Download - Troy University

Healthcare BenefitsMedical (Blue Cross Blue Shield of AL)Make the Most of Your Network-Based Healthcare PlansBlue Cross Blue Shield of Alabama has contracted with a networkof providers, including physicians, hospitals and other types ofproviders. In order to receive the highest level of benefits and paythe least amount out of your pocket, you need to access care fromthe providers who have elected to be part of the network.This plan allows you to seek care from a provider who is not inthe network. Just remember that if you make this choice, you willbe required to pay a larger portion of the expenses out of yourpocket, and the expenses may be subject to the Reasonable andCustomary charging pattern for the area. This could also result in agreater out-of-pocket expense for you. We want you to get the mostfrom your healthcare plan. Please log on to www.bcbsal.org for anyadditional information about Blue Cross Blue Shield of Alabama.Prescription Drugs (Blue Cross Blue Shield of AL)DeductibleIndividualFamilyRetail Co-paymentsNo deductibleNo deductibleGeneric $10.00Preferred $35.00Non Preferred $50.00Mail Order Co-payments(90 day supply)Generic $20.00Preferred $70.00Non Preferred $100.002012 Health and Dental Insurance Benefit CostMonthlyBi-WeeklyLess than $30,000 Salary $30,000 Salary and over Less than $30,000 Salary $30,000 Salary and overEmployee $95.26 $142.88 $47.63 $71.44Family $213.54 $320.30 $106.77 $160.15Note: 2012 rates cover medical, dental, prescription and Behavioral Health benefits.Please call 1-866-688-9727. Troy University 2012 Benefits Enrollment Guide 3

Healthcare BenefitsMedical (Blue Cross Blue Shield of AL)Medical Summary of BenefitsPPO Plan Benefits In-Network Out-of-Network Out-of-AreaOffice Visits(Primary Care Physician / Specialist)Hospital ServicesInpatientOutpatient Surgery &Emergency ServicePreventive Care ServicesRoutine Well Child CareRoutine ImmunizationsPhysicians ServicesIn-Hospital Visits,Surgery, Anesthesia,Diagnostic X-rays & Lab$25 / $40 70% after deductible 80% after deductible$300 deductible per admission,100% after deductible$950 deductible per admission, $50copay per day, 80% after deductible80% after deductible$125 copay, 100% after copay $300 copay, 100% after copay 80% after deductible$25 copay; 100% after copay100% of allowed amount; nodeductible or copayNo deductible;100% of allowed amountCovered only when provided byPrimary Care PhysicianCovered only when provided byPrimary Care PhysicianCovered only when provided byPrimary Care PhysicianCovered only when provided byPrimary Care Physician70% after deductible 80% after deductibleServices for treatment inthe Emergency RoomOther Covered ServicesDurable MedicalEquipment, PhysicalTherapy, AmbulanceServiceChiropractic ServicesDeductibles(Individual / Family)Out-of-Pocket Maximum(Individual / Family)$40 copay, then 100% 70% after deductible 80% after deductible80% after deductible 70% after deductible 80% after deductible80% after Ded, limit 12 visits peryear or $400 a yearNot Covered80% after Ded, limit 12 visits peryear or $400 a year$500 / $1,500 $500 / $1,500 $500 / $1,500$400 / No family maximum $400 / No family maximum $400 / No family maximumMental Health and Substance AbuseBehavioral Health Systems (BHS) specializes in managing mentalhealth and substance abuse benefits. BHS has a preferredprovider network of credentialed mental health care providers.Benefits are available to all persons enrolled and eligible under aTroy University-sponsored medical plan. To qualify for coverage,you must be pre-certified and referred through Behavioral HealthSystems. It is your responsibility to make sure that approval isreceived from BHS before you are treated. If you do not receiveapproval, no benefits will be paid.To Access Benefits: Call 1-800-245-1150 or visit their websiteat www.behavioralhealthsystems.com. Member login is Troysu.Please call 1-866-688-9727. Troy University 2012 Benefits Enrollment Guide 4

Healthcare BenefitsPre-Tax Cafeteria Plan (Section 125)Troy University provides its employees with the option of havingcertain benefit premiums payroll deducted on a pre-tax basis. Youmay choose to have your health, dental, flexible spending, andsome voluntary coverage deducted from your check on a pre-taxbasis (section 125).A Cafeteria Plan is an employee benefits program designed totake advantage of Section 125 of the Internal Revenue Code. ACafeteria Plan allows employees to pay certain qualified expenses(such as health insurance premiums) on a pre-tax basis, therebyreducing their total taxable income and increasing their spendable/take-home income. Funds set aside in Flexible Spending Accounts(FSAs) are not subject to federal, state, or Social Security taxes.It is important to know that under the pre-tax option once you makeyour benefit election you cannot change that election unless youhave a qualified life event, such as marriage, birth, divorce, orloss of other coverage. The reduction does also lower the salaryon which Social Security benefits are calculated. While the actualimpact on the benefit calculation is typically very minor, if youare concerned and you are close to beginning a Social Securitybenefit, you may wish to consider waiving the Section 125 Plan.About Qualifying EventsChanges to benefits for which you elect to have your premiumsdeducted on a pre-tax basis are NOT allowed during the plan year,except for a “qualifying life event.” Qualifying life events that couldresult in changes to your coverage include:• marriage or divorce• birth or adoption of a child• death of a dependent• Medicare entitlement• termination of your spouse’s employment that affectsbenefits and/or loss of other group coverageIf you have a qualifying life event, you must notify The EnrollmentCenter and provide the necessary documentation within30 days of the event. If you do not do so, you must wait untilthe next Annual Enrollment.Example of Employee SavingsCafeteria Plan Waived(premiums deducted post-tax)Cafeteria Plan Elected(premiums deducted pre-tax)Employee Gross Pay $2,000 $2,000Medical Premiums $142.88Taxable Income $2,000 $1,857.12Tax Rate 25% 25%Taxes Withheld $500 $464.28Employee Net Pay $1,500 $1,392.84Medical Premiums $148.88 0Take Home Pay $1,351.12 $1,392.84An employee who elected pre-tax cafeteria plan option paid less tax and took home more pay.Please call 1-866-688-9727. Troy University 2012 Benefits Enrollment Guide 5

Healthcare BenefitsDental (Blue Cross Blue Shield of AL)In- Network and Out-of-NetworkDental Coinsurance Covered Procedures80% Basic Services• Routine oral examinations (two per calendar year)• Routine Cleanings (two per calendar year)• Topical applications of fluoride (childrenthrough age 18, 2x per calendar year)• Space maintainers (through age 18)• Dental X-rays (full mouth 1x during any 36months in a row, Bitewing 2x in a calendar year)• Sealants*Dental Benefits are available to you and your eligible familymembers to cover routine care, such as exams, x-rays andcleanings, fillings, and periodontal care.Orthodontia is not included. Under the BCBS of AL Plan, youcan go to the dental provider within the Dental PPO Network.If you choose to go to an out-of-network provider, the samepercentages will be paid, but you will be responsible for anyReasonable or Customary charges.Dental Summary of BenefitsDental ExpensesPlan pays after deductibleBasic Services 80%Supplemental Services 80%Periodontic Services 80%Annual Maximum$1,000 per covered personDeductibleIndividual $25.00Family$75.00(Three $25 deductibles per family maximum)• Fillings*• Simple tooth extractions• Repairs to removable dentures*Refer to SPD for limitations80% Supplemental Services• Oral surgery – tooth extractions and impactedteeth and to treat mouth abscesses• General anesthesia• Treatment of the root tip of the tooth including its removal80% Periodontic Services• Periodontic exams 2x each 12 months• Removal of diseased gum tissue and reconstructing gums• Removal of diseased bone• Reconstruction of gums and mucous membranes by surgery• Removing plague and calculus below the gum line forperiodontal diseasePlease call 1-866-688-9727. Troy University 2012 Benefits Enrollment Guide 6

flexible spendingEligible and Ineligible FSA ExpensesEquipmentEligible:• Diabetic supplies,including monitoring system,insulin pump, glucose kit,test strips, lancets• Blood pressure monitor kits• Condoms• Denture supplies• Female contraceptivesand spermicidal products• Incontinence supplies• Ovulation & pregnancy tests• Crutches• Oxygen equipment and oxygenused to relieve breathingproblems that result from amedical conditionIneligible:• Maternity clothing• Toilet paper and tissues• Diapers• Feminine products (sanitarynapkins, tampons, pads)Assistance for the DisabledEligible:• Braille books and magazines inexcess cost of regular editions• Cost of note-taker for a deafchild in school• Household visual alert systemfor hearing impaired• Walkers, crutches, canes• Wheelchair and/or includingcost if operating/maintaining• Artificial limbs• Guide dog or other animal forvisually or hearing impaired(includes purchase, trainingand care)• Excess costs of specificallyequipping automobile for adisabled person over the costsof ordinary automobile; devicefor helping a disabled personinto an automobileDrugsEligible:• Prescription DrugsIneligible:• OTC drugs without prescription• Drugs for cosmetic purposes• Toiletries including shampoo,soap, shaving cream,deodorant, toothpaste• Drugs that are merelybeneficial for general health(e.g. multi-vitamins)Procedures/TreatmentsEligible:• Anesthesiologist• Surgery• Hospital Services• Weight loss programsprescribed to treat a medicalcondition (e.g. Obesity)• Smoking cessation programs• Treatment for alcoholism ordrug dependency• Acupuncture• Infertility Treatment• Speech Therapy• Obstetrical and gynecologicalprocedures• Dermatological procedures• Chiropractors and osteopaths• Sterilization and reversedsterilization• Nursing services for care of aspecific medical ailment• Cosmetic surgery/procedurethat treats deformity caused byan accident or trauma, disease,or an abnormality at birthIneligible:• Physical treatments unrelatedto specific health problem (e.g.,massage for general well being)• Any illegal treatment• Cosmetic surgery/proceduresthat improve patient’sappearance but does notmeaningfully promote theproper function of the body orprevent/treat an illness/diseaseVision/HearingEligible:• Hearing aids, batteries foroperation of hearing aids,hearing aid repairs• Optometrist ofophthalmologist fees• Eyeglasses• Contact lenses andcleaning solutions• Corrective eye surgeryincluding radial keratotomyIneligible:• Lens replacement insurance• Warranties• Protection plans• Coating/tints that do nottreat a medical conditionDentalEligible:• Dental Care• Artificial teeth/dentures• Braces, orthodontic servicesIneligible:• Teeth Bleaching• Tooth bonding that is notmedically necessaryPsychiatric CareEligible:• Psychotherapists,psychiatrists, andpsychologists services• Legal fees directly related tocommitment of mentally ill personIneligible:• Psychoanalysis undertaken tosatisfy curriculum requirementsof a student• Marriage counselingInsuranceEligible:• Deductibles and co-paymentsfor health care plans• Coinsurance (only the % ofcharges not paid by yourhealth care plan)• Amounts over usual andcustomary limitsIneligible:• All premiums/contributions forinsurance coverage• Expenses paid by your healthcare planDiagnostic/PreventativeEligible• Routine/preventative physicals• X-ray• Vaccinations/Immunizations• Flu ShotsIneligible• Umbilical cord storageMiscellaneous ChargesEligible:• Shipping, handling, deliverycharges, and sales tax foreligible expenses• Expenses connected withdonating an organ• Lodging expenses (not providedin a hospital or similar institution)not to exceed $50 per nightper individual while away fromhome if the lodging is primarilyfor and essential to medical careprovided by a doctor• Transportation expensesprimarily for and essential tomedical care including mileage,bus taxi, train, plane fares,ambulance services, parkingfees and tolls• Social security tax paid withrespect to wages of qualifiednurse’s servicesIneligible:• Payments for child care (eligibleunder the Dependent Care)• Diaper Services• Distilled water purchase toavoid drinking fluoridated citywater supply• Installation of power steering inan automobile• Pajamas purchased to wearin hospital• Mobile telephone used forpersonal phone calls as well ascalls to physician• Payments for services whichare not medical in nature• Domestic help, companion,babysitter, chauffeur, etc. whoprimarily render services of anon-medical nature• Nursemaid or practical nursewho renders general care forhealthy infantsPlease call 1-866-688-9727. Troy University 2012 Benefits Enrollment Guide 14

enrollmentPreparing for On-Line or CallingPlease take the time to review this enrollment guide. It containsimportant information about your benefits and the deductions thatwill be taken from your paycheck. We’ve given you examples ofpayroll deductions throughout the enrollment guide. By reviewingthis information in advance, you will have the opportunity to decidewhich benefits are the most important to you.• Changes made during Annual Enrollment are effectiveJanuary 1, 2012 (except for policies and/or amounts thatrequire the approval of underwriters).• Verify that changes have been processed. Reviewyour Earnings Statement to confirm that your enrollmentsand deductions are correct.• If you notice an error on your Earnings Statement,contact Human Resources or The Enrollment Center.Please note that this guide is a general summary of your benefits.For specific details, you may refer to each carrier’s summary plandescription which is available at troyuniversity.empowHR.com.Every effort has been made to ensure that this booklet accuratelyrepresents the benefits. However, if there are any discrepanciesbetween the terms in this booklet and the terms in the plandocument, the plan document will prevail.Some Information You Will NeedPlease have the following information ready when enrolling:• Your name, date of birth and Social Security Number• The name(s), date(s) of birth and Social Security Number(s)of your dependent children up to age 26. Dependent childreninclude your natural children, adopted children, stepchildrenand children for whom you have legal guardianship.• The name, date of birth and Social Security Number ofyour spouse (if applicable)• Your current address, so that we can update our records.This will also ensure that both your ID cards and otherimportant benefit information are sent to the correct address.• The full name and relationship of your beneficiary(Your beneficiary must be at least 18 years old or youwill be required to name a guardian for him or her.)How to Enroll On-lineYou may make your benefit elections and enroll online. Yourenrollment is confidential and secure. To enroll online, just followthese simple steps:1. To begin your enrollment, go to troyuniversity.empowHR.com.Including the “www” will direct you to the wrong website.2. Enter your personal User ID which is the first initial of yourfirst name and your full last name and the last four digits ofyour SSN (for example, Tina Smith = tsmith6789). Do not usespaces or suffixes.3. Enter your personal password which is your full SocialSecurity number (no spaces or dashes).4. You will be asked to select a new password after your initiallogin. Please keep this information in a secure location forfuture access.5. Read the instructions and click OPEN ENROLLMENT at thebottom of the screen to begin enrollment.6. Enter Spouse and Dependent children information by choosingadd or edit dependent on your verify information screen.7. Click Next at the bottom of the screen once all dependentsare entered into the system.8. Make your benefit elections from the benefits offered by clickingthe appropriate circle on the screen for that benefit. You will clickNext at the bottom of the screen to move to the next benefit plan.9. You may “elect” or “decline” coverage by clicking theappropriate box. Some coverage’s may require you to input a$ amount (for example, Voluntary Life and Flexible SpendingAccounts) or select one of several options.10. After completing all of the benefit sections, click the I havecompleted my online enrollment and agree to benefitspresented button to securely process your form.11. If you are unable to complete your form in its entirety, you mayclick the Print and Save in your File Cabinet button to saveyour data and complete at a later time. All enrollments must becompleted by midnight prior to your effective date or the lastday of your company’s annual enrollment period.12. Upon submitting your enrollment form, you will receive aConfirmation Page. Please print a copy of this page for your records.13. To complete a saved enrollment or make changes to anexisting enrollment, simply use your personal User ID andpassword from your confirmation screen to access and makeedits to your selections.Please call 1-866-688-9727. Troy University 2012 Benefits Enrollment Guide 16

Please note that this guide is a general summary of your benefits. For specific details, you may refer to each carrier’s summary plandescription. Every effort has been made to ensure that this booklet accurately represents the benefits. However, if there are anydiscrepancies between the terms in this booklet and the terms in the plan document, the plan document will prevail.