2013 Benefit Enrollment Guide - Troy University
2013 Benefit Enrollment Guide - Troy University 2013 Benefit Enrollment Guide - Troy University
important notices Important Medical Coverage Notices Medicaid and the Children’s Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. For more information please visit http://www.cms.gov or call 1-877-267-2323, ext. 61565. Women’s Health and Cancer Rights Act Notice Under the Women’s Health and Cancer Rights Act of 1998, a plan participant or beneficiary who elects breast reconstruction in connection with a covered mastectomy is also entitled to the following benefits: All stages of reconstruction of the breast on which the mastectomy was performed; Surgery and reconstruction of the other breast to produce a symmetrical appearance; and, Prostheses and treatment of physical complications of the mastectomy, including lymphedemas. Health plans must provide coverage of mastectomy-related benefits in a manner determined in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services are subject to deductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan. Newborns’ and Mothers’ Health Protection Act Notice Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Important Health Care Reform Notices Grandfathered Status Troy University believes this plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits. Questions regarding which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status can be directed to the plan administrator in the Human Resources Department. You may also contact the Employee Benefits Security Administration, U.S. Department of Labor at 1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website has a table summarizing which protections do and do not apply to grandfathered health plans. Please call 1-866-688-9727. Troy University 2013 Benefits Enrollment Guide 16
important notices Summary Plan Descriptions (SPD) As required under the Employee Retirement Income Security act (ERISA), all employees and their covered dependents must be given access to a copy of the Summary Plan Description (SPD) for the employees welfare benefit plans. The SPD outlines the eligibility, schedule of benefits and covered/excluded items of the benefit plans offered by Troy University. Employees and/or their covered dependents are given 2 options to access/obtain a copy of an SPD: 1. The Enrollment Center - EmpowHR – follow these simple steps. • Log onto EmpowHR at troyunviversity.empowhr.com using your personal ID and password. Personal ID - First initial of first name + your full last name + last four digits of SSN Password – first time logging in will be full SSN – you will be asked to reset this and select a new password. If you have already done this enter your new password. • At the top of the page click on “Protection” then choose “Plan Information”. A page will open listing all available benefits. Listed in each section is an underlined link to both the summary of the benefit as well as the SPD. • Click on the link and the document will open. You may view, save or print a copy of the document. When finished simply close the document and “logoff” of EmpowHR. 2. You may also request a paper copy of a SPD from the Human Resources Benefits Department. Please call 1-866-688-9727. Troy University 2013 Benefits Enrollment Guide 17
- Page 1 and 2: 2013 Benefit Enrollment Guide an ov
- Page 3 and 4: introduction Enrollment Current Emp
- Page 5 and 6: Healthcare Benefits Medical (Blue C
- Page 7 and 8: Healthcare Benefits Pre-Tax Cafeter
- Page 9 and 10: Healthcare Benefits BlueCard Worldw
- Page 11 and 12: Voluntary Life Insurance Voluntary
- Page 13 and 14: travel assistance MEDEX ® Travel A
- Page 15 and 16: flexible spending Flexible Spending
- Page 17: etirement Mandatory Retirement Plan
- Page 21 and 22: Troy University-54395/000 Coverage
- Page 23 and 24: Common Medical Event If you need dr
- Page 25 and 26: Excluded Services & Other Covered S
- Page 27 and 28: Questions and answers about the Cov
- Page 29 and 30: BlueCard PPO: Troy University Cover
important notices<br />
Important Medical Coverage Notices<br />
Medicaid and the Children’s Health Insurance<br />
Program (CHIP) offer free or low-cost health<br />
coverage to children and families<br />
If you are eligible for health coverage from your employer, but<br />
are unable to afford the premiums, some states have premium<br />
assistance programs that can help pay for coverage. These states<br />
use funds from their Medicaid or CHIP programs to help people<br />
who are eligible for employer-sponsored health coverage, but need<br />
assistance in paying their health premiums. For more information<br />
please visit http://www.cms.gov or call 1-877-267-2323, ext. 61565.<br />
Women’s Health and Cancer Rights Act Notice<br />
Under the Women’s Health and Cancer Rights Act of 1998, a<br />
plan participant or beneficiary who elects breast reconstruction<br />
in connection with a covered mastectomy is also entitled to the<br />
following benefits: All stages of reconstruction of the breast on<br />
which the mastectomy was performed; Surgery and reconstruction<br />
of the other breast to produce a symmetrical appearance;<br />
and, Prostheses and treatment of physical complications of<br />
the mastectomy, including lymphedemas. Health plans must<br />
provide coverage of mastectomy-related benefits in a manner<br />
determined in consultation with the attending physician and the<br />
patient. Coverage for breast reconstruction and related services<br />
are subject to deductibles and coinsurance amounts that are<br />
consistent with those that apply to other benefits under the plan.<br />
Newborns’ and Mothers’ Health Protection Act Notice<br />
Group health plans and health insurance issuers generally may<br />
not, under federal law, restrict benefits for any hospital length of<br />
stay in connection with childbirth for the mother or newborn child<br />
to less than 48 hours following a vaginal delivery, or less than 96<br />
hours following a cesarean section. However, federal law generally<br />
does not prohibit the mother's or newborn's attending provider,<br />
after consulting with the mother, from discharging the mother or<br />
her newborn earlier than 48 hours (or 96 hours as applicable). In<br />
any case, plans and issuers may not, under federal law, require<br />
that a provider obtain authorization from the plan or the issuer for<br />
prescribing a length of stay not in excess of 48 hours (or 96 hours).<br />
Important Health Care Reform Notices<br />
Grandfathered Status<br />
<strong>Troy</strong> <strong>University</strong> believes this plan is a “grandfathered health<br />
plan” under the Patient Protection and Affordable Care Act (the<br />
Affordable Care Act). As permitted by the Affordable Care Act,<br />
a grandfathered health plan can preserve certain basic health<br />
coverage that was already in effect when that law was enacted.<br />
Being a grandfathered health plan means that your plan may not<br />
include certain consumer protections of the Affordable Care Act<br />
that apply to other plans, for example, the requirement for the<br />
provision of preventive health services without any cost sharing.<br />
However, grandfathered health plans must comply with certain<br />
other consumer protections in the Affordable Care Act, for<br />
example, the elimination of lifetime limits on benefits.<br />
Questions regarding which protections apply and which<br />
protections do not apply to a grandfathered health plan and what<br />
might cause a plan to change from grandfathered health plan<br />
status can be directed to the plan administrator in the Human<br />
Resources Department. You may also contact the Employee<br />
<strong>Benefit</strong>s Security Administration, U.S. Department of Labor at<br />
1-866-444-3272 or www.dol.gov/ebsa/healthreform. This website<br />
has a table summarizing which protections do and do not apply to<br />
grandfathered health plans.<br />
Please call 1-866-688-9727. <strong>Troy</strong> <strong>University</strong> <strong>2013</strong> <strong>Benefit</strong>s <strong>Enrollment</strong> <strong>Guide</strong> 16