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BENEFITS

Health Benefit Program Overview

Eligibility: All employees working 50% or more of full time for seven months or longer.

Waiver of Coverage: Employees who have other medical coverage may waive participation by signing a waiver of coverage and providing proof of other coverage

Coverage Begins: Date of hire for eligible employees and enrolled dependents.

Coverage Ends: The day employment ends, or the last day of employment in an eligible category.

Continuation of Coverage: When health benefits terminate, you have 60 days to elect to continue health coverage under the provisions of COBRA.

Cost of Coverage: The employee pays monthly the amounts listed below by payroll deduction. Employees on family and medical leave (FMLA) pay for health benefits at the monthly payroll deduction rate. Individuals on COBRA and unpaid Leave of Absence pay the entire monthly health premium listed below.

Payroll Deductions for Health Benefits: Employees choose health between three United HealthCare options. Each option offers the same coverage and exclusions; you determine how much and when you want to pay. You can elect a lower premium and pay higher deductibles and co-insurance rates or you can elect higher premiums and pay lower deductibles and co-insurance. Health coverage rates for payroll deductions are listed below.

 

Special Enrollment Dates

All employees may enroll their legally married spouse and certain unmarried children or eligible domestic partner, effective the first date of employment. If you decline enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may in the future be able to enroll your dependents in this plan, provided that you request enrollment within 31 days after the other coverage ends.  In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll your dependents, provided that you request enrollment within 31 days after the marriage, birth, adoption, or placement for adoption.

Open Enrollment

During the open enrollment period, you can change from one plan to the other.  You can also add or delete dependent coverage.  Otherwise, you are only allowed to make changes within 31 days of a qualifying change in family status.

Qualifying Change Family Status

Qualifying events include: marriage, divorce, legal separation, birth, adoption or placement for adoption, death of a dependent or spouse, termination or commencement of employment by the employee or a dependent, changing from part-time to full-time (or vice versa) employment by employee or spouse, or a significant change in family's health coverage attributable to the spouse's employment.

Application for a change must be made within 31 days of the qualifying change family status and documentation of the event must be provided.

Benefits Enrollment/Change Form

Health Benefit Summaries (pdf): Plan 13 | Plan 9 | Plan 10 | Plan Comparisons

Health Coverage Rates  2010 Per Month

2010 Rates
Plan 13
Plan 9
Plan 10
Basic Option (Low)
Basic Plus (Medium)
Basic Choice (High)
Employee Only
Less than $35,000
$32.01
$70.49
$160.07
$35,000 to $64,999
$51.40 $89.88 $179.45
$65,000 to $94,999
$89.88 $128.06 $217.94
$95,000 & above
$121.89 $160.07 $249.94
Employee + Spouse
Less than $35,000
$242.63 $317.03 $417.98
$35,000 to $64,999
$301.66 $367.94 $470.08
$65,000 to $94,999
$341.00 $443.85 $548.52
$95,000 & above
$386.90 $507.26 $613.80
Employee + Child(ren)
Less than $35,000
see note*
$185.94 $245.68 $379.60
$35,000 to $64,999
$261.49 $324.56 $432.00
$65,000 to $94,999
$332.21 $435.15 $522.40
$95,000 & above
$372.98 $497.31 $584.57
Family
Less than $35,000
$271.49 $416.78 $522.17
$35,000 to $64,999
$347.03 $467.14 $574.58
$65,000 to $94,999
$422.86 $561.79 $672.48
$95,000 & above
$498.69 $637.33 $750.62
         
*Above rates reflect monthly employee contribution toward their total health coverage rate.

Pharmacy Benefits (doc)
For more information, please refer to the United Healthcare Pharmacy Summary (pdf)

 

Vision Benefits

For more information, please refer to the Vision Program brochure (doc)

 

Health Benefit Forms

If you would like to sign up for coverage with United Healthcare, complete the Benefits Enrollment/Change Form and submit it to WFMO within your first 31 days of employment or return from leave of absence. If an employee fails to make a selection within 31 days of employment, that individual will automatically be enrolled into Plan 13, by default, with employee only coverage. An Employee that defaults to Plan 13 will not have the option of adding a spouse or dependent until open enrollment or unless there is a change in status. 

Health Insurance: Change in Family Status Form
If you have had a change in family status within the last 31 days you may be allowed to make changes in your insurance coverage. Print and fill out this form and return it to WFMO with the required supporting documentation and the Benefits Enrollment/Change Form.

 

Prescription Drug Reimbursement Form

 

Health Flexible Spending Account (FSA)

Tulane University offers two Flexible Spending Account (FSA) Plans: a Health FSA and a Dependent Care FSA. The Plans offer you tax savings throughout the year. You can review a brief description of how these tax savings plans can benefit you, informed with important dates and provide more information about reimbursements by using one of the following links.

Flexible Spending Account Summary

FSA Questions & Answers Worksheet (pdf)

FSA Enrollment
New Hires and employees with a change in family status who wish to participate in the FSA Plan can enroll in the Flexible Spending Account Plan outside of the annual Open Enrollment Period.  New hires and employees with a qualifying change in family status must submit the enrollment form to WFMO within 31 days of employment or 31 days from the date of the status change. Employees with a change in family status must also submit the Benefits Enrollment/Change Form and the required supporting documentation.

In an effort to streamline the Reimbursement Account process, Benefit Concepts is implementing a new claim submission procedure. All claim information and associated substantiation will be scanned directly into our administration system as it is received. This initiative combined with our on-line claims submission functionality will further enhance the participant experience. Our goal is to accelerate the reimbursement process and provide on-line access to all submitted forms and substantiation documents.

 

Health FSA Reimbursement Claim Form (pdf)

Health FSA Reimbursement Requirements (pdf)

FSA Facts (pdf)

Dependent Care Flexible Spending Account Summary

Dependent Care FSA Questions, Answers and Worksheet

Dependent Care FSA Reimbursement Requirements

Additional Dependent Care Substantiation Statement

FSA Dependent Care Paperless Claim Submittal  (pdf)

Dependent Care Claim Form

In an effort to streamline the Reimbursement Account process, Benefit Concepts is implementing a new claim submission procedure. All claim information and associated substantiation will be scanned directly into our administration system as it is received. This initiative combined with our on-line claims submission functionality will further enhance the participant experience. Our goal is to accelerate the reimbursement process and provide on-line access to all submitted forms and substantiation documents.

 

Dental Insurance

MetLife Preferred Dentist Program Information (pdf)

Vision Benefits

For more information, please refer to the Vision Program brochure (doc)

 

Payroll/Personnel Information Form
Adjusts employee data such as a change of address, department name, or phone number.  Submit this form to have your address changed with benefit vendors (i.e. United HealthCare etc.) also. 



 
 

BENEFITS

 

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