BENEFITS

Health Benefit Program Overview

Eligibility: All Employees working more than 50% of full time for at least seven months.

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 Rates

All employees may enroll their legally married spouse and certain unmarried children of the employee and spouse, 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 depenendts in this plan, provided that you request enrollment within 30 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 30 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 30 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 30 days of the qualifying change family status and documentation of the event must be provided. Approval of the application is required prior to the effective date of the change.

Health Care FAQ 2008 (pdf)

Health and Dental Open Enrollment 2008 (pdf)

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

Health Coverage Rates

Pharmacy Benefits (doc)
For more information, read the United Healthcare Pharmacy Summary (pdf)

Vision Benefits Open Enrollment Form (doc)
For more information, read the Vision Program brochure (doc)

Health Benefit Forms

United Healthcare Enrollment Form
If you would like to sign up for or make changes with United Healthcare, complete the form and submit the form to WFMO.

Health Insurance: Change in Family Status Form
If you have had a change in family status within the last 30 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 United Enrollment/Change form.

Premium Conversion Plan Form
Plan that allows employees to have health insurance premiums withheld either before or after taxes are paid.

Health Insurance Waiver Form
To opt out of a University sponsored health plan, you have to submit this signed form to WFMO.

Prescription Drug Reimbursement Form

2009 FSA OPEN ENROLLMENT 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 (pdf)

FSA Questions & Answers Worksheet (pdf)

FSA Enrollment Form
New Hires and employees with a change in family status that 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 30 days of employment or 30 days from the date of the status change. Employees with a change in family status must also submit the Change in Status 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.

 

FSA Reimbursement Claim Form (pdf)

FSA Reimbursement Requirements (pdf)

FSA Privacy Notice

FSA Facts (pdf)

FSA Brochure (pdf)

FSA Frequently Asked Questions (pdf)

FSA Paperless Health Care Claim Submittal  (pdf)

FSA Calendar (pdf)

FSA Notice of Privacy Practices (pdf)

Dependent Care Flexible Spending Account

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
Only employees participating in the FSA Plan can file a reimbursement claim form.  Employees can file their expensed by completing the form and submitting the form and receipts to BCI via mail or fax.  The address and fax number is at the top of the 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.

Health Care Claim Form

Only employees participating in the Cafeteria Plan can file a reimbursement claim form.  Employees can file their expensed by completing the form and submitting the form and receipts to BCI via mail or fax.  The address and fax number is at the top of the form.

Dental Insurance Forms

MetLife Preferred Dentist Program Information (pdf)

MetLife Dental Enrollment Form If you would like to sign up for or make changes to your dental coverage, complete the Met Life Dental Form and submit the form to WFMO.

Change in Status Form
If you have had a change in family status within the last 30 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 MetLife Dental Enrollment/Change Form.

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. 

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