Benefits Administration Guidelines

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DEPARTMENT OF EDUCATION DIVISION OF HUMAN
RESOURCES
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Benefits Administration Guidelines

• The Government of the United States Virgin
  Islands
• Health Insurance Program

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Review of Points

• 1. Introduction
• 2. Overview of Fundamental Polices
• I - Legislative Compliance
• II- Participation in Non-Contributory Benefits
• III Annual Enrollment Period

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INTRODUCTION

• The Health Insurance Program for Government
  Employees, Retirees and their Dependents, is
  administered by the Health Insurance Office,
  under the Division of Personnel. Included in the
  program are the employees and dependents of the
  Virgin Islands Port Authority and the University
  of the Virgin Islands.
• In order to ensure consistency, and maintain
  accountability in the administration of the group
  program., the following policies and procedures
  were implemented effective October1, 2001. For
  additional information regarding the Government
  of the US Virgin Islands Health Insurance
  Program, you may contact the Health Insurance
  Office at 714-5000.

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Enrollment Criteria Eligibility

• I -Current Employees Retirees-Basic Life
• II - Current Employees Retirees -Dependent Life
• III- Current Employees Retirees-Supplement Life
• IV- Current Employees Retirees-Medical and
  Dental
• V - Newly Hired Employees
• VI New Retires

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Summary of Benefits

• I Medical Coverage
• II Dental Coverage
• III Life Coverage

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Overview of Fundamental Policies

• I. Legislative Compliance
• In accordance with the Virgin Islands Code Title
  3, Section 634. Subsection A, all full-time
  employees will be required to enroll for medical
  coverage unless they can provide proof of medical
  coverage via another source.

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Participation in Non-Contributory Benefits

• All full time employees are eligible to receive a
  10,000 non-contributory basic life and
  accidental death and dismemberment benefit,
  whether or not they enroll for health benefits. A
  completed enrollment form must be forwarded to
  the Health Insurance Office appropriately signed
  and dated, indicating a designated beneficiary.

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Annual Enrollment Period

• Employees and retirees will be allowed to enroll
  or make changes to any line of coverage only
  during annual enrollment periods, unless a
  qualifying event occurs before such time.
  Qualifying events include, but are not limited to
  births adoptions, change in dependents age,
  marriage, divorce death

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Annual Enrollment Period-cont.

• Qualifying events include, but are not limited to
  births adoptions, change in dependents age,
  marriage, divorce, death or similar occurrence.

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Specifics of Fundamental Policies

• 1. An employee refusing medical coverage must
  present proof of coverage via another source.
• 2. An employee or retiree who did not enroll for
  medical insurance when first eligible, will be
  allowed to do so only during an annual enrollment
  period, unless a qualifying event occurs before
  the annual enrollment period

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Specifics of Fundamental Policies

• 3. An employee or retiree who does not wish to
  enroll for medical insurance is eligible to
  enroll for basic life insurance and supplemental
  life when first eligible or during the annual
  enrollment period, and dependent life insurance
  when first eligible, at annual enrollment or when
  a qualifying event occurs.

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Specifics of Fundamental Policies

• 4. An employee or retiree electing life insurance
  benefits only must submit a completed enrollment
  form indicating a designated beneficiary. Current
  employees and retirees who have not submitted a
  completed form previously, may do so during an
  annual enrollment period.

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Specifics of Fundamental Policies

• 5. During annual enrollment periods, an employee
  or retiree currently enrolled may elect to
  increase supplemental life insurance amounts in
  increments of 5,000 without evidence of
  insurability, or with evidence of insurability
  increase their life insurance coverage to any
  amount. When first eligible, an employee may
  elect supplemental life insurance coverage in any
  amount without evidence of insurability.

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Specifics of Fundamental Policies

• 6. During annual enrollment periods, an employee
  or retiree not currently enrolled may elect
  dependent life insurance for a spouse or children
  with evidence of insurability. When first
  eligible an employee may elect dependent life
  insurance coverage without evidence of
  insurability.

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Special Policy Note

• Only one parent is allowed to cover dependent
  children for dependent life insurance, as only
  one (1) dependent life benefit is applicable and
  payable per child.

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Enrollment Criteria Eligibility

• I. Current Employee and Retiree (Basic Life
  Accidental Death Dismemberment Insurance
• During annual enrollment periods, no action is
  necessary for employees and retirees who are
  enrolled for basic life and accidental death and
  dismemberment insurance to continue coverage for
  this benefit. Current employees and retirees not
  enrolled for basic life and accidental death and
  dismemberment insurance, will be allowed to
  enroll for these benefits during annual
  enrollment periods.

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Enrollment Criteria Eligibility

• I. Current Employee and Retiree (Basic Life
  Accidental Death Dismemberment Insurance
• Current employees and retirees not enrolled for
  basic life and accidental death and dismemberment
  insurance, will be allowed to enroll for these
  benefits during annual enrollment periods.

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Enrollment Criteria Eligibility

• I. Current Employee and Retiree (Basic Life
  Accidental Death Dismemberment Insurance
• Current employees and retirees not enrolled for
  basic life and accidental death and dismemberment
  insurance, will be allowed to enroll for these
  benefits during annual enrollment periods.

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Enrollment Criteria Eligibility

• II. Current Employees and retirees( Dependent
  Life Insurance)
• During annual enrollment periods, no action is
  necessary for employees and retirees who are
  enrolled for dependent life insurance to continue
  coverage for this benefit. Employees and retirees
  not enrolled for dependent life insurance will be
  allowed to enroll for these benefits during
  annual enrollment periods, with evidence of
  insurability.

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Enrollment Criteria Eligibility

• III. Current Employees and retirees( Dependent
  Life Insurance)
• During the enrollment periods, no action is
  necessary for employees and retirees to maintain
  their current supplemental life insurance amount
  . . To newly elect or increase the current
  benefit amount in more than 5,000 increments,
  during annual enrollment periods, employees and
  retirees must submit evidence of insurability.

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Enrollment Criteria Eligibility

• IV. Current Employees and Retirees (Medical and
  Dental)
• During annual enrollment periods, no action is
  necessary for employees and retirees to maintain
  their current medial and dental insurance
  selections. During this time, employees and
  retires may enroll, cancel or make changes to
  their medical and dental selections.

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Enrollment Criteria Eligibility

• V. Newly Hired Employees
• Newly hired employees will be immediately
  eligible for coverage. Within 30 days of becoming
  eligible for coverage, new employees may elect
  medical and dental, and supplemental life in any
  amount, and / or dependent life insurance. After
  such time, these employees will be regarded as
  current employees, and the criteria outlined in
  items I, II, III and IV will apply.

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Enrollment Criteria Eligibility

• New Retirees
• Newly eligible retirees will be immediately
  eligible to continue or cancel current and/ or
  newly applicable benefits. Within 30 days of the
  retirement effective date, an updated enrollment
  form must be completed, without which, any
  previously selected and /or newly applicable
  benefits will take effect. Thereafter, these
  retirees will be regarded as current retirees,
  and the criteria outlined in items I II III and
  IV above will apply.

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Summary of Benefits(Refer to Benefit Booklets
for more Details)

• I. Medical Effective 10/1/01
• In Network Out of Network
• Deductible - Individual 50 250
• Family 100 500
• Out of Pocket Maximum
• Individual 1,500 3,000
• Family 3,000 6,000
• Preventative Care Office Visits
• 100 after co pay See Benefits Booklet
• Other Covered Expenses
• 80 after co-pay 60

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II. Dental (Effective 10/1/01)

• Deductible Individual 25/ Family -100
• Annual Maximum 1,000
• Orthodontia Lifetime Maximum 1000 (for Dependent
  Children to age 19)
• Reimbursement level based on fee schedule (flat
  dollars amounts, no percentage levels used)

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III Life, ADD, Supplemental Dependent Life
(Effective 7/1/02

• Basic Life Employees 10,000
• Accidental Death Dismemberment 10,000
• Supplemental Life Employees
• Plan A 1,2,3, or 4 times salary rounded up to the
  next higher 1,000 to a maximum of 400,000

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III Life, ADD, Supplemental Dependent Life
(Effective 7/1/02

• Plan B 5000, 10,000, 15,000, 25,000, 50,000
  or 75,000
• Basic Life Retirees 5,000
• Supplemental Life Retirees 5,000, 10,000,
  15,000,
  20,000, 25,000, 30,000, 50,000 or 75,000
• Dependent Life Spouse -5,000
• Child -
  2,000

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6. Highlights of Life Insurance Plan

• Effective July 1,2002, MetLife will be the life
  insurance carrier. An enhanced supplemental life
  benefit will be offered. In addition to the
  current benefits, options are available to
  purchase supplemental life insurance based on a
  multiple of basic salary. This affords
  participants the opportunity to increase their
  current supplemental life benefit. The enhanced
  supplemental life benefit also increases the
  maximum supplemental life benefit from 75,000 to
  400, 000.

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Highlights of Life Plan- cont.

• Employees currently enrolled for supplemental
  life may choose to continue such benefits of
  transfer coverage as follows without evidence of
  insurability
• Plan B Plan A
• 5000,10,000 or 50,000 1 times salary to next
  higher 1,000
• 25,000 - 2 times
  salary to next higher 1,000
• 50,000 - 3 times salary to
  next higher 1,000
• 75,000 - 4 times salary to next
  higher 1,000
• Any increases in excess of the established
  parameters, or in excess of 5,000, will require
  evidence of insurability.

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Highlights of Life Plan- cont.

• Example- To determine supplemental life benefit
  amount Jane Doe has a 75,000 supplemental life
  benefit. Jane wishes to increase her current
  benefit. She is thinking of transferring to 4
  times her salary, which is currently 15,000. At
  4 times her salary her salary her supplemental
  life benefit would be 60,000., which turns out
  to be less than her current 75,000 supplemental
  life benefit. In Jamess case, it would be more
  beneficial for her to maintain plan B, than to
  transfer to plan A.

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Special Life Plan Notesto Remember

• Participants are allowed to elect supplemental
  life benefits based on Plan A or B, an transfer
  from Plan B (current options) to Plan A (new
  options).
• Be sure that employee would receive a greater
  benefit by transferring to a multiple of their
  salary, if that is their desire.
• No evidence of insurability will be required even
  though transferring from plan B to A will result
  in increasing the supplemental life insurance
  benefit by more than 5,000.

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7. PAYROLL DEDUCTION

• Effective October 1, 2002. Payroll deductions for
  supplemental life will be shown as a separate
  deduction from the health (medical and dental)
  deduction. The single flat rate based on the
  benefit amount chosen is no longer available to
  our group policy. The deduction for supplemental
  life will now be based on the employees age, and
  the supplemental life benefit amount chosen.
• The impact of these age-banded rates is that the
  younger population would pay significantly less
  for the benefit amount currently in effect, or
  slightly less of the same for an increased
  supplemental life benefit. Similarly, the
  deduction for dependent life will be shown a a
  separate deduction , and based on the age of the
  dependent spouse. The deduction for dependent
  life for children will remain at a flat amount.

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Payroll Deduction- cont.

• Example To determine supplemental life payroll
  deduction Jane Doe has a 50,000 supplemental
  life benefit for which he currently pays 9.27.
  Jan wishes to increase his supplemental life
  benefit by transferring to plan A. Based on the
  established parameters to transfer coverage. Jan
  is eligible to receive 3 times his alary without
  completing the evidence of insurability form. (To
  increase to 4 times his salary, Jan would need to
  complete the evidence of insurability form). His
  current salary is 30,000, and he is currently 34
  years old, but he will be 35 by October 1, 2002.
  At 3 times his salary, Jan is eligible to
  purchase 90,000. Jans payroll deduction for
  supplemental life is

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Payroll Deduction- cont.

• Jans payroll deduction for supplemental life
  is

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Determining Supplemental Life Payroll Deduction
(cont.)

• Using the chart
• Age 35-39 at 30,000 (since 30 x 3 is 90) 1.935
  x 3 5.805
• Or
• Age 35-39 at 45,000 (since 45 x 2 is 90) 2.903
  x 2 5.806
• (there may be slight differential in calculations
  due to rounding of decimals)
• Notes
• The bi-weekly deduction based on age is reflected
  on the payroll deduction worksheet. Be sure to
  use the age of employee as of the date when the
  deduction would take effect, not the date that
  the form is completed. (for 2002 annual
  enrollment, the effective date is 10/1/02).

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Payroll Deduction-(cont.)

• Even if no change is made to the supplemental
  life benefit amount currently in effect, there
  will be a change in the payroll deduction. In
  most cases, there will be a reduction in the
  deduction amount however, in some instances
  there may be increases. Please refer to the
  payroll deduction worksheet to determine the new
  amount.
• If as a result of the age-banded rates, an
  unacceptable payroll deduction is effected, the
  participant has two (2) months of four (4) pay
  periods from the deduction start date, to notify
  the Health Insurance Office to adjustment the
  deduction. If this timeframe expires and the
  participant has not contacted the Health
  Insurance Office, the deduction will continue
  until the next annual enrollment period.

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General Information

• Eligible Employees
• An employee must consistently work 40 hours a
  week in order to be eligible to participate in
  the health insurance program. This includes
  full-time regular employees, temporary and
  provisional employees.
• Eligible Dependents
• Eligible dependents include spouses, natural or
  adopted children under age 19 and children over
  age 10, but under age 25 who are full-time
  students. Siblings and parents are not
  considered eligible dependents. Proof of
  legitimate dependency will be required at time of
  enrollment.
• Beneficiaries
• A beneficiary is someone appointed to receive the
  proceeds of a life insurance benefit upon death.
  It is advisable not to appoint minor children
  instead appoint a legal guardian in trust for
  minor children. A beneficiary can be changed at
  any time.

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General Information- cont.

• Changes
• An updated enrollment form is needed when the
  following changes occur
• Name change (attached supporting documents)
• Address change
• Beneficiary change
• Dependent status change (attached supporting
  documents)
• Benefit Selection change (at annual enrollment,
  unless a qualifying event occurs).

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General Information-contQualifying Events

• These are life-changing events such as births,
  adoptions, marriage, divorces, death, changes in
  employment, retirement, or loss of coverage. When
  these events occur, participants and / of
  dependents have a 30-day window of opportunity to
  enroll for benefits, for which they or their
  dependents become eligible as a result of the
  event.

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General Information-cont.

• Coverage Effective Date
• Coverage is effective the first of the month
  following a qualifying event, except in case of
  newborns, where coverage is effective on the date
  of birth.
• Note To facilitate internal processing,
  enrollments received from the 1st through the 6th
  of the month will be processed to take effect the
  1st of the following month. Enrollments received
  from the 7th through the end of the same month
  will be processed to take effect the 1st of the
  month following the next month.
• Coverage Termination Date
• Coverage terminates on the last day of the month,
  following a qualifying event, or the employees
  separation date.

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General Information-cont.

• Conversion Rights
• After separation, an employee is eligible to
  convert their group policy to an individual
  policy. There is a 30-day window of opportunity,
  within which the employee must submit their
  notice of conversion to the Insurance Company.
  After such time, they are no longer eligible to
  exercise their conversion right.
• Payroll Deduction Start Date
• Deductions will commence on the 2nd pay period of
  the month following the effective date of
  coverage.
• Payroll Deduction Stop Date
• Deduction will cease on the 1st pay period of the
  month following the termination date of coverage.

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General Information-cont.

• Premium Payments and Refunds
• In some instances, additional premium payments
  may become due as a result of a qualifying event.
  At such time, the participant and /or dependent
  will be required to make such payment in order to
  effect coverage. If a refund becomes due as the
  result of a qualifying event, the Health
  Insurance Office will process the same
  accordingly.
• Note During annual enrollments, if there are
  unavoidable delays in processing enrollment
  information timely to meet the effective or
  termination date, participants will not be
  required to remit additional premiums to effect
  coverage, nor will they be given refunds for
  overpayments.

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General Information-cont.

• Leave Without Pay
• During an unpaid leave, employees participating
  in the health insurance program are required to
  remit premiums for missed health insurance
  payroll deductions. These payments in the form
  of money orders, should be payable to the Health
  Insurance Fund. Failure to remit premiums will
  result in termination of benefits.

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General Information-cont.

• Procedures for Retiring
• When an employee, who is covered under the health
  insurance program, is planning to retire, the
  Health Insurance Office must be notified. A new
  enrollment form must be completed indicating
  their retirement date, and the benefits and
  deductions applicable to retirees will take
  effect on the first of the month following the
  retirement date.
• Note Retirement is a qualifying event for
  covered participants.

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General Information-cont.

• Retirement Benefits
• At retirement, basic life insurance is reduced to
  5,000, and accidental death and dismemberment is
  not available. The maximum amount of
  supplemental life benefits available to retirees
  is 75,000. The medical and dental remain the
  same
• Note An employee who is enrolled in Plan A
  (multiple of salary) for the supplemental life
  insurance, will be entitled to the Plan B (flat
  amount) equivalent at retirement.

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General Information-cont.

• Death Benefits
• Upon death, the designated beneficiary will be
  eligible to receive the life insurance proceeds
  of the participant. For dependent life
  benefits, the beneficiary is the employee. Life
  insurance benefits are payable by the contracted
  Insurance Company through the Health Insurance
  Office.

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Q When may I enroll for Coverage?

• A You may enroll for coverage within 30 days of
  your date of hire, or during an annual enrollment
  period. If you are not currently enrolled for
  coverage, you may be eligible to enroll for
  coverage during the next annual enrollment period.

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Frequently Asked Questions

• Q Once I have enrolled, may I cancel my coverage
  at any time?
• In accordance with the Virgin Islands Code, all
  Government employees must have medical coverage,
  either through the Governments Plan or via
  another source. As an active employee, you may
  cancel your coverage at any time, if a qualifying
  event occurs, which makes you eligible to
  received coverage elsewhere.

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Frequently Asked Questions-cont.

• When may I add my dependents to my coverage?
• You may add your dependents to your coverage
  within 30 days of you or them becoming eligible
  for coverage ( at employment of as qualifying
  events occur). You will need to submit documents
  of proof ( such as birth certificates, court
  documents, marriage certificates, etc.) If they
  are not added at that time, you may add them
  during an annual enrollment period. Evidence of
  insurability will be required for dependent life
  insurance.

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Frequently Asked Questions-cont.

• Can I cover all children who live with me?
• You may only cover those children who are your
  natural children ( including step children or
  legally adopted). To cover any other children
  under your health insurance, you must present a
  document showing court appointed guardianship.

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Frequently Asked Questions-cont.

• Can I drop my dependents from my coverage at any
  time?
• You may drop your dependents from your coverage
  at annual enrollment, or at any time if a
  qualifying event occurs. You will need to provide
  proof of the qualifying event in order to cancel
  coverage.

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Frequently Asked Questions-cont.

• Do I need to enroll for this coverage if I have
  coverage elsewhere?
• If you have coverage elsewhere, or as a dependent
  under this plan, you may or may not elect to
  enroll for medical coverage. If you elect not to
  enroll for basic, supplemental, and dependent
  life insurance.

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Frequently Asked Questions-cont.

• Can I be covered under this plan if I lose my
  other coverage?
• Losing your coverage is regarded as a qualifying
  event. As such, you will have 30 days from the
  date you lose coverage to enroll within that
  time, you may enroll for coverage during the next
  annual enrollment period.

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Frequently Asked Questions-cont.

• If I no longer work for the Government, can I
  continue my health coverage?
• You may convert from group policy to an
  individual policy administered directly between
  you and the Insurance Company. You will have to
  submit your conversion application within 30 days
  of your separation.

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II. Regarding Life Coverage

• Can I enroll for Supplemental Life benefits
  without taking health coverage?
• As an employee, you are eligible to enroll for
  Life insurance, including supplemental life,
  without enrolling for health coverage. If you do
  not enroll when you are first eligible, you may
  enroll at the annual enrollment, at which time,
  you may be required to provided evidence of
  insurability for supplemental life insurance
  benefits.

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II. Regarding Life Coverage

• If I am enrolled for supplemental life benefits,
  when can I increase my benefit amount.
• You may increase your supplemental life benefit
  amount at annual enrollment only. Evidence of
  insurability will be required for increases in
  excess of 5,000.

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Regarding Life Coverage-cont.

• If I am participating in Plan A (multiple of
  salary) for supplemental life and I receive a
  salary increase, will I need to complete the
  evidence of insurability form to receive an
  increased benefit?
• As long as you are maintaining your current
  benefit selection, you will not need to complete
  the evidence of insurability form to receive an
  increased benefit. You will only need to complete
  an enrollment form indicating your new salary
  amount in order to start the new deduction. The
  form must be completed within 30 days of the
  effective date of the increase.

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Regarding Life Coverage-cont.

• If I am participating in Plan B (flat amount),
  when may I increase my supplemental life benefit
  by transferring to Plan A (multiple of salary)?
• You may transfer to Plan A if you were at the
  maximum benefit amount for Plan B, and you
  receive a salary increase, which would result in
  an increased supplemental life benefit in you
  transferred to Plan A. You will need to complete
  an enrollment form indicating your transfer and
  new salary amount in order to start the new
  deduction. The form must be completed within 30
  days of the effective date of the increase. You
  may also transfer at annual enrollment.

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Regarding Life Coverage-cont.

• Can I continue my supplemental life coverage if I
  no longer work for the Government?
• You may continue your supplemental and dependent
  life coverage directly with the Insurance
  Company, if you no longer work for the Government.

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Review of Points Covered

• 1. Introduction
• 2. Overview of Fundamental Polices
• I - Legislative Compliance
• II- Participation in Non-Contributory Benefits
• III Annual Enrollment Period