitmaximumsunderthisprogram,includingthelife-timemaximum,andamountsforservicesandsuppliesnotcoveredunderthisprogramdo notaccruetowardyourindividualorfamilymedicalcoinsuranceout-of-pocketmaximum.

individual mediCal out-oF-poCket maXimum

Based upon coveredandallowablecharges,theplanyearmaximumcoinsurancethatanindividualwouldpay,afterthedeductible,isshowninthetablesbelow.Duringtheplanyear,afteryoupaytheout-of-pocketmaximumforcoveredmedicalservicesfromnetworkproviders,anyfurthercoveredandallowablemedicalexpensesincurredbyyoufromnetworkproviderswouldbereimbursedat100percent(subjecttoallowablecharges)fortherestofthatplanyear.Seethefollowingtablesfordetailbyplanoption.

FamilY mediCal out-oF-poCket maXimum

Based upon coveredandallowablechargesforservicesfromnetworkproviders,theyearlymaximumcoinsuranceforafamily,aftersatisfyingthefamilydeductible,isshowninthetablesbelow.Duringtheplanyear,ifyourfamilyweretoreceivesufficientcoveredmedicalservicesfromnetworkproviderstoreachyourcoinsurancemaximum,anyfurthercoveredmedicalexpensesincurredbyyourfamilyfromnetworkproviderswouldbereimbursedat100percent(subjecttoallowablecharges)fortherestofthatplanyear.Seethefollowingtablesfordetailbyplanoption.

24

out-oF-poCket maXimums BY plan option

Themedicalout-of-pocketmaximumcoinsuranceisthemostyou’llpayforcoveredin-networkmedicalexpensesafteryourdeductibleissatisfied.Thismaximumisforcoveredin-networkmedicalexpensesonly;itdoesnotincludepharmacy,visionordentalcoinsuranceorcopays.(Thepharmacyplanhasitsownmaximumout-of-pocketlimit,seethePharmacyProgramsectionformoreinformation.)Themaximumout-of-pocketyou’llpayforcoveredandallowedin-networkexpensesisasfollows:

Individual Family High Deductible Health Plan Limit Limit

Deductible $1,250 $3,000MaximumCoinsurance $3,750 $8,000TotalOut-of-PocketChargesYou’llPay $5,000 $11,000 for the Plan Year

Individual Family 750 Plan Limit Limit

Deductible $750 $2,250MaximumCoinsurance $3,500 $7,000TotalOut-of-PocketChargesYou’llPay $4,250 $9,250 for the Plan Year

Individual Family 500 Plan Limit Limit

Deductible $500 $1,500MaximumCoinsurance $3,000 $6,000TotalOut-of-PocketChargesYou’llPay $3,500 $7,500 for the Plan Year

maXimum liFetime BeneFit

ThemaximumlifetimebenefitforanypersoninsuredundertheUniversity’shealthcareplanisunlimited.

25

PREVENTIVE (WELLNESS) BENEFIT

Oursharedgoalisahealthyandproductiveworkforce.TheUAChoicePlanincludesaPreventiveBenefitthatexpandsthemedicalcareavailabletoemployeesandtheirdependents.Itallowsyoutodecidewhatroutinetests,screeningsandimmunizationsarerightforyouandyourfamily.ThePreventiveBenefitisavailabletoyouinaddi-tiontotraditionaldiagnosticcare.

Recenthealthcarereformlegislationhasexpandedthelistofeligiblepreventiveservices.Asaguide,wehavepub-lishedalistoftheseservicesandthesuggestedappropriateageguidelinesontheUniversityofAlaska’sbenefitswebsiteatwww.alaska.edu/benefits/health-plan.Thelistisalsoonlineatwww.premera.com.

Preventivemedicalservicesarenowdefinedtoinclude:

• Evidence-baseditemsorserviceswitharatingof“A”or“B”inthecurrentrecommendationsoftheU.S.Pre-ventiveTaskForce(USPSTF).Alsoincludedareadditionalpreventivecareandscreeningsforwomennotde-scribedaboveinthisparagraphasprovidedforincomprehensiveguidelinessupportedbytheHealthResourcesandServicesAdministration.

• ImmunizationsasrecommendedbytheAdvisoryCommitteeonImmunizationPracticesoftheCentersforDis-easeControl(CDC).

• Evidence-informedinfant,childandadolescentpreventivecareandscreeningsprovidedforinthecomprehen-siveguidelinessupportedbytheHealthResourcesandServicesAdministration.

ThisPreventiveMedicalCarebenefitcoversroutineexamsandimmunizations.Othermedicalservicesthatqualifyaspreventiveasshownabovearecoveredundervariousotherbenefitsofthisplan.Forexample,colonoscopiesarenormallycoveredunderthesurgicalservicesbenefit.Whentheseservicesmeetthefederalrequirementsforpreven-tivemedicalservices,however,theplanwillprovidebenefitsforthemasstatedbelowinsteadofasdescribedinthebenefitwhichnormallycoverstheservices.

Preventivehealthservicesarecoveredat100%ofallowablecharges,withnodeductible,copayorcoinsurance.Benefitsareprovidedforroutineandpreventiveservicesperformedonanoutpatientbasis,andaren’tsubjecttoaplanyearbenefitlimit.Examplesofcoveredservicesincluderoutinephysicalexams,immunizations,well-babyandwell-childexams,physicalexamsrelatedtoschoolorsports.

Servicesthatarerelatedtoaspecificillness,injuryordefinitivesetofsymptomsarecoveredunderthenon-preven-tivemedicalbenefitsofthisplan.

Wellness limitations

Inadditionto“GeneralLimitationsandExclusions,”PreventiveMedicalCarebenefitswillnotbeprovidedfor:

• dentalexaminations,treatment,thefittingofdentalappliancesordentures,orotherservicesprovidedbyaden-tist(exceptasspecifiedunderDentalCareBenefits);

• inpatientroutinenewbornexamswhilethechildisinthehospitalfollowingbirth(theseservicesarecoveredundertheNewbornCarebenefit);

• routinevisionandhearingexaminations(exceptasspecifiedunderVisionCareBenefitsandAudioCareBen-efits);

• contraceptivedevices;• servicesthatarerelatedtoaspecificillness,injury,ordefinitivesetofsymptomsexhibitedbytheenrollee;• physicalexamsforbasiclifeordisabilityinsurance;or• work-relatedphysicalexams,work-relateddisabilityevaluationsormedicaldisabilityevaluations.

26

CARE MANAGEMENT HEALTHCARE UTILIZATION

CareManagementservicesworktohelpensurethatyoureceiveappropriateandcost-effectivemedicalcare.YourroleintheCareManagementprocessissimple,butimportant.

Thisprogram’sbenefitsdonotrequirepreauthorizationforcoverage.Youmustbeeligibleonthedatesofserviceandservicesmustbemedicallynecessary.WeencourageyoutocallCustomerServicetoverifythatyoumeettherequiredcriteriaforclaimspaymentandtohelpBlueCrossidentifyadmissionswhichmightbenefitfromcaseman-agement.

individual Case manaGement

CaseManagementworkscooperativelywithyouandyourphysiciantoconsidercare-effectiveandcost-effectivealternativestohospitalizationandotherhigh-costcaretomakemoreefficientuseofthehealthcareprogram’sbenefits.Thedecisiontoprovidebenefitsforthesealternativesiswithintheplan’ssolediscretion.YourparticipationinanalternativetreatmentplanthroughIndividualCaseManagementisvoluntary.IfanagreementisreachedwithBlueCrossforanalternativeprogram,youoryourlegalrepresentative,yourphysicianandotherproviderspartici-patinginthetreatmentplanwillberequiredtosignwrittenagreementsthatsetforththetermsunderwhichbenefitswillbeprovided.

IndividualCaseManagementissubjecttothetermssetforthinthesignedwrittenagreements.BlueCrossmayutilizeyourplanbenefitsasspecifiedinthesignedcasemanagementagreements,buttheagreementsarenottobeconstruedasawaiveroftherighttoadministerthebenefitsprovidedunderthehealthcareprograminothersitua-tions.Allpartieshavetherighttore-evaluateorterminatetheIndividualCaseManagementagreementatanytime,attheirsolediscretion.IndividualCaseManagementterminationmustbeprovidedinwritingtoallparties.Yourremainingbenefitsunderthisprogramwouldbeavailabletoyouatthattime.

appeals revieW

ShouldyouoryourphysiciandisagreewiththeCareManagementdetermination,youmayfollowtheappealproce-duresexplainedinthe“YourQuestions,ComplaintsandAppeals”sectionofthishandbook.

BestBeGinninGs

BestBeginningsprovidesmothers-to-bewithquickandeasyaccessthroughouttheirpregnancytoanursetrainedinobstetrics.TheBestBeginningsnursecanhelpanswerquestionsaboutpregnancy,prenatalcareanddelivery,andprovidemothers-to-bewithotherhelpfulinformationtoassisttheminmakinghealthychoicesduringtheirpreg-nancy.

TheemployeeandanyenrolleddependentoftheemployeemayparticipateinBestBeginnings.

Assoonasyouknowyouarepregnant,calltheBestBeginningstoll-freenumber,(888)773-6399.

27

THE BLUECARD PROGRAM

PremeraBlueCrossBlueShieldofAlaska,likeallBlueCrossand/orBlueShieldLicensees,participatesinaprogramcalled“BlueCard.”EnrolleescantakeadvantageofBlueCardwhentheyreceivecoveredservicesoutsideAlaskaandWashingtonorinClarkCounty,Washingtonfromhospitals,doctors,andothermedicalcareproviderswhohavecontractedwiththelocalBlueCrossand/orBlueShieldlicensee,calledthe“HostBlue”inthissection.ThenationalBlueCardprogramisavailablethroughouttheUnitedStates,theCommonwealthofPuertoRico,andU.S.VirginIslands.

YouridentificationcardtellscontractingproviderswhichindependentBlueCrossand/orBlueShieldLicenseeisyours.ItisimportanttonotethatreceivingservicesthroughBlueCarddoesnotchangecoveredbenefits,benefitlevels,oranystatedresidencyrequirementsofyourprogram.However,whenyouuseyouridentificationcard,youwillreceivemanyoftheconveniencesyou’reaccustomedtofromPremeraBlueCrossBlueShieldofAlaska.Inmostcases,therearenoclaimformstosubmitbecausecontractingproviderswillhandleclaimsubmissionforyou.Inaddition,yourout-of-pocketcostsmaybelessasexplainedbelow.

Here’s HoW BlueCard Helps keep Costs doWn

WhenyouobtainhealthcareservicesoutsideAlaskaandWashingtonorinClarkCounty,WashingtonthroughBlueCard(excludingBlueCardWorldwide,seebelow),theamountyoupayforcoveredservicesiscalculatedonthelowerof:

• Thebilledchargesforyourcoveredservices,or• The“negotiatedprice”thattheHostBluepassesontoPremeraBlueCrossBlueShieldofAlaskaforyourcov-

ered services.ThemethodsusedtodeterminethenegotiatedpricewillvaryamongHostBluesaccordingtothetermsoftheirpro-vidercontracts.Often,thisnegotiatedpricewillconsistofasimplediscount,whichreflectstheactualpriceallowedaspayablebytheHostBlue.But,sometimes,itisanestimatedpricethatfactorsinaggregatepaymentsexpectedtoresultfromtheHostBlue’ssettlements,withholds,orothercontingentpaymentarrangementsandnon-claimstransactionswithyourhealthcareproviderorwithaspecifiedgroupofproviders.Thenegotiatedpricemayalsobeadiscountfrombilledchargesthatreflectsanaverageexpectedsavingswithyourhealthcareprovidersoraspecificgroupofproviders.Thepricethatreflectsaveragesavingsmayresultingreatervariationaboveorbelowtheactualpricethanwilltheestimatedprice.InaccordancewithnationalBlueCardpolicy,theseestimatedoraveragepriceswillalsobeadjustedfromtimetotimetocorrectforoverestimationorunderestimationofpastprices.However,theamountonwhichyourpaymentisbasedremainsthefinalpriceforthecoveredservicesbilledonyourclaim.

SomestatesmaymandateasurchargeoramethodofcalculatingwhatyoumustpayonaclaimthatdiffersfromBlueCard’susualmethodnotedabove.Ifsuchamandateisinforceonthedateyoureceivedcoveredcareinthatstate,theamountyoumustpayforanycoveredserviceswillbecalculatedusingthemethodsrequiredbythatman-date.Suchmethodsmightnotreflecttheentiresavingsexpectedonaspecificclaim.

Clark County Providers

SomeprovidersinClarkCounty,WashingtondohavecontractswithPremeraBlueCross.TheseproviderswillsubmitclaimsdirectlytoPremeraBlueCrossandbenefitswillbebasedontheallowablechargefortheserviceorsupply.

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non-BlueCard Claim suBmission

Ifahospital,doctor,orothermedicalcareproviderdoesnotcontractwiththeHostBlue,thatclaimmaynotbefiledonyourbehalf.Forinstructiononhowtofileaclaiminthissituation,refertothe“HowToSubmitAClaim”sectionofthisHandbook.

BlueCard WorldWide

IfyouareoutsidetheUnitedStates,theCommonwealthofPuertoRicoandtheUnitedStatesVirginIslands,youmaybeabletotakeadvantageofBlueCardWorldwide.BlueCardWorldwideisunlikethenationalBlueCardPro-gramincertainways.Forinstance,althoughBlueCardWorldwideprovidesanetworkofcontractinghospitals,itof-fersonlyreferralstodoctors.Whenreceivingcarefromdoctors,youwillhavetosubmitformsonyourownbehalftoobtainreimbursementfortheservicesprovidedthroughBlueCardWorldwide.

ToaccesshealthcareservicesthroughBlueCardWorldwideandtoobtainadditionalinformationaboutproviders’charges,pleasecall(800)810-BLUE(2583).

FurtHer questions?

IfyouhavequestionsorneedadditionalinformationaboutusingyourcardoutsideAlaskaorWashington,pleasecallBlueCross’CustomerServiceat(800)364-2982.TolocateapreferredproviderinanotherBlueCrossand/orBlueShieldLicenseeservicearea,call(800)810-BLUE(2583).BesuretospecifythatyourhealthcareprogramisaPPOandyouwishtolocatea“preferredprovider.”

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COVERED SERVICES AND SUPPLIES

Thissectionofyourhandbookdescribesthespecificbenefitsavailableforcoveredservicesandsupplies.Benefitsareavailableforaserviceorsupplydescribedinthissectionwhentheymeetalloftheserequirements:

• Itmustbefurnishedinconnectionwiththediagnosisortreatmentofacoveredillnessoraccidentalinjury.• Itmustbe,inthejudgmentofPremeraBlueCrossBlueShieldofAlaska,medicallynecessaryandmustbe

furnishedinamedicallynecessarysetting.Inpatientcareisonlycoveredwhenyourequirecarethatcouldn’tbeprovidedinanoutpatientsettingwithoutadverselyaffectingyourconditionorthequalityofcareyouwouldreceive.

• Itmustbeprescribedbyaphysician,asdefinedinthishandbook.• Itmustnotbeexcludedfromcoverageunderthehealthcareprogram.• Theexpensefortheserviceorsupplymustbeincurredwhileyouarecoveredunderthehealthcareprogramand

afteranyapplicablewaitingperiodrequiredunderthisprogramissatisfied.• Itmustbefurnishedbyaproviderthatiscoveredundertheapplicablebenefit.

Hospital inpatient Care

Coveredcostsincludehospitalroomandboard;intensiveandcoronarycareunits;plusservicesandsupplies,suchasdiagnosticservices,surgicaldressings,anddrugs,furnishedbyandusedwhileconfinedinahospital.Benefitsarepayableforamaximumof365daysperconfinement.

Please Note:Whencoveredinpatientdiagnosticservicesarefurnishedandbilledbyaninpatientfacility,theyareonlyeligibleforcoverageundertheapplicableinpatientfacilitybenefit.All“HospitalInpatientCare”servicesaresubjecttothehealthcareplan’sdeductiblesandout-of-pocketmaximums.

Hospital inpatient limitations

Inadditionto“GeneralLimitationsandExclusions,”hospitalinpatientcarebenefitswillnotbeprovidedforthefol-lowing:

• Hospitaladmissionsfordiagnosticpurposesonly,unlesstheservicescannotbeprovidedwithouttheuseofinpatienthospitalfacilities,orunlessyourmedicalconditionmakesinpatientcaremedicallynecessary

• Anydaysofinpatientcarethatexceedthelengthofstaythatis,inthejudgmentofPremeraBlueCrossBlueShieldofAlaska,medicallynecessarytotreatyourcondition

Hospital outpatient Care

Coveredcostsincludeemergency,procedure,operating,andrecoveryrooms;plusservicesandsupplies,suchassurgicaldressings,anddrugs,furnishedbyandusedwhileatahospitalforservicesthatarefurnishedtoanenrolleewhoisnotconfinedasafull-timeinpatient.Forbenefitinformationondiagnosticservicesdonewhileatthehospi-tal,seetheDiagnosticServicesbenefit.

PleaseNote:All“HospitalOutpatientCare”servicesaresubjecttothehealthcareplan’sdeductiblesandout-of-pocketmaximums.

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skilled nursinG FaCilitY

Thisbenefitisonlyprovidedwhenyouareatapointinyourrecoverywhereinpatienthospitalcareisnolongermedicallynecessary,butskilledcareinaskillednursingfacilityis.Yourattendingphysicianmustactivelysuperviseyourcarewhileyouareconfinedintheskillednursingfacility.

Coveredcostsincludeservicesandsupplies,includingroomandboard,furnishedbyandusedwhileconfinedinaskillednursingfacilityforupto100daysinanyoneplanyear.

skilled nursinG Care limitations

Inadditionto“GeneralLimitationsandExclusions,”thisbenefitwillnotbeprovidedforthefollowing:

• Custodialcare• Carethatisprimarilyforseniledeterioration,mentaldeficiencyormentalretardation• Chemicaldependency

amBulatorY surGiCal Center

Servicesandsuppliesfurnishedbyandusedwhileatthecenter,suchassurgicaldressingsanddrugsarecovered.

pHYsiCians’ serviCes

Home,office,emergencyroom,andinpatientvisits;therapeuticinjectionsincludingallergytestingandallergyinjections;surgery;anesthesiaadministration,corneatransplantation,skingraftsandtransfusionofbloodorbloodderivativesarecovered.Alsoincludedinthisbenefitareprostateandcervicalcancerscreeningexaminations,unlesstheymeetthestandardsforpreventivemedicalservicesdescribedinthePreventiveMedicalCare(Wellness)benefit.

assistant surGeon

Benefitsareonlyprovidedforservicesofanassistantsurgeonwhenmedicallynecessary,andcannotexceed20percentoftheprimarysurgeon’sallowablecharge.

multiple surGiCal proCedures

Ifmultipleorbilateralsurgicalproceduresareperformedduringthesameoperativesession,benefitswillbeprovid-edbasedontheallowablechargeforthefirstormajorprocedure,andone-halftheallowablechargeforsecondaryprocedures.

mental HealtH serviCes

Forinpatientandoutpatientmentalhealthcareofpsychiatricconditions,includingtreatmentofeatingdisorders(suchasanorexianervosa,bulimia,oranysimilarcondition),benefitswillbeprovidedaccordingtothemedicalscheduleofbenefits.

“Outpatienttherapeuticvisit”(outpatientvisit)meansaclinicaltreatmentsessionwithamentalhealthproviderofadurationconsistentwithrelevantprofessionalstandardsasdefinedinthePhysician’s Current Procedural Termi-

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nology,aspublishedbytheAmericanMedicalAssociation.

Coveredservicesmustbefurnishedbyalegally-operatedhospital,aphysician,apsychologist,apsychologicalasso-ciate,amasterofsocialwork,alicensedfamilyandmaritaltherapistorcounselor,alicensedclinicalsocialworker,oranAdvancedNursePractitioner(A.N.P.).Seethe“GlossaryofTerms”forfurtherdefinitionofacoveredprovider.

mental HealtH Care limitations

Inadditionto“GeneralLimitationsandExclusions,”thisbenefitwillnotbeprovidedforwhatare,inthejudgmentofBlueCross,thefollowingcases:

• substanceusedisorderssuchasalcoholismordrugaddiction(seebelow),sexualdysfunctions,dementia,andsleepdisorders;

• servicesfurnishedinconnectionwithobesity,eveniftheobesityisaffectedbypsychologicalfactors;• neurologicalandpsychologicaltestingandevaluationsrelatedtorehabilitationtherapy;or• testing,evaluations,andotherpsychologicalservicesrelatedtochronicpaincare.

CHemiCal dependenCY

Forinpatientandoutpatienttreatmentofchemicaldependencyconditions,includingdetoxification,theplanwillpayaccordingtothemedicalscheduleofbenefits.Coveredservicesmustbefurnishedbyastate-approvedtreatmentfacility,hospital,physician(M.D.orD.O.),psychologist,psychologicalassociate,licensedclinicalsocialworker,licensedfamilyandmaritalcounselor,oragovernment-approvedmethadoneclinic.Seethe“GlossaryofTerms”forfurtherdefinitionofacoveredprovider.

Benefitsfortherapeuticandsupportingservicesthatareprovidedtoenrolledfamilymemberstoassistinthechemi-callydependentenrollee’sdiagnosisandtreatmentareappliedtothebenefitmaximumsofthechemicallydependentenrollee.

CHemiCal dependenCY treatment limitations

Inadditionto“GeneralLimitationsandExclusions,”thisbenefitwillnotbeprovidedforthefollowingsituations:

• treatmentofnondependentalcoholordruguseorabuse;• voluntarysupportgroups,suchasAlanonorAlcoholicsAnonymous;or• court-orderedservicesorservicesrelatedtodeferredprosecution,deferredorsuspendedsentencing,ortodriv-

ingrights,exceptasdeemedmedicallynecessarybyBlueCross.

Indeterminingwhetherservicesforchemicaldependencytreatmentaremedicallynecessary,PremeraBlueCrossBlueShieldofAlaskawillusethecurrenteditionofthePatient Placement Criteria for the Treatment of Sub-stance-Related Disorders,aspublishedbytheAmericanSocietyofAddictionMedicine.

tHerapeutiC nuClear mediCine

Servicesandsuppliesfurnishedinconnectionwithradium,radioisotope,andX-raytherapyarecovered.

diaGnostiC serviCes

Administrationandinterpretationofdiagnosticimagingandscans(includingX-raysandEKGs),pathology,andlaboratorytestsarecovered.Screeningtestsforprostateandcervicalcancerarecovered.

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Please Note:Whencoveredinpatientdiagnosticservicesarefurnishedandbilledbyaninpatientfacility,theyareonlyeligibleforcoverageundertheapplicableinpatientfacilitybenefit.Pleaseseethe“GeneralPreventiveBenefit”under“WellnessProvisions”forinformationonpreventivediagnosticservices.


• Diagnosticsurgeriesandscopinsertionprocedures,suchascolonoscopiesorendoscopieswhicharecoveredunderthe“Physician’sServices”benefit,unlesstheymeetthestandardsforpreventivemedicalservicesde-scribedinthePreventiveMedicalCare(Wellness)benefit

• Allergytesting(seethe“Physician’sServices”benefit)

diaGnostiC and sCreeninG mammoGrapHY

Thisbenefitisnotsubjecttotheplanyeardeductibleorcoinsurance.Benefitsareprovidedforscreeninganddiag-nosticmammographyasfollows:

• abaselinemammogramandannualmammogramscreeningsthereafter,regardlessofage;and• asrecommendedbyaphysicianforanenrolleewithsymptoms,ahistoryofbreastcancer,orwhoseparentor

siblinghasahistoryofbreastcancer.

ContraCeptive manaGement and steriliZation serviCes

Professionalservices,includingsurgeryandimplantingorinjectingcontraceptives,andoutpatientsurgicalfacilityservicesareprovided,subjecttotheplanyeardeductibleandcoinsurance.Benefitsincludeconsultations;steriliza-tionprocedures;injectablecontraceptives;implantablecontraceptives(includingIUDsandhormonalimplants);andemergencycontraceptionmethods(oralorinjectable),whenfurnishedbyyourhealthcareprovider.

presCription ContraCeptives dispensed BY a pHarmaCY

Prescriptioncontraceptives(includingemergencycontraception)andprescriptionbarrierdevices,suchasdia-phragmsandcervicalcaps,dispensedbyalicensedpharmacyarecoveredonthesamebasisasanyothercoveredprescriptiondrug.PleaseseethePharmacyProgramsectionformoreinformation.

ContraCeptive manaGement and steriliZation serviCes limitations

Inadditionto“GeneralLimitationsandExclusions,”thisbenefitwillnotbeprovidedfornonprescriptioncontracep-tivedrugs,suppliesordevices;sterilizationreversal;testing,diagnosisandtreatmentofinfertility,includingfertilityenhancementservices,procedures,suppliesanddrugs;orcontraceptivedrugs,suppliesordevicesdispensedbyalicensedpharmacy.

masteCtomY and Breast reConstruCtion serviCes

Benefitsareprovidedformastectomynecessaryduetoillnessoraccidentalinjury.Foranyenrolleeelectingbreastreconstructioninconnectionwithamastectomy,inamannerdeterminedinconsultationwiththeattendingphysicianandthepatient,thisbenefitcovers:

• reconstructionofthebreastonwhichmastectomyhasbeenperformed;• surgeryandreconstructionoftheotherbreasttoproduceasymmetricalappearance;• prosthesis;and• physicalcomplicationsofallstagesofmastectomy,includinglymphedemas.

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transplants

AlthoughpriorapprovalbyPremeraBlueCrossBlueShieldofAlaskaisnotrequiredbeforebenefitscanbepro-vided,youoryourphysicianareencouragedtocontactBlueCrosstoseeiftheproposedtransplantwillmeettherequirementsofthisbenefit.

Covered transplants

Solidorgantransplantsandbonemarrow/stemcellreinfusionproceduresmustnotbeconsideredexperimentalorinvestigationalforthetreatmentofyourcondition.(RefertotheGlossaryofTermsforthedefinitionof“Experimen-tal/InvestigationalServices.”)PremeraBlueCrossBlueShieldofAlaskareservestherighttobasecoverageonallofthefollowing:

• Solidorgantransplantsandbonemarrow/stemcellreinfusionproceduresmustbemedicallynecessaryandmeetBlueCross’criteriaforcoverage.PremeraBlueCrossBlueShieldofAlaskareviewsthemedicalindicationsfortransplant,documentedeffectivenessoftheproceduretotreatthecondition,andfailureofmedicalalternatives.

• Thetypesofsolidorgantransplantsandbonemarrow/stemcellreinfusionproceduresthatcurrentlymeetBlueCross’criteriaforcoverageare:• heart• heart/doublelung• singlelung• doublelung• liver• kidney• pancreas• pancreaswithkidney• bonemarrow(autologousandallogenic)• stemcell(autologousandallogenic)

Forthepurposesofthisprogram,theterm“transplant”doesnotinclude:corneatransplantation,skingrafts,orthetransplantofbloodorbloodderivatives(exceptforbonemarroworstemcells).Benefitsforsuchservicesareprovidedunderotherbenefitsofthisprogram.

• Yourmedicalconditionmustmeetourwrittenstandards.PleasecallPremeraBlueCrossCustomerServiceat(800)364-2982formoreinformation.

• Thetransplantorreinfusionmustbefurnishedinanapprovedtransplantcenter.(“Approvedtransplantcen-ter”isahospitalorotherproviderthathasdevelopedexpertiseinperformingsolidorgantransplants,orbonemarroworstemcellreinfusion,andisapprovedbyBlueCross.)PremeraBlueCrossBlueShieldofAlaskahasagreementswithapprovedtransplantcentersinAlaskaandWashington,andhasaccesstoaspecialnetworkofapprovedtransplantcentersaroundthecountry.Whenevermedicallypossible,BlueCrosswilldirectyoutoanapproved transplant center that has contracted for transplant services.

• Ofcourse,ifnoneofPremeraBlueCrossBlueShieldofAlaska’scentersorthenetworkcenterscanprovidethetypeoftransplantyouneed,benefitswillbeprovidedforyourtransplantfurnishedbyanothertransplantcenter.

Please Note:Transplantsaresubjecttothehealthcareprogram’spre-existingconditionwaitingperiod.

transplant serviCes and supplies

Thisbenefitcoverstheservicesandsupplieslistedbelowforallcoveredtransplants:

• Recipient Costs—Hospitalandprofessionalservicesandsuppliesfurnishedbythetransplantcenterduringthe

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stayinwhichthetransplantisperformed.Forbonemarrowtransplants,coveredservicesincludeanychemo-therapyandradiationtherapythatisapartofthecarethatiscoveredbythisbenefit.

• Donor Costs—Covereddonorservicesincludetheselection,removal(harvesting)andevaluationofthedonororgan,bonemarroworstemcell;transportationofdonororgan,bonemarrow,andstemcells,includingthesurgicalandharvestingteams;donoracquisitioncostssuchastestingandtypingexpenses;andstoragecostsforbonemarrowandstemcellsforaperiodofupto12months.

• Transportation and Lodging Expenses—Reasonableandnecessaryexpensesfortravel,lodgingandmealsforthetransplantrecipient(whilenotconfined)andonecompanion,exceptasstatedbelow,arecoveredbutlimitedasfollows:

• thetransplantrecipientmustresidemorethan50milesfromtheapprovedtransplantcenter;• thetravelmustbetoand/orfromthesiteofthetransplantforpurposesofanevaluation,thetransplant

procedure,ornecessarypost-dischargefollow-up;• whentherecipientisnotadependentminorchild,transportation,coveredlodgingandmealexpensesfor

therecipientandonecompanionwillbereimbursedupto$80perday;• whentherecipientisadependentminorchild,transportation,coveredlodgingandmealexpensesforthe

recipientandtwocompanionswillbereimbursedupto$125perday.• Coveredtransportation,lodgingandmealexpensesincurredbythetransplantrecipientandcompanion(s)

arelimitedto$7,500pertransplant.

transplant limitations


• servicesandsuppliesthatarepayablebyanygovernment,foundation,orcharitablegrant,includingservicesperformedonpotentialoractuallivingdonorsandrecipients,andoncadavers;

• donorcostsforasolidorgantransplantorbonemarroworstemcellreinfusionthatisnotcoveredunderthisbenefitorforarecipientwhoisnotanenrollee;however,complicationsandunforeseeneffectsfromanenroll-ee’sorganorbonemarrowdonationwillbecoveredunderthisprogramasanyotherillness;

• donorcostsforwhichbenefitsareavailableunderothergrouporindividualcoverage;• nonhumanormechanicalorgans,unlessBlueCrossdeterminestheyarenotexperimentalorinvestigationalac-

cordingtothecriteriastatedunder“GlossaryofTerms;”• personalcareitems;• anti-rejectiondrugs,exceptthoseadministeredbythetransplantcenterduringtheinpatientoroutpatienthos-

pitalstayinwhichthetransplantisperformed.OutpatientprescriptiondrugsarecoveredunderyourPharmacyDrugBenefit.

• Plannedstorageofbloodformorethan12monthsagainstthepossibilityitmightbeusedatsomepointinthefuture.

reHaBilitation tHerapY, CHroniC pain Care, and neurodevelopmental tHerapY

Inpatientcareisonlycoveredwhenservicescannotbedoneinalessintensivesetting.

reHaBilitation tHerapY

Servicesmustbemedicallynecessarytorestoreandimproveabodilyorcognitivefunctionthatwaspreviouslynormalbutwaslostasaresultofanaccidentalinjury,illness,orsurgery.

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Inpatient Care

ServicesmustbefurnishedinaspecializedrehabilitativeunitofahospitalandbilledbythehospitalorbefurnishedandbilledbyanotherrehabilitationfacilityapprovedbyPremeraBlueCrossBlueShieldofAlaska.Thecaremustalsobepartofawrittenplanofmultidisciplinarytreatmentprescribedandperiodicallyreviewedbyaphysicianspecializinginrehabilitationmedicine.

Outpatient Care

Thefollowingservicesarecoveredwhenfurnishedandbilledbyahospital,anotherrehabilitationfacilityapprovedbyPremeraBlueCrossBlueShieldofAlaska,aphysician(M.D.orD.O.),oraphysical,occupational,orspeechtherapist:

• physical,speech,andoccupationaltherapyservices,includingcardiacrehabilitation;and• neurologicalandpsychologicaltestsandevaluationsrequiredtoprescribeanappropriatetreatmentplan.This

includesanylaterreevaluationstomakesurethatthetreatmentisachievingthedesiredmedicalresults.Fortheseservices,apsychologist,psychologicalassociate,orlicensedclinicalsocialworkeriscoveredinadditionto the providers listed above.

• outpatientphysicaltherapyislimitedto45visitsperplanyear;additionalvisitsmaybeavailablebasedonmedicalnecessity;and

• massagetherapyislimitedto26visitsperyear,andmustbebilledandsupervisedbyaphysician(M.D.orD.O.),Chiropractor,orPhysicalTherapist.

Chronic Pain Care

TheInpatientandOutpatientRehabilitationTherapyBenefitsalsocoverservicesthataremedicallynecessarytotreat intractable or chronic pain.

Neurodevelopmental Therapy

Neurodevelopmentaltherapymustbemedicallynecessarytorestoreandimprovefunction,ortomaintainfunctionwhere,inthejudgmentofBlueCross,significantphysicaldeteriorationwouldoccurwithoutthetherapy.

• Inpatient Care—Servicesmustbefurnishedandbilledbyahospitalorbyanotherrehabilitationfacilityap-proved by Blue Cross.

• Outpatient Care—Thefollowingservicesarecoveredwhenfurnishedandbilledbyahospital,anotherrehabil-itationfacilityapprovedbyBlueCross,aphysician(M.D.orD.O.),orwithaphysician’sreferral,byaphysical,occupational,orspeechtherapist:• physical,speech,andoccupationaltherapyservices,includingcardiacrehabilitation,arelimitedtoamaxi-

mumof45visitsinaplanyear;and• neurologicalandpsychologicaltestsandevaluationsrequiredtoprescribeanappropriatetreatmentplan.

Thisincludesanylaterreevaluationstomakesurethatthetreatmentisachievingthedesiredmedicalresults.Fortheseservices,apsychologist,psychologicalassociate,orlicensedclinicalsocialworkeriscovered in addition to the providers listed above.

reHaBilitation tHerapY, CHroniC pain Care, and neurodevelopmental tHerapY limitations

Inadditionto“GeneralLimitationsandExclusions,”thisbenefitwillnotbeprovidedforthefollowingsituations:

• nonmedicalself-help,suchas“OutwardBound”or“WildernessSurvival;”recreational,vocational,oreduca-tionaltherapy;workhardening,orexerciseprograms;

• socialorculturaltherapy;

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• acupressureorservicesofamassagetherapist,exceptassupervisedandbilledbyaphysician(M.D.orD.O.),physicaltherapist,orchiropractor;

• treatmentwhichisnotactivelyengagedinbytheill,injured,orimpairedenrollee;• gymorswimtherapy;and• custodialcare,excepthabilitativeservicesundertheNeurodevelopmentalTherapyBenefit.

Home HealtH Care

Tobecovered,thehomehealthcareservicesmustbepartofawrittenplanoftreatmentprescribed,periodicallyreviewed,andapprovedbyaphysician(M.D.orD.O.),anditmustbeginwithinsevendaysafterdischargefromahospitalasaninpatient.Intheplanofcare,thephysicianmustcertifythatconfinementinahospitalorskillednursingfacilitywouldberequiredwithouthomehealthcareservices.MedicallynecessaryhomehealthcaremustberenderedandbilledbyahomehealthagencythatisMedicare-certifiedassuchorislicensedorcertifiedassuchbythestateinwhichitoperates.

Coveredservicesincludehomecarebyoneormoreofthefollowingagencyemployeesuptoamaximumof130intermittentvisitsperenrolleeeachplanyear:

• aregisteredorlicensedpracticalnurse;• alicensedorregisteredphysicaltherapist;• acertifiedrespiratorytherapist;• aspeechtherapistcertifiedbytheAmericanSpeech,Language,andHearingAssociation;• alicensedoccupationaltherapist;• alicensedclinicalsocialworker;• amasterofsocialwork;or• ahomehealthaidewhoisdirectlysupervisedbyoneoftheaboveproviders(performingservicesprescribedin

theplanofcaretoachievethedesiredmedicalresults).

Home HealtH Care limitations


• socialservices;• servicesoffamilymembersorvolunteers;• nonmedicalservices,suchasspiritual,bereavement,legal,orfinancialcounseling;• normallivingexpenses,suchasfood,clothing,andhouseholdsupplies;• housekeepingservices,exceptforthoseofahomehealthaideasprescribedbytheplanofcare;• transportationservices;• chargesinexcessoftheaveragewholesalepriceshowninthePharmacist’s Red Bookforprescriptiondrugs,

insulin,andintravenousdrugsandsolutions;• over-the-counterdrugs,solutions,andnutritionalsupplements;• drugsandsolutionsreceivedwhileyouareaninpatient;• servicesprovidedtosomeoneotherthantheillorinjuredenrollee;• services,supplies,orprovidersnotinthewrittenplanofcareornotnamedascoveredinthisBenefit;• custodialcare;• dietaryassistance,suchas“MealsonWheels,”ornutritionalguidance;or• servicesprovidedduringanyperiodoftimeinwhichtheenrolleeisreceivinghospicecarebenefitsofthispro-

gram.

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HospiCe Care

Tobecovered,hospicecareservicesmustbefurnishedandbilledbyahospiceagencythatisMedicare-certifiedassuchorlicensedorcertifiedassuchbythestateinwhichitoperates,andmustbepartofawrittenplanofcareprescribedandperiodicallyreviewedbyaphysician(M.D.orD.O.).Thisphysicianmustcertifythattheenrolleeisterminallyillandthathospitalorskillednursinghomeconfinementwouldberequiredintheabsenceofthehospiceplanofcare.Theplanofcareshallalsodescribetheservicesandsuppliesforthepalliativecareandmedicallynec-essarytreatmenttobeprovidedtotheenrollee.

Benefitsareavailableforthefirstsixmonthsfromtheinitialdateofhospicecarecoveredunderthisprogram.How-ever,attheendofthesix-monthperiod,applicationsmaybemadeforanextensionifhospicecarebenefitshavenotbeenexhausted.

Thishospicebenefitcoversonlytheservicesandsupplieslistedbelow:

• Homecareuptoamaximumof$4,000forvisitsbyeachofthefollowingforintermittentcare:• registeredorlicensedpracticalnurse;• licensedphysicaltherapist;• certifiedrespiratorytherapist;• AmericanSpeech,Language,andHearingAssociation-certifiedspeechtherapist;• licensedoccupationaltherapist;• licensedclinicalsocialworker;• masterofsocialwork;or• homehealthaidewhoisdirectlysupervisedbyoneoftheaboveproviders(performingservicesprescribed

intheplanofcaretoachievethemedicallydesiredresults).• Upto10daysofinpatientcareinahospicethatisMedicare-certifiedassuchorlicensedorcertifiedassuchby

thestateinwhichitoperateswhenorderedbytheattendingphysician(M.D.orD.O.)• Upto120hoursofrespitecareforahomeboundenrolleeineachthree-monthperiodofhospicecare;thethree-

monthperiodbeginsontheinitialdateofhospicecarecoveredunderthisprogram

HospiCe Care limitations


• servicesprovidedtootherthantheterminallyillenrollee,includingbereavementcounseling;• pastoralandspiritualcounseling;• servicesperformedbyfamilymembersorvolunteerworkers;• homemakerorhousekeepingservices,exceptbyhomehealthaidesasorderedinthehospiceplanofcare;• supportiveenvironmentalmaterialsincluding,butnotlimitedto,handrails,ramps,airconditioners,andtele-

phones;• expensesforthenormalnecessitiesoflivingincluding,butnotlimitedto,food,clothing,andhouseholdsup-

plies;• dietaryassistance(e.g.,MealsonWheels)ornutritionalguidance;• separatechargesforreports,records,ortransportation;• legalandfinancialcounselingservices;• servicesandsuppliesnotincludedinthehospiceplanofcare,ornotspecificallysetforthasacoveredexpense;• servicesandsuppliesinexcessofthespecifiedlimitations;or• servicesprovidedduringanyperiodoftimeinwhichtheenrolleeisreceivingbenefitsunderthehomehealth

carebenefitofthisprogram.

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liCensed amBulanCe serviCe

Benefitsareprovidedformedicallynecessarytransportationtothenearestmedicalfacilityequippedtotreatyourcondition.Medicallynecessaryservicesandsuppliesprovidedbytheambulancearealsocovered.

speCial transport

Please Note: Thetravelbenefitisintendedtoallowyouaccesstohealthcareserviceswhennolocaloptionexists.

Benefitsfortransportationwillbeprovidedtothenearesthospitalequippedtofurnishspecialcaredeemedmedi-callynecessaryfortreatmentofinjuryorillnessiftheinjuryordiseaseislife-endangering,ifsurgeryisrequiredthatcannotbeperformedlocally,orifaconditionexiststhatcannotbetreatedlocally.Transportationmaybebyair,am-bulance,railroad,orcommercialairlinesonaregularlyscheduledflight.Travelinpersonalvehiclesisnotcovered.Ticketsobtainedthroughmileageplansorotherrewardsprogramsarenotcovered.

Airfareforthreeroundtripsperplanyearbythepatientwillbeallowedforanyonecondition.Ifthepatientisaminorage17oryounger,airfarewillbepaidforoneaccompanyingparentorguardianforeachtrip.

Theattendingphysicianmustcertifythenecessityofanychargesforspecialtransportation.AlthoughpriorapprovalbyPremeraBlueCrossBlueShieldofAlaskaisnotrequiredbeforebenefitscanbeprovided,youoryourphysicianareencouragedtocontactBlueCrosstoseeiftheproposedtravelwillmeettherequirementsofthisbenefit.

Home mediCal and respiratorY equipment/mediCal supplies

Durablemedicalequipmentandmedicalsuppliesareeligibleexpensesasfollows:

• Home Medical and Respiratory Equipment—Rental,nottoexceedthepurchaseprice,iscoveredwhenmedicallynecessaryandprescribedbyaphysicianfortherapeuticuseindirecttreatmentofacoveredillnessorinjury.BlueCrossmayalsoprovidebenefitsfortheinitialpurchaseofequipment,inlieuofrental.Examplesofmedicalequipmentareawheelchair,ahospital-typebed,tractionequipment,ventilators,diabeticequipmentandlightboxes.• Incaseswherethereisanalternativetypeofequipmentthatislesscostlyandservesthesamemedical

purpose,BlueCrosswillprovidebenefitsonlyuptothelesseramount.• Repairorreplacementofhomemedicalandrespiratoryequipmentmedicallynecessaryduetonormaluse

orgrowthofachildiscovered.• Medical Supplies, Orthotics And Orthopedic Appliances

• Appliancessuchasbraces,ribbelts,crutchesanddiabeticsuppliesarecovered.• Orthoticsforthefeet(shoeinserts),includingimpressioncasting,andrelatedsupplies,devices,andshoes

arecovered.Benefitsarelimitedtoaplanyearmaximumof$350.• Benefitsareprovidedforvisionhardwareforthefollowingmedicalconditionsoftheeye:cornealulcer,

bullouskeratopathy,recurrenterosionofthecornea,tearfilminsufficiency,aphakia,Sjorgren’sDisease,congenitalcataract,cornealabrasionandkeratoconus.

Home mediCal and respiratorY equipment/mediCal supplies limitations


• specialorextra-costconveniencefeatures;• itemssuchasexerciseequipmentorweights;• orthopedicappliancesprescribedprimarilyforuseduringparticipationinsports,recreation,orsimilaractivities;

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• whirlpools,whirlpoolbaths,portablewhirlpoolpumps,saunabaths,andmassagedevices;• over-bedtables,elevators,visionaidsandtelephonealertsystems;• structuralmodificationstoyourhomeorpersonalvehicle;or• eyeglasses,contactlensesandothervisionhardwareforconditionsnotlistedasacoveredmedicalcondition,

includingroutineeyecare(seetheVisionCaresectionforthesebenefits).

prostHetiC deviCes

Devicestoreplaceallorpartofanabsentbodylimbortoreplaceallorpartofthefunctionofapermanentlyinop-erativeormalfunctioningbodyorganarecovered.

Benefitswillonlybeprovidedfortheinitialpurchaseofaprostheticdevice,unlesstheexistingdevicecannotberepaired,orreplacementisprescribedbyaphysicianbecauseofachangeinyourphysicalcondition.

Benefitswillbeprovidedforthepurchaseofawigorhairpiecetoreplacehairlostduetoanaccidentorradiationtherapyorchemotherapyforacoveredcondition.Benefitswillbelimitedtoonewigorhairpieceperplanyear,uptoaplanyearmaximumof$350.

prostHetiC deviCes limitations


• electronicprostheses,penileprostheses,ordevicesdirectlyrelatedtoanorgantransplant;or• prosthetics,intraocularlenses,appliancesordevicesrequiringsurgicalimplantation,Theseitemsarecovered

undertheSurgicalServicesbenefit.ItemsprovidedandbilledbyahospitalarecoveredundertheHospitalInpa-tientCareorOutpatientCarebenefits.

Blood transFusions

Thecostofbloodandbloodderivativesarecoveredwhenmedicallynecessary.

pku dietarY Formula

Adietaryformulathatismedicallynecessaryforthetreatmentofphenylketonuria(PKU)iscovered.Thisbenefitisnotsubjecttothewaitingperiodforpre-existingconditions.

oBstetriC Care

Pregnancy,childbirth,andrelatedconditionsarecoveredthesameonthesamebasisasanyotherconditionforallfemalemembers.Coveredservicesincludescreeninganddiagnosticproceduresduringpregnancy,andrelatedgeneticcounseling,whenmedicallynecessaryforprenataldiagnosisofcongenitaldisorders.Planbenefitsarealsoprovidedformedicallynecessaryservicesandsuppliesrelatedtohomebirths.

Please Note:Attendingproviderasusedinthisbenefitmeansaphysician,aphysician’sassistant,acertifiednursemidwife(C.N.M.),alicensedmidwifeoranadvancedregisterednursepractitioner(A.R.N.P.).Iftheattendingpro-viderbillsasinglefeethatincludesprenatal,deliveryorpostpartumservicesreceivedonmultipledatesofservice,thisplanwillcoverthoseservicesasitwouldanyothersurgery.

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Planbenefitsarealsoprovidedformedicallynecessaryservicesandsuppliesrelatedtohomebirths.

Inpatienthospitalservicesandrelatedinpatientmedicalcarefollowingchildbirthasdeterminedtobenecessarybytheattendingprovider,inconsultationwiththemother,willbeprovidedupto:

• 48hoursafteravaginalbirth;or• 96hoursafteracesareanbirth.

Ifitisdeterminedthatthelengthofstaywillexceedtheabovelimitations,BlueCrossrecommendsthatthehospitalcontactCareManagementat(800)722-4714fordischargeplanningandpotentialcasemanagement.

HelpfulinformationaboutpregnancyandproperprenatalcareisavailablebycallingBestBeginnings’resourceline,(888)773-6399.Pleasesee“BestBeginnings”intheCareManagementsectionofthishandbook.

routine neWBorn Care

Benefitsforroutinehospitalnurserychargesandrelatedinpatientwell-babycareforanewborndependentchildareprovided up to:

• 48hoursafteravaginalbirth;or• 96hoursafteracesareanbirth.

Benefitsarealsoprovidedforroutinecircumcisionuptosixmonthsfollowingbirth.

Newbornchildrenborntodependentdaughtersarenoteligibleforcoverage.

Ifitisdeterminedthatthelengthofstaywillexceedtheabovelimitations,BlueCrossrecommendsthatthehospitalcontactCareManagementat(800)722-4714fordischargeplanningandpotentialcasemanagement.

Please Note:Benefitsforcareofanillbabyareprovidedunderthechild’scoverage,subjecttohisorherownComprehensiveMedicalCalendarYearDeductibleandout-of-pocketrequirements.

The University requests that you enroll your newborn as soon as possible from the date of birth. Enrollments after 60 days from date of birth will not be accepted until the next open enrollment period. Please contact your regional human resources office for assistance with enrolling your newborn.

neWBorn HearinG eXams and testinG

Thisbenefitprovidesforonescreeninghearingexamfornewbornsupto30daysafterbirth.Benefitsarealsopro-videdfordiagnostichearingtests,includingadministrationandinterpretation,forchildrenuptoage24monthsifthenewbornhearingscreeningexamindicatesahearingimpairment.

aCupunCture

Benefitsareprovidedforacupunctureserviceswhenmedicallynecessarytorelievepain,inducesurgicalanesthe-sia,ortotreatacoveredillness,injuryorcondition.Acupuncturebenefitsaren’tsubjecttoacalendaryearbenefitmaximum.

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CHiropraCtors’ serviCes

Theservicesofachiropractor(D.C.)operatingwithinthescopeofhisorherlicensearecoveredonthesamebasisasforanycoveredphysicianprovidingmedicallynecessaryservices.

Please Note:Chiropracticbenefitsarelimitedtoamaximumof26visitsperplanyear.

HealtH manaGement

Theseservicesareprovidedat100%ofallowablecharges.Benefitsforhealtheducationservicesandnicotinede-pendencyprogramsarenotsubjecttoacalendaryearmaximum.

HealtH eduCation

Benefitsareprovidedforoutpatienthealtheducationservicestomanageacoveredcondition,illnessorinjury.Examplesofcoveredhealtheducationservicesareasthma,painmanagement,childbirthandnewbornparenting,lactationandself-managementtrainingandeducationtomanagediabetes.

niCotine dependenCY proGrams

Benefitsareprovidedfornicotinedependencyprograms.Youpayforthecostoftheprogramandsendproofofpay-menttoBlueCrossalongwithareimbursementform.Theplanwillprovidebenefitsasstatedaboveinthisbenefit.Claimformsareavailableontheuniversity’sbenefitswebsiteatwww.alaska.edu/benefits,oryoucanrequestonefromBlueCrossCustomerService.

nutritional tHerapY

Benefitsfornutritionaltherapyarenotsubjecttotheplanyeardeductibleandcoinsuranceunlessservicesarepro-videdbyahospitalorhospital-basedchemicaldependencytreatmentprogramthatisnotintheBlueCrossnetwork.Out-of-networkbenefitswillbesubjecttotheplanyeardeductibleandcoinsurance.Benefitsareprovidedforoutpa-tientnutritionaltherapyservicestomanageyourcoveredcondition,illnessorinjury,includingdiabetes.Thisbenefitisnotsubjecttoaplanyearbenefitlimit.

skilled nursinG Care

ServicesofaRegisteredNurse(R.N.)oraLicensedPracticalNurse(L.P.N.)arecoveredforthepurposeofperform-ingskillednursingcare.Coveredservicesincludethefollowing:

• visitingnursingcareofnotmorethantwohoursperdayforthepurposeofperformingspecificskillednursingtasks;or

• privatedutynursingcareofgreaterthantwohoursperday,ifBlueCrossdeterminesthatvisitingnursingcareisnot adequate to treat your condition

skilled nursinG Care limitations

Inadditionto“GeneralLimitationsandExclusions,”thisbenefitwillnotbeprovidedforthefollowingservices:

• allorthatpartofanynursingcarethatdoesnotrequiretheskillsofanR.N.orL.P.N.;or• anynursingcare,givenwhiletheenrolleeisaninpatientinahealthcarefacility,thatcouldsafelyandadequate-

lybefurnishedbythefacility’sgeneralnursingstaffifitwerefullystaffed.

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temporomandiBular joint (tmj) disorders

Benefitsformedicalservicesandsuppliesforthetreatmentoftemporomandibularjoint(TMJ)disordersarepro-videdonthesamebasisasanyothermedicalcondition.Thisbenefitcoversinpatientandoutpatientfacilityandprofessionalcare,includingprofessionalvisits.Coveredservicesincludethefollowing:

• Inpatientandoutpatientprofessionalservices,includingsurgery• Outpatientsurgicalfacilityservices• Inpatientfacilityservices

Medicalservicesandsuppliesarethosethatmeetallofthefollowingrequirements:

• reasonableandappropriateforthetreatmentofadisorderofthetemporomandibularjoint,underallthefactualcircumstancesofthecase;

• effectiveforthecontroloreliminationofoneormoreofthefollowing,causedbyadisorderofthetemporo-mandibularjoint:pain,infection,disease,difficultyinspeaking,ordifficultyinchewingorswallowingfood;

• notexperimentalorinvestigational,asdeterminedaccordingtothecriteriastatedunder“Definitions,”orpri-marilyforcosmeticpurposes.

ortHoGnatHiC surGerY (jaW auGmentation or reduCtion)

Whenmedicallynecessarycriteriaaremet,benefitsforupperand/orlowerjawaugmentationorreduction(orthog-nathicand/ormaxillofacial)surgeryisprovidedataconstant80percentofallowablecharges,uptoalifetimebenefitmaximumof$25,000.

oBesitY treatment

non-surGiCal WeiGHt manaGement

Benefitsfornon-surgicalweightmanagementarecoveredonthesamebasisasanyothercoveredcondition,subjecttotheapplicablebenefits,limitationsandexclusions.Non-SurgicalWeightManagementbenefitsinclude,butaren’tlimitedto,coverageofthefollowingoutpatientmedicalservices:

• Behavioralhealthvisits• Nutritional/dieticianvisits• PhysicalTherapyvisits(subjecttothe45visitsperplanyearlimit)• Physicianvisits• Prescriptiondrugs• Relatedlabanddiagnosticservices

surGiCal treatment oF morBid oBesitY

Benefitsforsurgicaltreatmentofmorbidobesityarecoveredthesameasanyothercoveredcondition,subjecttothecriterialistedbelow,applicablebenefits,limitationsandexclusions.

A benefit advisory is recommended for members considering this approach to weight loss.Forinformationonobtainingabenefitadvisory,pleasecontactPremeraCustomerServiceat(800)364-2982.

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CoverageisavailableforbariatricprocedureslistedasmedicallynecessaryinPremeraBlueCross’medicalpolicy,whenconservativemeasureshaveprovenineffective.Examplesofconservativemeasuresincludebutaren’tlimitedtocoveredservicesundertheNon-SurgicalWeightManagementbenefit,medicallysuperviseddietandexerciseprograms.Toqualifyforthesurgicaltreatmentformorbidobesitybenefit,themembermustmeetthefollowing:

• DiagnosedasmorbidlyobesewithaBodyMassIndex(BMI)greaterthanorequalto40;or• OverweightwithaBMIgreaterthan35withco-morbidities,includingbutnotlimitedto:

• CongestiveHeartFailure(CHF)• CoronaryHeartDisease• Diabetes• Hyperlipidemia• Hypertension• SleepApnea

Forspecificsurgicaltreatmentbenefitinformation,pleaseseetheHospitalInpatient,HospitalOutpatientandPhysi-cianServicesbenefits.

Thesurgicaltreatmentofmorbidobesitybenefitissubjecttoalifetimebenefitmaximumof$25,000forcoveredservices,includingbutnotlimitedtosurgery,anesthesia,facilityandotherchargesdirectlyrelatedtosurgicalcare.Medicallynecessarytreatmentofsurgicalcomplicationsdonotaccruetowardthisbenefitmaximum.

oBesitY treatment BeneFit limitations

Inadditionto“GeneralLimitationsandExclusions,”thisbenefitwillnotbeprovidedforthefollowingservices:

• Proceduresortreatmentsdeemedexperimentalorinvestigational(pleaseseetheGlossaryofTerms)• Surgicalremovalofexcessabdominal,armorotherskinorliposuctionunlessmedicallynecessary• Over-the-countermedicationsforweightloss• Liquiddietorfastingprograms• Otherfoodreplacementandnutritionalsupplements• Membershipindietprograms• Healthclubs,exerciseequipment,orwholebodycalorimeterstudies• Wiringofthejaw• Vitamininjections

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DISEASE MANAGEMENT

Managinganyhealthconditionischallenging,butchronicconditionssuchasdiabetesorasthmawon’tgoaway.However,withjustafewkeylifestylechanges,youcancontrol,lessentheeffectstohelpyourselflivehealthierandfeelyourbesteachday.That’swhytheUniversityofAlaskahaspartneredwithAlere,anationallyrecognizedhealthorganization,toprovidetheAlereCareHealthManagementprogram.Alereisaleaderinpersonalhealthsupportservices.Theirpersonalizedprogramsweredesignedtohelpindividualsdeterminewhatchangestheyfeelreadytomake,setrealisticgoalsandgivethemthetoolstobesuccessful.

TheAlereCareHealthManagementProgramisaconfidential,voluntaryprogramthatcangiveyoutheextrasupportyoumayneedtobettermanageyourhealth.AndAlereCareisprovidedtoyouatnoadditionalcostaspartofyourhealthcarebenefits.

Ifyouoracovereddependentarelivingwithanyofthefollowingconditions,youmaybeeligibletoparticipateintheAlereCareprogram:

• Asthma(adultandpediatric)• Chronicobstructivepulmonarydisease(COPD)• Coronaryarterydisease• Diabetes• Heartfailure

Theprogramgivesyouaccesstoa24/7supportsystemofregisterednurses,dieticiansandotherhealtheducatorswhocanhelpyoucreateaplantomanageyourspecifichealthcondition.

Your AlereCare nurse can help you:

• Followyourdoctor’streatmentplan• Preventordecreasehealthcomplications• Understandyourmedicines• Makethemostofyourdoctorvisits• Talkaboutwhatmedicalcareandtestsmightberightforyou• Findopportunitiestomakepositivelifestylechoices

Thisinformationdoesnotreplaceyourdoctor’sadvice.Itismeanttoserveasanotherresource.Allyourinformationiskeptconfidentialandonlyusedbylicensedhealthcareprofessionals.

Ifyouareidentifiedasacandidatefortheprogram,anAlereCarespecialistwillcontactyou.Youwillalsoreceiveaprogramwelcomepacketinthemail.Youdon’thavetowaitforacall.Ifyou’dliketoparticipate,orjustlearnmoreabouttheprogram,youmaycall1-866-674-9101totalktoanAlereCarespecialistatanytime.

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PHARMACY PROGRAM

YourprescriptiondrugplanisadministeredbyCVSCaremarkandisseparatefromyourmedicalplan.PleaseuseyourCVSCaremarkIDcardwhenhavingaprescriptionfilled.YourCVSCaremarkmemberIDnumberforyouandallenrolledfamilymembersisyourUniversityofAlaskaEmployeeID.YouwillreceiveanIDcardforyouandyourspouse,ifapplicable.Ifadditionalcardsareneededforyourdependents,pleasecallCustomerCareforCVSCaremarktoll-freeat1-800-596-2178.

Thepharmacybenefitprovidescoverageformedicallynecessaryprescriptiondrugsandinsulinwhenprescribedbyaphysicianforyouruseoutsideofamedicalfacilityanddispensedbyalicensedpharmacistinparticipatingmailorderorretailpharmacieslicensedbythestateinwhichthepharmacyislocated.Forthepurposesofthisprogram,aprescriptiondrugisanymedicalsubstancethat,underfederallaw,mustbelabeledasfollows:“Caution:Federallawprohibitsdispensingwithoutaprescription.”Itdoesnotincludeanydrugslabeled,“Caution—limitedbyfederallawtoinvestigationaluse.”

Thisprogramalsoprovidescoverageforthefollowing:

• PrenatalandFluoridatedVitamins• OralContraceptiveDrugs• PrescriptionNicotineDependencyDrugs• Inhalationspacerdevicesandpeakflowmeters• Insulinneedles/syringesandotherdisposablediabeticsupplies

maXimum mediCation supplY

Whenyoupurchaseprescriptionsataparticipating(network)pharmacy,youwillreceiveamaximum30-daysupply,unlessthedrugmaker’spackaginglimitsthesupplyinsomeotherway.This30-daysupplylimitationistypicalofmostprescriptiondrugprogramsbecauseitreduceswasteandconformswithstandardphysicianprescribingpat-terns.Ifyouaretakingaprescriptionforalong-termorchroniccondition,youshouldconsiderusingCVSCaremarkMailServicePharmacy,themailservicepharmacywhichallowsyoutopurchaseuptoa90-daysupply.

speCial Features oF tHe pHarmaCY netWork proGram

TheUniversityofAlaskahascontractedwithCVSCaremarktoaccesstheirpharmacynetwork.ThesepharmacieshaveagreedtoprovideUniversityofAlaskaplanparticipantsdiscountsequaltoorgreaterthananyavailablewhenpurchasingthemedicationforcash.Thepharmacynetworkprogramalsoincludessomeimportantqualityandcost-savingfeaturessuchas:

• drugutilizationreview;• electronicsubmissionofclaims;and• reducedpricesonmostprescriptiondrugs.

druG utiliZation revieW

Yourdrugbenefitincludesaspecialcomputerizedreal-timemonitoringservice.Whenyouhaveaprescriptionfilledatanetworkpharmacy(includingtheCVSCaremarkMailServicePharmacymentionedlaterinthissection),your

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prescriptionwillbeanalyzedforcertaintypesofpotentialproblemsrelatedto:

• interactionswithotherdrugsyouaretaking;• inappropriatedrugs,basedonyourage;• unusuallyhighorlowdrugdosage;and• drugduplicationorexcessiveuse.

Thismonitoringisbasedoninformationstoredfrompreviousprescriptionsyouhavehaddispensedfromanetworkpharmacy.Ifanyofthesepotentialproblemsarise,amessageistransmittedtoyourpharmacistbeforethedrugisdispensed.Thepharmacistmayconsultwithyouandmaywanttocontactyourphysiciantoresolveanyquestionsabouttheappropriatenessofaparticulardrug.

Toreceivebenefitsforprescriptiondrugsatanetworkpharmacy,justshowyourCVSCaremarkIDcardandpayyourcopaymentfortheprescription.ThepharmacistwillelectronicallyfilethebalanceoftheclaimwithCVSCaremark.Youdon’thavetofileaclaimformandyoudon’thavetowaittobereimbursed.Ifyouarecoveredbyanadditionalprogramyoumaysubmityourreceiptforthecopaymentforreimbursementfromthesecondarycarrier.IfyoursecondarycarrierisalsoCVSCaremark,completeaCVSCaremarkPrescriptionClaimFormandsendit,alongwithyourreceiptfortheprimarycoverage,toCVSCaremark.Formsareavailablethroughtheuniversity’sbenefitsWebsiteatwww.alaska.edu/hr/forms/hr_healthforms.xml.

GeneriC druGs

Oneofthemostimportantwaysthatyoucanhelpkeepprogramcostsdownovertimeisbyutilizinggenericdrugswheneverpossible.Thegenericversionofadrugismadefromthesamechemicalcompoundasitsbrandnamecounterpart.GenericdrugsaremanufacturedaccordingtothesamestandardsasbrandnamedrugsandhavetheFDA’sapprovalforsafetyandeffectiveness,yetgenericdrugscostafractionofthepriceoftheirbrandnamecoun-terparts.Theuseofgenericdrugsoffersasimpleandsafealternativetohelpreduceyourmedicationcosts.Youcanensurethatyouwillreceivethegenericproductwhenitisavailablebyaskingyourdoctortowriteyourprescriptionforthegenericorbyindicatinggenericsubstitutionisallowed.

Underthisprogram(includingtheCVSCaremarkMailServicePharmacy)genericswillbeusedinallsituationsexceptinthefollowingcases:

• thereisnogenericequivalent;• thepharmacyisunabletoprovidethegenericequivalentatthetimetheprescriptionisfilled;or• theemployeeordependentrequeststhenamebranddrugandagreestopaythedifferenceinthecostbetween

thegenericandnamebranddrug.

HiGH perFormanCe step tHerapY

TheHighPerformanceStepTherapyprogram(alsocalledGenericStepTherapy)isdesignedtoencouragetheuseoflower-costgenericsandpreferredbrand-namedrugstohelpreducepharmacycostsforbothemployeesandtheUniversityofAlaska.

StepTherapyrequiresthatacosteffectivegenericalternativebetriedfirstbeforeanon-preferredbranddrugiscovered.Inorderforanon-preferredbrandmedicationtobecovered,theplanrequiresyoutohaveuseda30-daysupplyofagenericalternativeinthesamedrugclasswithinthelast24months,oryourmedicalproviderwillneedtogetpriorauthorizationforthenon-preferreddrugtobecovered.

Thisprogramislimitedtoacertainnumberofdrugs.Foranup-to-datelisting,checkthebenefitswebsiteatwww.alaska.edu/benefits/pharmacy-benefits.

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approved druG list

CVSCaremarkhasidentifiedalistofapprovedorpreferreddrugs,calleda“formulary,”madeupofallFDA-approvedgenericdrugsandmanybrandnamedrugs.NewlyFDA-approvedmedicationswillbesubjecttoanynon-formularycopaymentpendingareviewbythePharmacyandTherapeuticscommittee.Alistofformularydrugsisinyourpharmacybenefitbooklet,senttoyouwithyourIDcards.Periodicupdatestotheformularymayoccur.ForthemostcurrentformularyinformationpleasecallCustomerCareforCVSCaremarktoll-freeat1-800-596-2178,orvisitwww.Caremark.com/members.Drugsthatarenotontheapprovedlist(callednon-preferredbrand-namedrugs)arecoveredatthehighestcopay(pleaseseethefollowingtable).

Pleasenote:certaincategoriesofdrugsareexcluded;see“PharmacyLimitations”formoreinformationonexcludeddrugs.

presCription druG CopaYment

Eachenrolleemustpayacopayforeachseparatenewprescriptionorrefill.A“copay”isafixedup-frontdollaramountthatyou’rerequiredtopayforeachprescriptiondrugpurchase.Ifpurchasedataparticipatingpharmacy,theamountyou’llpaywillbeasfollows:

Non-PreferredPer Prescription Generic Drug Brand Name Drug Brand DrugorRefill Copayment Copayment Copayment

NetworkPharmacy $5forgenericdrugs $25forbrandname $50copayfornon-(upto30-daysupply) preferredbrandname CVSCaremarkMailService $10forgenericdrugs $50forbrandname $100copayfornon-(upto90-daysupply) preferredbrandname

Whenavailable,agenericdrugwillbedispensedinplaceofabrandnamedrug.Intheeventagenericequivalentisnotmanufactured,thebrandnamecopaymentwillapply.

If you or your doctor request a brand name drugwhenagenericequivalentisallowedbylawandavailable,inadditiontothebrandnamecopaymentyouwillberequiredtopaythedifferenceinpricebetweenthebrandnamedrugandthegenericequivalent.

reFills

Benefitsforrefillswillbeprovidedonlywhenyouhaveusedthree-fourths(75percent)ofthecurrentsupply.The75percentiscalculatedbasedonthenumberofunitsanddayssupplydispensedonthelastrefill.

maintenanCe druGs

Thepharmacyplanencouragestheuseofmailorderformaintenancedrugsbychargingahighercopayforthethirdandfuturerefillswhenfilledataretailpharmacy.Aftertworefillsataretailpharmacy,theregularcopaywillbedoubledunlessyouusetheMailServicePharmacy.Alistofmaintenancedrugscanbefoundonthebenefitswebsiteatwww.alaska.edu/benefits/pharmacy-benefits.DrugsthatcouldbedamagedbyfreezingareexemptfromtheMailServicerequirement.

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out-oF-poCket maXimum

Pharmacyplancopaysarelimitedtoanindividualout-of-pocketmaximumof$1,000perperson,perplanyear.Thisisaseparateout-of-pocketmaximumfromthemedicalplanmaximum,andisnotcombinedwithanyotherplanlimits.

pHarmaCies outside alaska

Youridentificationcardwillalsobehonoredatmorethan62,000participatingindependentandchainpharmacieslocatedintheother49states,PuertoRico,andtheDistrictofColumbiathathavecontractswithCVSCaremark.Whenyoushowyouridentificationcard,thesepharmacieswillsendtheclaiminformationdirectlytoCVSCare-mark.Youwillonlyhavetopayyourplan’sapplicablecopaymentattimeofpurchase.

If you do not show your identification cardataCVSCaremarknetworkpharmacyorifyouuseanon-participat-ingpharmacy,youwillhavetosubmittheclaimasdescribedbelowinthe“Non-ParticipatingRetailPharmacy”sec-tion.Youwillbereimburseduptotheamountchargedbyaparticipatingpharmacy,lesstheapplicablecopayment.TheCVSCaremarkPrescriptionClaimFormisavailablethroughtheuniversity’sbenefitsWebsiteatwww.alaska.edu/hr/benefits.Toconfirmthestatusofapharmacy,askthepharmacistorcallCustomerCareforCVSCaremarktoll-freeat1-800-596-2178.

non-partiCipatinG retail pHarmaCY

Ifyoufillaprescriptionatanon-participatingpharmacy,youwillbereimburseduptotheamountallowedatapar-ticipatingpharmacy,lessyourapplicablecopayment.Youwillberesponsibleforthefullretailcostoftheprescrip-tionatthetimethepharmacistissuesyourmedication;youwillnotreceivethediscountedpriceofaparticipatingpharmacy.Thisbenefitappliestoallprescriptionsfilledbyanon-participatingpharmacy,includingthosefilledviamailorotherhomedelivery.Tobereimbursed,youwillneedtosubmitaCVSCaremarkPrescriptionClaimFormtoCVSCaremarkattheaddressontheform.Formsareavailablethroughtheuniversity’sbenefitsWebsiteatwww.alaska.edu/benefits.

Coordination oF BeneFits For presCription druG Claims

TofileaclaimforcoordinationofbenefitsforsecondarycoverageyouwillneedtosubmitaCVSCaremarkPrescriptionClaimFormtoCVSCaremarkattheaddressontheform.Theformisavailablethroughtheuniver-sity’sbenefitsWebsiteatwww.alaska.edu/benefits.Besuretoincludeanyreceiptsorexplanationsofbenefitsyoureceivedfromtheprimarycoverage.

Cvs Caremark mail serviCe pHarmaCY

TheCVSCaremarkMailServicePharmacyallowsemployeesandtheirdependentstofillmaintenanceprescrip-tionsatlesscostthanthrougharetailpharmacy.Ifyoutakeprescriptionmedicationonanongoingbasisand/oryouhaveaprescriptionthatwillneeda30-daytoa90-daysupply,youcanorderthatprescription(andrefills)bymail.Uptoa90-daysupplyofcoveredmedicationsmaybepurchasedthroughthemailserviceprogram,unlessthedrugmaker’spackaginglimitsthesupplyinsomeotherway,andthecosttoyouisthecopaymentshowninthePrescrip-tionDrugCopaymenttableperprescriptionorrefill.WhenyoureceiveyourmedicationfromtheCVSCaremarkMailServicePharmacy,youwillonlyreceiveabillforyourcopaymentamount,andCVSCaremarkwillbebilleddirectly for the balance.

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orderinG From Cvs Caremark mail serviCe pHarmaCY

Theeasiestwaytogetstartedwiththemailorderbenefitistogotowww.caremark.comandloginusingyourusernameandpassword.Ifyouhaven’talreadyregisteredwiththesite,youcansetupyourusernameandpasswordquicklyandgetstartedrightaway.ClickonStartaNewPrescriptionundertheMemberQuickLinksmenu.Justfol-lowthedirectionsandchoosethemethodoforderingthatyouprefer.

Ifyouprefertophoneinyourprescription,justcall800-875-0867andhaveyourmedicationnameandyourdoctor’sinformationavailable(name,phoneandfaxnumbers).Caremarkwillcontactyourdoctortogetyourprescriptionsetup,processed,andonit’swaytoyou.

YoucanalsoorderfromtheCVSCaremarkMailServicePharmacybycompletingtheconfidentialMailServiceEnrollmentForm,foundinyourPrescriptionBenefitServicesBooklet,andmailitinthepostage-paidenvelopepro-vided.Youwillonlyneedtocompletethisformforyourfirstorder.Obtainanewprescriptionwrittenfora90-daysupplywithrefillsasneededforayear.Makesurethatyouhaveatleastatwotothreeweeksupplyofeachmedica-tiononhandbeforeyousubmityourmailserviceclaim.

YourprescriptiondrugorderwillbeprocessedandmailedtoyouviaFirstClassMailorUPS,alongwithinstruc-tionsforfutureprescriptionsand/orrefills.Refillscanbeorderedoverthephoneortheinternet.Pleaseallowupto21daysfordeliveryofyourfirstorder,and14daysforrefills.

FormoreinformationabouttheCVSCaremarkMailServicePharmacy,callCustomerCareat1-800-596-2178.

Cvs Caremark speCialtY pHarmaCY

Patientswithcomplex,chronicmedicalconditionsneedthenecessarycaremanagementtomonitortheircondition.CVSCaremarkSpecialtyPharmacyisaprogramthatprovidesthatattention,workingone-on-onewithpatients,managingtheirtreatment.CVSCaremarkSpecialtyPharmacyprovidesafullcomplementofspecializeddrugsandservicesforpatientswithhepatitisC,cancer,hemophilia,RSV,Crohn’sdisease,multiplesclerosis,rheumatoidarthritis,growthdeficiency,organtransplants,andHIV/AIDS.Ifyouaretakingmedicationsforacomplex,chronicmedicalcondition,contactCVSCaremarkSpecialtyPharmacytoll-freeat1-800-619-7610,orvisittheMemberServicessectionofwww.Caremark.com/members.

Thefirstfillofaspecialtymedicationmaybeobtainedatalocalretailpharmacy.FuturerefillsarefilledviamailservicethroughtheCVSCaremarkSpecialtyPharmacyandaresubjecttotheapplicablecopayorcoinsuranceper30-dayfill.

pHarmaCY limitations


• Prescriptionvitaminsandfoodsupplements,exceptforpre-natalandfluoridatedvitamins• Fertilitydrugs,regardlessoftheirintendeduse• Therapeuticdevicesorappliances(including,butnotlimitedto,hypodermicneedles,syringes,supportgar-

ments,andothernonmedicalsubstances),exceptforinsulinneedles/syringesandotherdisposablediabeticsupplies

• Anyprescriptionorrefillthatisinexcessofthequantityspecified,orthatisdispensedafteroneyearfromthedatetheprescriptionwaswritten

• Anyclaimordemandforinjuryordamagearisinginconnectionwiththemanufacturing,compounding,dis-pensing,oruseofanyprescriptiondrug

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• Over-the-counterdrugs(non-legend),otherthaninsulinandephedrine-containingproducts(e.g.emergencyallergytreatmentkits);drugsthatbylawdonotrequireaphysician’sprescription;herbal,naturopathic,orho-meopathicmedicinesordevices

• Drugsthatareprescribedordispensedforcosmeticuse• Drugsforexperimentalorinvestigationaluse

PrescriptiondrugscoveredunderthisbenefitarenoteligibleforComprehensiveMedicalBenefits.

Thispharmacyprogrambenefitisintendedtoprovidecoverageforprescriptiondrugsandinsulinwhendispensedbyapharmacy.Althoughthefollowingdrugs,services,andsuppliesarenotavailableunderthepharmacyprogram,theymaybeavailableelsewhereinthisplan:

• Immunizationagents;biologicalsera,suchasrabiesserum• Bloodorbloodplasma• Humangrowthhormonedrugs• Anyinfusiontherapydrugsorsolutions• Injectablesorotherprescriptionsrequiringparenteraladministrationoruse(otherthaninsulin)• Servicesotherthanprescriptiondrugs• Administrationorinjectionofanydrug• Drugsdeliveredoradministeredbytheprescriber• Take-homeprescriptiondrugsdispensedandbilledbyamedicalfacility

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DENTAL CARE BENEFITS

introduCtion

Benefitsareavailableunderthedentalcaresectionofthebenefitprogramforservicesandsuppliesfurnishedincon-nectionwiththediagnosisandtreatmentofacovereddentalconditionifsuchservicesandsuppliesmeetalloftheserequirements:

• Theymustnotbeexcludedfromcoverageunderthisprogram.• Theymustbefurnishedbyadentist,exceptthattheymayalsobeprovidedbyadentalhygienistorother

individualperformingwithinthescopeofhisorherlicenseasallowedbylaw.Theseservicesmustalsoberenderedunderthesupervisionandguidanceofthedentist.

• Theymustbedentallynecessary.Aserviceisdentallynecessaryif,inthejudgmentofBlueCross,itmeetsallofthefollowingrequirements:• Essentialto,consistentwith,andprovidedforthediagnosisorthedirectcareandtreatmentofadisease,

accidentalinjury,orconditionharmfulorthreateningtotheenrollee’sdentalhealth• Consistentwithstandardsofgooddentalpracticewithintheorganizeddentalcommunity• Notprimarilyfortheconvenienceoftheenrolleeortheenrollee’sdentist

Please Note:Thefactthatthecoveredserviceswerefurnished,prescribed,orapprovedbyadentistdoesnotinitselfmeanthattheservicesweredentallynecessary.

Thedeductiblesandout-of-pocketmaximumsfromthecomprehensivemedicalbenefitsectionofyourbenefitplandonotapplytothedentalcarebenefit.

YouareresponsibleforfurnishingtoBlueCrossalldiagnosticevaluativematerial,suchasstudymodels,dentalX-rays,andchartsthatBlueCrossmayrequiretodetermineavailablebenefits.Benefitswillonlybeprovidedforden-talservicesthatcanbeverifiedascoveredservicesbasedonthediagnosticmaterialBlueCrosshasbeenfurnished.BlueCrosswillnotprovidebenefitsforthosedentalserviceswhichitisunabletoverifyascoveredserviceswhenanynecessarymaterialsarenotfurnisheduponrequest.

estimate oF BeneFits

YourdentistmaysubmitanestimateofbenefitsrequesttoBlueCrossforanyproposeddentalserviceorseriesofdentalservicesforwhichthetotalchargewillexceed$500.Itisalsoimportantthatanycastorporcelainrestora-tions,prostheticappliances,orperiodontalsurgeriesbesentforanestimateofdentalbenefits.Within72hoursafterBlueCrossreceivesthefullydocumentedrequest,BlueCrosswilldeterminewhethertheservicemeetsthestandardforcoverageunderthisprogram.Estimatesarevalidforsixmonths.

BlueCrossstronglyrecommendsthatyourequestanestimateofdentalbenefitssothatbenefitquestionsarean-sweredbeforeyourcourseoftreatmentbegins.Ifyourdentistmakesamajorchangeinthetreatmentplan,heorsheshouldsubmitarevisedplan.

BlueCross’estimateisconditionedontheprovisionsofthisprogramandyoureligibilityforcoverageatthetimetheserviceisrendered.IfBlueCrossfindstheproposedtreatmenttobedentallynecessary,theywillnotreversethatdecisionunlesstheinformationonwhichtheirdecisionwasbasedislaterfoundtobemateriallyincompleteorinaccurate.Thedecisiontodeny,reduce,orendbenefitsforanotherwisecoveredservicebecausetheserviceisnotdentallynecessarywillbemadebyaBlueCrossemployeeorconsultantwhoisalicenseddentalcareprovider.

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alternative BeneFits

Todeterminebenefitsavailableunderthisprogram,BlueCrossconsidersalternativeproceduresorservicescarry-ingdifferentfeesandare,inthejudgmentofBlueCross,consistentwithacceptablestandardsofdentalpractice.Inallcaseswherethereisanalternativecourseoftreatmentthatislesscostly,BlueCrosswillonlyprovidebenefitsforthetreatmentcarryingthelesserfee.Ifyouandyourdentistdecideuponamorecostlytreatment,thenyouareresponsiblefortheadditionalchargesbeyondthoseforthelesscostlyalternativetreatment.

plan Year deduCtiBle (750 and HiGH deduCtiBle HealtH plans onlY)

CovereddentalservicesareclassifiedasTypeA,TypeB,orTypeC.TypeAcoveredservices(Preventive)arenotsubjecttoanydeductible.HoweveradeductibledoesapplytoTypeBandTypeCcoveredservices.AdeductibleistheamountofexpenseyoumustincurforTypeBandTypeCcoveredservicesandsuppliesineachplanyearbeforebenefitsarepayableunderthisprogramforthoseservicesandsupplies.Foreachenrollee,thisdeductibleamountiseither$25(forthe750Planoption),or$50(fortheHighDeductibleHealthPlanoption).Theamountcreditedtowardthedeductiblewillnotexceedtheallowablechargeforthecoveredserviceorsupply,andwillnotapplytoanyotherdeductibleunderthehealthcareprogram.The500Planoptiondoesnothaveadeductible.

Covered dental eXpenses

Dentalbenefitsareprovidedforeachenrolleeaccordingtotheplanoptionineffectatthetimeservicesarerendered,uptothedentalbenefitplanyearmaximumof$2,000.

Type Of Covered Service 500 Plan 750 Plan HDHP

Deductibles:TypeA-PreventiveCareExpenses $0 $0 $0TypeB-OtherBasicExpenses $0 $25 $50TypeC-MajorDentalExpenses $0 $25(combinedwith $50(combinedwith BasicExpenses) BasicExpenses)

Coinsurance (thepercentofallowablechargeyouareresponsiblefor):TypeA-PreventiveCareExpenses 0% 0% 20%TypeB-OtherBasicExpenses 20% 20% 20%TypeC-MajorDentalExpenses 50% 50% 50%

Thedentalbenefitsofthisprogramarebasedonallowablechargesfordentallynecessarycoveredservices.Thepercentageofanallowablechargethatyouareresponsibleforiscalledcoinsurance.Pleaserefertothe“GlossaryofTerms”sectionforadetailedexplanationofAllowableCharge.

Thedentalbenefitsavailableunderthissectionwillbeprovidedpriortoanydentalbenefitswhichmaybeavailableunderotherprovisionsofthisprogram.

tYpe a—preventive Care eXpenses (not suBjeCt to dental deduCtiBle)

• Oralexaminations(twoperyear),whichincludesprophylaxis(cleaning,scaling,andpolishingofteeth)

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• DentalX-raysfordiagnosis;alsootherx-raysnottoexceedthefollowing:• onefullmouthseriesina36-monthperiod;and• onesetofbitewings(twiceayear).

• Topicalapplicationoffluoride,forenrolleesage15oryounger• Emergencypalliativetreatment• Spacemaintainers• Sealants,forenrolleesage15oryounger

tYpe B—BasiC eXpenses

• Permanentfillings,consistingofsilveramalgam,silicate,andcompositeresins;whendentallynecessary,resinfillingswillbeallowedonlyforthefrontteeth;forothertypesoffillings,suchasgoldfoils,theallowancewillbelimitedtowhatwouldhavebeenotherwiseallowedforamalgamfillings

• Temporaryfillings• Extractions,includingsurgerytoremoveoneofthefollowing:

• teethpartlyorcompletelyimpactedintheboneofthejaw;• teeththatwillnoteruptthroughthegum;• otherteeththatcannotberemovedwithoutcuttingintobone;• therootsofatoothwithoutremovingtheentiretooth

• Oralsurgeryfordiagnosisandtreatmentofcystsandabscesses• Generalanestheticsgiveninconnectionwithcovereddentalservices• Periodontalexaminations,andtreatmentofdiseasedperiodontalstructures• Endodontictreatment,includingrootcanaltherapy• Injectionofantibioticdrugs• Repairandrecementingofcrowns,inlays,bridgework,anddentures• Treatmentsofimpactionsandgingivectomies• Reliningand/orrebasingofdentures• Tissueconditioning• Occlusalanalysis,adjustments,andguards• Dentalimplants(priorapprovalisrequired)

tYpe C—major dental eXpenses

• Inlays,onlays,goldfillings,andcrownswhen,inthejudgmentofBlueCross,amalgamorcompositeresinfill-ingswouldnotadequatelyrestoretheteeth;thiscircumstanceincludesprecisionattachmentsfordentures

• Initialinstallationofdentures(includingadjustmentsduringthefirstsix-monthperiodfollowinginstallation)andfixedbridgework(includinginlaysandcrownstoformabutments)

• Replacementinlays,onlays,crowns,dentures,andfixedbridgework,butonlywhenoneofthefollowingistrue:• thepresentinlay,onlay,crown,dentureorbridgeworkcannotbemadeserviceable,andwasseatedatleast

fiveyearspriortoreplacement;• thereplacementoradditionofteethisrequiredtoreplaceoneormoreadditionalteethextractedafterinitial

placement;• repreparationofthenaturaltoothstructure(ornaturaltoothstructureundertheexistingfixedbridgework)

isrequiredasaresultofanaccidentalinjurytothatstructure;or

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• thepresentdentureisanimmediate,temporaryoneandcannotbemadepermanent;replacementbyaper-manentdentureisneeded;andittakesplacewithin12monthsfromthedatetheimmediatetemporaryonewasfirstinstalled.

• Labialveneers• Temporaryprosthetics

dental limitations


• Anyservicesorsuppliesreceivedwhenthisbenefitisnotineffectorwhenyouarenotcoveredunderthisben-efit(includingbridges,dentures,crowns,orrootcanalsfitted,prepared,started,ororderedbeforeyoureffectivedate),exceptforprostheticdevices,crowns,orrootcanalsthatfulfillthefollowingrequirements:• werefitted,prepared,started,ororderedpriortothedateyourcoverageunderthisbenefitended;and• werecompletedorseated,anddeliveredtoyouwithin30daysafterthedateyourcoverageunderthisben-

efitended.• Servicesandsuppliestoincreaseoraltertheverticaldimension• Servicesandsuppliesprovidedbymorethanonedentistforthesamedentalprocedure• ServicesandsuppliesnotcustomaryandacceptedbythedentalprofessioninthestatesofAlaskaorWashington• ServicesandsuppliesfororthodontiaundertheStandardorEconomyPlanoptions,exceptasprovidedforac-

cidentalinjury,includingcasts,models,X-rays,photographs,examinations,appliances,braces,andretainers;however,thisexclusiondoesnotapplytoextractionsincidentaltoorthodonticservices

• Servicesandsuppliestotreatcongenitalmalformations,exceptwhenthepatientisadependentchild• Servicesandsuppliesforcosmeticoraestheticpurposes• Myofunctionaltherapy,whichmeansmuscletrainingtherapyortrainingtocorrectorcontrolharmfulhabits• Dietaryplanningforthecontrolofdentalcaries,oralhygieneinstruction,andtraininginpreventivedentalcare• Chargesforbrokenappointments• Extradenturesorotherappliances,includingreplacementsduetolossortheft• Otherthanstandardtechniquesusedinthemakingofrestorationsorprostheticappliances,suchaspersonalized

restorationsorprecisionattachments• Anydrugsandmedicines,includingvitaminsandfoodsupplements,exceptasspecifiedinthisbenefit;how-

ever,benefitsmaybeavailableforfluoridatedvitaminsunderotherbenefitsofthisprogram• Dentalservicesreceivedfromoneofthefollowing:

• Dentalormedicaldepartmentmaintainedforemployeesbyoronbehalfofanemployer• Mutualbenefitassociation,laborunion,trustee,orsimilarpersonorgroup

• Facilitychargesfordentalprocedures• Anyservicesorsuppliesconnectedwiththediagnosisortreatmentoftemporomandibularjoint(TMJ)disorders

fracturesanddislocations;howeverbenefitsmaybeavailableunderComprehensiveMedical.

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ortHodontia (availaBle on 500 plan onlY)

Benefitsareavailablefortheservicesandsuppliesdescribedinthissectionsubjecttothefollowingrequirements:

• Anexistingorthodonticconditionmustbediagnosedasconsistingofahandicappingmalocclusionwhichisabnormalandwhichcanbereducedoreliminatedbycorrectingabnormallypositionedteeth;and

• Anexpenseforanorthodonticserviceorsupplyisincurredonthedatetheserviceisreceivedorthesupplyisordered.

• Anyplanyeardeductibles,coinsuranceandbenefitmaximumsofotherbenefitsunderthisplandon’tapplytothisbenefit.

Covered services and supplies include

• diagnosticservicesandsupplies,includingexaminations,x-rays,models,andphotographs;• activetreatment,includinginitialandsubsequentnecessaryappliances;and• retentiontreatment,includingnecessaryappliances.

PremeraBlueCrossBlueShieldofAlaskareservestherighttoreviewyourdentalrecords,includingx-rays,modelsandphotographs,todetermineiftherequestedservicesandsuppliesarewithinthelimitsofthisbenefit.

Benefitsareprovidedataconstant50percentuptoalifetimemaximumof$1,500perenrollee,oruntiltheenroll-ee’stotaltreatmentplan,includingretentiontreatment,ispaid,whicheveroccursfirst.

ortHodontia limitations

Inadditionto“DentalLimitations”and“GeneralLimitationsandExclusions,”thisbenefitwillnotbeprovidedforthefollowing:

• Anyreplacementorrepairtoanyappliance• Chargesbeyondthemonthofterminationoforthodonticservicesifsuchservicesareterminatedforanyreason

beforecompletion• Furtherorthodonticservicesandsupplies,aftercompletionoftheinitialtreatmentplan,unlessthisbenefit’s

lifetimemaximumhasn’tbeenreached• Servicesrenderedbyadentalcareproviderbeyondthescopeofhisorherlicenseorcertification• Orthognathicsurgery(jawaugmentationorreduction),althoughbenefitsmaybeavailableunderthemedical

plan• Servicesprovidedbymorethanonedentalcareproviderforthesamedentalprocedure• Expensesincurredfororthodonticservicesorsupplieswhenthisbenefitisn’tineffectorwhenyou’renotcov-

eredbythisbenefit

Inallcaseswheretherearealternativetechniquesoftreatmentwhichare,inBlueCross’judgment,consistentwithacceptablestandardsofdentalpractice,butwhichcarrydifferentcharges,benefitswillbeprovidedonlyforthetechniquecarryingthelessercharge.

Theorthodontiabenefitsavailableunderthissectionwillbeprovidedpriortoanyorthodontiabenefitsthatmaybeavailable under other provisions of this plan.

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VISION CARE BENEFITS

introduCtion

VisioncoverageisprovidedthroughVSP.VSPhasanextensivenationwidenetworkofdoctorswhoagreetoprovidevisioncareandmaterialstoparticipantsatdiscountedrates.FindingaVSPnetworkdoctoriseasy—visitwww.vsp.com,selecttheMemberportal,andclickon“FindaDoctor”orcall(800)877-7195.

OnceyouareenrolledintheVSPplan,yourpersonalizedbenefitinformationisavailableonwww.vsp.com.SimplyregisteratthesitebyenteringyouremployeeIDwhereindicated,andfollowthestepstoaccessyouraccount.YouremployeeIDwillbeyourVSPidentificationnumber;youwillnotreceiveaseparateIDcard.Youcanalsocheckdetailssuchasyoureligibility,dateofyourlasteyeexamandwhichVSPnetworkdoctoryouused.AllUAChoiceplanoptionshavethesamevisionbenefit.

Covered vision serviCes

Thereisnoplanyeardeductibleorcoinsuranceforvisionbenefits.Benefitsforyouoranyofyourcovereddepen-dentsarepayableaccordingtothefollowingschedule(planyearbeginsJuly1):

TypeOfService Benefit

CompleteVisionExamination VSPdoctor:Paidinfullafter$10copay

OnceeveryPlanYear Non-VSPdoctor:Uptoa$50reimbursement afterthe$10copayLensesandFrames—Onceeveryotherplanyear VSPProvider Lensescoveredinfullafter$25copay,frameofyourchoice upto$130,plus20%offanyout-of-pocketcosts

Non-VSPProvider Reimbursementafter$25copayasfollows: Singlevisionlenses Upto$50 Bifocallenses Upto$75 Trifocallenses Upto$100 Progressivelenses Upto$75 Frames Upto$70OR Contact Lenses—Once every other plan year VSPProvider ContactLensCareprogramgivesyoua$130allowancewith nocopayevery24monthsforthecostofyourcontactsandthe contactlensexam. Currrentsoftcontactlenswearersmayqualifyforaspecial programthatincludesacontactlensexamandinitialsupplyof lenses.Askyourdoctor,orvisitvsp.com.

Non-VSPProvider Reimbursementupto$105

eXtra disCounts and savinGs

WhenyougotoaVSPnetworkdoctor,youwillreceivethefollowingdiscounts:

• Averageof35-40%savingsonallnon-coveredlensextras(suchasscratchresistantandanti-reflectivecoat-ings)

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• 30%discountwhenyoupurchaseadditionalglassesandsunglasses,includinglensoptions,fromthesameVSPdoctoronthesamedayasyourWellVisionexam,or20%offfromanyVSPdoctorwithin12monthsofyourlasteyeexam

• 15%discountoffthecostofyourcontactlensfittingandevaluationexamfromaVSPnetworkdoctor;• Anaverageof15%offtheregularpriceoflaservisioncorrection,or5%offthepromotionalprice,througha

VSPnetworkdoctor.Aftersurgery,useyourframeallowance(ifeligible)forsunglassesfromanyVSPdoctor.

Benefitsreneweveryplanyearforcoveredvisionexaminations,andeveryotherplanyearforeyeglasses(lensesandframes)orcontacts.Benefitswillbeprovidedforeithereyeglassesorcontactlensesduringthesamebenefitperiod,not both.

usinG non-vsp providers

Youmayobtaineyecareservicesfromnon-VSPproviders.Reimbursementforservicesisaccordingtothereim-bursementbenefitsstatedabove.However,VSPcannotguaranteesatisfactionorextendtheadditionaldiscounttowardsmaterialsoranyoptionsthatyoumaychoose.

Whenyouobtainservicesand/ormaterialsfromanon-VSPprovider,pleasefollowthesesteps:

• Paythenon-VSPproviderthefullamountofthebillandrequestanitemizedcopyofthebill.Thebillneedstoshowthechargesfortheeyeexamandmaterials,includinglenstype.

• LogintotheVSPwebsiteandclickthelinkfor“Out-of-NetworkReimbursement”andfollowtheinstructionstocompleteandthenprinttheonlineform,oryoucanattachasheetandincludethefollowinginformationwithyourreceipt:EmployeenameandID,patient’sname,dateofbirthandrelationshiptotheemployee.

• SendacopyoftheitemizedbillalongwiththecompletedOut-of-NetworkReimbursementFormto:VSP

POBox997105Sacramento,CA95899-7105

Pleasenotethatclaimsforreimbursementmustbefiledwithinsixmonthsofthedateofservice.Youwillbereim-bursedaccordingtothereimbursementschedule.

Coordination oF BeneFits

Ifyouhavecoverageasanemployeeandasadependent,pleaselettheVSPmemberdoctorknowatthetimeser-vicesarerendered,andprovidetheothercoverageIDnumber.Thedoctor’sofficewillfiletheclaimsonyourbehalf.

Ifyouchoosetouseanon-VSPprovider,youwillneedtopaythefullamountofthebillatthetimeofservice,andsubmityouritemizedcopyofthebillasdescribedabove,beingsuretoreferenceboththeprimaryandsecondaryIDnumbers.

vision limitations

Inadditionto“GeneralLimitationsandExclusions,”thefollowinglimitationswillapplytothisbenefit:

• visiontherapy,eyeexercise,oranysortoftrainingtocorrectmuscularimbalanceoftheeye(orthoptics),orpleoptics;

• planolenses;• expensesassociatedwithsecuringmaterialssuchaslensesandframes;

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• medicalorsurgicaltreatmentoftheeyes;or• replacementoflensesandframesfurnishedunderthisprogram(underacoveredallowance),exceptatthenor-

malintervalswhenservicesareavailable.Discountsonadditionalmaterialsareprovidedonanunlimitedbasisfortwelvemonthsfollowinganeyeexam.

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AUDIO CARE BENEFITS

introduCtion

Benefitsareavailablefortheservicesandsuppliesdescribedinthissectionthatarefurnishedinconnectionwithhearingloss.

Thedeductiblesandout-of-pocketmaximumsofthecomprehensivemedicalbenefitsinthisprogramdonotapplytothisbenefit.

Inordertoreceiveyouraudiocarebenefit,youmustbeexaminedbyoneofthefollowing:

• aphysiciancertifiedasanotolaryngologistorotologist;or• anaudiologistperformingtheexaminationatthewrittendirectionofalegallyqualifiedotolaryngologistor

otologist;theaudiologistmusteitherbelegallyqualifiedinaudiology,orholdaCertificateofClinicalCompe-tenceinAudiologyfromtheAmericanSpeechandHearingAssociationintheabsenceofanyapplicablelicens-ingrequirements.

A“coveredhearingaid”isanelectronichearingaidinstalledinaccordancewithaprescriptionwrittenduringacoveredhearingexaminationasstatedabove.

Covered serviCes and supplies

Benefitswillbeprovidedaccordingtothemedicalscheduleofbenefitsuptoamaximumbenefitof$400inaperiodofthreeconsecutiveplanyearsforthefollowing:

• oneaudiometric(hearing)examination;and• onehearingaidperear• hearingaidrentalwhiletheprimaryunitisbeingrepaired

audio limitations

Inadditionto“GeneralLimitationsandExclusions,”thehearingbenefitsofthisprogramwillnotbeprovidedforthefollowing:

• anyearorhearingexaminationtodeterminethepresenceofdiseaseorinjury,formedicalorsurgicaltreatmentorfordrugsormedicines;

• batteriesorotherancillaryequipmentotherthanthatobtaineduponpurchaseofthehearingaid;• repairs,servicing,andalterationofhearingaidequipmentpurchasedunderthisplan;• expensesincurredafteryourcoverageendsunderthisprogramunlessahearingaidwasorderedpriortothat

dateandwasdeliveredwithin30daysafterthedaycoverageended;• servicesandsuppliesthatwerereceivedpriortotheenrollee’seffectivedate;and• hearingaidsfurnishedororderedasaresultofahearingexaminationthatoccurredpriortotheenrollee’seffec-

tive date.• Hearingaidchargesinexcessofthisbenefitarenoteligibleforcomprehensivemajormedicalbenefits.

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HOW TO SUBMIT A CLAIM

automatiC Claims suBmission

GenerallyifyouuseaBlueCrossnetworkprovider,theproviderwillsubmityourclaimdirectlytoBlueCross.Onreceiptoftheclaimfromanetworkprovider,BlueCrosswillpaytheproviderdirectly—evenifyoupaythepro-viderin-fullupfrontfortheirservice.ThecontractsbetweennetworkprovidersandBlueCrossrequireallpaymentsbe sent directly to the provider.

IfyouareoutsideofAlaskaandWashingtonandhavereceivedmedicalservicesfromahospitalorotherhealthcareprovider,yourproviderofcaremustbillthelocalBlueCrossand/orBlueShieldLicenseedirectly.

BlueCrossisavailabletoanswerquestionsregardinghealthinsurancebenefitsandtheirpayment.Theycanbereached by letter at:

Premera Blue Cross Blue Shield of AlaskaPOBox327

Seattle,WA98111-0327

Oryoumayphonetollfree:

(800)364-2982

UnresolvedquestionsshouldbetakentoyourregionalhumanresourceofficeortotheStatewideOfficeofHumanResources.

manual Claims FilinG

Ifyouchoosetogotoanon-networkprovider,ortoaprovideroutsideofAlaskaandWashingtonfordentalorvi-sionservices,youhavetheoptiontomarktheclaimformfordirectpaymenttotheprovideroryourself.Ifyoudonotindicateontheclaimformthatyouwantthepaymentsenttoyou,BlueCrosswillpaybenefitstothehospital,doctor,dentist,oranyothercoveredproviderwhoservedyou.

Step 1

Completeaclaimform.Aseparateclaimformisnecessaryforeachpatientandeachprovider.ClaimformsareavailablefromBlueCross,yourregionalhumanresourcesoffice,orontheUniversityofAlaskabenefitswebpageathttp://www.alaska.edu/benefits/.

Step 2

Attachtheitemizedbill.Theitemizedbillmustcontainallofthefollowinginformation:

• Namesoftheemployeeandtheenrolleewhoincurredtheexpense• IdentificationnumbersforboththeenrolleeandtheUniversityofAlaska(theseareshownontheenrollee’s

identificationcard)• Name,address,andIRStaxidentificationnumberoftheprovider• Informationaboutotherinsurancecoverage• Dateofonsetoftheillnessorinjury

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• DiagnosisorICD-9code• Procedurecodes(CPT-4,HCPCS,ADA,orUB-92)foreachservice• Datesofserviceanditemizedchargesforeachservicerendered• Iftheservicesrenderedarefortreatmentofanaccidentalinjury,thedate,time,location,andabriefdescription

of the accident

Step 3

IfyouarealsocoveredbyMedicare,andMedicareisprimary,youmustattachacopyofthe“ExplanationofMedi-careBenefits.”

Step 4

Checkthatallrequiredinformationiscomplete.Billsreceivedwillnotbeconsideredclaimsuntilallnecessaryinformationisincluded.

Step 5

Signtheclaimforminthespaceprovided.

Step 6

Mail your claims to the following address:

Premera Blue Cross Blue Shield of AlaskaP.O.Box240609

Anchorage,Alaska99524-0609

air or surFaCe transportation Claims

Tomakeclaimforcoveredairorgroundtransportationservices,pleasefollowthesesteps:

Completeaclaimform.Aseparateclaimformisnecessaryforeachpatientandeachcarrierortransportationserviceutilized.Attachoneofthefollowingformsofdocumentation:

• Acopyoftheticketfromtheairlineorothertransportationcarrier.Theticketsneedtoindicatethenamesofthepassenger(s),datesoftravel,costofticketandtheoriginationandfinaldestinationpoints.

• Acopyofthedetaileditineraryasissuedbytheairline,transportationcarrier,travelagencyoron-linetravelwebsite.Theitinerarymustidentifythenameofthepassenger(s)thedatesoftravel,andtheoriginationandfinaldestinationpoints.

PleaseNote:Creditcardstatementsorotherpaymentreceiptsarenotacceptableformsofdocumentation.Travelinpersonal vehicles is not covered transportation.

suBmission oF pHarmaCY druG Claims

Tomakeaclaimforcoveredpharmacydrugs,pleaserefertothe“PharmacyDrugBenefit”sectionofthishandbook.

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Claims FilinG timelines

Youshouldsubmitallclaimswithin90daysofthestartofserviceorwithin30daysaftertheserviceiscompleted.BlueCrossmustreceiveclaimswithinthefollowingtimelimits:

• Within365daysofdischargeforhospitalorothermedicalfacilityexpenses,orwithin365daysofthedateonwhichexpenseswereincurredforanyotherservicesorsupplies

• ForenrolleeswhohaveMedicare,claimsmustbefiledwithintheabove-mentioned365-daytimeframeorwithin90daysoftheprocessdateshownontheExplanationofMedicareBenefits,whicheverisgreater

BlueCrosswillnotprovidebenefitsforclaimstheyreceiveafterthelaterofthesetwodates,norwillBlueCrossprovidebenefitsforclaimswhichweredeniedbyMedicarebecausetheywerereceivedpastMedicare’ssubmissiondeadline.

Claims proCedure

BlueCrosswillmakeeveryefforttoprocessclaimsasquicklyaspossible.Claimsforbenefitswillbeprocessedunderthefollowingtimeframes;

• Iftheclaimincludesalloftheinformationneededtoprocesstheclaim,BlueCrosswillprocessitwithin30calendar days of receipt.

• Ifmoreinformationisneededtoprocesstheclaim,BlueCrosswilltellyouortheproviderwhosubmittedtheclaimthattheyneedmoreinformation.Theywillmakethatrequestwithin30calendardaysofreceipt.Youoryourproviderwillhave45daysfromthenoticetoprovidetheadditionalinformation.Iftheadditionalinforma-tionisnotreceived,BlueCrosswillcontinuetonotifyyouevery45calendardaysfromtheinitialnotice,untiladecisionismadeaboutyourclaim.

• OnceBlueCrossreceivestheadditionalinformationforyourclaim,theywillprocessyourclaimwithin15daysofthedatetheyreceivetheinformation.

Whenyourclaimisprocessed,BlueCrosswillsendawrittennoticeexplaininghowtheclaimwasprocessed(an“ExplanationofBenefits,”or“EOB”).Iftheclaimisdeniedinwholeorinpart,theywillsendawrittennoticethatstatesthereasonforthedenial,andinformationonhowtorequestanappealofthatdecision.

denied Claims

BlueCrossmaydenybenefitsafteryouhavefiledaclaim.TheUniversityofAlaskahasalsograntedBlueCrossthediscretionaryauthoritytodetermineeligibilityforbenefitsandtoconstruethetermsusedinthisprogram.OnceBlueCrosshasmadeadecision,theywillsendyouan“ExplanationofBenefits”(EOB)showingbenefitsprovidedunderthisprogram.Ifyourclaimwasdenied,inwholeorinpart,theEOBwillincludethereasonsforthedenialandareferencetotheprovisionsofthisprogramonwhichitisbased,aswellasadescriptionofadditionalinformationBlueCrossmayneedandwhyitisneeded.

Your questions, Complaints and appeals

WHen You Have questions

Callyourproviderofcarewhenyouhavequestionsaboutthehealthcareservicesyoureceive.Ifyouneedmoreinformationaboutthisprogramorhaveaquestionaboutyourclaim,youmaycontactBlueCrossCustomerServiceatthefollowingnumbers:

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• University of Alaska dedicated number: 1-800-364-2982• Alaska Number: 1-800-345-6784• Hearing-impaired TTY: 1-800-842-5357(Onlycallsfromthehearing-impairedwillbeacceptedonthisline.)

PleasegiveBlueCrosstheGroupandemployeenumbersshownonyouridentificationcardwhenyoucallorwrite.BlueCrossneedsthisinformationtoidentifythetypeofcoverageyouhave.IfyouareaskingaboutaspecificclaimthatBlueCrosshasprocessed,pleasealsoincludeorhaveavailabletheEOByoureceivedfromthemforthatclaim.

Ifyouneedaninterpretertohelpwithyourquestion,pleasetellBlueCrosswhenyoucall,andtheywillprovideonefor the call.

WHen You Have a Complaint

AcomplaintisanexpressionofdissatisfactionwithanactionorpolicyofBlueCross,aclaimforbenefits,orwithaproviderofcareorservice.ThecomplaintprocessletsCustomerServicequicklyandinformallycorrecterrors,clarifydecisionsorbenefits,ortakestepstoimproveBlueCross’service.BlueCrossrecommends,butdoesnotrequire,thatyoutakeadvantageofthisprocesswhenyouhaveaconcernaboutabenefitorcoveragedecision.IfCustomerServicefindsthatyouneedtosubmityourcomplaintasaformalappeal,theywilltellyou.

Whenyouhaveacomplaint,callorwriteBlueCross’CustomerServiceDepartment.Ifyourcomplaintisaboutthequalityofcareyoureceive,itwillbegiventotheClinicalQualityManagementstaffforreview.Ifthecomplaintisofanon-medicalnaturerelatingtoaprovider,itwillbegiventotheProviderNetworkstaffforreview.BlueCrossmayrequestmoreinformationifneeded.Whentheyreceiveallneededinformation,theywillreviewyourcomplaintandrespondassoonaspossible,butinnocasemorethan30days.

WHen You Have an appeal

Anappealisanoralorwrittenrequesttoreconsider

• adecisiononacomplaint,or• adecisiontodeny,modify,reduce,orendpayment,coverage,orauthorizationofcoverage.

Thisincludesadmissionsto,andcontinuedstaysin,afacility.Yourappealmustbereceivedwithin180calendardaysofthedateyoureceivednoticeofthedecision,Ifyouareappealingacomplaintdecision,yourappealmustbereceivedwithin180calendardaysofthedatethatdecisionwasgiventoyou.

AlthoughanappealmadebyphonetotheCustomerServiceDepartmentwillbeaccepted,it’sabetterideatoputappealsinwriting.Pleasesendallwrittenappealstotheaddressbelow.Youwillbenotifiedwhenyourappealisreceived.YouhavetherighttosendBlueCrosswrittencomments,documents,orotherinformationtosupportyourappeal.

Mail all appeals to:

Premera Blue Cross Blue Shield of AlaskaAttn: Appeals Coordinator

POBox91102Seattle,WA98111-9202

appeals proCess

Thisplan,theUniversityofAlaskaandPremeraBlueCrossBlueShieldofAlaskawillcomplywithanynewrequirementsasnecessaryundertheAffordableCareActanditsgoverningregulations.Thefullappealprocessisavailableatwww.premera.com,orbycallingPremeraCustomerServiceat(800)364-2982.

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Theplan’sstandardappealsprocesshastwolevelsofreview,asexplainedbelow.

Level I:TheLevelIappealpanelwilldecidemostappealswithin30calendardays.Thispanelwillincludehealthcareprovidersasneeded.Personsinvolvedintheinitialdecisionwillnotbeonthepanel.Thereviewtimecanbeextendedupto15morecalendardaysifmoreinformationisneeded.You’llbenotifiedifadelayoccurs.

Ifyoudon’tagreewiththedecisionreachedintheLevelIreview,youmayaskPremeraBlueCrosstoperformaLevelIIreviewofyourappeal.Ifyou’reappealingaqualifyofcareissue,adecisionthataserviceorsupplyisnotmedicallynecessaryorappropriate,isexperimentalorinvestigational,orotherwisedenied,youhavetheoptiontorequestindependentreviewinsteadofLevelIIreview(see“Independentreview”below).Withanyoftheaboveop-tions,youmayalsosendmoreinformationtosupportyourappeal.YoumustmakeyourrequestforaLevelIIreviewnomorethan60calendardaysafterthedateyoureceivetheLevelIdecision.

Level II: YourappealwillbereviewedbyapanelthatincludeshealthcareprovidersandisdifferentfromtheLevelIpanel.Youand/oryourauthorizedrepresentativemaymeetwiththepanel.Thepanelwillgiveyouadecisionwithin45calendardaysofthedateyourLevelIIrequestisreceived.

Note:Unlessyourappealisdeemedurgent,yourwrittennoticeofthelevelIandLevelIIdecisionswillbemailedtoyouwithinfivedaysafterthereviewiscomplete.

Independent ReviewIndependentreviewsareconductedbyanindependentrevieworganization(IRO),whichisanorganizationofmedicalexpertsqualifiedtoreviewyourappeal.BlueCrosswillsubmityourfiletotheIROonyourbehalfandwillpaythechargesoftheIRO.TheIROwillmakeitsdecisionwithin21daysofreceiptoftheappeal(72hoursforurgentappeals)andgiveyouitsdecisioninwriting.BlueCrosswillimplementtheIRO’sdeter-minationpromptly.ThedecisionoftheIROisbindingunlessyouappealthedecisiontothesuperiorcourt,andthatappealmustbefiledwithinsixmonthsafterthedateofthedecisionoftheIRO.

PleasecallCustomerServiceifyouhavequestionsorneedmoreinformationaboutBlueCross’complaintorappealprocess.Thenumbersareshownin“WhenYouHaveQuestions”above.

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COORDINATION OF BENEFITS

introduCtion

Youmayalsobecoveredunderoneormoreotherhealthcareplans,suchasonesponsoredbyyourspouse’sem-ployer.Yourhealthcareplanincludesa“coordinationofbenefits”featuretohandlesuchsituations.BlueCrosswillcoordinatethebenefitsoftheUniversity’splanwiththoseofyourotherplanstomakecertainthat,ineachplanyear,thetotalpaymentsfromallplansarenotmorethanthetotalallowableexpenses.Allofthebenefitsofthisplanaresubjecttocoordinationofbenefits.

Ifyoudohaveothercoveragebesidesthisplan,BlueCrossrecommendsthatyousendyourclaimstotheemploy-ee’sprimaryplanfirst.Inthatway,thepropercoordinatedbenefitsmaybemostquicklydeterminedandpaid.

Ifyouarecoveredasanemployeeandalsoasadependentofacoveredemployee,youwillreceivebenefitsbothasanemployeeandasadependent.BenefitsyoureceivearesubjecttothisCoordinationofBenefitsprovision.

terms You sHould knoW

Tounderstandcoordinationofbenefits,itisimportanttoknowthemeaningsofthefollowingterms:

• Allowable Medical Expense—theusual,customaryandreasonablechargeforanymedicallynecessaryhealthcareserviceorsupplywhentheserviceorsupplyprovidedbyalicensedmedicalprofessionaliscoveredatleastinpartunderanyoftheplansinvolved.Whenaplanprovidesbenefitsintheformofservicesorsuppliesratherthancashpayments,thereasonablecashvalueofeachservicerenderedorsupplyprovidedshallbeconsideredanallowableexpense.

• Allowable Dental Expense—theusual,customaryandreasonablechargeforanydentallynecessaryserviceorsupplyprovidedbyalicenseddentalprofessionalwhentheserviceorsupplyiscoveredatleastinpartunderthisplan.Whenaplanprovidesbenefitsintheformofservicesorsuppliesratherthancashpayments,therea-sonablecashvalueofeachservicerenderedorsupplyprovidedshallbeconsideredanallowableexpense.

• Claim Determination Period—aplanyear(July1throughJune30)• Medical Plan—allofthefollowing,eveniftheydon’thavetheirowncoordinationprovisions:

• Group,individualorblanketdisabilityinsurancepolicies• Groupagreementswithhealthcareservicecontractorsandhealthmaintenanceorganizationsthatareissued

byinsurers,healthcareservicecontractors,andhealthmaintenanceorganizations• Labor-managementtrusteedplans,labororganizationplans,employerorganizationplans,oremployee

benefitorganizationplans• Governmentprogramsthatprovidebenefitsfortheirowncivilianemployeesortheirdependents• GroupcoveragerequiredorprovidedbyanylawincludingMedicare;thisdoesnotincludeworkers’com-

pensation• Groupstudentcoveragethatissponsoredbyaschoolorothereducationalinstitution,andincludesmedical

benefitsforillnessordisease• Dental Plan—allofthefollowing

• Group,individualorblanketdisabilityinsurancepolicies• Groupagreementswithhealthcareservicecontractorsandhealthmaintenanceorganizationsthatareissued

byinsurers,healthcareservicecontractors,andhealthmaintenanceorganizations• Labor-managementtrusteedplans,labororganizationplans,employerorganizationplans,oremployee

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benefitorganizationplans• Governmentprogramsthatprovidebenefitsfortheirowncivilianemployeesortheirdependents

Eachcontractorotherarrangementforcoveragedescribedaboveisaseparateplan.Also,ifanarrangementhastwoormorepartsandthecoordinationofbenefitsprovisionappliesonlytooneofthetwo,eachofthetwopartsisaseparate plan.

order oF Claim FilinG

Animportantpartofcoordinatingbenefitsisdeterminingtheorderinwhichtheplansprovidebenefits.Oneplanisresponsibleforprovidingbenefitsfirst.Thisiscalledthe“primary”plan.Theprimaryplanprovidesitsfullbenefitsasiftherewerenootherplansinvolved.Theotherplansthenbecome“secondary.”Thismeanstheyreducetheirpaymentamountssothatthetotalbenefitsfromallplansarenotmorethantheallowableexpenses.Coordinationofbenefitsalwaysconsidersamountsthatwouldbepayableundertheotherplan,whetherornotaclaimhasactuallybeenfiled.

Hereistheorderinwhichtheplansshouldprovidebenefits:

First: Aplanthatdoesnotprovideforcoordinationofbenefits.Next: Aplanthatcoversyouasotherthanadependent,i.e.asanemployee.Next: Aplanthatcoversyouasadependent.Fordependentchildren,thefollowingrulesapply:

• Whentheparentsare notseparatedordivorced—Theplanoftheparentwhosebirthdayfallsearlierintheyearwillbeprimary,ifthatisinaccordwiththecoordinationofbenefitsprovisionsofbothplans.Other-wise,therulesetforthintheplanwhichdoesnothavethisprovisionshalldeterminetheorderofbenefits.

• Whentheparentsareseparatedordivorced—Ifacourtdecreemakesoneparentresponsibleforpayingthechild’shealthcarecosts,thatparent’splanwillbeprimary.Otherwise,theplanoftheparentwithcustodywillbeprimary,followedbytheplanofthespouseoftheparentwithcustody,followedbytheplanoftheparentwhodoesnothavecustody.

Iftherulesabovedonotapply,theplanthathascoveredyouforthelongesttimewillbeprimary,exceptbenefitsofaplanthatcoversyouasalaid-offorretiredemployee,orasthedependentofsuchanemployee,shallbedeter-minedafterthebenefitsofanyplanthatcoversyouasotherthanalaid-offorretiredemployee,orasthedependentofsuchanemployee.Thisapplies,however,onlywhenotherplansinvolvedhavethisprovisionregardinglaid-offorretiredemployees.

eFFeCt oF mediCare

IfyouarealsocoveredunderMedicare,federallawmayrequirethisprogramtobeprimaryoverMedicare.Whenthisprogramisnotprimary,BlueCrosswillcoordinatebenefitswithMedicareasstatedinCoordinationofBenefits.

riGHt oF reCoverY/FaCilitY oF paYment

PremeraBlueCrossBlueShieldofAlaskahastherighttorecover,onbehalfoftheGroup,anypaymentsmadebytheplanthataregreaterthanthoserequiredbythecoordinationofbenefitsprovisionsfromoneormoreofthefol-lowing:thepersonstheplanpaidorforwhomithaspaid,providersofservice,insurancecompanies,serviceplans,orotherorganizations.Ifapaymentthatshouldhavebeenmadeunderthisprogramwasmadebyanotherprogram,PremeraBlueCrossBlueShieldofAlaskaalsohastherighttodirecttheplan’spaymentdirectlytoanotherprogramofanyamountthatshouldhavebeenpaidbytheplan.Thepaymentwillbeconsideredabenefitunderthisprogramandwillmeettheplan’sobligationstotheextentofthatpayment.

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tHird partY liaBilitY (suBroGation)

Iftheplanmakesclaimspaymentonyourbehalfforinjuryorillnessforwhichanotherpartyisliable,orforwhichuninsured/underinsuredmotorist(UIM)orpersonalinjuryprotection(PIP)insuranceexists,theplanisentitledtoberepaidforthosepaymentsoutofanyrecoveryfromthatliableparty.Theliablepartyisalsoknownasthe“thirdparty”becauseit’sapartyotherthanyouortheplan.ThispartyincludesaUIMcarrierbecauseitstandsintheshoesofathirdpartytortfeasorandbecausetheplanexcludescoverageforsuchbenefits.

Thefollowingtermshavespecificmeaningsinthissection:

SubrogationmeansBlueCrossmaycollect,onbehalfoftheplan,directlyfromthirdpartiestotheextenttheplan has paid on your behalf for illnesses or injury caused by the third party.

Reimbursementmeansthatyouareobligatedtorepayanymoniesadvancedbytheplanfromamountsre-ceivedonyourclaim.

Restitutionmeansallequitablerightsofrecoverythattheplanhastothemoniesadvancedunderyourplan.Becausetheplanhaspaidforyourillnessorinjuries,theplanisentitledtorecoverthoseexpenses.

Theplanisentitledtotheproceedsofanysettlementorjudgmentthatresultsinarecoveryfromathirdparty,uptotheamountofbenefitstheplanpaidforthecondition,whetherornotyouhavebeenmadewholepriortotheplan’srecovery.Theplan’srighttorecoverexistsregardlessofwhetheritisbasedonsubrogation,reimbursementorres-titution.Thisrightallowstheplantopursueanyclaimagainstanythirdpartyorinsurer,whetherornotyouchoosetopursuethatclaim.Theplan’srightsandpriorityarelimitedtotheextenttheplanhasmadeorwillmakebenefitpaymentsfortheinjuryorillness,butdoextendtoanycoststhatresultfromtheenforcementofitsrights.

Inrecoveringbenefitsprovidedonbehalfoftheplan,BlueCrossmay,attheGroup’selection,eitherhireanattorneyorhavetheplanberepresentedbyyourattorney.BlueCrosswillnotpayforanylegalcostsincurredbyyouoronyourbehalf,andyouwillnotberequiredtopayanyportionofthecostsincurredbytheplanortheGrouporontheirbehalf.

Beforeacceptinganysettlementonyourclaimagainstathirdparty,youmustnotifyPremeraBlueCrossinwritingofanytermsorconditionsofferedinasettlement,andyoumustnotifythethirdpartyoftheplan’sinterestinthesettlementestablishedbythisprovision.YoualsomustcooperatewithBlueCrossinrecoveringamountspaidbytheplanonyourbehalf.Ifyouretainanattorneyorotheragenttorepresentyouinthematter,youmustrequireyourattorneyoragenttoreimbursetheplandirectlyfromthesettlementorrecovery.

IfyoufailtocooperatefullywithPremeraBlueCrossintherecoverofbenefitstheplanhaspaidasdescribedabove,youareresponsibleforreimbursingtheplanforsuchbenefits.Totheextentthatyourecoverfromanyavailablethirdpartysource,youagreetoholdanyrecoveredfunintrustorinasegregatedaccountuntiltheplan’ssubroga-tionandreimbursementrightsarefullydetermined.

aGreement to arBitrate

AnydisputesbetweenyouandtheGroupand/orPremeraBlueCrossontheGroup’sbehalfthatariseincarryingoutthisprovisionwillberesolvedbyarbitration.YouandBlueCrossandtheUniversityofAlaskawillbeboundbythedecisionsofthearbitrationproceedings.

DisputeswillberesolvedbyasinglearbitratorinaccordancewiththecurrentrulesoftheAmericanArbitrationAs-sociation.Eitherpartymaydemandarbitrationbyservingnoticeofthisdemandontheotherparty.Eachpartywillbearitsowncostsandshareequallyinthefeesofthearbitrator.Arbitrationproceedingspursuanttothisprovisionshalltakeplaceinamutuallyagreeduponlocation.

Thisagreementtoarbitratewillbeginonthedatetheplangoesintoeffect.ItwillcontinueuntilanydisputeaboutPremeraBlueCross’effortstorecoverpaymenthavebeenresolved.

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TERMINATION OF BENEFITS

termination oF CoveraGe

Exceptasspecifiedunder“ExtendedBenefits,”coveragewillendwithoutnoticeonthelastdayofthemonthinwhichoneoftheseeventsoccurs:

• Fortheemployeeanddependents,whentheemployeeterminatesfromabenefits-eligibleposition,ortheem-ployeediesorisnolongereligibleasanemployee;terminationmeanscessationofemploymentforanyreason,includingresignation,retirement,andnon-retention

• Foraspouse,whenhisorhermarriagetotheemployeeisannulled,orheorshebecomeslegallyseparatedordivorcedfromtheemployee

• Forachild,whenheorsheisnolongereligibleasadependent

Please Note:TheemployeemustnotifytheUniversitywithin30daysofthedateoftheenrollee’slossofeligibil-itywhenanenrolledfamilymemberisnolongereligibletobeenrolledasadependentunderthisprogram.FailuretonotifytheUniversitywithin30daysmayresultinlossofeligibilityforcontinuationofcoverage.TheUniversitywillgiveBlueCrossnoticeofanenrollee’scancellation.

CertiFiCate oF Group HealtH CoveraGe

WhenyourcoveragethroughtheUniversityofAlaska’shealthplanterminates,theUniversityofAlaskawillprovideyouwitha“CertificateofGroupHealthCoverage.”Thecertificatewillprovideinformationregardingyourcover-ageundertheUniversityofAlaska’shealthplan.Whenyouprovideacopyofthecertificatetoyournewhealthplan,youmayreceivecredittowardanywaitingperiodforpre-existingconditions.Youwillneedacertificateeachtimeyouleaveahealthplanandenrollinaplanthathasawaitingperiodforpre-existingconditions.Therefore,itisimportantforyoutokeepthecertificateinasafeplace.

Ifyouhavenotreceivedacertificate,orhavemisplacedit,youhavetherighttorequestonefromtheUniversityofAlaskawithin24monthsofthedatecoverageterminated.

WhenyoureceiveyourCertificateofGroupHealthCoverage,makesuretheinformationiscorrect.ContacttheStatewideOfficeofHumanResourcesifanyoftheinformationlistedisnotaccurate.

plan termination

Norightsarevestedunderthisplan.TheGroupisnotrequiredtokeeptheplaninforceforanylengthoftime.Iftheplanweretobeterminated,youwouldonlyhavearighttobenefitsforcoveredcareyoureceivebeforetheplan’senddate.TerminationoftheGroupContractforthisprogramcompletelyendsallenrollees’coverageandallUni-versityofAlaskaandPremeraBlueCrossBlueShieldofAlaska’sobligations,exceptasprovidedunder“ExtendedBenefits.”

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COVERAGE CONTINUATION (COBRA)

Underthefollowingconditions,youand/oryourdependentsmaycontinuetoparticipateinthehealthplansafteryou,orthey,wouldnormallybecomeineligibleforcoverage.Youmaycontinuecoverageforyourselfandyourdependentsforupto18monthsafteroneofthefollowingqualifyingevents:

• Youretire• Youareterminated(forreasonsotherthangrossmisconduct)• Youremploymentstatusischangedtoapositionthatdoesnotincludebenefits• Reductionofhoursbelowthethresholdforbenefiteligibility,includingleavewithoutpay

COBRAcoveragecanbeextendedifyoulostcoverageduetooneoftheeventsabove,andaredeterminedtobedisabledunderTitleII(OASDI)orTitleXVI(SSI)oftheSocialSecurityActatanytimeduringthefirst60daysofCOBRAcoverage.Insuchcases,allfamilymemberswhoelectedCOBRAmaycontinuecoverageforuptoatotalof29consecutivemonthsfromthefirstdateofCOBRAeligibility.

Yourspouseand/ordependentchildrenmaycontinuecoverageforupto36monthsafteroneofthefollowingquali-fyingevents:

• Yourdeath(theUniversityofAlaskawillpaytheirfirsttwelvemonthsofcoverageandwillcountthistimeconcurrentwithCOBRA)

• Youaredivorcedorlegallyseparated• Yourdependentchildrenceasetoqualifyforcoveragebecauseofage

UndertheCOBRAregulations,you(theemployee)orafamilymemberhastheresponsibilitytonotifytheUni-versityofAlaskauponadivorce,legalseparation,orachild’slossofdependentstatus.TonotifytheUniversityofAlaskaofaqualifyingeventforspouseordependentchild,youmustsubmitadependentenrollment/dropformtoyourregionalhumanresourcesoffice.Youorafamilymembermustprovidethisnoticenolaterthan60daysafterthedateofdivorce,legalseparationorachildlosingdependentstatus.

IfyouorafamilymemberfailstoprovidethisnoticetotheUniversityofAlaskaduringthis60-daynoticeperiod,anyfamilymemberwholosescoveragewill not be offered the option to elect COBRA continuation coverage. Fur-thermore,ifyouorafamilymemberfailstonotifytheUniversityofAlaska,andanyclaimaremistakenlypaidforexpensesincurredafterthedateofthedivorce,legalseparationorachildlosingdependentstatus,thenyouandyourqualifyingfamilymemberswillberequiredtoreimbursethePlanforanyclaimssopaid.

Individualswillnolongerbeeligibleforthiscontinuedcoverageifoneofthefollowingoccurs:

• Youoryourdependentsfailtopaytherequiredpremiumforaparticipatingindividualonatimelybasis• Youoryourdependentsbecomecoveredunderanothergrouphealthplanwithnopre-existingconditionclause

afterthedateyouelectCOBRAcoverage• YouoryourdependentsbecomeentitledtoMedicarebenefitsafterthedateyouelectCOBRAcoverage• Aneligiblespouseremarriesandbecomescoveredbyagrouphealthplan• Youoryourdependentsarenolongersubjecttothepre-existingconditionclauseofanothergrouphealthplan• TheUniversityceasestoprovideagrouphealthplan

ThecontinuationcoverageprovidesthesamebenefitsastheUniversity’sHealthCarePlan.Nomedicalexaminationisrequiredforcontinuation;however,theelectionmustbemadewithin60daysofeitherthedatecoveragewastoendduetothequalifyingeventorthedateyouarenotifiedofyourcontinuationrights,whicheverislater.

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Shouldyouwishtocontinueplancoverage,youand/oryourdependentsarerequiredtopaythecostoftheinsurancepremiums.Contactyourregionalhumanresourcesofficeforcontinuationcoverageinformationandcurrentrates.

leave oF aBsenCe

Coverageforanemployeeandenrolleddependentsmaybecontinuedforupto18monthswhentheUniversityofAlaskagrantstheemployeealeaveofabsenceandtherequiredpremiumscontinuetobepaid.

TheleaveofabsenceperiodcountstowardthemaximumCOBRAcontinuationperiod,exceptasprohibitedbystateandfederalfamilyleavelaws.Contactyourregionalhumanresourcesofficeforinformationonleavesofabsence.

mediCare supplement CoveraGe

IfyouareeligibleforandenrolledinPartsAandBofMedicare,youmaybeeligibleforguarantee-issuedcoverageundercertainMedicaresupplementplans.Youmustapplywithin63daysoflosingcoverageunderthisplan.Formoreinformation,contactPremeraBlueCrossBlueShieldofAlaskacustomerserviceat(800)364-2982.

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EXTENDED BENEFITS

Underthefollowingcircumstances,certainbenefitsofthisprogrammaybeextendedafteryourcoverageends.

eXtended inpatient BeneFits

Theinpatientbenefitsofthisprogramwillcontinuetobeavailableaftercoverageendsif:

• yourcoveragehadbeenineffectformorethan31days;• yourcoveragedidnotendbecauseoffraudoranintentionalmisrepresentationofmaterialfactundertheterms

ofthecoveragebyyouortheGroup;• youwereadmittedtoamedicalfacilitypriortothedatecoverageended;and• youremainedcontinuouslyconfinedinamedicalfacilitybecauseofthesamemedicalconditionforwhichyou

wereadmitted.

Suchcontinuedinpatientcoveragewillendwhenthefirstofthefollowingoccurs:

• Youarecoveredunderahealthplanorcontractthatprovidesbenefitsforyourconfinementorcouldprovidebenefitsforyourconfinementifcoverageunderthisprogramdidnotexist.

• Youaredischargedfromthatfacilityorfromanyotherfacilitytowhichyouweretransferred.• Inpatientcareisnolongermedicallynecessary.• Themaximumbenefitforinpatientcareinthemedicalfacilityhasbeenprovided.Iftheplanyearendsbeforea

planyearmaximumhasbeenreached,thebalanceisstillavailableforthecoveredinpatientcareyoureceiveinthenextyear.Onceitisusedup,however,aplanyearmaximumbenefitwillnotberenewed.

Continued eliGiBilitY For a disaBled enrollee

Ifonthedateanemployee’scoverageterminates,heorsheisdisabledbyinjuryorillness(includingpregnancy)andisunabletoworkathisorherownoccupationasdeterminedbyanapprovedapplicationforLTDbenefits,theben-efitsoftheStandardPlanoptionwillbepaidfortheemployeeandenrolleddependentsforupto12monthsjustasiftheemployee’scoveragewerestillineffect.TheStandardPlanoptionisthedefaultuniversity-paidoption;DeluxePlanbenefitsmaybepurchasedonaself-paybasis.

However,thesebenefitswillbeavailableonlyifexpensesareforcoveredservicesandsuppliesthathavebeenren-deredand/orreceivedpriortotheendofthe12-monthperiod.

Suchbenefitswillbepaidforchargesincurreduntiltheearliestofthefollowing:

• oneyearfromthedatetheenrollee’scoverageterminatesforcomprehensivemedicalbenefits• thedateonwhichtheenrolleebecomescoveredunderanothergroupprogram• thedatetheenrolleeisnolongerdisabled• thedatetheenrollee’smaximumbenefitispaid

Thiscontinuedeligibilityrunsconcurrentwiththefirst12monthsofyourCOBRAeligibility.

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survivinG dependents

Intheeventofyourdeath,yoursurvivingenrolleddependentswillcontinuetoreceivethebenefitsoftheStandardPlanoptionforupto12months,atnocosttothesurvivingdependents.TheStandardPlanoptionisthedefaultuni-versity-paidoption;DeluxePlanbenefitsmaybepurchasedonaself-paybasis.

However,thesebenefitswillbeavailableonlyifexpensesareforcoveredservicesandsuppliesthathavebeenren-deredand/orreceivedpriortotheendofthe12-monthperiod.

Suchbenefitswillbepaidforchargesincurreduntiltheearlierofthefollowing:

• The12-monthperiodends• Adependentbecomescoveredunderanothergroupmedicalprogram• Dependentcoverageceasesunderthisprogram• Forthespouse,whenheorsheremarries• Forachild,whenheorsheisnolongereligibleasadependent

Thiscontinuedeligibilityrunsconcurrentwiththefirst12monthsoftheirCOBRAeligibility.Ifcoverageisbeingcontinuedforyourdependents,yourchildbornafteryourdeathwillalsobecovered.

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GENERAL LIMITATIONS AND EXCLUSIONS

Thissectionofyourhandbookoutlinescircumstancesinwhichbenefitsofthisprogramarelimitedorinwhichnobenefitsareprovided.BenefitscanalsobeaffectedbyBlueCross’CareManagementprovisionsandyoureligibility.Inaddition,somebenefitshavetheirownspecificlimitations.

WHat Your proGram does not Cover

Inadditiontothespecificlimitationsstatedelsewhereinthisprogram,benefitswillnotbeprovidedforthefollow-ing:

• Servicesandsuppliesdirectlyrelatedtoanycondition,service,orsupplythatisnotcoveredunderthisprogram• Servicesandsuppliesreceivedororderedwhenthisprogramisnotineffect,orwhenyouarenotcoveredunder

thisprogram,exceptasstatedunderspecificbenefitsandunder“ExtendedBenefits”• Servicesandsuppliesforwhichnochargeismade,forwhichnonewouldhavebeenmadeifthisprogramwere

notineffect,orforwhichyoudonotlegallyhavetopay,unlessbenefitsmustbeprovidedbylawinthecaseoffederallyqualifiedhealthcenterservices

• Servicesandsuppliesthatareoutsidethescopeoftheprovider’slicense,registration,orcertification,orthatarefurnishedbyaproviderthatisnotlicensed,registered,orcertifiedbythejurisdictioninwhichtheservicesorsupplieswerereceived

• Servicesandsuppliesthatyoufurnishtoyourselforthatarefurnishedtoyoubyaproviderwholivesinyourhomeorisrelatedtoyoubyblood,marriage,oradoption;examplesofsuchprovidersareyourspouse,parent,or child

• Servicesandsuppliesthatarenotmedicallynecessary,inthejudgmentofBlueCross,eveniftheyarecourt-or-dered;thisalsoincludesplacesofservice,suchasinpatienthospitalcare

• Servicesandsuppliesthatareforyourconvenienceorthatofyourfamily;servicesofapersonalnature,suchasmealsforguests,long-distancetelephonecharges,radioortelevisioncharges,orbarberorbeauticiancharges

• Anydirectcomplications,consequences,oraftereffects,whetherimmediateordelayed,thatarisefromanycondition,service,orsupplythatisnotcoveredunderthisprogram,exceptasspecificallystatedinthisprogram

• Amountsthatexceedtheallowablechargeormaximumbenefitforacoveredservice• Separatechargesforrecords,correspondenceorreports,exceptthoserequestedforutilizationreview• Custodialcare,exceptasspecifiedintheHospiceBenefit• AnyserviceorsupplythatBlueCrossdeterminesisexperimentalorinvestigationalonthedateitisfurnished;

thedeterminationisbasedonthecriteriastatedinthedefinitionof“Experimental/Investigational” IfBlueCrossdeterminesthataserviceisexperimentalorinvestigational,andthereforenotcovered,youmay

appealthedecision.Pleasereferto“YourQuestions,ComplaintsandAppeals”foranexplanationoftheappealsprocess.

Note:thisexclusiondoesnotapplytocertainexperimentalorinvestigationalservicesprovidedaspartofoncol-ogyclinicaltrials.Benefitdeterminationisbasedonthecriteriaspecifiedinthedefinitionof“OncologyClinicalTrials”intheGlossaryofTermssection.

• Carerenderedbyanymedicalfacilitythatisownedoroperatedbyagovernmentagencytotheextentrequiredbystateandfederallaw;however,thisexclusiondoesnotapplytocoveredservicestotreatamedicalemer-gency,ortocoveredservicesforwhichavailablebenefitsmustbeprovidedbylaworregulation.

• Counseling,education,ortrainingservices,exceptasstatedundertheHealthManagement,NutritionalTherapyandtheMentalHealthCareBenefit,servicesrelatedtocontraceptivemanagementandthesupportservicesstatedintheChemicalDependencyTreatmentBenefitorforservicesthatmeetthestandardsforpreventive

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medicalservicesinthePreventiveMedicalCare(Wellness)Benefit.Thisincludesvocationalassistanceandoutreach;andfamily,marital,social,sexual,lifestyle,nutritional,andfitnesscounseling

• Communitywellnessclassesandprogramsthatpromotepositivehealthandlifestylechoices.Examplesoftheseclassesandprogramsareadult,childandinfantCPR,safety,baby-sittingskills,backpainprevention,stressmanagement,bicyclesafetyandparentingskills.

• Habilitative,education,ortrainingservicesorsuppliesfordyslexia,forattentiondeficitdisorders,andfordisordersordelaysinthedevelopmentofachild’slanguage,cognitive,motor,orsocialskills,includingevalua-tionstherefor;however,thisexclusiondoesnotapplytotreatmentofneurodevelopmentaldisabilitiesundertheRehabilitationTherapy,ChronicPainCare,AndNeurodevelopmentalTherapyBenefit

• Therapydesignedtoprovideachangedorcontrolledenvironment• Cosmeticservicesandsupplies(includingreconstructivesurgeryanddrugs)orotherservicesandsupplies

whichimprove,alterorenhanceappearance,except that benefits will be provided for the following:• Allstagesoftherepairofadefectthatistheresultofanaccidentalinjuryifthesurgeryisperformedinthe

calendaryearoftheaccidentorinthenextcalendaryear• Allstagesoftherepairofadependentchild’scongenitalanomaly• ReconstructivebreastsurgeryinconnectionwithamastectomyasprovidedundertheMastectomyand

BreastReconstructionServicesbenefit• Allstagesoftherepairofamalformationthatisadirectresultofadisease,orsurgeryperformedtotreata

disease or injury• CorrectionoffunctionaldisordersuponBlueCross’reviewandapproval

• Hairprosthesis,suchaswigsorairweaves,transplants,andimplants,exceptasstatedintheProstheticDevicesbenefit;drugs,supplies,equipmentorprocedurestoreplacehair,slowhairloss,orstimulatehairgrowth

• Treatmentofobesityandservicesandsuppliesconnectedwithweightlossorweightcontrol,exceptasspecifiedunder Morbid Obesity

• Routineorpalliativefootcare,includinghygieniccare;impressioncastingforprostheticsorappliancesandpre-scriptionstherefor,exceptasspecifiedunderthe“HomeMedicalandRespiratoryEquipment/MedicalSupplies”benefit;fallenarches,flatfeet,careofcorns,bunions(exceptforbonesurgery),calluses,andtoenails(exceptforingrowntoenailsurgery),andothersymptomaticfootproblems.However,thisexclusiondoesn’tapplytoservicesandsuppliesthatmeettherequirementsforpreventivemedicalservicesasdescribedinthePreventiveMedicalCare(Wellness)Benefit.

• Diagnosisandtreatmentofsexualdisordersanddefects,whetherornottheyaretheconsequenceofillnessorinjury;examplesareimpotence,frigidity,andinfertility

• Assistedfertilizationtechniques,regardlessofreasonororiginofcondition,includingbutnotlimitedtoartifi-cialinsemination,in-vitrofertilization,andgameteintra-fallopiantransplant(GIFT)

• Reversalofsurgicalsterilization• Treatmentorsurgerytochangegender• Militaryandwar-relatedconditions,includingillegalacts.Thisincludes:

• Actsofwar,declaredorundeclared,includingactsofarmedinvasion• Serviceinthearmedforcesofanycountry,includingtheAirForce,Army,CoastGuard,Marines,National

Guard,Navy,orcivilianforcesorunitsauxiliarythereto• anenrollee’scommissionofanactofriotorinsurrection• anenrollee’scommissionofafelonyoractofterrorism

• Treatmentofcaffeinedependency,exceptforservicescoveredundertheHealthManagementBenefit• Treatmentofnicotinedependence,exceptforservicescoveredundertheHealthManagementBenefit,andas

specifiedinthePharmacyDrugBenefit• Anyillnessorinjuryarisingoutoforinthecourseofemploymentorself-employmentforwagesorprofit;for

whichtheenrolleeisentitledtoreceivebenefits,whetherornotaproperandtimelyclaimforsuchbenefitshasbeenmadeunder:

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• Occupationalcoveragerequiredof,orvoluntarilyobtainedby,theemployer• Stateorfederalworkers’compensationacts,or• anylegislativeactprovidingcompensationforwork-relatedillnessorinjury

• Servicesorsuppliestotheextentthatbenefitsarepayableunderthetermsofanycontractorinsuranceofferingoneofthesecoverages:• Motorvehiclemedical,motorvehicleno-fault,orpersonalinjuryprotection(PIP)coverage• Commercialpremisesorhomeowner’smedicalpremisescoverage,orothersimilartypeofcontractor

insurance• Servicesandsuppliesthatarenotdirectlyrelatedtoanillness,accidentalinjury,ordistinctphysicalsymptoms,

exceptasspecifiedundertheRoutineNewbornCareBenefit,theWellnessProvisionsBenefit,Physicians’ServicesBenefit,DiagnosticServicesBenefit,ortheDiagnosticandScreeningMammographyBenefit

• Well-babycare,exceptfortheservicesprovidedundertheRoutineNewbornCareBenefitandthePreventive(Wellness)Benefit

• Visiontherapy,eyeexercise,oranysortoftrainingtocorrectmuscularimbalanceoftheeye(orthoptics),andpleoptics;alsonotcoveredaretreatmenttochangetherefractivecharacterofthecornea;examplesareradialkeratotomy,keratomileusis,orrefractivekeratoplasty,includinganyresultsofsuchtreatment;routinevisionservicesandsupplies,includingservicesofanoptician,arenotcoveredexceptasspecifiedintheVisionBenefit

• Routinehearingcare,includinghearingexaminations,diagnosticscreenings,andtests;servicesandsuppliesfororrelatedtohearingaidsorotherdevicestoimprovehearingsharpnessexceptasspecifiedintheAudioCareBenefit

• Birthcontroldevices,exceptasstatedundertheContraceptiveManagementandSterilizationandthePharmacyDrugBenefit

• Over-the-counterdrugs,foodsupplements,andsupplies,exceptasspecifiedunderthePharmacyDrugBenefit• Vitamins,exceptforpre-natalandfluoridatedvitamins• Dentalservices,exceptasspecifiedundertheDentalCareBenefit,andexceptthoseperformedinconjunction

withtreatmentthatisthedirectresultofanaccidentalinjurytonaturalteeth,gums,orjaw,butonlywhenallofthefollowingrequirementsaremet:• theservicesarewithinthescopeoftheprovider’slicense;• theinjuryisnotcausedbybitingorchewing,evenifduetoaforeignobjectinfood;• theservicesareperformedintheplanyearoftheaccidentorinthenextplanyear;• forservicesprovidedtoanaturaltooth,thetoothmustbetheenrollee’snatural,livingtooththatwasfree

fromdecayandotherwisefunctionallysoundatthetimeoftheinjury.“Functionallysound”meansthattheaffected teeth:• donothaveextensiverestoration,veneers,crownsorsplints;and• donothaveperiodontaldiseaseorotherconditionthat,inthejudgmentofBlueCross,wouldcausethe

toothtobeinaweakenedstatepriortotheinjury.• theservicesare,inthejudgmentofBlueCross,essentialandappropriatetotherepairoftheaccidental

injury(treatmentplanreviewwillbeperformedbyadentistlicensedtopracticedentistryintheStateofAlaska);and

• themaximumbenefitsundertheDentalBenefitfortheaccidentalinjuryhavebeenprovided.• Orthodontia,includingcasts,models,X-rays,photographs,examinations,appliances,braces,andretainers,ex-

ceptinthecaseofaccidentalinjuryasdescribedabove,andasstatedundertheOrthodontiaBenefitofthe500Plan option

• Hospitalcarefordentalprocedures,unlessadequatetreatmentcannotbeprovidedwithouttheuseofhospitalfacilities,andyouhaveamedicalconditionbesidestheonerequiringtreatmentthatmakeshospitalcaremedi-cally necessary

• Treatmentofpsychiatricconditionsandeatingdisorders,suchasanorexianervosa,bulimia,oranysimilarcon-ditions,exceptasspecifiedundertheMentalHealthCareBenefit

• Electronic,on-lineorinternetmedicalconsultationsorevaluations.

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GENERAL PROVISIONS

enrollee Cooperation

Allenrolleesareduty-boundtocooperateinatimelyandappropriatemannerwiththeUniversityandPremeraBlueCrossBlueShieldofAlaskaintheadministrationofbenefitsorintheeventofalawsuit.

notiCe oF otHer CoveraGe

AsaconditionofreceivingbenefitsundertheUniversity’shealthcareprogram,youmustnotifyBlueCrossofthefollowing:

• AnylegalactionorclaimagainstanotherpartyforaconditionorinjuryforwhichBlueCrosspaidbenefits;andthenameandaddressofthatparty’sinsurancecarrier

• Thenameandaddressofanyinsurancecarrierthatprovidespersonalinjuryprotection(PIP),underinsuredmotorist,uninsuredmotorist,oranyotherinsuranceunderwhichyouareormaybeentitledtorecovercompen-sation

• Thenameofanyothergroupinsuranceplan(s)underwhichyouarecovered

evidenCe oF mediCal neCessitY

PremeraBlueCrossBlueShieldofAlaskahastherighttorequireproofofmedicalnecessityfromyouoryourproviderwhenyouarereceivingbenefitsunderthisprogram.Nobenefitswillbeavailableunderthisprogramiftheproof is not provided or not acceptable to the plan.

notiCe oF inFormation use and disClosure

PremeraBlueCrossBlueShieldofAlaskamaycollect,use,ordisclosecertaininformationaboutyou.Thispro-tectedpersonalinformation(PPI)mayincludehealthinformation,orpersonaldatasuchasyouraddress,telephonenumberorSocialSecurityNumber.BlueCrossmayreceivethisinformationfrom,orreleaseitto,healthcarepro-viders,insurancecompanies,orothersources.Thisinformationiscollected,usedordisclosedforconductingroutinebusiness operations such as:

• underwritinganddeterminingyoureligibilityforbenefitsandpayingclaims(BlueCrossdoesnotusegeneticinformationforunderwritingorenrollmentpurposes);

• coordinatingbenefitswithotherhealthcareplans;• conductingcaremanagement,casemanagementorqualityreviews;and• fulfillingotherlegalobligationsthatarespecifiedundertheplanandtheadministrativeservicescontractwith

theUniversityofAlaska.

Thisinformationmayalsobecollected,used,ordisclosedasrequiredorpermittedbylaw.

Tosafeguardyourprivacy,BlueCrosstakescaretoensurethatyourinformationremainsconfidentialbyhavingacompanyconfidentialitypolicyandbyrequiringallemployeestosignit.IfadisclosureofPPIisnotrelatedtoaroutinebusinessfunction,BlueCrossremovesanythingthatcouldbeusedtoeasilyidentifyyouortheyobtainyourpriorwrittenauthorization.Youhavetherighttorequestinspectionand/oramendmentofrecordsretainedbyBlue

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CrossthatcontainyourPPI.PleasecontactBlueCrossCustomerServiceandaskthatarequestformbemailedtoyou.

riGHt to and paYment oF BeneFits

Allrightstothebenefitsofthisprogramareavailableonlytomembers.

However,BlueCross,onbehalfoftheplan,willhonorsubscribers’requeststoassignbenefitpaymentstothepro-viderwhofurnishedthecarewhensuchrequestsdonotconflictwithBlueCross’obligationsundertheirprovideragreements.BlueCrosswillalsohonorsuchassignmentsonbehalfoftheplanwhentheyaremadebyathirdpartytowhomtherighttomakesuchassignmentshasbeenclearlydesignatedinavalidqualifieddomesticrelationsorder.Tofindouthowtomakeassignments,pleasecallCustomerServiceatthenumbersshownin“YourQuestions,ComplaintsandAppeals”sectionofthisHandbook.BlueCrosswillnothonoranyotherattemptedassignment,garnishment,attachmentortransferofanyrightofthisprogram.

AtBlueCross’optionandinaccordancewiththisprovision,BlueCrosshastherighttodirecttheplan’sbenefitstothesubscriber,provider,othercarrier,member,orotherpartylegallyentitledtosuchpaymentunderfederalorstatemedicalchildsupportlaws,orjointlytoanyofthese.Suchpaymentwilldischargetheplan’sobligationtotheextentoftheamountpaidsothattheplanwillnotbeliabletoanyoneaggrievedbytheirchoiceofpayee.

riGHt oF reCoverY

Onbehalfoftheplan,PremeraBlueCrosshastherighttorecoveramountstheplanhasoverpaidinerror.Suchamountsmayberecoveredfromtheemployee/subscriberoranyotherpayee,includingaprovider.Or,suchamountsmaybedeductedfromfuturebenefitsofthesubscriberoranyofhisorherdependents(eveniftheoriginalpay-mentwasnotmadeonthatmember’sbehalf)whenthefuturebenefitswouldotherwisehavebeenpaiddirectlytothesubscriberortoaproviderthatdoesnothaveacontractwithBlueCross.Theplanmayalsoexercisetherighttodelegateallorpartoftheresponsibilityforrecoveriestoanotherthirdparty.

venue

Allsuitsorlegalproceedings,includingarbitrationproceedings,broughtagainsttheUniversityofAlaskaand/orBlueCrossBlueShieldofAlaskabyyouoranyoneclaiminganyrightunderthisprogrammustbefiled:

• within3yearsofthedateBlueCrossdenied,inwriting,therightsorbenefitsclaimedunderthisprogram;and• inamutuallyagreeduponlocation.

Workers’ Compensation insuranCe

Thiscontractdoesnotreplace,affect,orsupplementanystateorfederalrequirementfortheUniversityofAlaskatoprovideworkers’compensationinsurance,employer’sliabilityinsuranceorothersimilarinsurance.

intentionallY False or misleadinG statements

Ifthisprogram’sbenefitsarepaidinerrorduetoanyintentionallyfalseormisleadingstatements,theplanwillbeentitledtorecovertheseamountsonbehalfoftheUniversityofAlaska.See“RightOfRecovery”above.

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Please Note: your coverage cannot be voided (in other words, cancel back to it’s effective date as if it had never existed at all) based on a misrepresentation you made unless you have performed an act or practice that constitutes fraud; or made an intentional misrepresentation of material fact that affects your (or your depen-dent’s) acceptability for coverage.

limitations oF liaBilitY

Theplan,theUniversityofAlaskaandBlueCrossarenotliableforanyofthefollowing:

• Situationssuchasepidemics,disasters,orothercausesorconditionsbeyondtheircontrol,thatpreventenrolleesfromobtainingthebenefitsofthiscontract

• Thequalityofservicesorsuppliesreceivedbyenrollees,ortheregulationoftheamountschargedbyanypro-vider,becauseallthosewhoprovidecaredosoasindependentcontractors

• Harmthatcomestoanenrolleewhileinaprovider’scare• Amountsinexcessoftheactualcostofservicesandsupplies• Amountsinexcessofthisprogram’smaximums;thisincludesrecoveryunderanyclaimofbreach• Generaldamagesincluding,withoutlimitation,allegedpain,suffering,ormentalanguish

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FLEXIBLE SPENDING ACCOUNTS

introduCtion

Thehighcostsofhealthcareanddependentcarearen’tgoingaway.Howcanyougetthecareyouneedandkeepmoremoneyinyourpocket?OpenaFlexibleSpendingAccount(FSA).TheseIRS-approvedaccountsallowyoutosetasideaportionofyourtaxableincomepriortopayingtaxes.Then,asyouincureligibleexpenses,yourequesttax-freewithdrawalsfromyouraccounttoreimburseyourself.TherearetwokindsofFSAs:aMedicalFSAandaDependentCareFSA.TheseflexiblespendingaccountsareadministeredbyFringeBenefitsManagementCompany,aDivisionofWageWorks.

BeneFits

BeginningonyoureffectivedateinthePlan,youmaychoosetoreduceyoursalarytopayforthefollowingtax-freebenefits:

• Medical FSA—Allowsyoutopayforyourmedical,dentalandvisionout-of-pocketexpensesbeforetaxes.Employeescancontributeamaximumof$5,000perPlanYear.

• Dependent Care FSA—Allowsyoutopayforemployment-relateddaycareexpensesbeforetaxes.Youmaycontributeamaximumof$5,000perPlanYear($2,500,ifmarried,filingseparately).

plan Year

ThePlanYearforboththeMedicalFSAandtheDependentCareFSArunsfromJuly1throughJune30.AllclaimsmustbesubmittedbySeptember30followingtheendoftheplanyear.

eliGiBilitY

Ifyouarearegularorterm-fundedemployeeandeligibletoparticipateintheUniversity’shealthcareplan,youareeligibletoparticipateintheFSAPlan.Currentemployeeshavetheopportunitytoelectaflexiblespendingaccounteitherduringopenenrollmentorwithin30daysafteramajorlifeevent.

enrollment

Tobecomeaparticipant,youmustfilloutandsigntheappropriateform.Ifyouareanewemployee,thisformshouldbecompletedandsignedpriortoreceivingyourfirstpaycheck,butnolaterthan30daysafteryoubecomeeligible.

IfyouwillbeaneligibleemployeeonJuly1,youreffectivedatewillbeJuly1.IfyoubecomeaneligibleemployeeafterJuly1,youreffectivedatewillbethedateyoubecomeeligibletoparticipate.IfyouelectanFSAbecauseofaneligiblemajorlifeevent,youreffectivedatewillbethedateofyourlifeevent.Yourpayrollreductionswillstartonthefirstpaydayonorafteryoureffectivedate.

You mustcompleteandsignanewelectionformduringtheopenenrollmentperiodforeachnewPlanYear.Ifyoudonotcompletetheappropriateformasindicatedabove,youwillnotbeeligibletoparticipateintheplanuntilthefollowingJuly1,unlessyouhaveamajorlifeevent.

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major liFe event

OnceyouhaveenrolledinthePlan,youcannotrevoke,discontinue,orchangeyourelectionforthedurationofthePlanYearunlessyouhaveaqualifiedchangeinfamilystatus,ormajorlifeevent.Ifyouhaveamajorlifeevent,youareallowedtochangeyourelectionprovidingthechangeisappropriateandconsistentwithyourlifeevent.

Someexamplesofmajorlifeeventsareasfollows:

• Marriageordivorceoftheemployee• Birthoradoptionofachild• Terminationorcommencementofyourspouse’semployment• Deathofaspouseorchild• Reductionorincreaseinhoursofyouroryourspouse’semployment

Contactyourregionalhumanresourcesofficeimmediatelyifyouexperienceamajorlifeeventandwouldliketochangeyourelection.Youmustnotifyyourregionalhumanresourcesofficewithin30daysofyourmajorlifeevent.Theeffectivedateofthechangewillbethedatethemajorlifeeventoccurred.

IfyouelecttoreducethecontributiontoyourMedicalFSAduetoamajorlifeevent,yourannualcontributionamountwillberecalculatedandreducedbasedonyournewelectionregardlessoftheamountofreimbursementsmadetoyou.IfyouelecttoincreasethecontributiontoyourMedicalFSAduetoamajorlifeevent,yourannualcontributionamountwillberecalculatedandincreasedbasedonyournewelectionregardlessoftheamountofreim-bursementsmadetoyou.

termination oF BeneFits

YouwillremainaparticipantintheFSAPlanuntiltheearliestofthefollowingdates:

• Thedateyouarenolongeraneligibleemployee(throughterminationortransfertoanineligibleposition)• ThedateyoustopparticipatinginthePlanbecauseofamajorlifeevent• ThedatethePlanYearends(June30)• ThedatethePlanends

use it or lose it rule

TheIRShasestablishedstrictguidelinesforflexiblespendingaccounts.Oneoftheguidelinesisknownasthe“useitorloseit”rule.ThismeansthatifyouelecttocontributemoneytoaFlexibleSpendingAccount,andthendonotincurenoughexpensesduringthePlanYeartomeettheamountyouelected,youwilllosetheunusedmoney.IfyouleavetheUniversityduringthePlanYear,youmaycontinuetosubmitclaimsandbereimbursedduringtheremain-derofthePlanYear;however,thedatesofserviceyouaresubmittingmusthavebeenpriortoyourtermination.Bylaw,anyforfeitedamountwillrevertbacktotheUniversitytocoveradministrativecostsassociatedwiththeFSAPlan.

BeconservativewhendeterminingtheamountyouwanttoputintoyourMedicaland/orDependentCareFSA.

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mediCal FleXiBle spendinG aCCount

Ifyouknowyouwillhaveout-of-pockethealthcareexpensesduringthePlanYear,youmayelecttosetupaMedi-calFSAtopayforthoseexpenseswithtax-freedollars.Afteryoudeterminetheamountyouwanttocontribute,theUniversitywilldeductasetdollaramounteachpayperiod,onapre-taxbasis,untilyouhavereachedyourannualgoalamount.ThemoneywillbeplacedinyourMedicalFSA,withthetotalannualgoalamountavailabletoyouatanytimeduringyourperiodofcoverage.It’slikeacashadvancebecauseyoudon’thavetowaitforthecashtoac-cumulateinyouraccountbeforeyoucanuseit.

AsyourhealthcareclaimsareprocessedbyBlueCross,yourout-of-pocketexpenseswillbeeligibleforreimburse-mentfromyourMedicalFSA.IfyouhaveexpensesthatarenotsubmittedtoBlueCrossbecausetheyarenoteli-gibleunderyourhealthplan,oryouhavesecondaryhealthcareinsurance,youmaysubmitacopyoftheprovider’sbillingoracopyoftheExplanationofBenefits(EOB)fromBlueCross(andanyotherinsuranceyoumayhave)withacompletedFSAReimbursementRequestFormforreimbursement.Pleasesee“HowToSubmitaReimburse-mentClaim”fordetailedinstructions.

Please note:premiumsforcontinuedcoverageunderCOBRAarenotaneligibleexpenseforyourMedicalFSA.

eliGiBle eXpenses

Healthcareexpensesthatareeligibleforreimbursement,perIRSregulations,areexpensesincurredbyyou,oryourspouseordependent(s),formedicallynecessaryservicesasdefinedinSection213oftheIRSCode.Yourdepen-dentsdonothavetobeenrolledinthehealthcareplantobeeligibleforthisplan,buttheydoneedtobedependentsasdefinedbyIRSCode.Taxable financially interdependent partners are not eligible for this plan.Expensesaretreatedashavingbeenincurredwhenthemedicalcarewasgiven,notthedateyouwerebilledorcharged,orthedateyoupaidfortheservices.Inaddition,theexpensemustnotbeeligibleforreimbursementfromanyotherhealthplan.

EffectiveJanuary1,2011,changestofederallawlimitsthereimbursementofover-the-counter(OTC)medica-tionstorequireaprescriptionororderfromyourphysician.Thischangedoesnotapplytoitemslikewristsplints,band-aids,magnifyingreaders,incontinenceproductsanddurablemedicalitemssuchascanesandcrutches.FringeBenefitsManagementCompanymaintainsacurrentlistofeligibleOTCmedicationsatwww.fbmc-benefits.com;itisyourresponsibilitytocheckthelistregularlyforupdates.AllclaimsforOTCmedicineexpensereimbursementmustincludeaprescriptionororderfromyourphysicianandadetailedreceiptshowingthepurchasedateandnameofthemedicine.

Someexamplesofeligibleexpensesare:

• Yourout-of-pocketexpenses,suchasdeductibles,coinsuranceandcopays• Hearingaids• Orthodontics• Dentures• Chargesovertheallowedamount• Acupuncture• Alcoholandsubstanceabusetreatmentchargesnotcoveredunderyourhealthplan• Naturopathy• Biofeedback• Psychiatriccarenotcoveredbyyourhealthplan• Eyeexaminationchargesnotcoveredbyyourvisionplan• Homehealthcare

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• Contactlensesandglasses• Experimentalorinvestigativetreatments• Certainover-the-counteritems(seelistofeligibleitemsatwww.fbmc-benefits.com)• Contactlenscleaningandsalinesolutions

SomeexpensesthatarenoteligibleforreimbursementfromyourMedicalFlexibleSpendingAccountinclude:

• Servicesforpurelycosmeticpurposes• VitaminormineralsupplementsnotcoveredbyBlueCross• ServiceswithdatesofserviceoccurringpriortoyoureffectivedateorafterthecloseofthePlanYear• Weightlossprogramsforgeneralhealthpurposes,evenifprescribedbyyourdoctor• Insurancepremiums(includingpremiumsforcontinuingcoverageunderCOBRA)• Exerciseequipmentforgeneralhealthpurposes,evenifprescribedbyyourdoctor• ClaimssubmittedwithoutafullycompletedReimbursementRequestForm,alongwithacopyofanexplanation

ofbenefitsfromyourinsurancecompany,oraprovider’sbillingshowingdatesofserviceandcharge

dependent Care FleXiBle spendinG aCCount

Ifyouknowyouwillhaveemployment-relateddependentdaycareexpensesforaneligibledependentduringthePlanYear,youmayelecttousetheDependentCareFSAtopayforthemwithtax-freedollars.Thismaybedoneonlyiftheexpensesareincurredtoallowyou(andyourspouse,ifapplicable)towork.Themaximumamountyoumaycontributetotheplaninaplanyearis$5,000($2,500ifmarriedandfilingseparately);orifyouoryourspouseearnslessthan$5,000ayear,yourmaximumcontributionisequaltothelowerofthetwoincomes.Ifyourspouseisafull-timestudentorincapableofself-care,yourmaximumcontributionamountis$2,400ayearforonedependentand$4,800ayearfortwoormoredependents.

Aneligibledependentfallsunderoneofthesetwocategories:

• Youoryourspouse’schild(dependingonthetaxstatusofthatdependent)whoisunder13yearsofage• Yourspouse(orotherindividualclaimedasadependentforfederaltaxpurposes)whoisphysicallyormentally

incapableofself-careandwhoregularlyspendsatleasteighthoursadayinyourhome

Dependentcarecanberenderedeitherinsideoroutsidethehome.Ifcareoutsidethehomeisprovidedbyadepen-dentcarecenterthatcaresforsevenormorechildren,itmustcomplywithallapplicablestateorlocallawsandregulations.Also,theprovidermustnotbeyourchildage18oryounger,orsomeonewhoyouclaimasadependentforfederalincometaxpurposes.

AfteryoudeterminetheamountofdependentcareexpensesyouwillincurduringthePlanYear,theUniversitywilldeductaportioneachpayperiod,onapre-taxbasis,untilyouhavereachedyourannualgoalamount.ThemoneywillbeplacedinyourDependentCareFSA,tobereimbursedtoyouasyouincurdependentcareexpenses.Pleasesee“HowToSubmitaReimbursementClaim”fordetailedinstructions.

Dependingonyourincomelevel,youmayalsousetheFederalIncomeTaxCreditfordependentcareexpenses.Itisimportanttorememberthatyoumayuseeitheroftheseuptothemaximumallowable,butyoumaynottakeataxdeductionforthoseexpensesreimbursedunderthisplan,orviceversa.SeeIRSPublication503oryourtaxadvisorformoredetails.

UnliketheMedicalFSA,anyreimbursementwillnotexceedthebalanceavailableinyouraccountwhenyourclaimisreceived.Dependentcareservicesmusthavebeenincurredtoreceivereimbursement,regardlessofwhenyoupayfor the service.

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HoW to suBmit a Claim For reimBursement

mediCal Fsa Claim suBmissions

It’seasytosubmitaclaimtoFringeBenefitsManagementCompany.JustcompleteaFlexibleSpendingAccountReimbursementRequestFormalongwiththeExplanationofBenefits(EOB)fromBlueCross(andanyotherinsur-anceyoumayhave)forservicescoveredbythehealthcareplan,oradetailedreceiptwithactualdateofservice,nameandaddressoftheprovider,descriptionoftheservicesrenderedandactualamountchargedfornon-coveredservices to FBMC.

Remember, to be reimbursed for your out-of-pocket expenses you must submit a claim form. If you have ques-tionsaboutyourclaim,callFBMCCustomerServiceat(800)342-8017,from4a.m.to6p.m.AlaskaTime.

PleasecompleteallsectionsoftheclaimformsothatFBMCcanprocessyourclaim.Ifyoufailtocompletetheforminfulland/oryoudonotprovideanExplanationofBenefitsoritemizedbillingshowingdatesofserviceandcharge,yourclaimwillbedelayedordenied.

dependent Care Fsa Claim suBmissions

CompleteaFlexibleSpendingAccountReimbursementRequestFormalongwiththereceiptsfromyourdependent/childcareprovidershowingthename,addressandtaxIDnumber(orSocialSecuritynumber)oftheprovider,andbeginningandenddatesofservice.Ifyourproviderisanindividual,theymustsignthereceipt.Inlieuofaseparatereceipt,yourdaycareprovidermaysigntheClaimForm.

Mailyourclaimstothisaddress:

Fringe Benefits Management CompanyA Division of WageWorks

POBox1800TallahasseeFL32302-1800

Oryoucanfaxyourclaimtollfreeto(866)440-7145,orsubmityourclaimonline.Seemyfbmc.comfordetails.

PleaseretainoriginalsofallclaimsanddocumentationforIRSpurposes.ItisyourresponsibilitytoprovidetheclaimsinformationifyouareauditedbytheIRS.

questions reGardinG Your plan?

IfyouneedadditionalinformationaboutyourFlexibleSpendingAccountsPlan,pleasecontacttheFBMCCustomerServiceDepartmentat(800)342-8017.

CoBra riGHts

TotheextentrequiredbytheConsolidatedBudgetReconciliationActof1985(COBRA,codifiedunderCodeSection4980B),theParticipant,Spouse,andDependents,whosecoverageterminatedunderthePlanbecauseofaCOBRAqualifyingevent,shallbegiventheopportunitytocontinuetheircoverageundertheMedicalReimburse-mentPlanonanafter-taxbasisforthetimeperiodprescribedbyCOBRA,subjecttoallconditionsandlimitationsunder COBRA.

IfyouhavequestionsaboutthePlan,youshouldcontactyourregionalhumanresourcesoffice.

84

EMPLOYEE ASSISTANCE PROGRAM

TheUniversityoffersanEmployeeAssistanceProgram(EAP)toallitsregularfull-orpart-timefacultyandstaffandtheirdependents,aswellasCOBRAparticipants.TheUniversityoffersthisprogrambecausefromtimetotime,anyonecanbeburdenedbythepressuresoflife.Suchburdenscanaffectyourhealth,familylife,abilities,andworkperformance.

Maintainingahealthybalancebetweenyourworkandpersonallifeisimportanttoyou.Atworkandhome,ourlivesarebusierthanever,andattimes,weallcanusealittleextrahelpincopingwithpersonalchallenges.YourEAPprovidesyouandyourfamilywithshort-term,person-to-personcounselingservicestohelpyouhandleconcernsbeforetheybecomemajorissues.

Toprovideyouwithafull-servicebenefitthatyouandyourfamilycaneasilyaccessasyouneedit,theUniversityofAlaskaselectedComPsych,oneofthenation’sleadingindependentprovidersofEAPservices.

Professionalcounselorsareavailable24hoursaday,7daysaweektohelpyouwithissuessuchas

• Joborworkstress• Family/Parentingissues• Alcohol,drugsandothersubstanceabuse• Burnout• Maritalorrelationshipproblems• Anxietyordepression

• Angermanagement• Legalissues• Financialconcerns• Copingwithchange• Self-esteem• Grieforbereavement

Crisiscounselingisalwaysavailabletoprovideyouwithassistanceyouneedwhenyouneedit.ComPsychalsoof-fersfree,easy-to-usepersonalhelpwithchildandeldercareservices.

AllEAPcounselorsarefullyqualifiedandlicensedintheirareaofservice.Theprogram’sstaffincludeslicensedpsychologists,socialworkers,marriageandfamilycounselors,andlawyers.Theidentityofthepeoplewhoelecttousethisprogram,aswellasanyinformationrevealedtoEAPstaff,isheldinthestrictestprofessionalconfidenceallowedbylaw.

HoW to use tHe proGram

YouoryoureligiblefamilymembersmaycontactComPsych,theGuidanceResourcesCompany,directlyanytime,24hoursaday,7daysaweek,at(866)465-8934foranyreasonandtalktoatrainedcounselor.Thesecounselingprofessionalscanassistyouandguideyoutoin-personcarewithanexpertinyourarea.TheEAPisstrictly confi-dential,asmandatedbylaw.

YoucanalsoaccessyourEAPservicesviatheWebwithGuidanceResourcesOnline.Gotowwwguidanceresources.comandentertheuniversityID:GC5901Q.Informationabouthealth,work-lifebalance,buyingcars,relocating,buyinganewhome,exerciseandfitness,lifeevents(suchasmarriage,havingoradoptingchildren,sendingchildrentocollege,divorce,deathofalovedone)andavarietyofothertopicsisjustaclickaway.

Formosttypesofproblems,youandyoureligibledependentsareentitledtoreceiveupto6counselingsessionsperincident.AllEAPsessionsareprepaidbytheUniversityofAlaska.IfyouwantcounselingbeyondthebenefitsoftheEAP,yourEAPcounselorcanhelpyouselectthemostcost-effectiveandappropriatetreatmentresources.

ContactyourlocalhumanresourcesofficeforfurtherinformationabouttheEmployeeAssistanceProgram.

85

DISABILITY BENEFITS

introduCtion

TheUniversity’sdisabilityplanwillhelptoreplacelostincomefromseriousdisabilitiesthatlastlongerthan90days.TheLongTermDisabilityincomeplanpremiumispaidbytheUniversityonyourbehalf.TheUniversity’sLongTermDisabilityplanbenefitsareprovidedbyTheHartford.

Inadditiontothisplan,youmaybeentitledtodisabilitybenefitsfromthefollowingsources:

• othergroupinsurancecontracts• Workers’Compensation• benefitsprovidedbyanystateorfederalgovernment• anyretirementplanbenefittowardwhichtheUniversitycontributesormakespayrolldeductions(suchasPERS

orTRS)• leaveshareprogram(s)

Becausedisabilityinsuranceisdesignedtosupplementotherdisabilitybenefits,theamountpayableundertheLongTermDisabilityplanwillbereducedwhencoordinatedwithpaymentsfromothersources.

eliGiBilitY

Ifyouareanactiveregularorterm-fundedemployeeworkingatleast20hoursaweek,youareeligibleforLongTermDisabilitycoverage.Youreligibilitybeginsonthefirstdayofthemonthfollowingthedateyouarehired.Dis-abilitiesresultingfrompregnancyarecoveredonthesamebasisasanillnessorinjury.

deFinition oF disaBilitY

Duringthefirst36months,disabilitymeansthatyouareunabletoperformwithreasonablecontinuitytheessentialfunctionsofyourownoccupation.

AfteryoureceiveLongTermDisabilitybenefitsfor36months,youareconsidereddisabledifyouareunabletoperformtheessentialfunctionsofanygainfuloccupationforwhichyouarequalifiedbyeducation,experience,ortraining.

BeneFits

LongTermDisabilitybenefitsstartafteryouhavebeendisabledforthelongerofthesequalifyingperiods:

• 90days• thedurationofyouraccumulatedsickleaveplusanyleavebenefitsfromanyapplicableleaveshareprogram(s) Ifyouareabletoreturntoworkinsomecapacity,youmaystillbeeligibleforbenefits.

Periodsofdisabilityasaresultofthesamecauseorcausesareconsideredasingleperiodofdisability,providedtheyareseparatedbyarecoveryperiodoflessthan180days.

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Ifyouhavemorethanoneperiodofdisabilityandtheperiodsarefromdifferentcauses,theyareconsideredseparateperiodsofdisability.Eachperiodofdisabilityissubjecttoanewqualifyingperiodandtothemaximumdurationofthebenefit.

montHlY BeneFit amount

TheincomeyoureceivefromtheLongTermDisabilityplandependsuponyourmonthlyearningsatthetimeyouaredisabled.Themaximummonthlybenefitisthelesserofthefollowing:

• 60%ofyourmonthlyearnings• or$3,000

Themaximumdisabilitybenefitisreducedbybenefitsyoumayreceivefromothersources(seeBenefitOffsets).

Theminimummonthlybenefitis$100,regardlessofhowmuchyoureceivefromothersources.Ifyouaredisabledforlessthanafullmonth,yourbenefitswillbeproratedforthatmonth.

montHlY earninGs

Ifyouarecompensatedona12-monthbasis,monthlyearningsmeansyourcurrentrateofwagesorsalary,computedonamonthlybasis.Thisdoesnotincludeovertimepay,out-of-classearnings,overloadpay,additionalassignmentpay,bonuses,shiftdifferential,premiumpay,orotherspecialcompensation.Thefollowingrulesapplytothecom-putationofyourannualrateofearnings:

• Ifyouarepaidonanannualcontractbasis,yourannualrateofearningsisyourannualsalaryforyourprimaryassignment.

• Ifyouarepaidonanhourlybasis,yourannualrateofearningsisyourhourlyratetimesthenumberofhoursyouareregularlyscheduledtoworkeachyear.Ifyoudonothaveregularhours,yourannualrateofearn-ingswillbebasedonthenumberofmonthsyouworked,notcountinganyhoursover173inanyonecalendarmonth.

• Ifyouarepaidonanyotherbasis,yourannualrateofearningswillbethepayyoureceivedfortheperiodyouareregularlyscheduledtoworkeachyear.

Monthsinwhichyouwouldnototherwisereceiveasalaryarenotusedincomputingmonthlyearnings.Monthlyearningsarebasedonyoursalaryorwagesthelastdayyouareatworkbeforeyouweredisabled.

BeneFit oFFsets (inCome From otHer sourCes)

Ifyouarealsoeligibletoreceivedisabilitybenefitsfromanyofthefollowingsources,theamountyoureceivemaybesubtractedfromyourmonthlyLongTermDisabilitybenefit:

• Benefitsforlossoftimeprovidedbythefollowing:• Anyothergroup-sponsoreddisabilityinsurancecontract• Worker’scompensation,non-job-relateddisabilitybenefitlaws,orsimilarlegislation

• BenefitspayableundertheU.S.SocialSecurityAct(asaprimarybenefit),oranyotherbenefitsprovidedbyU.S.orCanadianlaw,orbyanystateorfederalregulation

• RetirementbenefitsthatareprovidedbythePublicEmployees’RetirementSystem,theTeachers’RetirementSystemortheUniversityofAlaskaOptionalRetirementPlan

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• Periodicbenefitsforlossoftimeinconnectionwithaccidentalbodilyinjuryorillness

Foracompletedescriptionofallbenefitoffsets,pleaseseetheLongTermDisabilitybenefitbooklet,onlineatwww.alaska.edu/benefits/long-term-disability.

reHaBilitation/return to Work inCentive

TheLongTermDisabilityplanincludesarehabilitation/returntoworkincentiveforupto12consecutivemonths.Yourmonthlybenefitwillcontinueaslongasthesumofyourcurrentmonthlyearningsandnetdisabilitybenefitdonotexceed100%ofyourpre-disabilityearnings.Ifthesumofyourmonthlybenefitandearningsexceeds100%ofyourpre-disabilityearnings,themonthlybenefitwillbereducedbytheamountoftheexcess.However,yourmonthlybenefitwillnotbelessthantheminimummonthlybenefit.

Youmaybeeligibleforaworkplacemodificationbenefit.IftheuniversityandtheHartfordagreetoworkplacemodificationstoreasonablyaccommodateyourreturntoworkandtheperformanceofyouressentialjobfunctions,benefitsuptothemonthlymaximumbenefitmaybepayabletoreimbursetheuniversityforsuchworkplacemodifi-cations.

lenGtH oF BeneFit paYments

Thelongestperiodforwhichdisabilitybenefitsarepayableforoneperiodofcontinuousdisabilityisdeterminedasfollows:

Your Age When Disability Begins YourMaximumBenefitPeriod

63yearsofageoryounger Tonormalretirementageor48months,ifgreaterAge63 Tonormalretirementageor42months,ifgreaterAge64 36monthsAge65 30monthsAge66 27monthsAge67 24monthsAge68 21monthsAge69orolder 18months

NormalRetirementAgemeanstheSocialSecurityNormalRetirementAge,determinedbyyourdateofbirth.Formoredetails,seethelong-termdisabilitybenefitbookletatwww.alaska.edu/benefits/long-term-disability.

limitation oF BeneFits

Benefitswillnotbepaidforanyperiodwhenyouarenotunderthecareofaphysician.

Ifadisabilityiscausedbyamentaldisorder,alcoholism,drugaddiction,orchemicaldependency,paymentofben-efitsislimitedto24monthsduringyourentirelifetime.

However,ifyouarearesidentpatientinahospitalattheendofthe24months,oryoubecomearesidentpatientinahospitalwithin6monthsofdischargefromapreviousconfinementforwhichLTDbenefitswerepayable,thislimitationwillnotapplywhileyouremaincontinuouslyconfined.

Paymentofbenefitsislimitedto12monthswhileyouarecontinuouslyresidingoutsideoftheUnitedStatesandCanada.

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lonG term disaBilitY eXClusions

YourLongTermDisabilityinsurancedoesnotcoveranydisabilitycausedorcontributedtobyself-inflictedinjury,waroranactofwar,yourcommittingorattemptingtocommitanassaultorfelony,oryouractiveparticipationinaviolent disorder or riot.

lonG term disaBilitY Claims

Notifyyourregionalhumanresourcesofficeimmediatelyofyourdisabilityandobtainaclaimform.Completedformsaretobereturnedtothatofficefortransmittaltotheinsurancecarrier.Youmustfilewrittenproofofyourdis-abilitywithin90daysafterthebeginningofthedisability.Theinsurancecarrierhastherighttohaveyouexaminedbythedoctor(s)oftheirchoice.

termination oF insuranCe

YourinsuranceendswhenyouremploymentwiththeUniversityends,yourpositionnolongermeetstheeligibilityrequirements,ortheUniversitydiscontinuesofferingaLongTermDisabilityprogram.Ifyourenewyouremploy-mentcontractwiththeUniversityforthefollowingyearandthenceaseactive,full-timeworkduringthesummermonths,yourcoveragecontinuesduringthesummermonths.

Conversion privileGe

IfthisprotectionceasesbecauseyouremploymentwiththeUniversityterminates,youmayarrangewiththeinsur-ancecarriertoprovideLongTermDisabilitycoverageunderanindividualpolicy.Thiscoveragemaybeconvertedwithoutmedicalexaminationifyouapplywithin30daysfromthedateyourgroupcoverageceases.TheindividualLongTermDisabilitybenefitsarenotthesameastheUniversity’sGroupLongTermDisabilityPlan.

Torequestconversioncoverage,contactyourregionalhumanresourcesofficeforforms.Youmaynotconverttoanindividualplanifyouaredisabledatthetimeemploymentterminates.

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LIFE INSURANCE BENEFITS

introduCtion

Financialprotectionforyoursurvivorsintheeventofyourdeathisimportantforyourfamily’swelfare.TheUniver-sityofAlaskaprovidestheopportunityforincomeprotectionthroughthefollowingbenefitplans:

• Basiclifeinsurance• Supplementallifeinsurance(alsocalledOptionallifeinsurance)• Accidentaldeathanddismembermentinsurance

Benefitspaidtoyourbeneficiaryand/orbenefitstowhichtheymaybeentitledatthetimeofyourdeathmayincludethefollowing:

• LifeInsurance• PERS/TRSRetirementBenefits• UniversityofAlaskaPensionPlanBenefits• SickLeavePayoff• AnnualLeavePayoff• SpecialContinuationofHealthCareBenefits• DistributionsfromTDAAccounts• OptionalRetirementPlanAccounts

TheUniversityofAlaska’slifeinsuranceandaccidentaldeathanddismembermentbenefitsareprovidedbyTheStandard.

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BASIC LIFE INSURANCE

introduCtion

TheUniversityprovidesabasic$50,000LifeInsurancebenefitatnocosttoemployees.

Employeesmaypurchaseadditionallifeinsurancethroughpayrolldeductions(seesupplementallifeinsurancesec-tions).

eliGiBilitY

Allregularfull-time,andregularpart-timeemployeesareeligibleforinsurancecoverage.Eligibilitybeginsonthedate of hire.

BeneFits

Theamountthatwillbepaidtoyourbeneficiaryintheeventofyourdeathis$50,000(unlessyouhaveelectedtopurchaseadditionalinsurance).Benefitswillbepaidbycheckandsentdirectlytoyourbeneficiary.

BeneFiCiaries

Thebenefitswillbepaidtothebeneficiaryyoudesignateonthebeneficiaryform.Youmaychangeyourbeneficiaryatanytimebycompletinganewbeneficiaryformandreturningittoyourregionalhumanresourcesoffice.

Claims

Lifeinsuranceandtravelaccidentclaimsshouldbefiledthroughyourregionalhumanresourcesoffice.Claimsshouldbereturnedtothatofficeforfinalcompletionandtransmittaltotheinsurancecarrier.

termination

YourBasicGroupLifeInsuranceceasesonthedatethatyouterminateeligibleemploymentwiththeUniversity.ConversionorPortabilitytoanindividualpolicyisavailable;seethePortabilityorConversionPrivilegeinformationat the end of this section.

travel aCCident BeneFits

Thereisanadditional$250,000travelaccidentpolicyineffectanytimeyouaretravelingonUniversitybusiness.(Commutingtoandfromworkisnotcovered.)ThisbenefitisprovidedbyUARiskManagementandisnotpartofyour Group Basic Life Insurance.

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disaBilitY Waiver oF premium

Ifanemployeebecomestotallydisabledwhileinsuredandbeforereachingage60,basiclifeinsurancecoveragewillremainineffectwithoutfurtherpremiumpaymentaslongasthedisabilitycontinuesoruntilage65,whicheverissooner.

Proofofyourinabilitytoworkbecauseoftotaldisabilitymustbefurnishedannually.Ifdisabledpriortoage60,insurancewillcontinueaslongasyouaredisabled,butnotpastage65.Theamountofcontinuedprotectionissubjecttoanyplanchangesandtoreductionsshownintheinsuranceschedule.Withinoneyearofthestartofyourdisability,youmustsubmitproofthatyouarecurrentlydisabledandhavebeencontinuouslydisabledforatleastsixmonths.

Applicationforthewaiverofpremiumshouldbemadewithinthe90-daywaitingperiodpriortothecommencementofLong-TermDisabilitybenefits,butnolaterthansixmonthsafteryoubecomedisabled.

portaBilitY or Conversion privileGe

YoumayarrangewithTheStandardtocontinueyourbasiclifeinsuranceprotectionunderanindividualpolicy,withoutmedicalexamination,ifyouapplyforitwithin31daysafterthedateyourgroupinsuranceceases.

BecausetheGroupLifeInsurancewillbepayablefordeathoccurringduringthe31daysafterthedateyourinsur-anceceases,theindividualpolicywillnotbecomeeffectiveuntilafterthe31-dayperiodhasexpired.Withcon-version,theindividuallifeinsurancebenefitswillbeconvertedtoaWholeLifepolicy.Portabilityallowsyoutocontinuethesamegrouptermsupplementallifeinsuranceyouhadasanactiveemployee.

FormoreinformationandtorequestanapplicationforPortabilityorConversion,contacttheStandardat(800)378-4668,ext.6785within31daysofemploymentterminationorlossofeligibility.Applicationsshouldbesentto:

The Standard Insurance CompanyAttn:ContinuedBenefits

920SW6thAvePortland,OR97204

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SUPPLEMENTAL LIFE INSURANCE

introduCtion

Thisplanprovidesforincomebenefitstothesurvivorsofadeceasedemployee.Coverageamountsunderthisplanareinmultiplesof$25,000toamaximumof$400,000.Anewemployeemaypurchasethemaximumamountofcoveragewithin30daysofhire.IfyoudonotenrollinSupplementalLifewithinthistime,youmaynotenrolluntilthenextopenenrollmentperiod,orafteraqualifyingmajorlifeevent.

eliGiBilitY

OnlyUniversityofAlaskaemployeesareeligibleforenrollmentintheplan;dependentsarenotcovered.Ifyouarearegularfull-timeorregularpart-timeemployee,youareeligibleforthisoptionalplan;howeverbenefitreductionsapplytoemployeesage65orolder.

enrollment

Youmayenrollwithin30daysofthedateofyouremployment,duringopenenrollment,orafteraqualifyingmajorlifeevent.Themaximumamountofsupplementallifeinsurancethatauniversityemployeecanpurchaseunderthisplanis$400,000.Youwillneedtosubmitevidenceofinsurabilityifyouareelectingover$200,000ofcoverage.

SubmittheSupplementalBenefitsElectionformtoyourregionalhumanresourcesoffice.Ifelectingmorethan$200,000ofcoverage,youmustcompletetheMedicalHistoryStatementasevidenceofinsurability,andsenditdi-rectlytoTheStandardattheaddressontheform,orfaxitto(971)321-5060.Youwillbeissued$200,000untilthehigherbenefitlevelisapprovedbyTheStandard.Initialenrollmentinthesupplementallifeinsurancebenefitalsorequiresacompletedbeneficiaryform.Allformsareavailableonthebenefitswebsiteatwww.alaska.edu/hr/forms.

Employeeswithcurrentcoveragelevelsover$200,000whoareelectingahigherlevelofcoverageatopenenroll-mentorbecauseofaqualifyinglifeeventwillmaintaintheircurrentleveluntiltheincreaseisapproved.Iftheincreaseisnotapproved,theywillretaintheircurrentlevelofcoverage.

Youmaycancelthiscoverageatanytimebycompletingasupplementalbenefitselectionformoruponwrittenno-ticetoyourregionalhumanresourcesoffice.

Costs

Thisplanisage-bandedsothateachemployeepaysonlyforhisorherowncoverage.TheratethatwillbechargedanemployeeisbasedupontheirageasofJuly1ofeachyear.

Paymentsforthecoveragearemadethroughbi-weeklypayrolldeductionsonanafter-taxbasis.Forthemostcur-rentrates,pleaseseethebackpageofthecurrentyear’ssupplementalbenefitselectionform,orconsultwithyourregionalhumanresourcesoffice.

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paYment oF BeneFits

Theamountthatwillbepaidtoyourbeneficiaryintheeventofyourdeathisthemostrecenteffectivelevelofsupplementalinsurance.Employeesage65orolderarelimitedto$25,000ofsupplementalcoverage.

Ifyoudiewhilecoveredbytheplan,benefitswillbepaidbychecktothebeneficiaryyounameandsentdirectlytothatbeneficiary.

Torequestpaymentofbenefits,thebeneficiaryshouldcontactyourregionalhumanresourcesofficeforaclaimformandinformationaboutotherrequireddocuments.Claimsshouldbereturnedtothatofficeforfinalcompletionandprocessing.

termination

YourSupplementalLifeInsuranceceasesonthedatethatyouterminateeligibleemploymentwiththeUniversity.ConversionorPortabilitytoanindividualpolicyisavailable;seethePortabilityorConversionPrivilegeinformationbelow.

disaBilitY Waiver oF premium

Ifanemployeebecomestotallydisabledwhileinsuredandbeforereachingage60,coveragewillremainineffectwithoutfurtherpremiumpaymentaslongasthedisabilitycontinuesoruntilage65,whicheverissooner.

Proofofyourinabilitytoworkbecauseoftotaldisabilitymustbefurnishedannually.Ifdisabledpriortoage60,in-surancewillcontinueaslongasyouaredisabled,butnotpastage65.Theamountofcontinuedprotectionissubjecttoanyplanchangesandtoreductionsshownintheinsuranceschedule.Waiverofpremiumbeginswhenyoucom-pletethewaitingperiod.Waitingperiodmeansthe180consecutivedayperiodbeginningonthedateyoubecometotallydisabled.Premiumpaymentmustcontinueuntilthelaterofthedateyoucompleteyourwaitingperiod,orthedateweapproveyourclaimforwaiverofpremium.

Applicationforthewaiverofpremiumshouldbemadewithinthe90-daywaitingperiodpriortothecommencementofLong-TermDisabilitybenefits,butnolaterthansixmonthsafteryoubecomedisabled.

portaBilitY or Conversion privileGe

YoumayarrangewithTheStandardtocontinueyoursupplementallifeinsuranceprotectionunderanindividualpolicy,withoutmedicalexamination,ifyouapplyforitwithin31daysafterthedateyourgroupinsuranceceases.

BecausetheGroupLifeInsurancewillbepayablefordeathoccurringduringthe31daysafterthedateyourinsur-anceceases,theindividualpolicywillnotbecomeeffectiveuntilafterthe31-dayperiodhasexpired.Withcon-version,theindividuallifeinsurancebenefitswillbeconvertedtoaWholeLifepolicy.Portabilityallowsyoutocontinuethesamegrouptermsupplementallifeinsuranceyouhadasanactiveemployee.

FormoreinformationandtorequestanapplicationforPortabilityorConversion,contacttheStandardat(800)378-4668,ext.6785within31daysofemploymentterminationorlossofeligibility.Applicationsshouldbesentto:

The Standard Insurance CompanyAttn:ContinuedBenefits

920SW6thAvePortland,OR97204

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ACCIDENTAL DEATH AND DISMEMBERMENT

introduCtion

Thissupplementalplanprovidesfinancialbenefitsforlossoflife,limbs,oreyesasaresultofbodilyinjuryinanaccident.

eliGiBilitY

Allregularfull-timeandregularpart-timeemployeesandtheirdependentsareeligibleforthisplan.Employeesbe-comeeligibleforenrollmentintheplanontheirdateofhireintoaneligibleposition.Employeedependentsbecomeeligibleforcoverageifandwhentheemployeeenrollsforfamilycoverageintheplan.

enrollment

Toenroll,completetheoptionalbenefitselectionformandreturnittoyourregionalhumanresourcesoffice.Yourcoveragewillbeginthefirstdayofthepayperiodfollowingyourpayrolldeductionforthiscoverage.Youmayenrollwithin30daysofthedateyouarehired,duringopenenrollment,orfollowingamajorlifeevent.

Costs

Currentratesmaybeobtainedatyourregionalhumanresourcesoffice.

BeneFits

Thefullbenefitamountforyou,theemployee,is$100,000.

If,whileyouarecoveredunderthisplan,youshoulddiewithinoneyearoftheaccident,thefullbenefitwillbepaidtothebeneficiaryyouhavedesignated.

Ifyoushouldhaveanyofthefollowinglosseswithinoneyearoftheaccident,benefitswillbepaidasfollows:

• Lossofbotheyes,feet,orhandsoranycombinationthereof:fullbenefitamount• Lossofoneeye,foot,orhand:one-halfofbenefitamount• Lossofthumbandindexfingerofsamehand:one-fourthofbenefitamount

Ifyouenrollforfamilycoverage,thebenefitamountfordependentsisbasedonthecompositionofthefamilyatthetimeoftheloss.Theactualamountthatwillbepaidisapercentageoftheamountthatyouwouldbepaidifyousustainedthesameloss:

• Ifyouhaveaspousebutnodependentchildren,yourspousewillbecoveredfor50%ofthefullbenefit.• Ifyouhavedependentchildrenbutnospouse,eachchildwillbecoveredfor15%ofthefullbenefit.• Ifyouhavebothaspouseanddependentchildren,yourspousewillbecoveredfor40%andeachchildfor10%

ofthefullbenefit.

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BeneFiCiaries

EmployeeAccidentalDeathbenefitswillbepaidtothebeneficiarytheyhaveselected.Ifyouwishtochangeyourbeneficiary,completeanewbeneficiaryformandreturnittoyourregionalhumanresourcesoffice.EmployeeAc-cidentalDismembermentbenefitsanddependentAD&Dbenefitswillbepaidtotheemployee.

ad&d eXClusions

Benefitswillnotbepaidifthelossresultsdirectlyorindirectlyfromanyofthefollowing:

• Waroractofwar;warmeansdeclaredorundeclaredwar,whethercivilorinternational,andanysubstantialarmedconflictbetweenorganizedforcesofamilitarynature

• Suicide,attemptedsuicideorotherintentionallyself-inflictedinjury,whilesaneorinsane• Committingorattemptingtocommitanassaultorfelony,oractivelyparticipatinginaviolentdisorderorriot;

activelyparticipatingdoesnotincludebeingatthesceneofaviolentdisorderorriotwhileperformingofficialduties.

• Thevoluntaryuseorconsumptionofanypoison,chemicalcompound,alcoholordrug,unlessusedorcon-sumedaccordingtothedirectionsofaphysician

• Sicknessorpregnancyexistingatthetimeoftheaccidentorexposure• Heartattackorstroke• Medicalorsurgicaltreatmentordiagnosticprocedureforanyoftheabove.

Claims

Torequestpaymentofbenefits,youoryourrepresentativeshouldcontactyourregionalhumanresourcesofficeforclaimformsandinformationaboutotherrequireddocuments.Claimsshouldbereturnedtothatofficeforprocessing.

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RETIREMENT PLANS AND OPTIONS

introduCtion

ThereareseveralretirementprogramsavailabletoUniversityofAlaskaemployees.Theyarethe:

• UniversityofAlaskaOptionalRetirementPlan(ORP)• UniversityofAlaskaPensionPlan• StateofAlaskaPublicEmployees’RetirementSystem(PERS)• StateofAlaskaTeachers’RetirementSystem(TRS)• Tax-DeferredAnnuityProgram(TDA)• SocialSecurity

Eachoftheaboveplanshaslimitationsastowhichemployeesareeligibletoparticipate.Theplansaredescribedinsummaryonthefollowingpages.Formoredetailedinformation,pleaseconsultthespecificplan’shandbookorplandocument.

soCial seCuritY

TheUniversityofAlaskawithdrewfromthefederalSocialSecuritysystemonJanuary1,1982,afteruniversityem-ployeesvotedtodiscontinueparticipationintheprogram.Consequently,universityemployeesdonotearnquarterstowardaSocialSecuritybenefitduringtheiremploymentwiththeuniversity.

PensionincomebasedonearningsfromajobnotcoveredbySocialSecuritycanreducefutureSocialSecuritybenefitswhenyouretireorbecomedisabled.UndertheSocialSecuritylaw,therearetwowaysyourSocialSecuritybenefitamountmaybeaffected.

• UndertheWindfall Elimination Provision,yourSocialSecurityretirementordisabilitybenefitisfiguredusingamodifiedformulawhenyouarealsoentitledtoapensionfromajobwhereyoudidnotpaySocialSecuritytax.Thisprovisionreduces,butdoesnottotallyeliminate,yourSocialSecuritybenefit.

• TheGovernment Pension Offset ProvisionoffsetsanySocialSecurityspouseorwidow(er)benefittowhichyoubecomeentitledbytwo-thirdsoftheamountofyourpension.Evenifyourpensionishighenoughtototallyoffsetyourspouseorwidow(er)benefit,youarestilleligibleforMedicareatage65.

SocialSecuritypublicationsandadditionalinformation,includinginformationaboutexceptionstoeachprovision,areavailableatwww.socialsecurity.gov.Youmayalsocalltollfree(800)772-1213,orforthedeaforhardofhear-ing,calltheTTYnumber(800)325-0778,orcontactyourlocalSocialSecurityoffice.

EffectiveApril1,1986,federallawrequiresthatallemployeeshiredafterMarch31,1986,participateintheMedi-careportionoftheSocialSecurityprogram.TheMedicareportionoftheSocialSecuritycontributionis1.45%ofgrosswagesinacalendaryear.

EffectiveJuly1,1991,alltemporarystaffemployeesarerequiredbyfederallawtoparticipatefullyinbothMedi-careandSocialSecurity.Thecontributionforbothportionsis7.65%ofsubjectgrosswages.Ifyouhaveanyques-tionsregardingyourparticipationineitherplan,contactyourregionalhumanresourcesoffice.

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UNIVERSITY OF ALASKA OPTIONAL RETIREMENT PLAN

EligibleUniversityofAlaskaemployeesmustmakeanirrevocableelectiontoparticipateineithertheOptionalRetirementPlan(ORP)ortheappropriatestateretirementsystem(TRSorPERS)within30daysfromnotificationofeligibility.YourchoicetoparticipateornottoparticipateisirrevocableforthedurationofyourcurrentemploymentorfutureemploymentwiththeUniversityofAlaskaoraslongasyouremaininaparticipatingposition.PleaseseetheUniversityofAlaskaRetirementPlanDecisionGuideformoredetailedinformationaboutthisprogramandadescriptionofthetiers.

eliGiBilitY

EffectiveJuly1,2006,allnewlyhiredbenefit-eligibleemployeesareeligibletoparticipateintheORPTier3.EmployeesfirsthiredbeforeJuly1,2006hadtobeafacultymember,officerorsenioradministratortoparticipateineitherTier1orTier2oftheORP.

ContriButions

ContributionsmadebyyouandbytheUniversityonyourbehalfwillbeinvestedinanaccountinyournameandwiththefundsponsor(s)youselectfromthelistbelow.TheamountofthecontributiondependsonwhichTieroftheplanyouareparticipatingin,basedonyourinitialdateofhireinaneligibleposition.

vestinG

TheOptionalRetirementPlanTier3providesforfullvestingoftheemployercontributionaccountafterthreeyearsofemployment.TheTier3employeecontributionaccountisalways100%vestedwiththeemployee.EmployeesparticipatingintheORPTier1orTier2areimmediately100%vestedinboththeemployerandemployeeaccounts.

Your investment deCision

Youmustchooseaninvestmentcompanyforallyouremployeeandemployercontributions(canbethesamefundsponsor,oradifferentoneforeachtypeofcontribution)fromthesefourinvestmentfundsponsors:

Company Phone Number

FidelityInvestments (800)343-0860LincolnNational (800)348-1212 TollFreeinAlaska (800)478-6393 inFairbanks 452-6393


TIAA-CREF (800)842-2776VALIC (866)350-8302 inAnchorage 279-8302 inFairbanks 451-0511

Theplanallowsyoutochangeyourinvestmentelectionswithinorbetweenfundsponsorsatanytime.

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Forms oF paYment

Afteranofficialterminationofallemploymentanda45-daywaitingperiod,youmaychooseoneofthefollowingoptions for your ORP account:

• Transferyouraccounttoanotherqualifiedplan• RollyouraccounttoanIRA• Receivepaymentofyouraccountbalancethroughanannuitycontractpurchasedfromthefundsponsor• Receivealump-sumdistribution,subjecttoanyapplicableearlywithdrawalpenaltiesandtaxes

Please Note:Loansorhardshipdistributionsarenotpermittedunderthisplan.Alldistributionsrequireemployerauthorization.

IfthereisanyconflictbetweeninformationintheRetirementPlandocumentandthishandbook,theRetirementPlandocumentwillprevail.

Your CHoiCes oF investment options

TheORPconsistsoftwoaccounts:oneforcontributionsmadebyyou(themandatory403(b)account),andoneforcontributionsmadebytheUniversityonyourbehalf(the401(a)employer-fundedaccount).Onlyoneoftheoptionslistedbelowcanbeselectedforeachaccountatanyonetime,yetchangescouldbemadeeachpayperiod.Youcanusethesamefundsponsorforbothaccounts,ordifferentfundsponsors.Youmayalsotransferaccountbalancesbetweenthefundsponsorsasallowedbyyourfundsponsor.Pleasebeawarethatsomeoftheaccountsthatfundsponsorsofferdohaverestrictions,penaltiesforearlywithdrawalandchargesformakingtransfers.

FidelitY investments

FidelityInvestmentsappliesmorethan50yearsofinvestmentexperience,innovationandprofessionalismtohelpmeettheneedsofitsclients.Onceknownprimarilyasamutualfundcompany,Fidelityhasadaptedandevolvedovertheyearstomeetthechangingneedsofitscustomers.InvestingwithFidelityInvestmentswillgiveyouabroadrangeofover100investmentoptions.Youcanchoosefromrelativelyconservativemoneymarketfundstoaggres-siveinternationalequityfunds.FidelityalsooffersafixedannuitywhichisunderwrittenbyMetropolitanLife.Atwww.fidelity.com/atworkyouwillfindanextensivearrayofretirementplanningtools,calculators,videosandotherretirementplanningresources.

linColn national

LincolnNationalLifeInsuranceCompany,amemberoftheLincolnFinancialGroup,wasfoundedin1905.LincolnNationalhasbeenselectedbyoverhalfamillionindividuals,withapproximatelyhalfoftheseemployedbyanedu-cationalorganization.Lincoln’svariableannuitybusinessisthesixthlargestinthenation,asmeasuredbyassetsasofJune30,2005.Withanemphasisoncustomerservice,LincolnNationalclientscanaccesstheiraccountsonline,throughLincoln’sautomatedtelephonenetwork,orbycontactingaLincolnretirementrepresentativewithofficesinFairbanksandAnchorage.Lincolnoffersawidevarietyofinvestmentoptionsandbringsyouthechoicesandflex-ibilitynecessarytohelpyoumeetyourretirementgoals.

tiaa-CreF

TIAA-CREFisthenationwide,non-profitorganizationservingtheeducationandresearchcommunities.Foundedin1918,TIAA-CREFmanagesmorethan$350billioninassets,providingretirementservicestooverthreemillionparticipantsat15,000institutions.TIAA-CREFoffersyouachoiceoftenaccountsinfourdifferentassetclasses.TheTIAATraditionalAnnuityisaguaranteedaccountwiththetopratingsfromthenation’sleadinginsurancerating

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agencies.TheTIAA-CREFvariableaccounts,withbroadlydiversifiedportfolios,offerparticipantstheopportunitytodiversifytheirretirementsavingsinequities,fixed-incomeandrealestateinvestments.ExpensesfortheTIAA-CREFaccountsareamongthelowestintheinsuranceandmutualfundindustries.

valiC

VALICstrivestopositivelyanddramaticallyimpactourclients’andtheirfamilies’financialfutures.Asbothanindustrypioneerandcurrentleaderoverthepasthalf-century,wespecializeinprovidingretirementprogramsandrelatedinvestment,recordkeepingandadministrativeservicestotwomillionemployeesofmorethan28,000em-ployersintheeducation,healthcareandgovernmentsectors.Ournationalnetworkofexperienced,trustedfinancialadvisorsincludefull-timeadvisorsinAnchorageandFairbanks.Theirmissionistohelpclientsplanfortheirfuturebyofferingobjectiveandexpertadviceandachoicefromavastarrayofproductsandservices.Valicisthemarket-ingnameforthegroupofcompaniescomprisingVALICFinancialAdvisors,Inc.,VALICRetirementServicesCom-pany,andtheVariableAnnuityLifeInsuranceCompany(VALIC),eachofwhichisamembercompanyofAmericanInternationalGroup,Inc.

deFault investment

TheUniversitywilldirectcontributionsforbothORPaccountstotheFidelityInvestmentsdefaultaccountuntilyouhaveselectedaninvestmentoption.ThedefaultinvestmentisoneoftheFidelityFreedomFunds,amixofequityandincomeinvestmentsbasedonyourprojectedretirementdate.

CHoosinG a Fund sponsor

Thevarietyofinvestmentopportunitiesprovidesconsiderableflexibilityindesigningaretirementinvestmentpro-gramthatfitsyourpersonalfinancialsituation.Youmightconsiderafewthingswhenmakingyourdecision:

• Yourfamilycircumstances• Thebalanceofriskandreturnyouarecomfortablewith• Youranticipatedincomeneedsatretirement• Yourfinancialobjectives• Yourabilitytosaveoutsidethepensionplan• Thenumberofyearstoretirement

IfyouhavequestionsabouttheUniversity’splan,contactyourregionalhumanresourcesoffice.

distriButions

VestedORPaccountbalancescanbedistributedafteranofficialterminationofallemploymentfromtheUniver-sity;however,distributionsaresubjecttoa45-daywaitingperiod.TerminationofemploymentmeansthatforanextendedperiodoftimeyouhavenotreceivedanywagesorsalaryfromtheUniversity(transferringintoapositionorstatusthatisnotbenefiteligibleisnotatermination).Theexceptiontothisruleisemployeeswhohavereachednormalretirementage(60)andhavetransferredtoanon-participatingposition.

TorolloveryouraccounttoanIndividualRetirementAccountoranotherqualifiedplan,beginanannuitypaymentorrequestalump-sumdistribution,contactyourfundsponsorfortheappropriateforms.Alldistributionsrequireemployerauthorization.

IfthereisanyconflictbetweeninformationintheRetirementProgramplandocumentandthisHandbook,theRe-tirementProgramplandocumentwillprevail.

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UNIVERSITY OF ALASKA PENSION PLAN

OnJanuary1,1982,inconjunctionwiththeUniversity’swithdrawalfromthefederalSocialSecuritysystem,asupplementalretirementplanwasadoptedforUniversityemployeescalledtheUniversityofAlaskaPensionPlan.ItdoesnotattempttoduplicatebenefitsavailableunderSocialSecurity.ThePensionPlanisaUniversity-sponsored401(a)plan.TheUniversitycontributestothisprogramonbehalfofeligibleregularfull-timeandpart-timefacultyandstaff.Employeesarenoteligibletomakesupplementalcontributionsintothisplan.

eliGiBilitY

Regularfull-timeandpart-timefacultyandstaffhiredpriortoJuly1,2006areeligibleforthePensionPlan.EmployeesfirsthiredonorafterJuly1,2006mustelecttheOptionalRetirementPlantoparticipateinthePensionPlan.

ContriBution rate

TheUniversitycontributesanamountequalto7.65%ofanemployee’swages,uptoanannualwagebaseof$42,000,totheemployee’sPensionPlanaccount.

vestinG and distriButions

EmployeesfirsthiredandparticipatingintheplanbeforeJuly1,2006are100%vestedfromthedateofhire.Partici-pantsfirsthiredonorafterJuly1,2006aresubjecttoavestingperiodofthreeyearsfromdateofhireinaneligibleposition.

VestedaccountbalancesareavailablefordistributionafterterminationofallemploymentfromtheUniversity(sub-jecttoa45-daywaitingperiod).Theexceptiontothisruleisemployeeswhohavereachednormalretirementage(60)andhavetransferredtoanon-participatingposition.Pleasenotethathardshipdistributionsorloansagainstthisaccountarenotallowed.

investment options

TheUniversity’sPensionPlanprovidesemployeesinvestmentflexibilityandbroadinvestmentopportunities.Youshouldreceiveastatementonaquarterlybasisfromthecompanyyouselecttomanageyourpensionplanaccount.Itiscriticalthatyouthoroughlyreviewyourquarterlystatementandnotifythecompanyand/ortheUniversityofanyerrors.

Theplanoffersemployeesfourinvestmentcompany(orFundSponsor)options:


FidelityInvestments (800)343-0860LincolnNational (800)348-1212 TollFreeinAlaska (800)478-6393 inFairbanks 452-6393


TIAA-CREF (800)842-2776VALIC (866)350-8302 inAnchorage 279-8302 inFairbanks 451-0511

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STATE RETIREMENT PLANS

ThroughtheUniversity’saffiliationwiththeStateofAlaska,regularemployeesareeligibletoparticipateineithertheTeachers’RetirementSystem(TRS)orthePublicEmployees’RetirementSystem(PERS).

eliGiBilitY

trs

Ifyouareanactiveregularemployeeoccupyingaregularpositionthatrequiresacademicstandingand/orteaching,youareeligibletoparticipateinTRSontheeffectivedateofhireorthefirstdayofemploymentunlessanelectionismadewithin30daystoparticipateintheOptionalRetirementPlan.

pers

Allregularfull-timeandpart-timeexemptornon-exemptstaffmembersareeligibleforPERSonthefirstdayofemployment.EmployeesfirsthiredbeforeJuly1,2006identifiedasExecutiveStaff,andalleligiblestaffmembershiredonorafterJuly1,2006,maychoosebetweenPERSandORP.

ContriBution rate

CostsoftheplanaresharedbytheemployeeandtheUniversity.TheamountofthecontributiondependsonwhetheryouareaparticipantofTRSorPERS,andyourdateofhire.

trs

EmployeesparticipatingintheTRSdefinedcontributionplanhiredonorafterJuly1,2006contribute8%ofsalarythroughabi-weeklypre-taxpayrolldeduction.ThedefinedcontributionplanisreferredtoasTRSTierIII.

EmployeesinTRShiredbeforeJuly1,2006contribute8.65%oftheirsalarythroughabi-weeklypayrolldeductiontotheTRSdefinedbenefitplanknownasTRSTierIorTierII.

ForallTRStiers,theUniversitycontributesanadditionalpercentageofsalaryasdeterminedannuallybytheTRSprogram.

pers

EmployeesparticipatinginthePERSdefinedcontributionplanhiredonorafterJuly1,2006contribute8%ofsalarythroughabi-weeklypre-taxpayrolldeduction.ThedefinedcontributionplanisreferredtoasPERSTierIV.

EmployeesinPERShiredbeforeJuly1,2006contribute6.75%oftheirsalary(7.5%forPeaceOfficersandFire-fighters)throughabi-weeklypre-taxpayrolldeductiontothePERSdefinedbenefitprogramunderPERSTiersI,IIor III.

ForallPERStiers,theUniversitycontributesanadditionalpercentageofsalaryasdeterminedannuallybythePERSretirementprogram.

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vestinG

BothTRSandPERScontainvestingfeaturesthatgiveyoutherighttoyouraccountbalanceorretirementbenefitsafteraspecifiedperiodoftime.Definedbenefitplanmembersaccruemembershipservicethat,whenvested,givesyoutherighttofutureretirementbenefitsregardlessofcontinuedemploymentwiththeUniversity.PleaserefertoyourPERSorTRShandbookformoredetailedinformationonvesting.

BeneFits

deFined ContriBution plan memBers

Withadefinedcontributionplan,youandtheuniversitymakebi-weeklycontributionstoaccountssetupforyoubytheStateofAlaskaDivisionofRetirementandBenefits.Contributionsandinvestmentearnings(andlosses)accu-mulateinyouraccountandthebenefitpayableatretirementdependsonthevalueofyouraccount.

deFined BeneFits memBers

TheamountofyourmonthlyretirementincomeisdeterminedbyyourlengthofserviceattheUniversity,aswellasanyadditionalcreditedservice,andyouraveragemonthlycompensation(usuallyyourthreehighestyears’salary;PERSyearsmustbeconsecutive,highestfiveconsecutiveyearsforPERSemployeesfirsthiredbetweenJuly1,1996andJune30,2006).Benefitsmayalsobepaidintheeventofapermanentdisabilityorintheeventofyourdeath.PleaserefertoyourPERSorTRShandbookformoredetailedinformation.

termination

IntheeventofyourterminationofemploymentwiththeUniversity,youremployeecontributionstoeitherTRSorPERSmayberefundedtoyou;employercontributionsarenon-refundable.Ifyouhavequestionregardingvestingand/orbenefitsavailableuponyourtermination,pleasecontactyourregionalhumanresourcesoffice.

additional inFormation

ThissummaryhighlightsonlykeyfeaturesoftheTRSandPERSplans.Formorespecificinformation,pleaserefertotheTRSorPERShandbook.Whereanyinconsistencyexistsbetweenthisdescriptionandtheofficialdocuments,therulesandregulationsofPERSandTRSwilltakeprecedence.AlloftheprovisionsoftheplansareexplainedinmoredetailinthePERSandTRShandbooks.ThehandbooksareavailablefromtheStateofAlaskaDivisionofRe-tirementandBenefits,P.O.Box110203,Juneau,AK99811-0203,or550West7thAvenue,Suite540,Anchorage,AK99501-3555.Youcanalsoaccessthehandbooks,formsandmoreinformationon-lineatthefollowingaddress:

http://doa.alaska.gov/drb/

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TAX-DEFERRED ANNUITY (TDA) PLANS

Tax-deferredannuityplans(TDAs)aredesignedtoofferyoutheopportunitytomaketax-deferredcontributionstosupplementyourretirementincome.Theseplansareavailableonlytoemployeesofnonprofitandgovernmentalorganizations.

AllUniversityofAlaskaemployeeshavetheopportunitytoinvestinavarietyoftax-deferredannuityor403(b)plans.Eachoftheseplanshasspecificadvantagesforretirementsecurity.WhencombinedwiththeUniversity’soth-erretirementprograms,theyenhanceyourabilitytoprovideasolidfinancialfoundationforyourretirementyears.

Tax-deferredannuitiesareavailablewithavarietyofcompaniesthroughtheUniversityofAlaska.Contactyourregionalhumanresourcesofficeforanupdatedlist,orvisitthebenefitswebsiteatwww.alaska.edu/benefits.

disClaimer oF responsiBilitY

Asabenefittoitsemployees,theUniversityofAlaskaallowsparticipationinvariousTDAplans.Anumberofthetax-deferredannuities(InternalRevenueCodeSection403(b)plans)areavailablethroughvariousproviderswhoareregisteredwiththeUniversity.Registrationmerelyindicatesthattheannuityorfundproviderhasagreedtoprovidetax-deferredannuitiestouniversityemployeesandhasdemonstratedthatanumberofemployeeshaveaninterestinparticipatingintheirplan.Registrationdoesnotmeanthattheproviderhasmetanyspecificstandardofqualityorreliability.

Important:Theparticipantissolelyresponsibleforpersonalincometaxconsequencesassociatedwiththepartici-pationintax-deferredannuityarrangements.IRSrequirementsrelatedto403(b)planscanbeextremelycomplex.WhilerecenttaxlawchangeshavemadecontributingtoaTDAeasierformanyemployees,theparticipantisurgedtoseekappropriateincometaxadvicepriortocontributingtoaTDAplan.

eliGiBilitY

AllemployeesoftheUniversityofAlaskaareeligibletoparticipateinthetax-deferredannuityplans.Participationis voluntary.

enrollment

Toenrollinthisprogram,youneedtocompleteanenrollmentformorapplicationwiththeappropriatecompanyaswellasaSalaryReductionAgreementform(availablefromyourregionalhumanresourcesofficeoronthewebatwww.alaska.edu/benefits).Throughthisagreement,youauthorizetheUniversityofAlaskatoreduceyoursalarybyadesignatedamountanddirectthisportionofyoursalarytoatax-deferredannuity.

ContriButions

Youdecidetheamountofyourbi-weeklypayrollreductionandhowthefundswillbeinvested.TheamountyoumayinvestislimitedbytheInternalRevenueCode.Employeesareresponsiblefordeterminingiftheircontributionsarewithintheprovisionsofthelaw.Fordetails,refertoIRSPublication571.

Ineffect,yourtotalyearlycontributionstotheTDAaccountreduceyourgrossannualsalarybythatamount.You

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payfederalincometaxonlyonyourreducedannualsalary.Contributionsandearningswillbetaxedupontheirwithdrawal.

IftheUniversitydeterminesthatyouhaveexceededthemaximumallowablecontributionlimits,theUniversitywilltakecorrectiveaction.

paYment oF BeneFits

Tax-deferredannuitiescanbeusedforavarietyofpurposes.Theyareprimarilyusedforretirementbecauseoftheimmediatetaxreductionstoyourincome.SomeTDAprogramsallowyoutoborrowagainstthevalueofyourac-count;checkwithyourTDAprovidertoseeifloansareaprovisionoftheir403(b)program.

Manydifferentpayoutoptionsareofferedatretirement,includingsinglelifeandsurvivorannuities;fundscanbedistributedasalifetimeannuity,anannuityoverafixedperiodofyears,apartialortotallump-sumpaymentwith-drawnatonetime,orotheroptions.ContactyourTDAproviderfortheoptionsofferedundertheirprogram.

IfyourdeathshouldoccurbeforeTDAretirementbenefitsbegin,avarietyofoptionsaregenerallyavailabletoben-eficiariesforthepaymentofdeathbenefits.

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OTHER BENEFITS

introduCtion

ThissectionsummarizesUniversitypoliciessuchasleavesandeducationalbenefitsthatdirectlyaffectregularnon-unionemployees.Youareencouragedtocontactyourregionalhumanresourcesofficeforanyfurtherpolicyinformationyoumayneed.

eduCational BeneFits

Allregularfull-timeandpart-timeemployeesmaytakeuptosixcredithoursofUniversitycoursecreditspersemes-ter,withnotuitionfee,toamaximumof12credithourspercalendaryear.Youmaytakeupto3credithoursduringworkinghours,withoutbeingrequiredtomakeupthetime,ifthecoursewillenhancejob-relatedskillsorknowl-edge;approvalmustbegrantedbyyoursupervisorandtheappropriateformscompleted.

Inaddition,youmayhavecoursechargeswaivedforuptothreenon-creditcoursesfromaUA-approvedlistpersemester,withpriorapprovalfromyoursupervisor.Thesenon-creditcoursesaredesignedtoenhancejob-relatedskillsandworkperformance.

Coursechargesmaybewaivedforamaximumof12credithoursandsixnon-creditcoursesperacademicyear,be-ginningwiththefallsemesterandendingwiththesummerterm.Coursefeesotherthantuition,suchaslab,supplyortechnologyfees,studentactivityorhealthcenterfees,andbooks,etc.,arenotcoveredbythetuitionwaiverandarethestudent’sresponsibility.

Yourspouseanddependentchildrenthroughage23maytakeUniversitycoursecreditswithoutlimitationoratu-itionfee(self-supportcoursesexcluded).

Ifthecoursestakenbyeitheranemployee,spouse,ordependentareconsideredgraduatelevelcourses,thevalueoftheseclasseswillbeaddedtotheemployee’sgrossincomeandtaxedasifitwereregularearnings.However,iftheemployeeistakinggraduate-levelcoursesthatarearequirementoftheirposition,thosecoursesmaynotbesubjecttotaxation.

HolidaYs

TheUniversityobservestwelveholidayseachyear.TheseincludeNewYear’sDay,MartinLutherKing,Jr.DayinCelebrationofAlaskaCivilRights(thethirdMondayinJanuary),adayduringspringrecess,MemorialDay,Inde-pendenceDay,LaborDay,ThanksgivingDayandthefollowingFriday,andChristmasDay.Threeadditionaldays,eitherthedaybeforeorafterNewYear’s,July4,andChristmas,arealsoobservedasholidays.Eachmemberoftheclassifiedstaffmayalsoselectapersonalholiday,whichmustbeapprovedbytheimmediatesupervisor.PersonalholidaycannotbeusedduringthepayperiodinwhichJuly1falls.

AlistofholidaysandthedatesonwhichtheyareobservedisissuedbythePresident’sOffice.Generally,holidaysfallingonaSaturdayareobservedontheprecedingFriday,whilethosefallingonaSundayarecelebratedonthefollowingMonday.

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annual leave

Universityemployees(non-faculty)earnannualleaveonabi-weeklybasis.Theamountearneddependsonthenumberofyearsemployed.Regularfull-time,regularpart-time,andextendedtemporaryemployeeswhoworkatleast20hoursaweekareentitledtoearnannualleave.Regularpart-timeemployeesareeligibletoearnanamountofleavebasedonthepercentageoffull-timehourstheyworkperweek.Yourimmediatesupervisormustapproveallannualleavetaken.Annualleavemustbetakenwhileanemployeeisoncontract.Facultydonotaccrueannualleave

Annualleaveforfull-timeemployeesisaccruedasfollows:

• 5.54hoursperpayperiodduringthefirst5yearsofemployment• 6.46hoursperpayperiodduringyears6through10• 7.38hoursperpayperiodafter10yearsofemployment

Unusedannualleavemaybeaccruedtoamaximumof240hours.AnyunusedleaveinexcessofthisamountwillbecanceledattheendofthepayperiodinwhichJanuary31falls.

Ifyoutransferfromapositionthatprovidesannualleavetoonethatdoesnot,orifyouterminatefromtheUniver-sity,youwillbepaidforthebalanceofyourearnedannualleavetimeupto240hours.Ifyoudiewhileemployed,yourbeneficiarywillbepaidforyouraccruedleavetime.

Annualleavecannotbeaccruedduringleavewithoutpay,norcananemployeeaccrueleavewhenrunningoutannualleaveforterminationpurposes.Annualleavecash-outwhileemployedorpay-offatterminationdoesnotgenerateretirementplancontributionsnorcounttowardscalculatingannualsalaryforretirementverification.

siCk leave

TheUniversitygrantspaidsickleavetoallfacultymembers,regularfull-time,regularpart-time,andextendedtemporaryemployeeswhowork20ormorehoursperweekonaregularbasis.Full-timeemployeesaccrue4.62hoursperpayperiod(iftheyareinpaystatusfortheentirepayperiod),whilepart-timeemployeesearnanamountbasedonthepercentageoffulltimehourstheyworkperpayperiod.Youmayusesickleaveforthosehoursyouareregularlyscheduledtowork.Ifyoursickleavebalanceisexhausted,eligiblesickleavehourswillbedeductedfromyourannualleave.Ifallleaveisexhausted,youmaybeeligiblefortheLeaveShareProgramorleavewithoutpay.

Sickleavemaybetakenforavarietyofreasons:

• Illnessormedicalcondition• Anappointmentwithadoctorordentist• Emergencycareformembersofyourimmediatefamily• Childbirth(byyouoryourspouse)ornewbornadoptedchild• Adoptionofaminorifrequiredbytheadoptionprocess• Adeathinthefamily;funeralattendance(maximumoffivedays);additionaltimemaybegrantedbythesuper-

visor/departmentheaduponapprovalofawrittenrequestfromtheemployee

Whenyoumustbeabsent,youmustnotifyyourimmediatesupervisorwithinthefirsthourofthenormallysched-uledworkday(exceptionsmaybemadeinemergencysituations).Anabsenceduetoanillnessmayrequireaphysician’snoteorotherverificationastoyourillness(unlesswaivedbyyoursupervisor).

Formoreinformation,orforextendeduseofsickleave,pleaseseethesectiononFamilyMedicalLeave(FML).

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leave oF aBsenCe WitHout paY

Ifanemployeemustbegonefromworkforanextendedperiodoftime,theUniversitymaygrantaleaveofabsencewithoutpay.Uptoayearofapprovedleavetimemaybegranted.Ifnecessary,theleavemayberenewedforanad-ditional year.

Duringtheleave,annualorsickleavedoesnotaccrue.However,participationinhealth,life,andretirementpro-gramsmaybecontinuediftheemployeepaysthepremium.TheeffectonPERSorTRSretirementservicecreditvaries.Pleasecontactyourregionalhumanresourcesofficeformoreinformationonbenefitcontinuationwhileonaleaveofabsencewithoutpay.

TheUniversitymaygrantleavesofabsenceforavarietyofreasons,andavailablebenefitsmayvarywitheachsetofcircumstances.YourregionalhumanresourcesofficecanexplainhowanextendedleaveofabsencewouldaffectyourownpositionandUniversitybenefits.Ingeneral,applicationmustbemadetocontinuebenefits.

otHer leaves

Leavesofabsencearegrantedforavarietyofreasons,includingmedical,family,andmilitary,aswellasjuryduty.

mediCal leave

Medicalleavemaybegrantedincaseofseriousillness,accident,surgery,orothermedicalconditionascertifiedbyaphysician.Duringamedicalleaveofabsence,youwillberequiredtouseallpaidleavethatyouhaveaccruedbeforebeginningleavewithoutpay.Thispaidleaveincludessickleavebenefitsandannualleave.After90daysofmedicaldisability,youmaybecomeeligibletoreceivelong-termdisabilitybenefits.

FamilY mediCal leave (Fml)

TheUniversity’sbenefitprogramshavetwodistincttypesofsickleaveabsences:absencesforminorillness,inju-ries,andprofessionalappointments;orabsencesforhealthconditionsthatqualifyundertheUniversity’sFamilyandMedicalLeaveprovisions.FamilyandMedicalLeave(FML)willbegrantedinaccordancewithapplicablestateandfederallawwhenanemployeetakesleaveforoneofthefollowingreasons:

• theemployeeisunabletoworkbecauseofaserioushealthcondition• theemployee’sorspouse’shealthisaffectedbypregnancy• childbirth• tocareforachild(withinthefirst12monthsfollowingbirthorplacementthroughadoptionorfostercare)• tocareforaspouseorcertainimmediatefamilymemberswithaserioushealthcondition• aqualifyingexigencywhenacoveredservicememberiscalledtoactiveduty

Uponapprovaloftheemployee’srequestorneedforFML,theemployeewillbegrantedFMLforoneormoreofthefollowing:

• upto18weeks(720hours)ina“rolling”24-monthperiodforaserioushealthconditionunderstatelaw,or• upto18weeks(720hours)ina“rolling”12-monthperiodforpregnancyorchildbirthunderstatelaw,and• upto12weeks(520hours)ina“rolling”12-monthperiodforanyqualifyingreasonunderfederallaw,

The12-and24-monthperiodsarecalculatedbackwardfromthedateofanyFMLAleaveusage.AllFMLtaken,

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eitherpaidorunpaiddependingontheemployee’savailableleavebalances,willbecountedtowardsthelengthofleaveavailableundertheUniversity’sFMLRegulation(R04.06.160).Wheneverpossible,stateandfederalFMLentitlementsarecountedconcurrently.FMLwillnotcontinuebeyondtheexpirationofanemployee’sappointment.

Inadditiontotheabovereasonsforleave,underthefederalFMLA,eligibleemployeesmayalsotakeupto26weeksofunpaidleaveinasingle12-monthperiodtocareforacoveredservicememberwithaseriousinjuryorill-ness.

Anemployeemustgive30days’noticeforscheduledoranticipatedleave,suchasscheduledsurgery,childbirthoradoption.If30days’noticeisnotpossible,theemployeemustgivenoticeassoonasitispracticabletodoso.

TobeeligibleforstateFML,anemployeemusthavebeenemployedwiththeUniversityofAlaskaforatleast35hoursaweekforatleastsixconsecutivemonths,orforatleast171/2hoursaweekfortwelveconsecutivemonthsimmediatelyprecedingtheleave.TobeeligibleforfederalFML,anemployeemusthavebeenemployedwiththeUniversityofAlaskaforatleasttwelvemonthsandhaveworkedatleast1,250hoursduringthe12-monthperiodimmediatelyprecedingthecommencementoftheleave.

Theemployeewillbeaskedtoprovidecertificationoftheserioushealthconditionfromtheirhealthcareprovider.TheemployermayplaceanemployeeonFMLwhenthereiscausetobelieveaserioushealthconditionexists.

IfyouanticipatetheneedforleaveunderFML,pleasecontactyourregionalhumanresourcesofficeformoreinfor-mationandthenecessaryforms.

leave sHare proGram

Aleaveshareprogramhasbeenestablishedtoallowemployeestovoluntarilytransferhoursfromtheirunusedsickleavebalancetothesickleavebalanceofanemployeewithacatastrophicmedicalcrisis.Tobeeligibleforleaveshare,anemployeemustbeeligibleforFML.Theleaveshareprogramislimitedtoamaximumof520hoursina12-monthperiod.

Proceduresforrequestanduseoftheleaveshareprogramareavailablethroughyourregionalhumanresourcesof-fice.

parental leave

Parentalleaveisavailabletoemployeesandwillbegrantedintheorderofsickleavewithpay,accruedannualleaveandsickleavewithoutpay.AllparentalleavewillbegrantedinaccordancewiththeUniversity’sFMLRegulations.Parentalleaveisnoteligiblefortheleaveshareprogram.TheuseofintermittentFMLforparentalleaveissubjecttosupervisory approval.

jurY dutY

InorderthatUniversityemployeesmayfulfilltheircivicresponsibilityasjurorsorsubpoenaedwitnesses,regularemployeesaregrantedleaveofabsencewithpayforthesepurposes.

Itistheresponsibilityoftheemployeetokeepher/hissupervisorordepartmentheadinformedoftheanticipatedtimetobespentawayfromthejobforthispurpose.

AnypayreceivedbyregularemployeesfromacourtsystemmustbepromptlysubmittedbytheemployeetotheUniversitytooffsetpartofthecostofsuchabsences.Temporaryemployeesreceiveleavewithoutpayandmayretainthemoneysfromthecourt.

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militarY leave

AregularemployeewhoisamemberofareservecomponentoftheUnitedStatesArmedForcesisentitledtoaleaveofabsencewithpayforalldaysduringwhichtheemployeeisrequiredtoserveinordertokeepcurrenttheirstatuswiththeNationalGuardorReserveForces.Suchleavesofabsencewithpaymaynotexceed16andone-halfworkingdaysinonecalendaryear.Otherthanfortrainingperiodsdiscussedabove,regularemployeesoftheUni-versityareentitledtoamilitaryleaveofabsencewithoutpaytoserveintheArmedForcesoftheUnitedStatesandshallbeentitledtostatutoryre-employmentbenefitsprovidedforbyfederallaw.

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GLOSSARY OF TERMS

Accidental Injury—Physicalharmcausedbyasuddenandunforeseeneventataspecifictimeandplace.Itisinde-pendentofillness,exceptforinfectionofacutorwound.

Affordable Care Act—ThePatientProtectionandAffordableCareActof2010(PublicLaw111-148)asamendedbytheHealthCareandEducationReconciliationActof2010(PublicLaw111-152).

Allowable Charge—PremeraBlueCrossBlueShieldofAlaskareservestherighttodeterminetheamountallowedforanygivenserviceorsupply.Themeaningofthistermdependsontheprovider:

Providers in Alaska and Washington Who Have Agreements with Premera Blue Cross—Theallowablechargeisthefeethattheproviderhasagreedtoacceptasfullpaymentformedicallynecessarycoveredservicesandsupplies.ThisfeeisdeterminedbyagreementsthatBlueCrosshaswiththeproviders.ProvidersthathavecontractswithBlueCrosswillseekpaymentfromBlueCrosswhentheyfurnishcoveredservicestoyou.Youwillberesponsibleonlyforanyapplicabledeductibles,coinsurance,copayments,chargesinexcessofthestatedbenefitmaximums,andchargesforservicesandsuppliesnotcoveredunderthisprogram.

Yourliabilityforanyapplicabledeductibles,coinsurance,copayments,andamountsappliedtowardbenefitmaximumswillbecalculatedonthebasisoftheallowablecharge.

Providers Outside Alaska and Washington Who Have Agreements with other Blue Cross Blue Shield Licensees—ForcoveredservicesandsuppliesreceivedoutsideAlaskaandWashington,allowablechargesaredeterminedasstatedin“TheBlueCardProgram”sectionofthishandbook.

Providers Who Do Not Have Agreements with Premera Blue Cross or another Blue Cross Blue Shield Li-censee—ForservicesandsuppliesreceivedwithinAlaskaandWashington,theallowablechargeisdeterminedbyestablishingaprofileofbilledcharges,usingstatisticallycreditabledataforaperiodoftwelvemonthsbyexaminingtherangeofchargesforthesameorsimilarservicefromproviderswithineachgeographicalareaforwhichclaimsarereceived.Theallowablewillbenolessthanthe80thpercentileofbilledchargesforthatser-vice.IfBlueCrossisunabletoobtainsufficientdatafromagivengeographicalarea,awidergeographicalareaisused.Ifinclusionofthewidergeographicalareastilldoesnotprovidesufficientdata,theallowablechargewillbesettonolessthantheequivalentofthe80thpercentileornolowerthan250%ofMedicareallowablechargesforthesameservicesorsupplies,whicheverisgreater.

Theallowablechargeforservicesandsuppliesfromthefollowingproviderclasseswillbenolessthanthe80thpercentileofbilledchargesasdeterminedfromaprofilederivedfromthemethodologydescribedabove

• ProfessionalProviders• AmbulatorySurgicalCenters• SkilledNursingFacilities• ExtendedCareFacilities• BirthingCenters• KidneyDialysisCenters• RehabilitationFacilities• OtherSub-acuteFacilities

ServicesfromHospitals(AcuteFacilities):Theallowablechargeisdeterminedbyestablishingaprofileofbilledcharges,usingstatisticallycreditabledataforaperiodoftwelvemonthsbyexaminingtherangeofchargesfor

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thesameorsimilarservicefromfacilitieswithineachgeographicalareaforwhichclaimsarereceived.Theallowablewillbenolessthanthe80thpercentileofbilledchargesforthatservice.IfBlueCrossisunabletoobtainsufficientdatafromagivengeographicalarea,awidergeographicalareaisused.Ifinclusionofthewidergeographicalareastilldoesnotprovidesufficientdata,theallowablechargewillbesettonolessthantheequivalentofthe80thpercentileornolowerthan250%ofMedicareallowablechargesforthesameservicesorsupplies,whicheverisgreater.

For Services and Supplies Received Outside Alaska and Washington theallowablechargeforcoveredser-vices and supplies is the fee schedule established by the local Blue Cross Blue Shield licensee.

Remember,whenyouseekservicesfromprovidersthatdonothaveagreementswithBlueCross,yourli-abilityisforanyamountabovetheallowablecharge,andforanyapplicabledeductibles,copayments,coinsur-ance,amountsinexcessofstatedbenefitmaximums,andchargesfornoncoveredservicesandsupplies.TheseamountswillbereflectedontheExplanationofBenefitsthatBlueCrosssendstoyou.

Ambulatory Surgical Center—Afacilitythatiscertifiedorlicensedasrequiredbythestateinwhichitoperatesandmeetsallofthefollowingrequirements:

• Ithasanorganizedstaffofphysicians.• Ithaspermanentfacilitiesthatareequippedandoperatedprimarilyforthepurposeofperformingsurgicalpro-

cedures.• Itdoesnotprovideinpatientservicesoraccommodations.

Chemical Dependency—Aconditioncharacterizedbyaphysiologicaland/orpsychologicaldependenceonalcoholorastate-regulated,controlledsubstance.Itisfurthercharacterizedbyafrequentorintensepatternofpathologicaluse,tothepointthattheuser:

• Losesself-controlovertheamountandcircumstancesofuse• Developssymptomsoftolerance,orpsychologicaland/orphysiologicalwithdrawalifuseisreducedorstopped• Substantiallyimpairsorendangershisorherhealthorsubstantiallydisruptshisorhersocialoreconomicfunc-

tion

Chemicaldependencyincludesalcoholanddrugpsychoses,andalcoholanddrugdependencesyndromes.

Complication of Pregnancy—Aconditionfallingintooneofthethreecategorieslistedbelowthatrequirescovered,medicallynecessaryservicesinadditiontothoseservicesusuallyprovidedforantepartumcare,normalorcesareandelivery,andpostpartumcare,inordertotreatthecondition:

• Diseasesofthemotherthatarenotcausedbypregnancybutco-existwithandareadverselyaffectedbypreg-nancy

• Maternalconditionscausedbythepregnancythatmakeitstreatmentmoredifficult.Theseconditionsarelim-itedtothefollowing:• Ectopicpregnancy• Hydatidiformmole/molarpregnancy• Incompetentcervixrequiringtreatment• Complicationsofadministrationofanesthesiaorsedationduringlaborordelivery• Obstetricaltraumauterinerupturebeforeonsetorduringlabor• Antepartumorpostpartumhemorrhagerequiringmedical/surgicaltreatment• Placentalconditionsthatrequiresurgicalintervention• Pretermlaborandmonitoring

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• Toxemia• Gestationaldiabetes• Hyperemesisgravidarum• Spontaneousmiscarriageormissedabortion

• Fetalconditionsrequiringinuterosurgicalintervention

Congenital Anomaly—Amarkeddifference,fromthenormalstructureofabodypart,thatisphysicallyevidentatbirth.

Coordination of Benefits—Agrouphealthprogramproceduredesignedtoeliminateduplicatepaymentsforthesameserviceasaresultofaclaimbeingsubmittedtotwodifferentprograms.

Convalescent Nursing Home—Aninstitutionthatprovidesroom,board,andskillednursingcare24hoursadayorunderthesupervisionofaregisteredprofessionalnurse.

Cost Containment—Planmodificationsthatareaimedatholdingdownthecostofthehealthcareprogramorreducingitsrateofincrease.

Cost Sharing—Aplanmodificationwherebyemployeespayaportionofthecostoftheirhealthcareprogram.

Custodial Care—Anyportionofaservice,procedure,orsupplythat,inthejudgmentofBlueCross,isprovidedprimarilyforthefollowingreasons:

• Ongoingmaintenanceoftheenrollee’shealth,andnotfortherapeuticvalueinthetreatmentofanillnessorinjury.

• Toassisttheenrolleeinmeetingtheactivitiesofdailyliving.Examplesarehelpinwalking,bathing,dress-ing,eating,preparationofspecialdiets,andsupervisionoverself-administrationofmedicationnotrequiringconstantattentionoftrainedmedicalpersonnel.

Dental Care Provider—Adentistorotherdentalcareprofessionalnamedinthisplanthatislicensedorcertifiedasrequiredbythestateinwhichtheserviceswerereceivedtoprovideadentalserviceorsupply,andwhodoessowithinthelawfulscopeofthatlicenseorcertification.

Dentally Necessary—Thosecoveredservicesandsuppliesthatadentist,exercisingprudentclinicaljudgment,wouldprovidetoapatientforthepurposeofpreventing,evaluating,diagnosingortreatinganillness,injury,diseaseoritssymptoms,andthatare:

• Inaccordancewithgenerallyacceptedstandardsofdentalpractice• Clinicallyappropriate,intermsoftype,frequency,extent,siteandduration,andconsideredeffectiveforthe

patient’sillness,injuryordisease• Notprimarilyfortheconvenienceofthepatient,dentistorotherdentalcareprovider,andnotmorecostlythan

analternativeserviceorsequenceofservicesatleastaslikelytoproduceequivalenttherapeuticordiagnosticresultsastothediagnosisortreatmentofthatpatient’sillness,injuryordisease

Forthosepurposes,“generallyacceptedstandardsofdentalpractice”meansstandardsthatarebasedonauthoritativedentalorscientificliterature.

Decisionsregardingdentalnecessityarebasedonthecriteriastatedabove.Ifyoudisagreewithadecisionthathasbeenmade,youhavetherighttoadditionalreview.Seethe“WhenYouHaveAnAppeal”sectionofthisHandbook.

Disability—Disabilityoccurswhenyouarepreventedfromengaginginyourcustomaryoccupationbecauseofinju-

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ryordisease,andareperformingnoworkofanykindforpayorprofit,orwhenanyinsureddependentisprevented,becauseofinjuryordisease,fromengaginginsubstantiallyallofthenormalactivitiesofapersonoflikeageandingoodhealth.

Effective Date—Thedateonwhichyourcoverageunderthisprogrambegins.Ifyoureenrollinthisprogramafteralapseincoverage,youreffectivedatewillbethedatethatthecoveragebeginsagain.

Enrollee—Apersonwhoiscoveredunderthisprogramasanemployeeordependent,asdescribedinthe“Eligibil-ity”sectionofthishandbook;alsocalled“you”and“your”inthisbooklet.

Enrollment Date—Fortheemployeeandeligibledependentsenrollingwhenfirsteligible,theenrollmentdateistheemployee’sdateofhireorthedatetheyenteraneligibleclass,whicheverislater.Foradependentwhoenrollsonadateotherthanwhenfirsteligibleforcoverage,theenrollmentdateistheeffectivedateofcoverage.

Expense Incurred—Anexpenseisincurredonthedatethattheserviceisreceivedorthesupplyisordered.

Experimental/Investigational—Anyservice,includingatreatment,procedure,equipment,drug,drugusage,medi-caldevice,orsupplywhich,asdeterminedbyPremeraBlueCrossBlueShieldofAlaska,meetsoneormoreofthefollowingcriteria:

• AdrugordevicewhichcannotbelawfullymarketedwithouttheapprovaloftheUnitedStatesFoodandDrugAdministration,andhasnotbeengrantedsuchapprovalonthedateitisfurnished.

• TheserviceissubjecttooversightbyanInstitutionalReviewBoard.• Reliableevidencedoesnotdemonstrateefficacyoftheservice,nordoesitdefineaspecificrolefortheservice

inclinicalevaluation,managementortreatment.• Theserviceisthesubjectofongoingclinicaltrialstodetermineitsmaximumtolerateddose,toxicity,safetyor

efficacy.• Evaluationofreliableevidenceindicatesthatadditionalresearchisnecessarybeforetheservicecanbeclassi-

fiedasequallyormoreeffectivethanconventionaltherapies.

Reliableevidenceincludes,butisnotlimitedto,reportsandarticlespublishedinauthoritativemedicalandscientificliterature,andassessmentsandcoveragerecommendationspublishedbytheBlueCrossBlueShieldAssociationTechnicalEvaluationCenter(TEC).

Explanation of Benefits (EOB)—Asummarydescriptionofbenefitsreceivedandpaidunderthehealthprogram.

Group—Theentitythatsponsorstheself-fundedhealthplan,inthiscasetheUniversityofAlaska.

Home Medical and Respiratory Equipment/Medical Supplies—Mechanicalequipmentthatcanstandrepeateduseandisusedinconnectionwiththedirecttreatmentofanillnessoraccidentalinjury.Itisofnouseintheabsenceof illness or accidental injury.

Hospital—Afacilitylegallyoperatingasahospitalinthestateinwhichitoperatesandthatmeetsthefollowingrequirements:

• Ithasfacilitiesfortheinpatientdiagnosis,treatment,andacutecareofinjuredandillpersonsbyorunderthesupervision of a staff of physicians.

• Itcontinuouslyprovides24-hournursingservicesbyorunderthesupervisionofregisterednurses.

Innoeventwilla“hospital”beaninstitutionthatisrunmainlyasoneofthefollowing:

• Arest,nursing,orconvalescenthome;residentialtreatmentcenter;orhealthresort

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• Toprovidehospicecareforterminallyillpatients• Forcareoftheelderly• Fortreatmentofchemicaldependencyortuberculosis

Illness—Asickness,disease,medicalcondition,complicationofpregnancy,orpregnancy.

Inpatient—Confinedinamedicalfacilityasanovernightbedpatient.

Medical Emergency—Asuddenonsetofamedicalconditionoraccidentalinjurymanifestingitselfbyacutesymptomsofsufficientseveritythattheabsenceofimmediatemedicalattentionwouldreasonablybeexpectedbyaprudentpersonwhopossessesanaverageknowledgeofhealthandmedicinetoresultinoneofthefollowing:

• Placetheenrollee’slifeinseriousjeopardy• Seriousimpairmenttobodilyfunctions• Seriousandpermanentdysfunctionofanybodilyorganorpart

Medical Facility(alsocalledFacility)—Ahospital,skillednursingfacility,state-approvedchemicaldependencytreatmentfacility,orhospice.

Medically Necessary—Thosecoveredservicesandsuppliesthataphysician,exercisingprudentclinicaljudgment,wouldprovidetoapatientforthepurposeofpreventing,evaluating,diagnosingortreatinganillness,injury,diseaseoritssymptoms,andthatare• Inaccordancewithgenerallyacceptedstandardsofmedicalpractice;• Clinicallyappropriate,intermsoftype,frequency,extent,siteandduration,andconsideredeffectiveforthe

patient’sillness,injuryordisease;and• Notprimarilyfortheconvenienceofthepatient,physician,orotherhealthcareprovider,andnotmorecostly

thananalternativeserviceorsequenceofservicesatleastaslikelytoproduceequivalenttherapeuticordiag-nosticresultsastothediagnosisortreatmentofthatpatient’sillness,injuryordisease.

Forthesepurposes,“generallyacceptedstandardsofmedicalpractice”meansstandardsthatarebasedoncred-iblescientificevidencepublishedinpeerreviewedmedicalliteraturegenerallyrecognizedbytherelevantmedi-calcommunity,physicianspecialtysocietyrecommendationsandtheviewsofphysicianspracticinginrelevantclinical areas and any other relevant factors.

Member—Apersonwhoiscoveredunderthisprogramasanemployeeordependent,asdescribedinthe“Eligibil-ity”sectionofthishandbook;alsocalled“you”and“your”inthisbooklet(alsosee:Enrollee).

Non-Occupational Injury/Disease—A non-occupational injury is an accidental bodily injury that does not arise out of(orinthecourseof)anyworkforpayorprofit,norinanywayresultsfromaninjurythatdoes.

Anon-occupationaldiseaseisadiseasethatdoesnotariseoutof(orinthecourseof)anyworkforpayorprofit,norinanywayresultsfromadiseasewhichdoes.However,ifproofisfurnishedthattheindividualiscoveredunderaworkers’compensationlaworsimilarlaw,butisnotcoveredforthatparticulardiseaseundersuchalaw,thatdiseasewillbeconsiderednon-occupationalregardlessofcause.

Oncology Clinical Trials—Treatmentthatispartofascientificstudyoftherapyorinterventioninthetreatmentofcancerbeingconductedatthephase2orphase3levelinanationalclinicaltrialsponsoredbytheNationalCancerInstituteorinstitutionofsimilarstature,ortrialsconductedbyestablishedresearchinstitutionsfundedorsanctionedbyprivateorpublicsourcesofsimilarstature.AllapprovabletrialsmusthaveInstitutionalReviewBoard(IRB)ap-provalbyaqualifiedIRB.

Theclinicaltrialmustalsobetotreatcancerthatiseitherlife-threateningorseverelyandchronicallydisabling,hasapoorchanceofapositiveoutcomeusingcurrenttreatment,andthetreatmentsubjecttotheclinicaltrialhasshown

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promiseofbeingeffective.

An“oncologyclinicaltrial”doesnotincludeexpensesfor:

• costsfortreatmentthatarenotprimarilyforthecareofthepatient(suchaslabservicesperformedsolelytocol-lectdataforthetrial;

• anydrugordeviceprovidedaspartofaphase1oncologyclinicaltrial;• services,suppliesorpharmaceuticalsthatwouldnotbechargedtothemember,weretherenocoverage;• servicesprovidedinaclinicaltrialthatarefullyfundedbyanothersource.

Thememberforwhombenefitsarerequestedmustbeenrolledinthetrialatthetimeoftreatmentforwhichcover-ageisbeingrequested.You,yourprovider,orthemedicalfacilityshouldaskBlueCrossforabenefitadvisorytodeterminecoverage before you enroll in the clinical trial.

Orthodontia—Thebranchofdentistrythatspecializesinthecorrectionoftootharrangementproblems,includingpoorrelationshipsbetweentheupperandlowerteeth(malocclusion).

Orthotics—Asupportorbraceappliedtoanexistingportionofthebodyforweakorineffectivejointsormuscles,toaid,restore,orimprovefunction.

Outpatient—Treatmentreceivedinasettingotherthanasaninpatientinamedicalfacility.

Period of Convalescent Nursing Home Confinement—Ifyouarere-admittedintoaconvalescentnursinghomeandlessthan90dayshaspassedbetweenconfinements,itisconsideredonestay.

Periods of Hospital Confinement—Ifyouarere-admittedintoahospitalandtherehasnotbeenatleast90daysbetweenconfinements,itisconsideredonestay.

Physician—Astate-licensedDoctorofMedicineandSurgery(M.D.),DoctorofOsteopathyandSurgery(D.O.)oraPodiatrist(D.P.M.).Professionalservicesprovidedbyoneofthefollowingtypesofproviderswillalsobeconsid-eredtobephysicians’servicesforthepurposesofthisprogrambutonlywhentheproviderislicensedtopracticewherethecareisprovided,isprovidingaservicewithinthescopeofthatlicense,isprovidingaserviceorsupplyforwhichbenefitsarespecifiedinthisprogram,andwhenbenefitswouldbepayableiftheserviceswereprovidedbya“Physician”asdefinedabove:

• AdvancedRegisteredNursePractitioner(A.R.N.P.)• CertifiedDirect-EntryMidwife• Chiropractor(D.C.)• ChristianSciencePractitionerauthorizedbytheMotherChurch,theFirstChurchofChrist,Scientist,inBoston,

Massachusetts• Dentist(D.D.S.orD.M.D.)• LicensedClinicalSocialWorker(L.C.S.W.)• LicensedMaritalandFamilyTherapist(L.M.F.T)• LicensedMarriageandFamilyCounselor(L.M.F.C.)• Naturopath(N.D.)• NurseMidwife• OccupationalTherapist(O.T.)• Optometrist(O.D.)• PhysicalTherapist(P.T.)• PhysicianAssistantsupervisedbyacollaboratingM.D.orD.O.

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• PsychologicalAssociate• Psychologist

Physician Assistant—Aprofessionalwhoistrainedtoperformcertainmedicalproceduresandisemployedunderthe supervision of a physician.

Plan (also called “This Plan”)—Theself-fundedhealthplandescribedinthisHandbook.

Plan Year—Theperiodof12consecutivemonthsthatstartseachJuly1at12:01a.m.andendsonthenextJune30atmidnight.

Premera Blue Cross Blue Shield of Alaska—PremeraBlueCrossBlueShieldofAlaskaintheStateofAlaska,andPremeraBlueCrossinWashingtonState.

Prescription Drug—Anymedicalsubstance,includingbiologicalsusedinananticancerchemotherapeuticregimenforamedicallyacceptedindicationorforthetreatmentofpeoplewithHIVorAIDS,thelabelofwhich—undertheFederalFood,Drug,andCosmeticAct,asamended—isrequiredtobearthelegend:“Caution:Federallawprohib-itsdispensingwithoutaprescription.”

Benefitsavailableunderthisprogramwillbeprovidedfor“off-label”use,includingadministration,ofprescrip-tiondrugsfortreatmentofacoveredconditionwhenuseofthedrugisrecognizedaseffectivefortreatmentofsuchconditionbyoneofthefollowingstandardreferencecompendia:

• TheAmericanHospitalFormularyService-DrugInformation;• TheAmericanMedicalAssociationDrugEvaluation;• TheUnitedStatesPharmacopoeia-DrugInformation;or• OtherauthoritativecompendiaasidentifiedfromtimetotimebytheFederalSecretaryofHealthandHuman

ServicesortheInsuranceCommissioner.

Ifnotrecognizedbyoneofthestandardreferencecompendiacitedabove,thenrecognizedbythemajorityofrel-evant,peer-reviewedmedicalliterature(originalmanuscriptsofscientificstudiespublishedinmedicalorscientificjournalsaftercriticalreviewforscientificaccuracy,validity,andreliabilitybyindependentunbiasedexperts),ortheFederalSecretaryofHealthandHumanServices.

“Off-label”usemeanstheprescribeduseofadrugwhichisotherthanthatstatedinitsFDA-approvedlabeling.

BenefitsarenotavailableforanydrugwhentheU.S.FoodandDrugAdministration(FDA)hasdetermineditsusetobecontraindicated,orforexperimentalorinvestigationaldrugsnototherwiseapprovedforanyindicationbytheFDA.

Program, This—Thebenefits,terms,andlimitationssetforthinthecontractbetweenPremeraBlueCrossBlueShieldofAlaskaandtheUniversityofAlaska.

Provider—Aphysicianorotherhealthcareprofessionalorfacilitynamedinthisprogramthatislicensed,regis-tered,orcertifiedtoprovideamedicalserviceorsupplyasrequiredbythestateinwhichtheserviceswerereceived,andwhodoessowithinthelawfulscopeofthatlicense,registration,orcertification.

Psychiatric Condition—Aconditionlistedinthecurrenteditionof“DiagnosticandStatisticalManualofMentalDisorders.”

Required Contributions—Theratesforthebenefitsofferedinthisprogram.

Reasonable and Customary Charge—SeeAllowableCharge.

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Service Area—TheserviceareaforPremeraBlueCrossmeansthestateofAlaskaandthestateofWashington,exceptforClarkCountyWashington.

Skilled Care—Carewhichisorderedbyaphysicianand,inthejudgmentofBlueCross,requiresthemedicalknowledgeandtechnicaltrainingofalicensedregisterednurse.

Skilled Nursing Facility—Amedicalfacilityprovidingservicesthatrequirethedirectionofaphysicianandnursingsupervisedbyaregisterednurse,andthatisapprovedbyMedicareorwouldqualifyforMedicareapprovalifsorequested.

Subscriber—AnenrolledemployeeoftheUniversityofAlaska.Coverageunderthisplanisestablishedinthesubscriber’sname.

Temporomandibular Joint (TMJ) Disorders—TMJdisordersshallincludethosedisorderswhichhaveoneormoreofthefollowingcharacteristics:paininthemusculatureassociatedwiththetemporomandibularjoint,internalderangementsofthetemporomandibularjoint,arthriticproblemswiththetemporomandibularjoint,oranabnormalrangeofmotionorlimitationofmotionofthetemporomandibularjoint.

University—University of Alaska

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