Emmanuel College Open Enrollment Tuesday, November 13, 2012 - Friday, November 30, 2012
Open Enrollment 2013
This publication is produced by the Office of Human Resources
Open Enrollment We are very pleased to announce that through careful negotiation, Emmanuel College’s renewal with Harvard Pilgrim Health Care will remain at the current rates with NO increase in premiums for 2013. In addition we would like to highlight the following:
There will also be NO increase to the Delta Dental rates this year.
To help with our wellness initiatives, Harvard Pilgrim will continue to partner with us on prevention and wellness programs such as stress management workshops, health risk assessments and preventative screenings.
For 2013 the College is implementing an employee paid, optional vision plan for the first time. We are offering this new benefit option to supplement the benefits already provided through HPHC or for those employees that would like a vision plan but are not members or HPHC. The plan offers great savings on a multitude of services including; frames, lenses, lens options and contact lenses. You will find more information on the rates for this plan through VSP (Vision Service Plan) on the following page and additional benefit information on page 7.
The 2013 Annual Benefits Open Enrollment period is from Tuesday, November 13, 2012 through Friday, November 30, 2012. Open Enrollment is your once-a-year opportunity to make changes to your current benefit elections. The benefit elections you choose will be effective January 1, 2013. These elections will remain in effect through the 2013 calendar year and may be changed only if you experience a qualifying change in life/family status as defined by the Internal Revenue Code (IRC). We will also continue to give benefits eligible employees the opportunity to save money by paying your share of the insurance premiums on a pre-tax basis, unless you notify the Office of Human Resources that you do not want to take advantage of this pre-tax savings option.
Harvard Pilgrim Health Care
2013 Rates Individual HMO Individual POS
2013Total Cost (Monthly) $587.79 $658.21
Emmanuel Pays (Monthly)
Employee Pays (Monthly)
Employee Pays (Semi-Monthly)
$470.23 (80%) $470.23*
*The same dollar amount contribution will also be applied to the POS Plan.
Delta Dental of Massachusetts Delta Dental will continue offering Rollover Max feature. Members with claims that do not exceed $700 within the plan year may rollover up to $500 for use during the next plan year. Members must go for at least one cleaning or one Total Cost (Monthly)
Emmanuel Pays (Monthly)
Employee Pays (Monthly)
Employee Pays (Semi-Monthly)
oral exam in order to be eligible for the rollover. VSP Vision Care VSP Vision Care is a new voluntary benefit offered to eligible employees for 2013. The VSP Signature Plan being offered provides value and savings, personalized care, eyewear and choice of providers for those employees that require eyeglasses or contact lenses.
Employee + One
Employee + Children)
Employee + Family
Employee Pays Monthly
Patient Protection and Affordable Care Act As a result of Federal Health Care Reform, also known as the Patient Protection and Affordable Care Act, the following benefit changes are being made to our coverage. These changes are being made for group health plans in all states, and they will go into effect as Emmanuel renews its coverage with Harvard Pilgrim Preventative Care with No Cost Sharing*- There will be no cost sharing (i.e. copayments, deductibles or coinsurance) on any in-network adult annual visits, well child visits, annual gynecological visits, routine pre-natal and post-partum visits or select preventative services and diagnostic tests described on the next page. Child Dependent Coverage- Coverage will be provided to child dependents until age 26. Lifetime Limits- Aggregate lifetime dollar benefit limits and lifetime dollar limits on essential health benefits will be eliminated for Harvard Pilgrim group plans. Durable Medical Equipment- There will be no annual dollar limits for the Durable Medical Equipment benefit. In addition to the changes above, beginning on July, 1, 2011, a minimum coinsurance of 20% will be introduced for this benefit. If your plan already has coinsurance of 20% or greater for durable medical equipment purchased from a network provider, there will be no charge in your member cost sharing for such equipment. This information governs in any case in which the benefits information in another Harvard Pilgrim enrollment documents may be different. *The list of preventative care services and tests that will be covered in full is subject to change upon the issuance of further guidance from the federal government pursuant to the Affordable Care Act. For POS and PPO plans, services are covered in full at the in-network benefit level. The benefit changes described above are subject to regulatory approval.
Preventive services and tests covered in full, in-network: Abdominal aortic aneurysm screening (for males 65-75 one time only, if ever smoked) Alcohol Misuse screening and counseling (primary care visits only) Behavioral Assessments (children of all ages; developmental surveillance, in primary care settings)
Autism Screening (for children at 18 and 24 months of age: primary care settings) Aspirin for the prevention of heart disease (primary care counseling only)
Breast Cancer Chemoprevention (Counseling only for women at high risk for Breast Cancer and low risk for adverse effects of chemoprevention)
Breast cancer screening, including mammograms and counseling for genetic susceptibility.
Breastfeeding Primary Care Interventions (Applicable to pregnant women and new mothers; includes lactation classes and support at prenatal and post partum visits, and newborn visits.
Cervical cancer screening, including pap smears.
Cholesterol screening (for adults only)
Colorectal cancer screening, including colonoscopy sigmoidoscopy and fecal occult blood test
Congenital Hypothyroidism Screening (for newborns only)
Dental caries prevention- oral fluoride (for children to age 5 only) [Note: Coverage for fluoride is only provided if your Plan includes outpatient pharmacy coverage.
Depression screening (adults, Children ages 12-18, primary care visits only)
Diet Behavioral Counseling (included as part of annual visit and intensive counseling by primary care clinicians or by nutritionists and dieticians)
Dyslipidemia Screening (For children at high risk for higher lipid levels)
Folic acid supplements (women planning or capable of pregnancy only) [Note: coverage for folic acid is only provided if your Plan includes outpatient pharmacy coverage.] Hemoglobin A1c
Blood pressure screening (adults, without known hypertension
Hearing Screening (Screening for newborns only, primary care settings)
Lead screening (Children at risk)
Hepatitis B testing Immunizations, including flu shots (for children and adults as appropriate. Iron deficiency prevention (primary care counseling for children age 6 to 12 months only) Microalbuminuria test
Obesity screening (Adults and children screening only, in primary care setting.)
Osteoporosis screening (screening to begin at age 60 for women at increased risk)
HIV screening Iron Deficient Anemia (pregnant women at prenatal visits)
Ovarian cancer susceptibility screening Rh(D) Incompatibility, Screening Sexually transmitted diseases (STDs)-screening and counseling Total cholesterol tests Vision screening (children to age 5 only)
Phenylketonuria Screening (Newborns before 7 days old) Sickle Cell Disease, Screening (Screening at birth and first newborn visit) Tobacco use counseling (primary care visit only) Tuberculosis skin testing
Flexible Spending Accounts: Benefit Resource, Inc. The limit on medical accounts will continue to be $2,500. Examples of medical expenses include doctor co-pays, dental (cleanings, fillings, crowns, etc.), prescription drug co-pays, allergy injections, prescription eyewear and contact lenses, and orthodontia. The limit for Dependent Care FSAs will continue to be $5,000. New enrollment forms need to be completed each year for this benefit. Please note: The deadline to submit receipts for reimbursement is March 1st of each year. Any funds remaining in the Account after this will be forfeited. Health Care Reform Impacts Purchasing Over-the-Counter Drugs and Medicines with FSA Funds Medical FSA funds may no longer be used to purchase OTC drugs and medicines (other than insulin) without a prescription from a medical provider. This also means that these items cannot be purchased with a benefit card but must be submitted as a claim for reimbursement with a prescription. Some examples of OTC drugs and medicines that will require a prescription are: Allergy and sinus medicines Pain relief medicines Cough, cold and flu medicines This rule does not apply to eligible OTC medical supplies such as band-aids, contact lens solution and hearing aid batteries. Please be advised that this is not a comprehensive list of OTC items. Please visit www.BenefitResource.com for more information. Vision Care: VSP This comprehensive vision plan has many benefits including a $130 allowance for contact lenses (annually) and frames (bi-annually); single vision, lined bifocal or trifocal lenses with no additional co-pay; and a generous allowance for progressive lenses on an annual basis. Program also offers discounts for additional glasses and sunglasses of up to 30% and an average discount of 15% for laser vision correction. For more information please watch for our upcoming webinars hosted by a VSP representative!
Supplemental Life Insurance The College will once again be offering benefits eligible employees working at least 25 hours per week the opportunity to enroll in supplemental life insurance coverage. You may purchase this for yourself, your spouse or your dependents.
Short-Term Disability The Office of Human Resources is pleased to continue offering this benefit which was offered for the first time at the 2012 Open Enrollment. This voluntary Short-Term Disability benefit through The Hartford Insurance Company is an optional, employee-paid benefit that is designed to supplement your current sick and long-term disability benefits. This coverage provides a weekly income to you if you are disabled. You simply pay for it through convenient payroll deductions. Plan highlights include: ď‚ˇ ď‚ˇ ď‚ˇ
60% of weekly pre-disability earnings (post-tax) to a $1,000 weekly maximum after the 15th day for accident or sickness; Coverage for pregnancy and non-occupational injury or sickness; Competitive group rates.
Short-term disability insurance protects you from lost wages due to sickness or injury after your accrued sick time is exhausted and before your long-term disability plan begins. Retirement Account For the 2013 tax year, the elective deferral contribution limit for employees who participate in 403(b) plans has increased from $17,000 to $17,500. The catch-up contribution limit for those age 50 and over remains unchanged at $5,500. Although you may change your retirement contributions at any time of the year, the open enrollment period is a good reminder to review your contributions and elections.
Important Notice from Emmanuel College About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Emmanuel College and about your options under Medicareâ€™s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. There are two important things you need to know about your current coverage and Medicareâ€™s prescription drug coverage: Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. Emmanuel College has determined that the prescription drug coverage offered by the Harvard Pilgrim Health Care HMO and POS is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan. When Can You Join A Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
What Happens To Your Current Coverage If You Decide to Join A Medicare Drug Plan? If you decide to join a Medicare drug plan, your current Emmanuel College coverage will not be affected. If you do decide to join a Medicare drug plan and drop your current Emmanuel College coverage, be aware that you and your dependents will be able to get this coverage back. When Will You Pay A Higher Premium (Penalty) To Join A Medicare Drug Plan? You should also know that if you drop or lose your current coverage with Emmanuel College and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later. If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following November to join. For More Information About This Notice Or Your Current Prescription Drug Coverage… Contact the person listed at the end of this booklet for further information. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Emmanuel College changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage… More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans. For more information about Medicare prescription drug coverage: Visit www.medicare.gov Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1 -877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Date: November 12, 2012 Name of Entity/Sender: Emmanuel College Contact--Position/Office: Erin Farmer Noonan, Director of Human Resources Address: 400 The Fenway, Boston, MA 02115 Phone Number: 617-735-9991
Next Steps If you are staying with your current health, dental and life insurance choices, you do not need to do anything. If you are making changes to your current benefit elections please stop by the Office of Human Resources for the appropriate paperwork. If you are enrolling or re-enrolling in the FSA you need to complete a new enrollment form. Please download the form on the HR Forms Team Site on the portal or come by the Office of Human Resources to complete a new form. Please be advised that Open Enrollment will end promptly on Friday, November 30th and all employees must be enrolled in all benefit plans at that time. For information regarding Medicaid and children’s health insurance program (CHIP), please refer to the notice posted on the Portal 10/11/2012. For information on Prescription Drug coverage and Medicare please refer to the notice posted on the Portal on 10/11/2012. For questions regarding the following benefit plans please contact: Medicare and Creditable Coverage Erin Farmer Noonan 617-735-9892 firstname.lastname@example.org Vision Care, Supplemental Life Insurance and Short-term Disability Scott Lerner 617-735-9967 email@example.com Flexible Spending Accounts Leah Kendall 617-975-9332 firstname.lastname@example.org Health and Dental Coverage Contact any of the above individuals for assistance.