Title: Welcome To Benefits Enrollment
1Welcome To Benefits Enrollment!
2Agenda
- First Section
- Health Plans medical, dental
- Retirement Plans
- Welfare Benefits life insurance, fitness
- Second Section
- Split into two groups
- Research Associates/External Graduate Students
- All other Staff
- Forms, Questions, Other Benefits
3Benefits Administration
- Benefit Card Information Sheet
- Contact Information
- (858) 784-8487
- benefits_at_scripps.edu
- Website
- http//www.scripps.edu/hr/benefits/
4New Hire Website
- www.scripps.edu/hr/benefits/newhire.html
- Links
- Forms
- Benefit Enrollment Slides
- Plan information
5When are my benefits effective?
- Date of Hire
- Date of Employment Status Change
6Who can I add to my health benefits as a
dependent?
- Spouse
- California Registered Domestic Partner
- Child (under age 19, or under age 25 if a full
time student) - Please note - An employee may enroll in the
health plans either as a participant or as a
covered dependent of his/her spouse who also
works at TSRI, but not both. Please notify
Benefits Administration if you have a dependent
that also works at TSRI.
7Proof of Dependency
- Always required when a dependent is added to the
medical and/or dental plan - Examples
- Birth Certificate or Adoption Paperwork (child)
- Marriage Certificate (spouse)
- California Certificate of Domestic Partnership
(domestic partner) - Visa Paperwork/Visa Passport Stamps (spouse or
child) - Prior years tax returns (spouse or child)
8Medical Plan
- 3 Options
- Comprehensive (PPO)
- Catastrophic
- Health Maintenance Organization (HMO)
9Comprehensive Plan Option 1
- Preferred Provider Organization (PPO)
- Preferred Provider Network Aetna Signature
Administrators - No Primary Care Physician required
- No need for referrals to Specialists
- Freedom to choose between In Network or
Non-Network Providers
10Comprehensive Plan
- How to find an ASA Provider
- Phone (866) 484-6534
- Website www.principal.com
- Claims Administrator Principal
- Other Website Tools
- Claim Status
- Electronic Explanation of Benefits
11Comprehensive Plan
- In-Network
- 200 per person, 600 per family Annual
Deductible - Covered at 90 after deductible is met
- Out of Pocket Max 1,500 per person, 3,000 per
family - Out-of-Network
- 400 per person, 1,200 per family Annual
Deductible - Covered at 70 after deductible is met
- Out of Pocket Max 3,000 per person, 6,000 per
family
12Catastrophic Plan Option 2
- Claims administrator Principal
- No provider network, freedom to choose any
provider - 2,000 per person, 6,000 per family Annual
Deductible - Coinsurance at 80
- Out of Pocket Max 5,000 per person, 10,000 per
family
13Comprehensive and Catastrophic Medical Plans
- Chiropractic Coverage
- 20 visits per year
- Acupuncture
- No In-Network Providers
- Covered at In-Network Rate (usual and customary
applies) - 20 visits per year
- Send receipts to Principal for reimbursement
14- Sample Explanation of Benefits
- with deductible
- deductible met
15Prescription Plan
- Caremark
- Network Pharmacies
- 10 co-pay for generic drugs
- 25 co-pay for formulary brand name drugs
- 50 co-pay for non-formulary brand name drugs
- Mail Order Service up to a 90 day supply
- 20 co-pay for generic drugs
- 50 co-pay for formulary brand name drugs
- 100 co-pay for non-formulary brand name drugs
- When filling prescriptions at pharmacies that do
not accept Caremark, you must pay out-of-pocket
and submit for reimbursement - Caremark The Health Improvement Company
- Refill Prescriptions
- Drug Interactions
- Summary of Benefits
16Mental Health Plan
- United Behavioral Health (UBH)
To receive the In-Network level of benefits, you
must call UBH at 800-888-2998 BEFORE services are
provided. To utilize the Out-of-Network level
of benefits, you do not need to contact UBH.
17HMO Plan Option 3
- HMO Network of Providers
- Aetna Value Network HMO
- Primary Care Physician required
- Referrals to see specialists required
- Exception Mental Health, OB-GYN, Chiropractic
- Only in-network services will be covered
18HMO Plan
- No deductible
- 15 co-pay for outpatient and preventive services
- 100 covered for inpatient hospital services
- 100/visit to an emergency room
- 50/visit to urgent care
- Chiropractic care covered for 20 visits/year
- Acupuncture services are not covered
- 1,500 per person, 3,000 per family
out-of-pocket max
19HMO Plan
- How to find a Primary Care Physician
- Call Aetna at 877-402-8742
- Visit www.aetna.com
- Fill out PCP form to designate a PCP for each
covered family member - Turn in PCP form along with Benefits Enrollment
Form within 30 days of your date of hire - Can change PCPs once a month provided you notify
Aetna of the change before the 16th of the
preceding month
20Prescription Coverage
- Retail
- 10 co-pay for generic drugs
- 25 co-pay for brand name drugs
- 50 co-pay for non-formulary
- Mail Order Service
- Up to a 90-Day Supply
- 20 co-pay for generic drugs
- 50 co-pay for brand name drugs
- 100 co-pay for non-formulary
-
To find out which tier a medication is on, or to
see if pre-certification is needed visit
www.aetna.com/formulary
21Mental Health Services
To locate a provider call 800-424-5928
22Comparing Medical Plans
23Vision PlanAll medical plan options
- Medical Eye Services (MES)
- Medical Eye Services Vision Providers
- Make sure to bring an MES Claim Form every visit
- 10 co-pay annually
24Vision Plan
- Benefits Available
- Every 12 Months
- One routine eye exam and
- Standard pair of lenses (additions such as
scratch resistance, UVA protection, etc., are
out-of-pocket expenses) or - Pair of contact lenses (100 allowance)
- Every 24 Months
- Pair of frames (110 allowance)
Benefits are reduced when a non-participating
provider is used.
25Counseling and Psychological Services
- Professional counseling services for
employees, - graduate students, and family members.
- No Cost
- Confidential
-
Jan Hill, LCSW 784-2950 or janhill_at_scripps.edu Da
phne Lurie, PhD 784-7915 or dlurie_at_scripps.edu
26Life Events Resources
Access Code Group Number 10730 Health and
Wellness Articles Educational Resources Private
Online Consultations Chats with Experts Financial
Fitness Tools .and More
27Life Events Resources
- Personal consultation service for information and
resources to solve lifes everyday challenges - Confidential service provided by UBH
- Available 24 /7
- Save time and reduce stress!
- Assistance with
- - finding a childcare facility near home
- - finding housing options for an aging parent
- - legal or financial advice
- - finding language tutors
- - and much more
- Call 1-866-374-6061 or log onto
www.liveandworkwell.com, - Access Code 10730
28Postdoctoral Services
- Available to all TSRI postdocs and graduate
students to - support their research during their training
appointments. - Information on San Diego and on how to find
housing - Career Resources
- TSRI Group Information
- www.scripps.edu/services/postdocs/
- Contact Ryan Wheeler at 784-9740 or
rwheeler_at_scripps.edu -
-
29Dental Plan
- Delta Dental
- How to find a Delta Dentist
- Website Online Delta Dentist directory
- You may also view Eligibility and Benefits
Summary Info - Phone (800) 335-8227
30Dental Plan
Of Reasonable and Customary Charges
31Comprehensive and Catastrophic Health Plan Cards
TSRI BENEFIT OFFICE 858-784-8487 AUTHORIZATION
IS REQUIRED PRIOR TO HOSPITAL ADMISSIONS AND
SELECTED OUT-PATIENT SERVICES OR SURGERIES. FOR
AUTHORIZATION CALL 866-484-6534 MEDICAL CLAIMS
TO PRINCIPAL LIFE INSURANCE CO PO BOX 39710
COLORADO SPRINGS CO 80949-3910 MENTAL HEALTH
PLAN 10730 UNITED BEHAVIORAL HEALTH 800-888-2998
PO BOX 30755 SALT LAKE CITY UT
84130-0755 DENTAL PLAN 8593 DELTA DENTAL
888-335-8227 PO BOX 997330 SACRAMENTO CA
95899-7330 VISION PLAN 97-005 MEDICAL EYE
SERVICES PO BOX 25209 SANTA ANA CA 92799
800-877-6372 AETNA PARTICIPATING DOCTORS AND
HOSPTIALS ARE INDEPENDENT PROVIDERS, NOT AGENTS
OR EES OF AETNA. REFER TO YOU BOOKLET FOR
FURTHER DETAILS Visit us at www.principal.com
12/15/07
The Scripps Research Institute Issuer
(80840) Payor 61271 ID 991132765
Account P90844-5 Name JANE DOE
Eff
1/01/08 Deps John Billy Sarah
The Scripps Research Institute
Card Type Medical Managed Care
Network/Preferred Provider Organization AETNA
SIGNATURE ADMINSTRATORS
Benefit Ph 866-484-6534 CAREMARK
800-966-5772 RXPCN PCS RX Group
K011-0001 RX Bin 610415 RX
Copay 10/25/50 RX Mail Service
20/50/100
Front Back
32Comprehensive and Catastrophic Health Plan Cards
- Cards will be mailed to your home address
- Contact Principal to order replacement cards or
cards for child dependents
33HMO Health Plan Cards
www.aetna.com Except in emergencies or for direct
access benefits, referrals to specialists or
hospitals must be issued by the primary care
physician (PCP) you have selected before service
is performed, OR YOU WILL BE RESPONSIBLE FOR THE
COST OF THE SERVICE. Benefits are provided under
the terms of the applicable contract, including
limitations and exclusions. Participating
physicians, hospitals and other health care
providers are independent contractors and are
neither agents nor employees of
Aetna EMERGENCY/URGENT CARE Call your local
emergency hotline (ex. 911) or go to the nearest
emergency facility. If a delay would not be
detrimental to your health, call your PCP.
Notify your PCP as soon as possible after
treatment. AETNA HEALTH OF CALIFORNIA INC. PO
BOX 14089 LEXINGTON, KY 40512-4089 Payor ID
60054 BIN 610502
0225-04/06
Aetna Value Network HMO
GRP US0378525
Valid 01/01/2008 RX ID
MEMBER NAME BBCCDDEA JOHN DOE DR
123-456-7890 123456 BBCCDDEB JANE DOE
DR 123-456-7890 123456 BBCCDDEC JACK
DOE DR 123-456-7890 123456 BBCCDDED
JILL DOE DR 123-456-7890
123456
DR 15 MEMBER SERVICES
800-123-4567 SP 15 PROVIDERS CALL
800-624-0756 BEHAVIORAL HEALTH 800-123-4567
FRONT
BACK
34HMO Health Plan Cards
- HMO cards will reflect medical, mental health,
and prescription coverage - Need to print out a card for Dental plan from
www.deltadentalins.com - No card for Vision plan, just bring claim form
- Cards will be mailed to your home address
- Contact Aetna to order replacement cards or cards
for child dependents - Can print temporary cards from Aetna website
35Dependent Care Spending Account
- Allows you to pay for qualified dependent care
expenses such - as day care with pre-tax gross income instead of
after-tax net - income.
- 5,000 maximum pre-tax annual election
- Estimate carefully, unused amounts forfeited at
the end of the year - Election may only be changed in the event of a
Qualified Status Change - Principal - Claims Administrator
- DCSA vs. Federal Tax Credit contact Principal
for more information - Effective date of hire
- Must re-enroll each year
36Open Enrollment
- One time of the year changes to benefits can be
made, - no questions asked
- Held annually, in October/November
- Online, secure web-based system
- Changes effective the following January 1st
- Special events Benefits Fair, Question and
Answer Sessions
37Qualified Status Changes
- Outside of Open Enrollment, you may only make
changes to your benefit plans due to a mid-year
qualified status change - Examples of Mid-Year Status Changes
- Birth, Adoption
- Marriage, Divorce, Legal Separation, Annulment
- California Registered Domestic Partnership
- Dependents entering the United States (must
provide valid passport) - Loss of other health coverage (must provide
letter from prior employer/insurance carrier) - Obtaining other health coverage (must provide
proof of other coverage and/or fill out Proof of
Other Coverage form to waive TSRI medical
coverage)
38Qualified Status Change
- When adding a dependent the change goes into
effect on the next administratively possible pay
period, but in no event later than the first of
the following month after the Benefits Change
Form and Proof of Dependency is received - - Exception For a birth or adoption the
change - goes into effect the date of the birth
or adoption - Changes to drop a dependent go into effect the
next administratively possible pay period after
form is received and/or after the change has
occurred
39Qualified Status Changes
- Remember! You have 31 days following a status
change to add/drop dependents
40Cash Balance Retirement Plan
- 100 TSRI paid
- 3-Year Vesting Plan any calendar year in which
you work at least 1,000 hours (hours worked must
be in a non-stipend paid status) - Yearly TSRI contribution
- 5 of your compensation for the calendar year or
- 2,000 if you complete at least 1,000 hours of
service or 1,000 if you complete at least 500,
but less than 1,000 hours of service
41Tax Sheltered Annuity (TSA) Plan - 403(b)
- Pre-Tax Voluntary Retirement Plan Exempt
- from Federal and State taxes until distribution
- Contribution Limits
- Under age 50, up to 15,500 in 2008
- Age 50 or over, up to 20,500 in 2008
- Contribution amounts can be changed, started or
stopped at any time - Direct Rollovers from previous qualified employer
plans accepted
42Tax Sheltered Annuity (TSA) Plan - 403(b)
- Fidelity Investments
- Level One Choice of 35 Fidelity and non-Fidelity
mutual fund options - Level Two Brokerage Link window
- Enrollment kits will be mailed to your home
directly from Fidelity. - Enroll via phone at 1-800-343-0860 or web at
www.fidelity.com/atwork.
43TSA Match Credits
- TSRI will match 50 on up to the first 6 of pay
you contribute (max 3) - Match Credits are added to your Cash Balance
Retirement Plan (vesting schedule applies)
44TSA Match Credit Example
- Account Balance January 1, 2007 is 2,500
- 2007 Annual Pay is 40,000
- Effective Annual Rate for Interest Credits is
5.5 - You completed 1,000 hours of service during 2007
45Scholar Share
- A voluntary 529 college savings program designed
- to help California families meet the increasing
costs - of higher education.
- Money can be used at virtually any college,
university, trade or technical school across the
nation and even some overseas - Withdrawals for qualified higher education
expenses currently exempt from Federal and State
Taxes - Managed by Fidelity Investments
- Contact Benefits Administration with questions
or for assistance - enrolling in the plan
46Supplemental Life Insurance
- Adams Group Insurance (AGI)
- May be purchased during Open Enrollment
- Self spouse/domestic partner and children are
eligible - Minimum 10,000
- Maximum 500,000
- Rates are based on age
47Business Travel Accident Insurance
- Provides coverage for accidental death or
dismemberment while traveling on official
business for TSRI - Travel to and from work is not covered
- Please refer to handout for coverage amounts
48Workers Compensation
- Occupational Medicine Provider Sharp Rees-Stealy
(SRS) - Located on Activity Road in Mira Mesa
- Maps posted in labs and offices, TSRI Website
- Hours of Service for Treatment
- Between 8AM and 5PM, Occupational Medicine
offices at SRS - Between 5PM and 8PM, Urgent Care facility at SRS
- Between 8PM and 8AM, injuries are treated at
Scripps Memorial Hospitals Urgent Care facility
on Genesee Avenue
49Workers Compensation
- If a life-threatening injury or situation occurs,
dial 77 and Security will make the connection
to the 911 operator - Please remember to report all workplace injuries
to your supervisor and Human Resources
50Leave Of Absence
- If absent for more than a week, notify Human
Resources - 30 days advance notice if possible
- Human Resources will provide an application for
leave to be completed by you and signed by
supervisor
51Types of Leave of Absences
- FMLA/CFRA - Family Medical Leave Act/California
Family Rights Act - Up to 12 weeks of unpaid job-protected leave in
12-month period - At least 1 year of service and 1,250 hours in
last 12 months - Birth or adoption own serious illness/injury
care for dependent with serious illness/injury
52Types of Leave of Absences
- PDL - Pregnancy Disability Leave
- Up to four months of unpaid job-protected leave
for pregnancy-related disability - No minimum length of employment required
- Personal Leave
- If not eligible for other types of leave
- At TSRIs discretion
- Not job-protected and unpaid
53SDI and PFL
- State Disability Insurance (SDI)
- Disabled and unable to work for more than 7 days,
you may be eligible to apply for SDI benefits - Paid Family Leave (PFL)
- Provides up to 6 weeks of partial pay for time
off to care for a family member or bond with a
newborn - Notify Human Resources any time you apply for SDI
or PFL to ensure your pay is properly coordinated
with these payments - Applications obtained in Human Resources or
online at www.edd.ca.gov - You pay an SDI and PFL tax on your paycheck
54COBRA
- Cobra is a Federal Law that requires employers to
- offer continuation of health benefits at the
- employees expense for 18, 29, or 36 months
- TSRI Health Benefits coverage terminates on the
last day of the month in which eligibility ends - COBRA continuation coverage becomes effective the
1st day of the following month - Administered by Conexis
55Transit Benefit
- Allows you to deduct eligible transportation
expenses on - a pre-tax basis
- Up to 115 per month pre-tax payroll deduction
- Eligible expenses include
- Bus Fares
- Commuter Railroad Fares (Coaster)
- Commuter Van Fares (Vanpools)
- Ineligible expenses
- Taxicab fares
- Carpooling
- Expenses associated with operation of a motor
vehicle - Contact Benefits for assistance enrolling in the
plan
56Fitness Club Membership
- Enroll on-line or at a TSRI on-site enrollment
- Access Code 73378 for online enrollment
57On-Site Seated Chair Massages
- Relief Unlimited Rob Walshe
- Certified by the National Certification Board for
Therapeutic Massage and Bodywork - 10 to 30 minute massages
- Offered every other Friday
- Cost 11 for 10 minutes, 17 for 15 minutes, 22
for 20 minutes, 28 for 25 minutes and 33 for 30
minutes - Call Benefits to make an appointment
58Wellness Benefits
- Yoga
- Sessions held weekly
- Contact Pia Weber at (858) 623-0318 or
pia_1997_at_yahoo.com - Â Tai Chi
- Sessions held weekly
- Contact Jesse Tsao at (858) 793-8939
- Tuition Reimbursement for Wellness Course
- Smoking Cessation or Weight Management
- 125 maximum per calendar year
- Annual Health Fair
59Discount Coupons Tickets
- www.ticketsatwork.com Corporate Discount
Program - Passport Unlimited Cards
- Use to save money with local and national
retailers and restaurants - For more information register your card at
www.passportlifestyle.com - Local Area Attractions Discounts Available at
HR Front Desk - San Diego Zoo/Wild Animal Park
- Universal Studios
- Legoland
- San Diego Harbor Excursion
- AVIS
60Discount Coupons Tickets
- Movie Tickets
- Regal, Edwards and United Artists 6.00/7.00
- AMC 6.00/7.50
- Pacific 5.50
- Ultra Star 5.50
- Sea World Tickets
- Adult 46.50 Child 41.00
- Disneyland Tickets
- Adult 61.00 Child 53.00 Standard 1 Day/1Park
Ticket - Adult 106.00 Child 91.00 2 Day Park Hopper
Ticket
Available at the HR Front Desk, check payments
only
61Employee Online
- A secure website that provides a current snapshot
of - your personal HR information
- View your health plan selections and enrolled
dependents - View retirement plan participation
- Update local address and emergency contact
information - View flexible spending account deductions
- https//ifas.scripps.edu/employeeonline
625 Minute Break
63Health Care Spending Account
- Used for reimbursement of health care expenses
not - covered by a health plan
- Deductibles, co-insurance, over-the-counter
medication, dental visits, vision exams - 5,000 pre-tax annual maximum election
- Estimate carefully, unused amounts forfeited at
the end of the year - Election may only be changed in the event of a
Qualified Status Change - Principal - Claims Administrator
- Effective date of hire
64Health Care Spending Account
- You do not have to be enrolled in TSRIs Medical
plan to enroll in HCSA - Have until 3/15/09 to incur expenses for 2008,
and until 6/30/09 to submit receipts for
reimbursement - Reimbursements paid out on Fridays
- Must re-enroll each year during Open Enrollment
- COBRA continuation
65Health Care Spending Account
- Automatic Reimbursement for PPO only
- Eligible expenses (i.e. coinsurance and
deductibles) submitted to the TSRI medical plan
at Principal will automatically roll over to the
health care spending account department - Enroll or stop at any time
- EOBs will tell you if charges rolled over to
HCSA - Cannot participate if you have more than one
insurance
66Group Term Life Insurance/ADD
- CIGNA
- Options- must enroll in one of the choices
- 1 x annual salary
- 2 x annual salary
- 3 x annual salary
- Flat 10,000
- TSRI provides benefit credits for 2 x annual
salary - Costs shown on your benefit enrollment form
- Must list beneficiaries
- The federal government requires employees to pay
taxes on amounts in excess of - 50,000 with age group rates taken into
consideration. This tax will be reflected on
your - paycheck and included on your W2 taxable earnings.
67Dependent Life Insurance
- CIGNA
- 5,000 coverage for each dependent
- Cost 24/year (regardless of the number of
dependents covered) - Spouse/Domestic Partner and children are eligible
68Long Term Disability
- Prudential
- Offers replacement income for employees
- who become disabled and are unable to work
- more than 90 consecutive days.
- Provides up to 60 of salary if disabled
- Allows up to 70 of pay if integrated with other
sources of income - TSRI pays 100 of the premium
69Long Term Disability
- Taxation of LTD Benefit
- You must decide how you want to be taxed on the
LTD benefit premium - Taxed now - results in a tax-free benefit, should
you become disabled - Taxed later - would be taxed on the benefit
amount, should you become disabled - Please refer to the Long Term Disability Taxation
Explanation for estimated monthly tax information
70Long Term CareUNUM
- Long Term Care Insurance provides coverage for
- care received either at home or in a facility
- May be purchased for yourself, spouse/domestic
partner, parents, parents-in-law, grandparents,
grandparents-in-law, siblings and adult children - May only be purchased during Open
Enrollment/one-time Guarantee Issue opportunity
for employee only - Family members and self enrollments after first
opportunity to purchase must go through medical
underwriting
71Paid Time Off
- Paid Personal Leave (PPL)
- Accrue 16 days a year/Max accrual of 288 hours
- Accrual starts on date of hire/change in status
- Use for vacation, first 2 days of illness for
self/family member, personal business - Extended Sick Leave (ESL)
- Accrue 7 days a year/Max accrual of 480 hours
- Use from the third day of absence on due to
illness for self/family member - For hospitalizations/surgeries for self/family
member begin using ESL from day one - The days per year listed above are based on
full time employment (40 hrs/wk). Days are
pro-rated if you work less than 40 hours
72Holidays
12 Paid Holidays a year
Note There will be one floating holiday in 2008
73Tuition Reimbursement
- 2,500 maximum benefit per year
- Eligible Courses (Courses must start after date
of hire or change of status and be taken on your
own time) - Required of a degree program or
- Relevant to your professional development at TSRI
- TSRI approved smoking cessation/weight management
- Eligible Fees (Courses must be taken at an
accredited college/ university or local
educational institute providing interactive
training) - Tuition
- Books/software required for course
74Tuition Reimbursement
- Must receive at least a B or a Pass grade
- Available after 90-days of working at TSRI
- Ineligible Courses and Fees
- Seminars, conferences
- Continuing education units (CEUs)
- Miscellaneous fees (parking, registration)
- Exam prep classes (MCAT, LSAT)
- Tuition Reimbursement Form available on website
- Need pre-approval before class starts
- Contact Benefits with any questions
75Benefit Credits
- You are given an allotment of benefit credits
to spend as you see fit - The allotment will cover you with a medical plan,
a dental plan and life insurance at two times
your annual salary, at no cost to you -
- Pay Period Annual
- Medical 102.77 2,466.48
- Dental 9.09 218.16
- Life (2X) 3.25 78.00
- Total 115.11 2,762.64
76Benefit Credits continued
- If your annual benefit costs are greater than the
credits, the difference will be a pre-tax
deduction on your paycheck - If your annual benefit costs are less the
credits, the difference is added to your salary
as taxable income - If your annual benefit costs equal the credits,
there will be no effect on your pay
77(No Transcript)
78FormsBenefit Enrollment FormPCP Designation
Form (HMO only)Cash Balance Beneficiary
FormBusiness Travel Accident Form
79(No Transcript)