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Benefits Overview The information contained in this presentation is not a contract and is subject to change by the proper authorities. It should be understood that explanations in this summary cannot alter, modify or otherwise change the controlling legal documents or general statutes in any way, nor can any right by reason of any inclusion or omission of any statement in this presentation.
Who’s Eligible • Permanent (non-temporary) part-time employees working 20 – 29 hours per week are eligible for many benefit programs, typically without employer contributions • Permanent (non-temporary) part-time employees working 30 to 39 hours per week or permanent full-time employees working 40 hours per week are considered to be benefits eligible
Health Benefits • State Health Plan of NC – administered by Blue Cross and Blue Shield of North Carolina (BCBSNC) • Use any medical provider you choose • In Network: Your costs are lower when you use a doctor, hospital or other provider from the BCBSNC Blue Options network. • Out of Network: For other providers, your deductibles, coinsurance and copays may be higher • Choose from three plan options: • Traditional 70/30 Plan (lower contributions, lower coverage levels) • Enhanced 80/20 Plan (higher contributions, higher coverage levels) • Consumer-Directed Health Plan (CDHP) (higher deductible, Health Reimbursement Account (HRA))
Prescription Coverage – 70/30 and 80/20 Plans • Prescription coverage (in-network) provided by Medco: • Generic: $12 copay, up to 30-day supply • Preferred Brand-name: $40 copay, up to 30-day supply • Non-preferred Brand-name: $64 copay, up to 30-day supply • Specialty: 25% coinsurance up to $100 or $150 (depending on the medication), 30-day supply • ACA preventive medications covered at 100% for 80/20 Plan; not applicable for 70/30 Plan • Prescription coverage (out-of-network) provided by Medco: • Applicable copay and the difference between charge and allowed amount • ACA preventive medications covered at 100% for 80/20 Plan; not applicable for 70/30 Plan
Prescription Coverage – CDHP • Prescription coverage (in-network) provided by Medco: • Generic, Preferred Brand-name, Non-Preferred Brand-name: 15% coinsurance after deductible • ACA preventive medications covered at 100% • CDHP Preventive Medications covered at 15%, no deductible • Prescription coverage (out-of-network) provided by Medco: • Generic, Preferred Brand-name, Non-Preferred Brand-name: 35% coinsurance after deductible • ACA preventive medications covered at 100% • CDHP Preventive Medications covered at 15%, no deductible
Additional Health Plan Resources • NC HealthSmart: voluntary program offering tools and resources to help you live a healthier life such as: • Member Focus newsletter, information on the 24-hour nurse line, the Stork Rewards program, Eat Smart, Move More, Weigh Less program • Sign up for the State Health Plan Member Newsletter at www.shpnc.org
Lower Your Premiums with Wellness Premium Credits—The Enhanced 80/20 Plan
Consumer-Directed Health Plan (CDHP) with HRA High-Deductible Health Plan Health Reimbursement Account (HRA) A different kind of health plan with two components • Covers the same services as other Plan options through the same PPO network • The deductible is higher than other Plan options, but the coinsurance is lower • In-network: $1,500 Individual/$4,500 Family • Out-of-Network: $3,000 Individual/ $9,000 Family • After the deductible is met, the member only pays the 15% coinsurance • The deductible applies to both Pharmacy and Medical expenses • If the member reaches his or her deductible and coinsurance out-of-pocket maximum, the Plan pays 100% of the covered expenses for the rest of the benefit year (medical and pharmacy) • The Plan funds the members’ Health Reimbursement Accounts (HRA) annually • HRA funding is based on the number of family members covered • $500 for employee/retiree only • $1,000 for employee/retiree + 1 $1,500 for employee/retiree + 2 or more dependents • HRA funds are used to pay a portion of the members’ deductibles & coinsurance • Once the HRA is depleted, the member must pay the remaining deductible & coinsurance • Incentives available to add value to HRA • Unused HRA funds are available the following year
How The HRA Helps The Member Meet Their Deductible Coverage Type HRA Pays Total Deductible You Pay Employee Only First $500 Remaining Deductible $1,000 $1,500 In-Network $3,000 Out-of-Network Remaining Deductible $2,500 Employee + One Family Member First $1,000 Remaining Deductible $2,000 $3,000* In-Network $6,000 Remaining Deductible $5,000 Out-of-Network Employee + Two or more Family Members First $1,500 Remaining Deductible $3,000 $4,500* In-Network $9,000 Remaining Deductible $7,500 Out-of-Network *The HRA is a pooled account and is available to whichever family member needs it first. It is possible for one family member to use all the funds before another family member has a claim.
How the Consumer-Directed Health Plan with HRA Works #1 #6 #2 #3 #5 To monitor HRA balance and claim’s payments, members may go online to www.shpnc.org and click on My Member Services. #4
Lower Premiums with Wellness Premium Credits— • Consumer-Directed Health Plan (CDHP)
Lower Member Health Care Costs with Wellness Incentives— • Consumer-Directed Health Plan (CDHP)
Monthly Rates for Health Coverage • If you are enrolled in the Enhanced 80/20 Plan or the Consumer-Directed Health Plan, you will have the opportunity to earn wellness premium credits each year, which will reduce your monthly premiums • Health insurance premiums are paid one month in advance of coverage (i.e., January premiums pay for February coverage) • No pre-existing condition exclusion *Assumes completion of three wellness activities
NCFlex Health & Other Insurance Programs • These voluntary programs provide a variety of plans to meet the needs of you and your family • You pay the full cost of coverage through payroll deductions on a pre-tax basis • Programs include: Dental, Vision, Health Care Flexible Spending Account, Dependent Day Care Flexible Spending Account, Cancer, Critical Illness, Group Term Life Insurance, Core AD&D and Voluntary AD&D Insurance
Dental Coverage • Coverage provided through United Concordia • Choose from two plan options: • High Option: Includes orthodontia for children under 19 • Low Option: Does not include orthodontia • Under both options: • Visit any provider • You are responsible for deductibles • You or your dentist may file claims • You may be subject to a waiting period before certain benefits are payable under the plan (see “Benefit Waiting Period” chart under Dental coverage on NCFlex website)
Vision Coverage • Coverage provided through Superior Vision Services (SVS) • Choose from three coverage options: • Core Wellness • Basic Plan • Enhanced Plan • Under all options, visit any provider but may pay lower expenses with in-network SVS provider
Health Care Flexible Spending Account • Coverage provided through P&A Group • Set aside money through pre-tax contributions to pay for eligible out-of-pocket medical, dental and vision expenses: • Deductibles • Co-pays and coinsurance • Out-of-network expenses • Uncovered procedures • Contribute from $120 to $2,500 per year • Convenience card (debit card) for all participants • “Use it or lose it” rule; you forfeit any unused contributions • Expenses can be incurred between January 1, 2014 and March 15, 2015, provided you remain actively employed for all of 2014. Prior year claims must be submitted by April 30, 2015.
Dependent Day Care Flexible Spending Account • Set aside money through pre-tax contributions to pay eligible child care and adult day care expenses so you (and your spouse) can work or attend school full-time: • Care of dependent children under age 13 • Care of dependent adult who lives with you at least 8 hrs/day • You may contribute from $120 to $5,000 per year • “Use it or lose it” rule: you forfeit any unused contributions • Expenses can be incurred between January 1 of the current plan year and March 15 of the subsequent plan year provided you remain actively employed for all of the plan year. Prior year claims must be submitted by April 30 of the subsequent year.
Other NCFlex Health Programs • Cancer Insurance provided through American Heritage Life: pays benefits for cancer-related expenses • Employee Only or Employee + Family Coverage • Low, High and Premium options • Critical Illness Insurance provided through Met Life: pays lump sum benefit in event of certain health conditions • Employee, Spouse, Children or Family Coverage • Three categories of coverage available
Monthly Rates for Critical Illness Coverage Employees may also cover eligible dependent children. Employee will pay one flat rate ($0.92) no matter how many children are covered.
Voluntary Group Term Life Insurance • Group Term Life provided through ING • Coverage available for yourself, your spouse and child(ren). You must be enrolled to cover your spouse/child(ren) • Employee only and Employee & Spouse coverage in $10,000 increments, from $20,000 to $500,000 (limited to five times your base annual earnings); spouse coverage cannot exceed 100% of employee’s elected amount • Coverage over $100,000 subject to Evidence of Insurability (EOI) • Dependent child(ren) coverage for $5,000 or $10,000
Accident Insurance • Core Accidental Death and Dismemberment (AD&D) Insurance provided through A.C. Newman • Elect coverage of $10,000 for yourself only • University pays full cost of coverage; however, you must enroll for coverage • Payment to your beneficiaries in case of your accidental death • Payment to you in case of your accidental dismemberment • Voluntary AD&D Insurance provided through A.C. Newman • Elect coverage up to $500,000 for you and your family • You pay the full cost of coverage
Income Protection Programs • Programs designed to provide you and/or your family with financial protection in the event of your death, disability or long-term illness • Some are offered at no cost to you; others require you to pay for coverage
Disability Plans • Disability coverage provided under the Disability Income Plan of North Carolina (DIP-NC) • Short-Term Disability • Provided to eligible employees at no cost • After one year of contributing membership to TSERS or participation in the ORP. • Pays 50% of base compensation up to $3,000/month • Payable up to 365 days, after 60-day waiting period • Long-Term Disability • Provided to eligible employees at no cost • After five years of contributing membership to TSERS or participation in ORP • Pays 65% of base compensation up to $3,900/month • Payable as long as you remain permanently disabled, until eligibility for unreduced service retirement
Supplemental Disability Plans • Can help fill gaps in State coverage • Replacement income while you are ineligible for state Short-Term Disability Plan • Waiting period: 90 days • Pays 66-2/3% of gross monthly salary up to $10,000 • Voluntary benefit; you pay full cost of coverage after-tax • Coverage through The Standard if you elect ORP • Includes continuing ORP contributions into your ORP account on your behalf • Coverage through Liberty Mutual if you elect TSERS
Retirement Programs • Participation in a retirement program is mandatory • You may choose between: • The North Carolina Teachers' and State Employees' Retirement System (TSERS), a defined benefit plan or • the UNC Optional Retirement Program (ORP), a defined contribution plan • You must make your election between TSERS and ORP within 60 days of your date of hire • Once you make the choice it cannot be changed; it is irrevocable
TSERS Plan Highlights • Defined benefit plan • State controls the investment • Benefit you receive is based on a formula (factors include your age, your average final compensation and your years/months of creditable service) • You must contribute 6% of your pay on pre-tax basis
ORP Plan Highlights • Defined contribution plan • You control your investments • The benefit you receive at retirement is based on investment performance and payment option chosen • Program serves as an alternate option to TSERS • You must contribute 6% of your pay on a pre-tax basis • The University contributes 6.84% • Each provider has a four-tier structure for their fund lineup. • Choose from two investment providers: • Fidelity Investments • TIAA-CREF
Retirement Plan Resources To review the booklet in greater detail, click on the picture to open the document. Or copy and paste these addresses: http://www.northcarolina.edu/hr/Mandatory_Retirement_Plan_Decision_Guide.pdf http://www.northcarolina.edu/hr/Guide_to_Investing.pdf
Retirement Plan Resources Two more resources to assist you in making a decision between TSERS and the ORP. Click on the either image to open a link to that tool.
Supplemental Retirement Plans • Allows you to put money away on a pre-tax basis for your retirement in addition to the 6% you contribute to TSERS or the ORP • There are three types of plans available • 403(b) plan administered by two different vendors, Fidelity and TIAA-CREF, and sponsored by the University • A 401(k) plan administered through Prudential and sponsored by the State of North Carolina • A 457 plan administered through Prudential and sponsored by the State of North Carolina • You may elect to begin, change the amount you contribute or stop your participation at anytime • You may elect to participate in the 403(b), 401(k) and the 457 at the same time, however there are limits to the amount you can contribute
WCU Employee Tuition Waiver • Full-time faculty and staff who are eligible for membership in the retirement system are eligible to enroll in two courses per academic year at a reduced rate, subject to approval by the employee's supervisor and Human Resources. Tuition Assistance Site http://www.wcu.edu/about-wcu/campus-services/human-resources-and-payroll/general-hr-resources/benefits/tuition-assistance.asp
