welcome to the colorado christian university annual enrollment meeting! for benefits effective july...

Welcome to the Colorado Christian

UniversityAnnual Enrollment Meeting!

For Benefits Effective July 1, 2013

Welcome

Monday, May 20 through Wednesday, May 29

All insurance changes must be made by close of business on Wednesday, May 29, 2013

Enrollment Information

During Open Enrollment you may elect to:

– Enroll in medical, dental, or vision plans

– Enroll in or change your voluntary life election

– Add qualified dependents

– Drop covered dependents

– Waive coverage

IRS Rules

Per IRS rules, you will be locked into your selection until the next annual enrollment period unless you experience a qualified life event during the plan year.

A qualified life event includes, but is not limited to:

Marriage: Coverage effective 1st of the month following the marriage

Birth: Coverage effective on date of birth

Adoption: Coverage effective on the date of adoption

Loss of coverage: Coverage effective 1st of the month following loss of coverage

• Marriage • Divorce• Birth • Death• Adoption, or placement of a child

in your home for adoption• Change in work hours for you or

your spouse

You have 31 days from the date of the qualified event to make corresponding changes and return a completed change form to Human Resources. If you miss your 31 day window of opportunity, you must wait until the next enrollment period to make changes.

It is your responsibility to notify Human Resources when a change in status has occurred, such as legal separation,

divorce, a dependent child reaches the age limit, etc. Failure to do so could result in the inability to make changes or to

elect COBRA coverage.

What to Expect

• Save yourself hassle of additional coverage form– Verifies whether or not spouse/dependents have

additional coverage– Complete survey now to avoid delays in claim

processing– Only for those with spouse/dependents on plan

• Plan documents available within 60 days of plan start

Your Responsibilities

1. Participate in open enrollment meeting/review enrollment materials

2. Complete an Additional Coverage Survey only if you have a spouse or dependents on the plan

3. Complete an Enrollment/Change Form only if you are making any changesAdded “Employee + Child(ren)” tier – must complete enrollment form to take advantage of these rates

4. Complete a Waiver Form if you are waiving coverage for yourself, and/or qualified dependents for medical & vision, dental, indicate the reason.

5. Return completed enrollment/change/waiver forms to Human Resources no later than Wednesday, May 29, 2013.

Quick Overview

• Rate Increase– Rate shift in market– Starting to see effects of PPACA– Usage of 222 plan: 174% increase in utilization

• New Health Insurance Network– United Health Care Choice Plus Network

• New Third Party Administrator– UMR – replaces CNIC– Owned by United Health Care

Quick Overview

Plan Changes•Plan 222 is now titled “Select Plan”– Continues to be a no-deductible plan

•Plan 622 is now titled “Choice Plan”– Continues at $500/$1,500 deductible– Continues with $2,500/$5,000 out of pocket maximum

•Plan designs will not be identical

• Dental plan will have separate rate structure— Dental is now separate and not attached to medical

IntroductionIMA & UMR

Our New Insurance Broker – IMA

Our IMA Representative: Suzanne Vargas

Our UMR Representative: Donna Truitt

Service Category

Select Plan (No Deductible)

Choice Plan(Deductible)

In-Network Out-of-Network In-Network Out-of-Network

Plan Year Deductible

(Three month deductible carry-forward applies)

None$500 per person

$1,500 max per family

$500 per person


$500 per person


Plan Coinsurance

100% most services

60% 80% 60%

Annual Plan Maximum

$2,000,000 $2,000,000

Plan Year Out-of-Pocket

Coinsurance Maximum

(deductibles and co-pays do not apply)

$2,000 per person


Per Covered Person: $10,000 Individual

$30,000 Family

$2,500 per person


Per Covered Person: $10,000 Individual

$30,000 Family

Medical Plans

Service Category




Physician Office Visit – Primary Care

(includes services incurred during the office visit)

$20 co-pay per visit; then covered 100%

60% after deductible



Physician Office Visit – Specialist





Preventive Care Office Visit and preventivetesting / screenings

Covered 100% 60% after deductible

Covered 100% 60% after deductible

Routine Prenatal and Postpartum Office Visits





Medical Plans

If treatment or surgery is performed during a routine colonoscopy, the medical benefit will apply and the visit will be subject to deductible and coinsurance or co-pay

Service Category




Diagnostic Lab & X-Ray Covered 100% 60% after deductible

Covered 100%, no deductible, at a free-

standing facility

Covered 80% after deductible for

Inpatient or Outpatient Hospital


MRI, CT, PET Scans, Nuclear Medicine &

Other High Tech Services

$100 co-pay; then covered 100%




Urgent Care Visit $50 co-pay per visit; then covered 100%


Emergency Room

$100 co-pay per visit; then covered 100%.

(co-pay is waived if admitted to Inpatient Hospital on an emergency basis)


Medical Plans

Service Category




Outpatient Surgery$100 co-pay per visit;

then covered 100%(co-pay applies toward

out-of-pocket maximum)




Inpatient Hospital$250 co-pay per admit;

then covered 100%(co-pay applies toward

out-of-pocket maximum)




Durable Medical Equipment

Covered 80%,no deductible




Chiropractic Care $40 co-pay per visit; then covered 100%




Medical Plans

Pre-Certification

Pre-Certification is required for:

•Inpatient hospital•Outpatient surgery (not performed in a physician’s office)•Inpatient rehabilitation•Home health care•Outpatient infusion therapy, chemo therapy, and radiation therapy•Transplants•Sleep disorder testing

You will be subject to a $250 penalty if pre-certification is not obtained.

Service CategoryBoth the Select (no deductible) and Choice (deductible) Plans

In-Network Out-of-Network

Retail Pharmacy: Up to a 90 Day Supply

Tier 1: Generics

$15/up to 30 day supply Not Covered

Tier 2:Brand-Name Formulary


Tier 3:Non-Formulary Drugs


Tier 4: Specialty / Injectables

20% coinsurance up to $250 per Rx Not Covered

Prescription Drugs

Mail Order: Up to 90 Day Supply

Service CategoryBoth the Select (no deductible) and Choice (deductible) Plans

In-Network Out-of-Network

Mail Order: Up to a 90 Day Supply

Tier 1: Generics

$30 Not Covered

Tier 2:Brand-Name Formulary

$60 Not Covered

Tier 3:Non-Formulary Drugs

$100 Not Covered

Tier 4: Specialty / Injectables

50% coinsurance up to $500 per Rx Not Covered

Mail Order – Getting started with Optum

• Prescriptions won’t transfer from WellDyne• Need new prescription for mail order – Contact doctor’s office

• Sign up for mail order online after 7/1

UMR.com

MonthlyMedical Payroll Deductions

Coverage Tier Select Plan(No Deductible)


Employee Only $279.49 $103.80

Employee plus Spouse $535.68 $192.33

Employee plus Child / Children $461.15 $163.93

Employee plus Family $754.61 $273.22

Medical Plan-Your Pre-Tax Deductions

Salaried MonthlyAmount Your Payroll Deduction Will Increase for Medical





Employee plus Child / Children $58.36 - $54.11


Cost Changes

Hourly Bi-WeeklyAmount Your Payroll Deduction Will Increase for Medical





Employee plus Child / Children $44.67 - $18.67


Cost Changes

DENTAL BENEFITDelta Dental

Dental Plan Key Benefits

Benefit DescriptionDelta Dental PPO Dentist

No Balance Billing

Delta Premier and Non-Participating

May Balance Bill

Calendar Year Deductible(Deductible resets every January 1st)

$50 per personUp to $150 maximum per family

Coinsurance Type I– Oral evaluations – Routine Cleanings

Covered 100%, no deductible for Type I services

Covered 80%, no deductible for Type I services

Type II– Basic Restorative (fillings)– Simple Extractions– Endodontics (root canal therapy)– Periodontics (gum disease treatment)


(Note: Endodontics, Periodontics and Complex Oral Surgery are

covered at 50% after deductible)


(Note: Endodontics, Periodontics and Complex Oral

Surgery are covered at 50% after deductible)

Type III– Crowns / Dentures / Bridges– Denture Rebase / Reline / Repairs



Type IV– Orthodontia Services (no age limit)

50% - no deductible for orthodontia services

50% - no deductible for orthodontia services

Dental Plan Key Benefits

Benefit DescriptionDelta Dental PPO Dentist

No Balance Billing

Delta Premier and Non-Participating

May Balance Bill

Calendar Year Dental Plan Maximum (Maximum resets every January 1st)

$1,250 per member, combined in-network

and non-network services

Orthodontia Lifetime Plan Maximum $1,500 per lifetime

Balance Billing

PPO Maximum Plan Allowance (MPA)

or actual fees charged, whichever is less.

Premier Dentist: Payment is based on the Premier

Maximum Plan Allowance (MPA), or the fee actually charged, whichever is less.

Non-Participating Dentist:Payment is based on the non-participating

Maximum Plan Allowance. Member is responsible for the difference between the

non-participatingMPA and the full fee charged.

deltadentalco.com

Delta Dental Plan Amount You Pay Monthly

Employee Only $0

Employee plus Spouse $2.50

Employee plus Child / Children $7.50

Employee plus Family $10.00

Dental Plan-Your Pre-Tax Deductions

VISION BENEFITVision Service Plan (VSP)

VSP Vision Key Benefits

Benefit Description

PPOIn-Network

PPONon-Network

YOU PAY . . . PLAN REIMBURSES . . .

Annual Exam Co-pay $10 co-pay Up to $45 for exams

Lenses$25 co-pay, then covered 100%(you pay additional amount for unlined bifocal, trifocal or progressive lenses,

coatings, tintings, etc.)

Single Lenses - up to $30Lined Bifocals – up to $50Lined Trifocals – up to $65

Progressive lenses – up to $50

Standard Retail Frames $130 allowance, no co-pay

Up to $70

Standard Contact Lenses(Instead of glasses)

$130 allowance; up to a $60 co-pay for contact lens exam,

fitting and evaluationUp to $105

Frequency of ServicesOnce every 12 months for exams, lenses, or contact lenses

Once every 24 months for frames

Discounts

You may receive a 20% discount from In-Network Providers for

certain services, such as the cost of a frame over $130, additional

glasses or sunglasses, etc.

N/A

vsp.com

VSP Vision Plan Monthly Amount You Pay

Employee Only $0

Employee plus One $3.51

Employee plus Family $12.49

Vision Plan-Your Pre-Tax Deductions

DISABILITY & LIFE INSURANCE

Sun Life Financial

Sun Life Life/AD&D Insurance

Life / Accidental Death & Dismemberment (AD&D)

Company-Paid Benefit

All Eligible Employees

Life Benefit Amount1.5 times the employee’s basic annual earnings. The minimum benefit is $50,000; the maximum

benefit is $150,000

AD&D Benefit Amount Matches your Life Benefit Amount

Age Reduction ScheduleAt age 70: reduces to 67%At age 75: reduces to 50%

Benefits terminate at retirement

Monthly Premium This is a base benefit that is paid for by Colorado Christian University

Sun Life Short Term Disability

Short Term Disability (STD)Company-Paid Benefit


Short Term Disability Benefit60% of Covered Earnings, up to a maximum benefit

of $1,000 per week(Benefit is taxable)

Benefits Begin On the 30th day of a qualified disability forsickness or accident

Benefit Duration Up to 9 weeks

24-Hour Coverage Only non-occupational sicknesses and accidents are covered under the plan

Special Features- Maternity covered the same as any other illness- No pre-existing condition limitations


Sun Life Long Term Disability

Long Term Disability (LTD)Company-Paid Benefit


LTD Benefit60% of Covered Earnings, up to a maximum benefit

of $6,000 per month(Benefit is taxable)

Benefits Begin On the 91st day of a qualified disability or at the end of the STD benefit period, whichever is later

Benefit Duration Up to your Social Security Normal Retirement Age (SSNRA)

24-Hour Coverage Yes. Covers on-the-job and off-the-job sicknesses and accidents

Loss of Income

First 24 months: You must not be able to earn more than 80% of your pre-disability earnings; After 24 months, you

must not be able to earn more than 60% of your pre-disability earnings

Own Occupation Definition

You must be disabled from the duties of your own occupation for the first 24 months; then any gainful occupation for which you are qualified due to experience, education or training

Long Term DisabilityCompany Paid!


Physician Certification Required? Yes - you must be under the continual care of a licensed Physician

Must you be totally disabled to receive a benefit? No, you never have to be totally disabled

Pre-Existing Conditions Limitation Three-month look back period or 12 months on the Plan

Other Benefit Limitations - Mental Illness - Drug & Alcohol

- Benefit is limited to 24 months - Benefit is limited to 24 months

Survivor Benefit 3 month lump sum


Sun Life Long Term Disability

VOLUNTARY LIFE INSURANCE

Unum

Unum Voluntary Life/ AD&D Insurance

• Last year to elect voluntary life for spouse & dependents

• Due to recent Colorado civil unions legislation– Changes in definitions of spouse– Conflicts with our traditional family values

Unum Voluntary Life/AD&D Insurance

Voluntary Life / Accidental Death & Dismemberment (AD&D)

Voluntary Plan

Employee | Spouse | Child

Employee Life/AD&D Benefit Amount Elect up to $500,000 (in increments of $10,000), not to exceed 5 times your annual salary

Spouse Life/AD&D Amount – Employee must enroll

Elect up to 100% of the Employee amount (in increments of $5,000), not to exceed $500,000

Child Life/AD&D Amount – Employee must enroll (age 6 months to age 26)

Elect up to 100% of the Employee amount (in increments of $2,000), not to exceed $10,000. (Benefit is $1,000 for children age live birth to 6 months)

Age Reduction Schedule At age 65: reduces to 65% of the original amount;At age 70: reduces to 50% of the original amount

Life Insurance Guarantee Issue Amount (GI)Health questions & approval required in future years

Available for new-hires within initial eligibility period.Employee: $120,000

Spouse: $25,000 (not available in future years)Child: All amounts (not available in future years)

Special Features- Portable - Waiver of Premium- Conversion - Accelerated Benefit

Complete a new Enrollment Form if you want to move from your current plan

Complete a Waiver Form if you are waiving coverage for yourself, and/or qualified dependents for medical & vision, dental.

Return completed enrollment/change/waiver forms to Human Resources no later than close of business on Wednesday, May 29, 2013.

How to Change Plans

Per IRS rules, you will be locked into your selection until the next annual enrollment period unless you experience a qualified life event during the plan year.

A qualified life event includes, but is not limited to, marriage, divorce, death, birth, adoption, or placement of a child in your home for adoption purposes, or a change in work hours for you or your spouse.

You have 31 days from the date of the qualified event to make corresponding changes and return a completed change form to Human Resources. If you miss your 31 day window of opportunity, you must wait until the next enrollment period to make changes.

It is your responsibility to notify Human Resources when a change in status has occurred, such as legal separation, divorce, a dependent child reaches the age limit, etc. Failure to do so could result in the inability to make changes or to elect COBRA coverage.

Enrollment Information

The information contained in this Annual Benefits Enrollment Overview are outlines of your benefits and are intended to be used for illustrative purposes only.

Please refer to your actual benefit booklets for more details about each plan, including any limits or pre-authorization requirements.

These documents will be available on the Human Resources My CCU page

If there are any discrepancies, the Insurance Company contract and plan documents will prevail.

Important Notice

Questions?

Conclusion

welcome to the colorado christian university annual enrollment meeting! for benefits effective july...

Documents

deductible plan plan

coverage effective

choice plan

days of plan

plan plan documents

plan year

additional coverage

cobra coverage