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Welcome To Temple University Health System!. Children Birth children* Step-children Adopted children* For whom you have legal custody under age 26. Children, cont. Any age, totally and permanently disabled Qualified Medical Child Support Orders Spouse Legally married spouse.
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Welcome To Temple University Health System!
Children Birth children* Step-children Adopted children* For whom you have legal custody under age 26 Children, cont. Any age, totally and permanently disabled Qualified Medical Child Support Orders Spouse Legally married spouse One System, One Program Eligible dependents: (medical, prescription drug, dental and vision plan benefits) (*) Dependents eligible for TUHS Tuition Remission Program
To enroll your dependents … • Proof of relationship • Social Security numbers & birth dates required for all covered dependents • If your dependent does not have a social security number, please write in their nationality • If enrolling a handicapped dependent child over the age of 26 • Evidence of prior group coverage • IBC handicapped certificate required for review
Life Events • You have 30 days from a life event to make the appropriate change to your enrollments • Marriage • Add spouse to current coverage • Divorce • Remove former spouse from current coverage • Birth, adoption • Add child(ren) to current plans • Loss of other benefits of no fault of your own • Elect medical, dental or vision YOUR TOMORROW BEGINS HERE
Medical Benefits • Personal Choice Plans • Temple Care • Advantage Plan • High Option
Medical Plan Features • Self-insured • Three Personal Choice options that offer: • Competitive array of covered services • Different ways to receive & pay for services • Financial incentives to use Temple Network • 3-tier drug program • Health & wellness education supporting informed choice • $75 Emergency Copay • Mid-year changes only for life events (30 days from life event to make change); open enrollment in Dec. for Jan 1 plan year
Understanding the networks TempleCare Network (900+) All providers are in Personal Choice network with privileges at TUHS facilities TPI /TUP employed docs: no copays TUH hospitals + CHOP & St. Chris Make sure you understand the out-of-pocket costs when selecting your insurance plan and if choosing non-network providers and facilities. Out-of-Network Providers Providers not in Personal Choice Network Annual deductible Higher out-of-pocket costs Personal Choice Network Benefits not as high as Temple Network All Temple providers are in Personal Choice Higher out-of-pocket than Temple Network Co-pays and deductibles Blue Card services across the country
TUHS Medical Plan Options No copays collected by Temple-employed physicians.
Which Option Is Best For You? • Ask these questions: • Do you already use Temple facilities and providers or do you plan to? • Do you travel or have children away at school? • Do you anticipate a procedure in the future at a facility other than TUHS? • Do you prefer to pay more out of your paycheck and less at the doctor’s office? • Or, less out of your paycheck and more at the time of service?
Accolade • New Service to Assist employees navigate the healthcare system! • Accolade Health Assistants serve as a single point of contact for all of your health benefits and healthcare needs • Provide services such as assistance with claims issues, finding a physician, or general questions regarding the TUHS medical and prescription plans • Connect with your health assistant by calling 888-659-8302 Monday – Friday 8AM – 8PM
Prescription drug benefitsCVS/Caremark • Features of our Prescription Plan: • Use of Generics • Where there is an exact chemical equivalent, you must use the generic • Generic Step Therapy • Certain medications require that you use a generic first. Refer to your handout “Brand Medications Requiring Use of a Generic First”
Prescription drug benefits • Maintenance Choice Program • Long term medications need to be dispensed at your local CVS pharmacy or through CVS/Caremark mail order service only • If using your local CVS pharmacy, you must receive a 90 day supply • Fills through CVS/Caremark mail order be filled for lesser quantities if you would like (30, 60 or 90 days) • One time fills at any participating pharmacy
Prescription drug benefits • Specialty Guideline Management • Specialty Guideline Management is a comprehensive specialty utilization management program that helps to ensure appropriate, safe and effective medication use, including review both before therapy initiation and during ongoing treatment • Refer to the listing of “Specialty Guideline” medications
Prescription Drug Benefits Three-tier coinsurance structure:
Dental Benefits • United Concordia (UCCI) Dental Plan • Alliance Preferred Provider Network • UCCI.com/client corner • Offers freedom of choice in providers • Manage your own dental care costs • Passive PPO Plan means benefits in- and out-of-network • Stay in-network: enjoy discounted, pre-negotiated fees • Out-of-network: subject to dentist’s balance billing
Concordia Flex Schedule of Benefits Plan Pays Class I Services Exams 100% All X-Rays 100% Cleanings 100% Fluoride Treatments 100% Space Maintainers 100% Palliative Treatment 100% Class II Services Basic Restorative 100% Endodontics 100% General Anesthesia 100% Simple Extractions 100% • General Anesthesia 80% All services listed on this Schedule of Benefits are subject to the Schedule of Exclusions and Limitations. Participating Dentists accept the Maximum Allowable Charge as payment in full. Schedule of Benefits $1,000 per person annual benefit
Vision benefits • Providers • TU Department of Ophthalmology • 215-707-5300 • Boyer Pavilion, 6th floor • Fort Washington • Jeanes Hospital • The Eye Institute of the Pennsylvania College of Optometry • 215-276-6111 • Benefits • Routine eye exam every 2 years • AND one of the following: • Glass, selected single vision lenses and plastic frame • Glass, selected bifocal lenses and plastic frame • Contact lens credit
Medical Flexible Spending Account Make the most of pre-tax savings … manage your out of pocket medical, dental or drug costs using your Medical FSA! Benefit runs 7/1 – 12/13/16, reenroll at OE for 2017 Use your Flex Card: • At most pharmacies and doctor offices • To prescription eyewear or contact lenses • To pay for prescription coinsurance amounts
Medical Flexible Spending Account Here’s how it works … • Elect now for 2016 or each December at OE you can elect to participate in a medical flexible spending account (FSA) for the following calendar year* • You can put away up to $2,550 (pre-tax!) per household in a medical FSA • You can submit your claims for reimbursement from your medical FSA until March 31 of the following plan year * Unless you experience a qualified Life Event throughout the year
Dependent Care Flexible Spending Account Make the most of pre-tax savings … manage your dependent care costs using your dependent care FSA! Benefit runs 1st of the month following hire for the calendar year, reenroll at OE for 2017 • Easy to use • You are able to use your Flex Card in some approved day care locations
Dependent Care Flexible Spending Account Here’s how it works … • Elect now for 2016 or each December at OE you can elect to participate in the dependent care flexible spending account (FSA) for the following calendar year* • You can put away up to $5,000 (pretax!) per household in a dependent care FSA • You can submit your claims for reimbursement from your dependent care FSA until March 31 after the end of the plan year * Unless you experience a qualified Life Event throughout the year
Basic Life and Basic Accidental Death & Dismemberment (AD&D) The Health System pays the full cost of your basic life and AD&D insurance coverage! • Basic life insurance coverage equals $10,000 benefit • Basic Accidental Death & Disability insurance coverage equals $10,000 benefit
Supplemental (Voluntary) Life Enhanced coverage options are available through the Universal Program • Supplemental employee only coverage available • Employees may buy from one and a half (1.5) to five (5) times their salary on an post-tax basis ($1,000,000 max) • Coverage for four (4) or five (5) times salary or above $500,000 requires completion of an Evidence of Insurability application and approval by the insurance company • Term coverage that is in effect during your employment with TUHS
Accidental Death and Dismemberment Insurance • Employees may purchase insurance on post-tax basis for: • Spouse • Eligible children • Coverage available in $10,000 increments, maximum $150,000 (benefits prorated for family members) • $2.25/mo for single coverage of $150,000 • $3.75/mo for family coverage of $150,000
TUHS Short Term Disability • Coverage is 60% of base weekly pay after the later of a 30 day elimination period or the exhaustion of other paid time • Maximum weekly benefit $1,250 • If approved, payments made through the 90 day elimination period for LTD • Pre-existing condition clause. 3/12 • If you were treated in the past 3 months from the date of issue for a condition that condition will be excluded for the next 12 months
Long Term Disability • Eligible Class: • RESIDENTS, INTERNS AND FELLOWS WORKING AT LEAST 20 HOURS PER WEEK • Eligibility Waiting Period: • None • Monthly Benefit: • The Monthly Benefit will be an amount equal to $2,000, less any other income. • Elimination Period: • 90 days per Period of Disability • Maximum Benefit Duration by age at time of disability: • LESS THAN AGE 60 TO AGE 65 • 60 TO AGE 65 • 61 TO AGE 65 • 62 42 MONTHS • 63 36 MONTHS • 64 30 MONTHS • 65 24 MONTHS • 66 21 MONTHS • 67 18 MONTHS • 68 15 MONTHS • 69 AND OVER 12 MONTHS
Retirement SavingsTax Sheltered Annuity • All employees are eligible to participate • Save additional funds for retirement on a pre-tax or Roth tax basis • Employees under age 50 are eligible to contribute up to $18,000 in 2016* • Employees age 50+ are eligible to contribute up to $24,000 in 2016* • Enrollment materials in your folder * This amount includes all pre-tax contributions with any employer to a 401k or 403b plan in 2016 as well as required employee contributions to the TUHS Pension Plan if eligible
Want to speak with the experts? • You can schedule a personal retirement counseling session with TIAA-CREF • 800 732-8353 • Telephone customer service representatives available, evenings and weekends • Call 800-842-2776 or • On the web www.tiaa-cref.org
Next Steps • Draw a on the top of your application if immediate medical services are needed • Complete your enrollment application • Names, DOB and SS#’s for all dependents • Place competed application in the envelope provided with required copies of proof of relationship • Return envelope to Benefits Representatives at top of steps • If you do not have all required documentation or have not fully completed the Enrollment Form, bring it to HR or place it in the inter-office mail by June 16th
Questions? • The Benefits Department can also be reached Monday through Friday from 8am to 5pm at 215-707-2500, option #2 • We are also available by e-mail: HR4U@tuhs.temple.edu • Please feel free to stay if you have individual benefits questions