2.1 Policy Statement
It is the University's objective to maintain a schedule of reasonably priced health, dental, and vision care benefits ("health and welfare") for its full-time, benefits-eligible, employees. The University will adhere to all federally mandated changes and will endeavor to communicate to all employees' any and all changes to the plans as they become necessary. The University's self-funded health care plan meets the "grandfather" requirements as defined by the PPACA and conforms to all the requirements for affordability and minimal essential coverage.
2.2.1 "Benefits-Eligible" - Full-time employees (Faculty, Staff, and Administration) as defined in the policy "Types of University Employment" are provided, as a part of their overall package, access to health and welfare benefits for themselves and for qualified dependents. Participation is optional with costs being shared in several plans by both the University and the employee; once authorized by the employee, the employee portion will be taken through pre-tax payroll deductions as premium contributions.
2.2.2 "Change in Employment Status" - Employees who either move from part-time to full-time or full-time to part-time.
2.2.3 "Initial Enrollment" - Employees who wish to enroll in one of the health and welfare plans must do so within the first thirty (30) days of employment.
2.2.4 "Open Enrollment" - Employees who wish to enroll in one of the health and welfare plans and have not done so during the initial enrollment period will be able to enroll during the annual open enrollment period defined by the University when benefit enrollment changes can be made per the plan rules.
2.2.5 "Premium Contribution" - The amount the employee contributes per pay along with the University's portion to maintain the benefit. The University does not contribute to the premiums for the health, dental or vision plans for the employees on unpaid leave of absence except as required by the Family and Medical Leave Act (FMLA) or specific federally mandated leave.
2.2.6 "Status Change" - Employees who wish to enroll in one of the health and welfare plans and have not done so during either the initial enrollment period or the open enrollment period may do so when one of five (5) events occurs as defined by the IRS: a change in marital status, a change in the number of dependants, a change in employment status (the employee, the spouse or the dependant), a change in a dependants eligibility or a change in residence of the employee, the spouse or a dependant. A change in the employees benefit plan coverage must be "on account" of one of these events and must be made within thirty (30) days of the event which precipitated the change.
2.2.7 "Summary Plan Descriptions" - Commonly referred to as "SPD"s, these are condensed versions of the University Plan which every employee who participates in the programs receives. The University reserves the right to amend the Plans and SPD's as it deems appropriate; the website will contain current versions.
2.2.8 "Patient Protection and Affordable Care Act" - PPACA, the federally mandated program to provide affordable, minimally essential, health care to all eligible full time employees.
2.3.1 The University offers a reasonably priced, multiple-option, health care plan to benefits-eligible employees. The University plans include both low and high cost option insurance for individual employees, employees plus one, or employees and their families. Depending upon the option selected, premium contributions may be made with pre-tax dollars. Premium contributions are reevaluated and adjusted annually prior to open enrollment and all employees are informed of the premium contribution at that time. Because the health care plan is a self-insured plan through a third party provider, the University assumes the balance of the cost after the employee contribution and the deductibles delineated in the plan.
2.3.2 The University offers a reasonably priced, multiple-option, dental care plan to benefits-eligible employees. The University options include both low and high cost option insurance for individual employees, employees plus one, or employees and their families. Depending upon the option selected, premium contributions may be made with pre-tax dollars. Premium contributions are reevaluated and adjusted annually prior to open enrollment and all employees are informed of the premium contribution at that time. The University assumes the balance of the cost after the employee contribution and the deductibles delineated in the plan.
2.3.3 The University offers two (2) reasonably priced vision care plans to benefits-eligible employees. The plans are 100% employee financed and include insurance for individual employees, employees plus one or employees and their families with a pre-tax premium contribution. That premium contribution is reevaluated and adjusted annually prior to open enrollment and all employees are informed of the premium contribution at that time.
2.3.4 Information on the current providers for health, dental, and vision can be obtained from Human Resources or the HR Website under "Forms - Benefits Information & Forms."
2.4 Employee Notification
Employees are notified of their enrollment options during:
2.4.1 Initial enrollment or when employees are hired. Employees may enroll at that time (within 30 days of hire) and, depending upon the plan selected, their coverage may begin with the first day of the month following the month of hire or within the period specified by the provider.
2.4.2 Open Enrollment. The University Human Resource Department will notify employees of the open enrollment period
through emails and postings and provide them with a list of plans, options and applicable premium contributions.
2.4.3 Employees are provided SPD's upon enrollment with amendments mailed out as needed.
2.5 Status Change / Change in Employment Status
Employees who have not previously been enrolled in the plans noted above or have been enrolled under one of the options may either enroll or change their option when they experience a status change or a change in employment status provided that they enroll within thirty (30) days of that change (see HIPPA Special Notice of Enrollment Rights on the HR Website under "Forms - Benefits Information & Forms").
The University will adhere to the provisions of the providers programs with respect to co-insurance.
2.7 Federal Health Care Reform - PPACA
2.7.1 The University reserves the right to initiate changes in the health care plan to address any impact resulting from the implementation of the Patient Protection and Affordable Care Act (PPACA), its amendments, and any other applicable Federal or State legislation regulating health care. The University will adopt reasonable modifications to the current health care program in compliance with the requirements of the PPACA and communicate the impact of these changes to affected employees. Currently, only full-time employees as defined within the policy on "Types of University Employment" are offered health care. Per the requirements of the PPACA, part-time employees as defined within the policy on "Types of University Employment" are ineligible for University provided health care including adjunct faculty members.
2.7.2 The University has determined that it is an applicable large employer as defined by the PPACA subject to the Employer Shared Responsibility provisions under section 4980H of the Internal Revenue Code. Consequently, the University must offer affordable health coverage that provides a minimum level of coverage to our full-time employees and their dependents. The University's Health Care Plan "B" meets both the affordability and minimum essential coverage requirements for an individual employee as determined by the PPACA.
2.7.3 The University has determined that it will utilize one (1) standard measurement period of twelve (12) months,
beginning January 1 and ending December 31. Employees' who average thirty (30) hours per week or one-hundred thirty (130) hours per month during the measurement period will be considered full-time and eligible for health care benefits for the number of month(s) in which they meet the average hour requirement. Two methods will be used to determine eligibility:
- Hours worked per month for each month of the measurement period, totaled, and divided by 12; or
- Hours worked per month for each month of the measurement period, totaled, and divided by 52.
2.7.4 The University has determined that it will utilize a ninety (90) day administrative period to evaluate the employees hours from the previous measurement period and, if the employee has served the required hours, extend an offer of health care. The offer will be valid for the twelve (12) month stability period during which it will overlap with the subsequent measurement period when the employee will be re-evaluated.