OPEN ENROLLMENT 2016

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OPEN ENROLLMENT

2016

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WELCOME

to the 2016 Benefits Open

Enrollment at Lafayette College.

This year’s Open Enrollment

begins on October 30 and

continues through November 23,

2015. All of the plans offered during

the Open Enrollment period are

based on a calendar year (January 1

through December 31, 2016).

The following pages of this booklet

summarize the benefit options for

your consideration during this Open

Enrollment period. This information

is to be used as a general guide

and does not reflect a complete

summary of the plans. Detailed

plan summaries can be found in

the Office of Human Resources

and on the Human Resources

web page, hr.lafayette.edu.

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OPEN ENROLLMENT

2016

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Welcome to the Annual Benefits Open Enrollment

Period for 2016

Each year, as part of the process of renewing our health insurance coverage for the following calendar year, the Office of Human Resources undertakes a rigorous review of our health care plans with the goal of identifying the best possible health care coverage for our community at the lowest possible cost. As you know, we continue to be faced with a challenging healthcare environment, and want to take this opportunity to thank the Faculty Subcommittee on Healthcare for its valuable contributions during the renewal process.

We are pleased to report that, for calendar year 2016, the College will be retaining its medical coverage with Highmark Blue Shield, and will be continuing to offer the three health plan choices that were offered in 2015: Low Deductible PPO Plan; Standard PPO Plan; and High Deductible PPO Plan with a Health Savings Account (HSA). With the exception of two minor plan design changes to the Standard PPO Plan, the plan designs for the three plans will remain the same (see below). By maintaining this range of plans, our colleagues will continue to be able to select the health plan that best suits their health care needs and the needs of their families. The College will continue to contribute to each plan the same dollar amount it contributes at each tier toward the Standard Plan.

The College was successful in negotiating the renewal of the Standard PPO Plan with an increase to premiums of 4.5%. The College will be increasing its contributions to

the Standard Plan by 4.5% at each tier, and the employees contributions will also increase by 4.5%. Premiums for the Low Deductible and High Deductible Plans have increased at a higher percentage (see rate sheet on page 11).

In addition, we are pleased to report that the College will continue to cover 90% of the Standard PPO medical premium for an individual employee; 78% for an employee with child/children; and 67% of the combined premium for employee and spouse/partner or family. These are the same College contribution percentages that existed in 2015. If you elect to enroll in the Low Deductible Plan (lower copays, deductibles, and coinsurance than in the Standard PPO), the College will contribute to that plan the same dollar amount it contributes to the Standard PPO Plan, with the employee paying the difference between that amount and the total premium for the Low Deductible PPO Plan.

If you select the High Deductible Health Plan with the HSA, the College will contribute to that plan the same “dollar amount” it contributes to the Standard PPO Plan, with the employee paying the difference. This amount includes the College’s annual contribution of $1500 in 2016 to an HSA for employee-only coverage, and $3000 in 2016 to an HSA for all coverage tiers above employee-only coverage. (These HSA contributions by the College represent 50% of the applicable annual deductible at the respective coverage tiers.)

The following pages will provide greater details for each of the three plan options, as well as information about the HSA account. We will also be holding a series of meetings for employees during the Open Enrollment period, in addition to hosting the annual Benefits Fair on Wednesday, October 28. (Please refer to the back of this brochure for the dates and

times of these meetings.)

During the annual Open Enrollment period, you may make changes to your medical, dental, flexible spending, HSA, and optional/supplemental life insurance coverage, without incurring a “life status change”.

If you are not making any changes to your medical/ dental/optional life coverage, you do NOT need to complete a form.

Employees dropping or changing their coverage, or adding/deleting covered dependents, MUST complete a new enrollment form. Your completed forms must be returned to the Office of Human Resources by Monday, Nov. 23, 2015.

Employees enrolling in a Flexible Spending Account (FSA) for 2016, or choosing to contribute to their HSA account for 2016, MUST complete a new enrollment form.

MEDIC AL PL AN CHOICE S FOR 2016:

The College will to continue to offer a range of three medical plan options for 2016, consisting of a “Standard PPO” plan, a “Low Deductible PPO” plan and a “Qualified High Deductible PPO + HSA” plan. All three plan designs are based on a Preferred Provider Organization (PPO) model. In a PPO, a member does not need to formally select a primary care physician, and does not need a referral to see a specialist. The following pages provide a summary of the plan options for 2016, as well as a side-by-side comparison of all three medical plans.

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4 | OPEN ENROLLMENT

2016

• Standard PPO Plan: The College’s premium

contributions for all medical plans will be based on this plan. (The College’s premium allowance for this plan, therefore, determines the premium allowance for the other two plans.) Standard PPO plan changes for 2016:

• Annual in-network deductible: $800 individual/$2400 family • Annual Rx deductible:

$250 individual/$750 family

• Low Deductible PPO Plan: A PPO plan which offers richer benefits (lower out-of-pocket expenses), in exchange for increased monthly premiums. This plan could be attractive to an employee willing to pay more in premiums (offered on a pre-tax basis), but who wants to reduce/limit the employee’s own out-of pocket costs.

• Qualified High Deductible Plan w/HSA: A qualified high deductible health plan (PPO based) which requires greater member out-of-pocket expense in exchange for lower monthly premiums. This plan will also feature a Health Savings Account (HSA) which the College will fund at 50% of the applicable annual deductible for both the individual and family coverage tiers for 2016.

A Health Savings Account, or HSA, is an interest bearing savings vehicle partially funded by the College (50% of the applicable annual deductible for 2016) and the employee (if desired), which can be used to pay for qualified health care expenses not covered in-full by the medical plan, on a pre-tax basis. If elected, the employee’s contribution is deposited into this account during the year and used to pay for qualified expenses incurred by the member. The College will make its contribution to this account (50% of the deductible) at the beginning of the year. Money in this account, and any interest, is tax-free if used to pay for qualified medical expenses. It works very much like a flexible spending account (FSA) with some advantages. In addition to higher annual contribution limits, the money in the account is fully owned by the employee, and the balance can be carried forward into future years without fear of forfeiture. Note: IRS guidelines prohibit an employee from participating in a medical FSA account if they are enrolling in the QHDHP/HSA option.

Note: Maximum HSA contribution limits (employer plus employee) for 2016 will be $3350 for individual and $6750 for family. Employees age 55 and older may contribute up to an additional $1000 for 2016.

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OPEN ENROLLMENT

2016

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IMP ORTANT REMINDER REGARDING

DEPENDENT CHILDREN ELIGIBILIT Y FOR 2016

Under the Health Care Reform legislation (Patient Protection and Affordable Care Act), all children (natural, adopted, or step children) under age 26 are considered “dependent” regardless of their student status, marital status,

and tax filing status. This legislation allows employees to cover children up to the age of 26, under the College’s medical (not dental) plans. However, HSA funds can only be used for dependent children claimed on your tax return.

DENTAL PL AN FOR 2016

The College is remaining with Blue Cross Dental as its dental insurance carrier for 2016. While the annual benefit remains at $1,000, the “rollover benefit” will continue into 2016. With this rollover feature, employees can rollover up to $500 of unused dental benefit from 2015 into 2016. The maximum annual benefit as a result of this rollover feature is $2,000.

A summary of the dental plan benefits can be found on page 10.

FLE XIBLE SPENDING ACCOUNTS (FSA)

The College will continue to use Discovery Benefits as its flexible spending administrator for 2016. A debit card

will be issued to all new members enrolling in the medical flexible spending account for 2016. Participants that are already enrolled in this plan year and re-enrolling in 2016 will keep their current debit card. All employees electing

to enroll for the 2016 calendar year must complete a new enrollment form, even if you are currently enrolled in the program for 2015.

Details regarding the flexible spending account plans can be found on page 11.

Note: Employees electing the High Deductible medical plan

option with the HSA funding account are prohibited by IRS regulations from also enrolling in a medical flexible spending account for 2016. Employees can elect one account or the other, not both.

FSA ANNUAL ELEC TION

As a result of health care reform legislation under The Patient Protection Act, the annual FSA limit for the medical flexible spending account continues to be $2,500 per employee. The dependent care account maximum remains at $5,000 per family.

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Deductible Individual Family $800 $2,400

(applies to all services unless a copayment is applied or otherwise noted)

$2,000 $6,000

$3,000 - Individual Tier Only $6,000 - All Other Tiers (applies to all services unless otherwise noted)

$300 $900

$1,200 $3,600

(applies to all services unless a copayment is applied or otherwise noted) Health Savings Account

Employer Contribution Individual

Family

$1,500 $3,000 Coinsurance (Eligible Charges)

Member Pays Plan Pays 15% 85% 45% 55% 20% 80% 50% 50% 10% 90% 25% 75% Medical Out-of-Pocket Max

Individual Family $1,350 $4,050 $4,000 $12,000 N/A N/A $10,000 $20,000 $1,200 $3,600 $2,250 $6,750 True Out-of-Pocket Maximum

(includes deductible, coinsurance, and copays for Medical and Rx)

Individual Family

$6,600 $13,200

None

Each person covered under Family category will have an individual TROOP of $5,000 per year $5,000

$10,000

$10,00 0

$20,000 $6,600 $13,200

None

Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited

Physician Office Visits Primary Care Specialists

$15 copay $25 copay

45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible $10 copay $20 copay

25% coinsurance after deductible

Telemedicine (3) $10 N/A 80% (lower cost) N/A $5 N/A

Preventive

(Pediatric/Adult Exams)

$0 copay; deductible waived 45% coinsurance after deductible $0 copay; deductible waived 50% coinsurance after deductible $0 copay; deductible waived 25% coinsurance after deductible Maternity/Newborn Baby Care 15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible Inpatient Hospital Services

(professional fees and facilities)

15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible Surgery & Anesthesia 15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible Outpatient Hospital Services

(professional fees, facilities, lab, x-ray, radiation therapy, chemo-therapy, anesthesia and surgery)

15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible

Radiology Testing/Imaging

(x-rays, MRI, CT, PET)

15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible Emergency Room Services Covered in full/$100 ER copay (waived

if admitted); deductible waived

Covered in full/$100 ER copay (waived if admitted); deductible waived

20% after network deductible 20% after network deductible Covered in full/$100 ER copay (waived if admitted); deductible waived

Covered in full/$100 ER copay (waived if admitted); deductible waived Hospice Care 15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible Prescription Drugs

(Express Scripts)

Deductible Individual Family

Retail–up to 31-day supply Generic

Brand Formulary Brand Non-Formulary

Mail Order–up to 90-day supply Generic Brand Formulary Brand Non-Formulary $250 $750 $10 copay $35 copay $50 copay $20 copay $70 copay $100 copay N/A

Rx Deductibles are Integrated with Medical Deductibles

$20 copay after deductible $40 copay after deductible $50 copay after deductible $40 copay after deductible $80 copay after deductible $100 copay after deductible

N/A $150 $450 $10 copay $30 copay $45 copay $20 copay $60 copay $90 copay N/A

Annual Preventive Mammogram

(age 40 and over)

Covered in full; deductible waived 45% coinsurance after deductible Covered in full; deductible waived 50% coinsurance after deductible Covered in full; deductible waived 25% coinsurance after deductible Preventive Gynecological Exam $0 copay; deductible waived 45% coinsurance after deductible $0 copay; deductible waived 50% coinsurance after deductible $0 copay; deductible waived 25% coinsurance after deductible Mental Health Inpatient Care 15% coinsurance after deductible 45% coinsurance after deductible 20% after deductible 50% coinsurance after deductible 10% after deductible 25% coinsurance after deductible Mental Health Outpatient Services $25 copay 45% coinsurance after deductible 20% after deductible 50% coinsurance after deductible $20 copay 25% coinsurance after deductible Substance Abuse Care: Inpatient 15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% after deductible 25% coinsurance after deductible Substance Abuse Care: Outpatient $25 copay 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible $20 copay 25% coinsurance after deductible

BENEFITS IN-NETWORK OUT-OF-NETWORK

Standard PPO

Q High Deductible+HSA

Low Deductible PPO

QHDHP + HSA ADVANTAGE S

• Tax savings on contributions made to the HSA for eligible expenses • Contributions made by employers

may be excluded from gross income • Funds belong to the employee

even after employment terminates • Funds can be used to cover a

wide range of qualified medical expenses—including those incurred by spouse/dependents (as long as they can be claimed on the individual’s federal tax return) • Unused funds in health savings

accounts can rollover from year to year for future medical needs • Acts as a savings vehicle for

members nearing retirement age • Offers lower premiums for

employees

• May use HSA funds for premiums after retirement

Highmark Blue Shield

The Highmark plans are fully insured PPO plans which locally utilize the Highmark Blue Shield PPO network of hospitals and medical providers. A current listing of local providers can be accessed online at highmarkblueshield. com. In addition, if you wish to obtain medical services from Blue Shield participating providers outside of the local area, you may use the BlueCard Worldwide PPO network. You can access the BlueCard Worldwide PPO directory from the Highmark website.

For more information about Highmark Blue Shield call 1-800-632-5071.

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$800 $2,400

$2,000 $6,000

$300 $900

$1,200 $3,600

(applies to all services unless a copayment is applied or otherwise noted) Health Savings Account

Employer Contribution Individual

Family

$1,500 $3,000 Coinsurance (Eligible Charges)

Member Pays Plan Pays 15% 85% 45% 55% 20% 80% 50% 50% 10% 90% 25% 75% Medical Out-of-Pocket Max

Individual Family $1,350 $4,050 $4,000 $12,000 N/A N/A $10,000 $20,000 $1,200 $3,600 $2,250 $6,750 True Out-of-Pocket Maximum

(includes deductible, coinsurance, and copays for Medical and Rx)

Individual Family

$6,600 $13,200

None

Each person covered under Family category will have an individual TROOP of $5,000 per year $5,000

$10,000

$10,00 0

$20,000 $6,600 $13,200

None

Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited

Physician Office Visits Primary Care Specialists

$15 copay $25 copay

45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible $10 copay $20 copay

25% coinsurance after deductible

Telemedicine (3) $10 N/A 80% (lower cost) N/A $5 N/A

Preventive

(Pediatric/Adult Exams)

$0 copay; deductible waived 45% coinsurance after deductible $0 copay; deductible waived 50% coinsurance after deductible $0 copay; deductible waived 25% coinsurance after deductible Maternity/Newborn Baby Care 15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible Inpatient Hospital Services

(professional fees and facilities)

15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible Surgery & Anesthesia 15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible Outpatient Hospital Services

(professional fees, facilities, lab, x-ray, radiation therapy, chemo-therapy, anesthesia and surgery)

15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible

Radiology Testing/Imaging

(x-rays, MRI, CT, PET)

15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible Emergency Room Services Covered in full/$100 ER copay (waived

if admitted); deductible waived

Covered in full/$100 ER copay (waived if admitted); deductible waived

20% after network deductible 20% after network deductible Covered in full/$100 ER copay (waived if admitted); deductible waived

Covered in full/$100 ER copay (waived if admitted); deductible waived Hospice Care 15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% coinsurance after deductible 25% coinsurance after deductible Prescription Drugs

(Express Scripts)

Retail–up to 31-day supply Generic

Brand Formulary Brand Non-Formulary

Mail Order–up to 90-day supply Generic Brand Formulary Brand Non-Formulary $250 $750 $10 copay $35 copay $50 copay $20 copay $70 copay $100 copay N/A

Rx Deductibles are Integrated with Medical Deductibles

$20 copay after deductible $40 copay after deductible $50 copay after deductible $40 copay after deductible $80 copay after deductible $100 copay after deductible

N/A $150 $450 $10 copay $30 copay $45 copay $20 copay $60 copay $90 copay N/A

Annual Preventive Mammogram

(age 40 and over)

Covered in full; deductible waived 45% coinsurance after deductible Covered in full; deductible waived 50% coinsurance after deductible Covered in full; deductible waived 25% coinsurance after deductible Preventive Gynecological Exam $0 copay; deductible waived 45% coinsurance after deductible $0 copay; deductible waived 50% coinsurance after deductible $0 copay; deductible waived 25% coinsurance after deductible Mental Health Inpatient Care 15% coinsurance after deductible 45% coinsurance after deductible 20% after deductible 50% coinsurance after deductible 10% after deductible 25% coinsurance after deductible Mental Health Outpatient Services $25 copay 45% coinsurance after deductible 20% after deductible 50% coinsurance after deductible $20 copay 25% coinsurance after deductible Substance Abuse Care: Inpatient 15% coinsurance after deductible 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible 10% after deductible 25% coinsurance after deductible Substance Abuse Care: Outpatient $25 copay 45% coinsurance after deductible 20% coinsurance after deductible 50% coinsurance after deductible $20 copay 25% coinsurance after deductible

OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK

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VIRTUAL

MEDICINE

JUST CLICK FOR

CARE THAT’S QUICK

And you can even schedule virtual behavioral health appointments for issues like depression, anxiety and relationship challenges.

In emergency situations, such as heart attack or stroke symptoms, always go to the emergency room or call 911.

HOW VIRTUAL MEDICINE WORKS

You can use online video 24 hours a day, 7 days a week to visit U.S. board-certified, state-licensed doctors who can diagnose, recommend treatment and prescribe medication, when appropriate, for minor medical issues like:

• Cold and flu

• Rashes • Pinkeye• Headaches

When you and your family

need quick care for minor

illnesses, virtual medicine

is a convenient option.

WHAT IF?

You feel a bad cold coming on.

Your primary care doctor is booked solid today and you don’t want to wait for an appointment.

You’re traveling with your kids.

What you thought was an earache from a long flight seems to be getting worse after you’ve been on the ground a while.

You have an itchy rash that is spreading.

You need to see a dermatologist but can’t get an appointment for three weeks.

GET STARTED TODAY!

And you will be ready when you need

it. It’s easy to start taking advantage

of virtual medicine.

Just register

online. See back for details.

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NETWORK DOCTORS If they have virtual medicine capabilities** dermatologistoncall.com

amwell.com doctorondemand.com

Specialist

Follow-Up

Visits

After you see a specialist in person, you can take advantage of virtual visits for any follow-up visits needed. These visits take place in real time at a primary care provider’s offi ce, outpatient clinic or other location close to you that has the equipment needed for virtual visits.

Primary

Care Visits

If your doctor has virtual medicine capabilities and chooses to use this service, you may be able to visit your primary care doctor virtually.

Minor

Illnesses

24/7 access to U.S. board-certifi ed doctors for minor illnesses.

Behavioral

Health

Virtual Behavioral Health is available for reliable and convenient scheduled therapy visits with certifi ed therapists.

AmWell is a trademark of American Well Corporation and may not be used without written permission.

Doctor on Demand is a trademark of Doctor on Demand, Inc. and may not be used without permission.

DermatologistOnCall is a registered trademark of IAGNOSIS, Inc. and may not be used without written permission.

American Well, DermatologistOnCall and Doctor on Demand are independent companies that provide telemedicine services and do not provide Blue Cross and/or Blue Shield products or services. American Well, DermatologistOnCall and Doctor on Demand are solely responsible for their telemedicine services.

**Also includes dermatologists and behavioral health providers.

Have Questions?

Virtual visits are covered in the same way as they would be if

you received in-person care.

*

YOUR OPTIONS

Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. Insurance may be provided by Highmark Blue Shield, Highmark Health Insurance Company, or Highmark Benefits Group.

*All benefits under your health plan are subject to the terms of the benefit agreement and applicable state law.

To find more information about Highmark’s benefits and operating procedures, such as accessing the drug formulary or using network providers, please go to DiscoverHighmark.com/QualityAssurance; or for a paper copy, call 1-855-873-4108. To determine the availability of telemedicine services under your health plan, please review your Outline of Coverage for details on benefits, conditions and exclusions. Highmark does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

We are committed to providing outstanding services for our applicants and members. If you require special assistance, including accommodations for disabilities or limited English proficiency, please call us at 1-888-269-8412 to request these free services (TTY/TDD users may call 711).

PID10316_9-15

If you have any questions, call the toll-free number on the back of your member ID card.

Skin, Hair

and Nail

Issues

Have a rash, mole or other skin, hair or nail issue you’re concerned about? Don’t want to wait for a dermatologist appointment? With DermatologistOnCall, you can take pictures of your symptoms and send these pictures to a consulting dermatologist through a secure website.

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Blue Cross Dental Plan Option

The Blue Cross Dental plan focuses on the importance of regular and preventive dental care. The plan is administered by Capital BlueCross.

The plan provides members significant savings by receiving services from participating dental providers, and also allows members to receive services from non-participating providers of their choice with insurance reimbursements based on the contracted allowances.

The Blue Cross Dental plan provides coverage for the full range of dental care needs, such as routine preventive and diagnostic, basic and major restorative, and orthodontic services. The plan utilizes the national Blue Cross network of dental providers. You can locate a participating dentist at their website: www.capbluecross.com.

When using a participating (in-network) dentist for diagnostic and preventive care, eligible services are

covered at 100%. When you receive basic restorative, major restorative, or orthodontic services, you are responsible for the coinsurance amounts of 20%, 50%, and 50% respectively. If you use an out-of-network dentist, the plan pays the same set allowance for the particular dental service as it does for a participating dentist. You are responsible for the coinsurance amount plus the difference between the out-of-network dentist’s actual charges and the Blue Cross Dental established allowance.

There is no deductible applicable under this plan. Although the annual dental benefit amount per person, per plan year, is $1,000, the plan allows for a rollover benefit of up to $500 of unused dental benefit from one year to the next, for a maximum annual benefit of $2,000 per person. Under the Blue Cross Dental plan, services covered under the “preventive and diagnostic” category (100%) are not counted towards the annual $1,000 benefit amount. The lifetime maximum benefit amount for a child’s (up to age 19) orthodontic care is $1,000.

Covered at 100% Routine Exams

(one every six months) Cleanings (one every six months) X-rays

Bitewings (one set of four every six months)

Full mouth (one every three years) Fluoride Treatments (one every

six months till age 19)

Sealants (one tooth every three years; permanent first molars to age 10; permanent second molars to age 15) Palliative Emergency Treatment

Covered at 80% Basic Restorations Endodontics Denture Repairs Simple Extractions Anesthesia Specialist

Consultations Non-Surgical

Periodontics Oral Surgery

Covered at 50% Inlays Onlays

Crowns (one per tooth in five years)

Prosthetics (one per tooth in five years) Pontics

Surgical Periodontics

Covered at 50% Diagnostic Active Treatment Retention Treatment (Covers children to age 19) $1,000 lifetime

maximum per patient

DIAGNOSTIC AND PREVENTIVE BASIC RESTORATIVE MAJOR RESTORATIVE ORTHODONTIA

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Flexible Spending Accounts (FSAs)

For 2016, the College will continue with Discovery Benefits as its administrator for the flexible spending account program. A Debit Card will be issued to all new members enrolling in the medical FSA for 2016. Participants that are already enrolled in this plan year and re-enrolling in 2016 will keep their current debit card. This program allows employees to save money on a pre-tax basis to pay for unreimbursed qualified health/medical care expenses and certain dependent care expenses. Reimbursements are, in essence, the employee’s own money paid back tax-free. The plan year is from January 1 through December 31.

Note: Employees may carryover up to $500 of unused

benefit in their 2015 medical flexible spending account into

the 2016 plan year. The carryover amount then may be used during that entire following plan year to pay for or reimburse qualified medical/health care expenses. (The carryover allowance does not apply to dependent care accounts.) The annual flexible spending account contribution maximum for 2016, remains at $2,500. However, because of the carryover rule change, a participant may be able to contribute $2,500 in 2016, plus up to $500 of unused carryover funds from 2015, for

a total available amount of $3,000 for 2016.

In this account, you save a portion of your pay with pre-tax dollars, thereby reducing your federal income tax burden. Specifically, the plan allows you to contribute your own

Lafayette College Medical/Dental Insurance Premium Rates

MONTHLY PAYROLL DEDUC TIONS FOR AC TIVE EMPLOYEE S

Beginning January 2016

MONTHLY

TOTAL PREMIUM ACTIVES COLLEGE CONTRIBUTION* _{EMPLOYEE CONTRIBUTION}

Highmark Standard PPO

Individual $579.95 $521.97 $57.98

Empl+Sp/Partner 1,592.56 1,067.22 525.34

Parent/Child 1,355.12 1,065.14 289.98

Parent/Children 1,424.60 1,115.44 309.16

Family 1,662.04 1,116.44 545.60

Highmark High Deductible/HSA

Individual $559.31 $521.95 $37.36

Empl+Sp/Partner 1,444.36 1,067.22 377.14

Parent/Child 1,266.29 1,065.13 201.16

Parent/Children 1,318.41 1,115.45 202.97

Family 1,496.47 1,116.44 380.03

Highmark Low Deductible

Individual $646.12 $521.96 $124.16

Empl+Sp/Partner 1,776.84 1,067.22 709.62

Parent/Child 1,511.93 1,065.14 446.80

Parent/Children 1,589.45 1,115.45 474.01

Family 1,854.37 1,116.44 737.93

Bluecross Dental Plus

Single Coverage $40.88 - $40.88

Two-Party 81.78 - 81.78

Family 105.74 - 105.74

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money, before federal income tax, Social Security tax, and state tax (exceptions apply) to accounts, which will then be used to reimburse you for qualified out-of-pocket medical or dependent care costs. Visit www.discoverybenefits.com.

Dependent care: You may have money deducted from your

pay on a pre-tax basis to cover costs for dependent care. The

maximum limit for the calendar year is $5,000. You save

money by paying for these expenses with pre-tax dollars.

Medical/Health care: You may have money deducted

from your pay on a pre-tax basis to cover qualified medical expenses that are not covered by your medical, dental, or vision insurance. The maximum contribution limit for

the 2016 calendar year is $2,500. You save money by paying

for these expenses with pre-tax dollars.

Reminder: Because of the healthcare reform legislation, you

may utilize funds in your medical flexible spending account to pay for qualified medical expenses for dependents to age 26.

Flexible spending accounts operate on a calendar year basis. If you wish to participate for 2016, you must complete and sign the Discovery Benefits flexible spending enrollment form.

IMPORTANT: Remember that you should fund the flex

accounts only for eligible expenses that you expect to incur in 2016.

Additional/Supplemental Life Insurance

The College has selected a new group life and disability insurance carrier for 2016 – Standard Insurance Company. The Standard Insurance Company provides additional life insurance for employees over and above the non-contributory (free) coverage already provided by the College.

During this open enrollment period, employees who currently have additional/supplemental life insurance, may purchase additional life insurance up to 20% of the

Guaranteed Issue amount in increments of $10,000, up to the Guaranteed Issue maximum (3 times annual salary up to $300,000), without providing evidence of insurability. At each subsequent open enrollment period, you may also purchase up to 20% of additional life insurance, up to the Guaranteed Issue maximum, without providing evidence of insurability.

During this open enrollment period, employees who currently DO NOT have additional/supplemental life insurance, may purchase additional life insurance up to 20% of the Guaranteed Issue amount in increments of $10,000, up to the Guaranteed Issue maximum (3 times annual salary up to $300,000), without providing evidence of insurability. At each subsequent open enrollment period, you may also

purchase up to 20% of additional life insurance, up to the Guaranteed Issue maximum, without providing evidence of insurability.

(Employees who do not currently have additional/

supplemental life insurance, and do not elect additional life insurance at this open enrollment period, will be subject to evidence of insurability requirements in the future.) Premiums, which are determined by the amount of the insurance taken and the age of the employee based on age-banded rates, are fully paid by the employee. If you wish to make any changes to your current level of additional/supplemental life insurance, please complete the supplemental life enrollment form. If required for underwriting purposes, you will be sent a personal health application from the Office of Human Resources, once you complete and return the enrollment form.

Additional Information

If there are any questions regarding the information contained in the booklet, or any questions related to the use of Employee Self-Service, please contact the Office of Human Resources at (610) 330-5060.

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URGENT CARE

OR THE ER?

HOW TO MAKE THE RIGHT CHOICE

Plan ahead. Highmark wants you to understand your options for immediate health care before you

need them. Review this information and find the appropriate care locations near you so you get

the help you need when you need it. It’s also a good idea to check your medical coverage to see

which care settings are available in your network. But, in any case, if you’re experiencing a

life-threatening emergency, always call 911 or go to the nearest emergency room immediately.

URGENT CARE: THE SMART,

CONVENIENT CHOICE FOR

IMMEDIATE HEALTH CARE

Shorter Wait Times

At an urgent care facility, you can usually see a doctor quicker, so you can start feeling better sooner. That’s more peace of mind.

Lower Costs

Urgent care centers typically charge less than hospital emergency rooms, and that can save you money. Review your insurance plan to compare costs.

More Convenience

Most urgent care facilities offer longer hours without needing an appointment, are usually less crowded and can do common tests on the premises. That’s a better all-around experience.

SAVE THE ER FOR LIFE-THREATENING

EMERGENCIES

When it could be a matter of life or death or medical emergency, go directly to a hospital emergency room or call 911. These and other critical conditions require an emergency room visit: • Severe shortness of breath or

chest pain

• Sudden or unexplained loss of consciousness

• Sudden, severe abdominal pain • A cut or wound that won’t

stop bleeding

URGENT CARE: THE ALTERNATIVE FOR

NON-LIFE-THREATENING EMERGENCIES

When your doctor’s office is closed, consider an urgent care center or retail clinic for treatment of non-life-threatening conditions. Both offer treatment that is faster and less expensive than the emergency room without compromising quality.

An urgent care center is a freestanding,

full-service, walk-in health care clinic that has extended hours, with no appointment necessary. These facilities employ board-certified doctors who offer the same care as a primary care or family physician. Many even offer physicals, immunizations and common testing services like x-rays and blood tests. Use an urgent care center for: • Sunburns

• Minor cuts and sprains • Poison ivy and other rashes • Colds, flu or sinus infections • Nausea, vomiting or diarrhea

A retail clinic is typically located in

a drugstore or other retail outlet and features convenient hours, including evenings and weekends. Clinics are usually staffed by certified registered nurses who treat many of the same health problems listed above.

HIGHMARKBLUESHIELD.COM

To find an urgent care center near you, log in to your Highmark member website.

Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. 11/14 CS 203132

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