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Your health, our promise. Enroll online from October 15 to November 1, 2019. 2020 OPEN ENROLLMENT Learn more at our new hr.nd.edu/benefits
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Your health, our promise. Enroll online from October 15 to November 1, 2019.
2020 OPEN ENROLLMENT
Learn more at our new
hr.nd.edu/benefits
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Benefits are a key part of your total rewards from Notre Dame. They are designed to address the holistic needs of you and your family. Along with take-home pay, paid time off, retirement benefits and tuition benefits, they give you comprehensive package that is competitive and geared toward helping you address many aspects of your life.
As you prepare for open enrollment—which starts on October 15 and ends on November 1— remember, this is your annual opportunity to re-evaluate your family’s needs and decide which benefit options best support you in the year ahead.
Keep in mind that enrollment is active this year, which means you must go online and select your benefits. Your current benefit elections will not roll forward, so if you don’t go online to enroll, you will not receive Notre Dame benefits in 2020.
Additionally, there are other changes and new offerings to consider. You can find these outlined in the “What’s New” section (pages 4-5) of this guide. We are excited to provide some ways for you to save money and better manage your healthcare dollars! Most of all, we believe these changes and new offerings will give you continued access to affordable, quality care from providers you like and trust.
If you have questions as you review the guide, be sure to take advantage of our information sessions prior to open enrollment. You can find a list of those on hr.nd.edu/benefits. We are here to be a resource for you as you make these important decisions for you and your family.
Use Ask ALEX to help decide which plan is best for you and your family! Learn more at:http://myalex.com/NotreDame/2020
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TABLE OF CONTENTS To learn more, visit hr.nd.edu/benefits
YOUR BENEFITS
What’s New for 2020 ..........................4
Medical Plans ........................................6
Funding Accounts .............................10
Prescription Drugs ............................12
Notre Dame Wellness Center .........13
Dental Plans ........................................14
Vision Plan ..........................................16
Life Insurance .....................................18
Accident Insurance ...........................20
Critical Illness Insurance.................22
RESOURCES
How to Enroll .......................................24
FAQs ......................................................26
Notices .................................................28
Open enrollment is October 15 to November 1. Unlike in the past, benefit selections will not roll forward.
You must complete online enrollment by the deadline to receive benefits in 2020.
We are here to help you achieve well-being for life.
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WHAT’S NEW
There are some important changes for 2020 to be aware of as you consider your choices. Below is a summary of what’s new.
Your Health, Our Promise. To learn more, visit hr.nd.edu/benefits
Medical Plan Changes
2020 Plan OptionsIn 2020, you will have a choice of three medical plans: the PPO, the HDHP/HRA, and a new Anthem HSA plan. The HMO plan will not be offered. We decided to discontinue the HMO because of its significantly higher costs and more restrictive options for selecting providers. Additionally, 2020 will be the last year for the HDHP/HRA plan since the new Anthem HSA provides more advantages and flexibility.
2020 Plan PremiumsIn the last four years, our medical and prescription drug costs have increased by $29 million—with the University covering almost 90% of the total cost. We’ve worked hard to manage this increase and not have it impact our faculty and staff, but unfortunately, we must share some of that with you. That’s why you’ll see premium increases for the PPO and HDHP/HRA plans in 2020. Because we strive to be good stewards of our resources, this is news that we never like to deliver. However, the rising costs have made premium increases unavoidable. There will be no increases in premiums or changes to our dental and vision plans. Premiums are decreasing for life, critical illness and accident insurance. Reminder: If you get a health screening, we’ll give you a $15 credit on your monthly premium. Plus, you can receive an additional $8 credit on your monthly premiums if your spouse completes a health screening.
2018 University medical average cost per member
$16,581
HM
OPP
O $13,320
Total University Medical and Prescription Cost (includes member contributions)
2014
2018
$63M
$92M
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Advantages to the New Anthem HSA Medical Plan • The Anthem HSA plan has the lowest premiums of the three
plans and a true family non-embedded deductible. With this, a family can meet the deductible by pooling deductible expenses. There is no limit to the amount one member can pay toward the family deductible.
• If you elect this plan and open a Health Savings Account (HSA) through Fidelity, Notre Dame will make an annual contribution of $500 for individual coverage or $1,000 for individual +1 or family coverage.
• Individual coverage for accident insurance and critical illness insurance are included.
• You can contribute pre-tax dollars, and all HSA contributions roll over every year. Best of all, the savings in your account always belong to you, even if you separate from Notre Dame.
• Finally, you also have the option to set aside tax-free money in a Limited Purpose Flexible Spending Account (LPFSA). This account can be used to pay for dental and vision expenses only.
See page 10 for more information.
Annual Notre Dame HSA Contribution
$500Individual
$1,000Individual + 1 or Family
Annual Premium Cost Savings for Life and Voluntary Plans
25%Supplemental Life
31% Critical Illness
16% Accident
Learn more about the benefits of an HSA in our video overview: hr.nd.edu/benefits
A note about FSA rollovers: If you currently have an FSA and elect the Anthem HSA plan for 2020, you will lose any unspent FSA funds on Jan. 1, 2020. This must occur so that Notre Dame can immediately fund your HSA. Therefore, it is important to use your FSA funds in 2019—otherwise, the FSA “use it or lose it” policy will take effect.
Cost Reductions for Life, Critical Illness and Accident CoverageWe have renegotiated our life and voluntary plans to offer you a significant cost reduction for 2020. The premiums for life, accident and critical illness benefits all will decrease in 2020.The plans will be offered through Securian Financial, the existing provider of our life insurance plans. The quality and level of coverage will remain the same, with the added option of choosing more coverage for critical illness.See pages 18-23 for coverage details.
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MEDICAL PLANS
NEW Anthem HSA• Lowest monthly premiums and highest
deductibles• Includes HSA, individual accident
insurance and critical illness insurance
Anthem PPO• Lower deductibles and out-of-pocket
maximums
Anthem HDHP with HRA• Low monthly premiums, high deductibles
and highest out-of-pocket maximums• Includes HRA, individual accident
insurance and critical illness insurance
HSA PPO HDHP WITH HRA
With Employee
Screening*
With Employee + Spouse
Screening*
Without Employee Screening
With Employee
Screening*
With Employee + Spouse
Screening*
Without Employee Screening
With Employee
Screening*
With Employee + Spouse
Screening*
Without Employee Screening
Individual $38 – $53 $79 – $94 $42 – $57
Individual + 1 $136 $128 $151 $216 $208 $231 $142 $134 $157
Family $176 $168 $191 $298 $290 $313 $186 $178 $201
MONTHLY MEDICAL PREMIUMS
* Only faculty/staff and spouses are eligible for health screenings.
Benefit-eligible faculty and staff may choose from three medical plans. The plan you choose determines how much you pay for services and how much the plan pays.
Exceptional Care, Close to You.To learn more, visit
hr.nd.edu/benefits
Use Ask ALEX to help decide which plan is best for you and your family. Learn more at: http://myalex.com/NotreDame/2020
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MEDICAL PLAN OVERVIEWHSA PPO HDHP WITH HRA
Preventive Care 100%, no deductible 100%, no deductible 100%, no deductible
Deductible
In-Network$2,000 individual
$3,750 true family$500 individual $1,000 family
$1,500 individual $3,000 family
Out-of-Network$4,000 individual
$7,500 true family$1,000 individual
$2,000 family$3,000 individual
$6,000 family
Coinsurance (plan pays after deductible is met)
In-Network 85% 85% 85%
Out-of-Network 65% 65% 65%
Out-of-Pocket Maximum
In-Network $3,000 individual $6,200 family
$3,000 individual $6,000 family
$5,000 individual $10,000 family
Out-of-Network $6,000 individual $12,400 family
$6,000 individual $12,000 family
$10,000 individual $20,000 family
Primary Care
In-NetworkActual cost of service until deductible met, then plan pays 85%
100% after $30 copay per physician office visit
Actual cost of service until deductible met, then plan pays 85%
Out-of-Network
Actual cost of service until deductible met,
then plan pays 65% of usual and customary
Actual cost of service until deductible met, then plan
pays 65% of usual and customary
Actual cost of service until deductible met, then plan pays 65% of usual
and customary
Specialist
In-NetworkActual cost of service until deductible met, then plan pays 85%
100% after $35 copay per physician office visit
Actual cost of service until deductible met, then plan pays 85%
Out-of-NetworkActual cost of service until deductible met, then plan pays 65%
Actual cost of service until deductible met, then plan pays 65%
Actual cost of service until deductible met, then plan pays 65%
Urgent Care In-NetworkActual cost of service until deductible met, then plan pays 85%*
$50 *Actual cost of service until deductible met, then plan pays 85%*
Wellness Center Office Visit$30 access fee + actual cost of services (i.e. labs)
until deductible met$15 $15
Lifetime Maximum Unlimited Unlimited Unlimited
Notre Dame Contributions to Funding Account **
Health Savings Account $500 individual
$1,000 +1 or familyN/A
Health Reimbursement Account**
$500 individual $1,000 +1 or family
Includes Accident Insurance *** Individual coverage only N/A Individual coverage only
Includes Critical Illness Insurance **** $5,000 individual coverage N/A $5,000 individual coverage
* Immediate and primary care are also available at the Notre Dame Wellness Center, with a $15 copay for PPO and HDHP/HRA medical plans, and $30 for HSA plan.** Faculty and staff may not deposit additional funds into an HRA. To set aside dollars for anticipated healthcare expenses, consider a Flexible Spending Account. See page 10. *** For more information on accident insurance, including rates and information on adding additional coverage for yourself or your dependents), see page 20.**** For more information on critical illness insurance, including rates and information on adding additional coverage for yourself or your dependents), see page 22.
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MEDICAL PLANS
All three Notre Dame medical plans offer 100% preventive care and access to a vast network of Anthem providers.
Which Plan is Right for You? To learn more, visit hr.nd.edu/benefits
Anthem HSA• Lowest monthly premiums, offering a
good way to save money if you don’t incur too many medical claims
• True family non-embedded deductible, which means your family can meet the deductible by pooling expenses
• Pay full cost of services until you meet the deductible
• 15% coinsurance after in-network deductible is met until you reach your out-of-pocket maximum
• Notre Dame HSA contribution, $500 for individual coverage and $1,000 for +1 or family coverage, helps pay for out-of-pocket expenses
• Ability to contribute pre-tax dollars to HSA
• If you are covered by a non-eligible medical plan, such as a spouse, Medicare Part A, or Tricare, you are unable to enroll in this plan
PPO Plan • Lowest deductibles and out-of-pocket
maximums• Copays and coinsurance for some
services• Balance of higher monthly premiums
and lower out-of-pocket costs
HDHP with HRA Plan• Embedded deductible, which means
each family member has an individual deductible in addition to the total family deductible.
• Pay the full cost of services each time until you meet the deductible
• 15% coinsurance after in-network deductible is met until you reach your out-of-pocket maximum
• Notre Dame HRA contribution, $500 for individual coverage and $1,000 for +1 or family coverage, helps pay for out-of-pocket expenses
• Employees can not contribute to their HRA.
• 2020 will be last year for the HDHP/HRA Plan and unused HRA funds will be forfeited
Use Ask ALEX to help decide which plan is best for you and your family. Learn more at: http://myalex.com/NotreDame/2020
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Get discounted premiums. If you get a health screening, you will receive a $15 credit on your monthly premium. Plus, you can receive an additional $8 credit on the monthly premium if your spouse completes a health screening.
Choose your care wisely. The medical care you choose can have a significant financial impact— and literally may mean a difference of hundreds of dollars.
WAYS TO SAVE $$$
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While it’s easy to focus on the cost of healthcare, there are several ways you can save, too!
Making the Most of Your Healthcare Dollars.To learn more, visit
hr.nd.edu/benefits
Take advantage of free preventive care. Get an annual physical and other preventive screenings that can detect problems before they become serious.
Choose LiveHealth Online for convenience and cost savings.Consult a doctor via your phone, tablet or computer for illnesses like colds, flu, allergies and sinus infections. PPO plan members have a $15 copay, and Anthem HSA and HDHP/HRA plan members have a $49 flat fee. Behavioral health services also are available with fees from $80 to $175 per visit.
Take steps to manage chronic illnesses. Chronic conditions are less complex and costly when effectively managed. Your healthcare provider can help you find the right resources.
Consider generic prescriptions. They contain the same active/key ingredients as brand name drugs, have the same strength and dosage form, and are a lot less expensive.
URGENT CARE DOCTOR’S OFFICE
RETAIL CLINIC*
LIVEHEALTH ONLINE
WELLNESS CENTER
$147$1,636 $15– $49
$15–$30$82$105
EMERGENCY ROOM
*Such as CVS MinuteClinic or Walgreens Healthcare Clinic
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Annual Maximum Contribution Limits
$3,550/$7,100Healthcare Savings Account individual/family maximums
$2,700*
Healthcare and Limited Purpose FSA maximums
$5,000*
Dependent Care FSA maximum
FUNDING ACCOUNTS
NEW Health Savings Account (HSA)• Tied to the Anthem HSA medical plan• University contribution of $500
(individual)/$1,000 (+1 or family) to help you pay for medical expenses
• Triple tax savings – contributions, earnings and distributions are tax-free when used to pay for qualified medical expenses
• Employee pre-tax contributions allowed and money is always yours. Use your savings for expenses now or invest them for future use, including during retirement
• Debit card available through Fidelity• Compatible with Limited Purpose FSA
NEW Limited Purpose Flexible Spending Account (LPFSA)• Employee pre-tax contributions for
dental and vision expenses only
Flexible Spending Account (FSA)• Employee pre-tax contribution of up to
$2,700 for medical, dental and vision expenses
• If you have an HRA and an FSA, eligible medical expenses deducted from HRA first, then FSA once HRA is depleted
• Rx claims will now automatically flow to FSA accounts for reimbursement through the anthem.com portal
We provide ways for you to set aside money for healthcare expenses by offering Health Savings Accounts, Flexible Spending Accounts and Health Reimbursement Accounts.
Funding Your Healthcare, Made Easy. To learn more, visit
hr.nd.edu/benefits
Health Reimbursement Account (HRA)*• Tied to the HDHP/HRA medical plan• University contribution of $500
(individual)/$1,000 (+1 or family) to help you pay for medical expenses
• Unused money forfeited if you leave Notre Dame
Dependent Care FSA• Employee pre-tax contribution of up to
$5,000 for dependent care services while you and your spouse work
• Eligible expenses include traditional daycare, latch-key programs, day camps (for children under age 13) and elder care
*2019 limit. Federal limit for 2020 was not released at the time of publication.
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HSA FSA LPFSA HRA
Medical PlanAvailable with Anthem HSA
Available with PPO, HDHP/HRA
Available with Anthem HSA
Available with HDHP/HRA
Who FundsFunded by
University and youFunded by you Funded by you
Funded by University
Unused Money Rolls Forward to Next Year
Yes
No.
Unused money only rolls forward to
March 31, 2021
No.
Unused money only rolls forward to
March 31, 2021
No.
Plan will not be offered in 2021
and unused money will be forfeited Dec. 31, 2020
What Funds Are Used For
Eligible medical expenses +
dental and vision expenses
Eligible medical expenses +
dental and vision expenses
Eligible dental and vision expenses
Expenses that apply toward your
deductible
Exclusions
Medical insurance premiums,
over-the-counter medications
Over-the-counter medications
Non-dental or vision-related
expenses
Prescriptions or Wellness Center
copays
PortableYes. Unused funds are yours to keep.
No. Unused money forfeited
if you leave Notre Dame
No. Unused money forfeited
if you leave Notre Dame
No. Balance forfeited if
employment terminates or you elect a non-HDHP
plan in future
Tax BenefitTax-free dollars,
does not count as income
Pre-tax contributions, taxes
may be reduced
Pre-tax contributions, taxes
may be reduced
Tax-free dollars, does not count as
income
Can Be Invested
Yes No No No
FUNDING ACCOUNT COMPARISON
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Retail Mail Order
Generic Drugs $5 $12
Preferred Brand-name Drugs $40 $80
Non-preferred Brand-name Drugs $55 $110
Specialty Drugs $100 $200
PRESCRIPTION DRUGS
Two Ways to Fill a Prescription• Retail Pharmacies: Fill short-term
(30 days or less) prescriptions at any in-network pharmacy.
• Mail Order: Long-term (over 30 days) prescriptions must be filled by mail or at the Wellness Center pharmacy.
Prescription ReminderThe Notre Dame Wellness Center pharmacy is an exception to the mail-order rule: 90-day prescriptions may be filled for the same copays as mail order prescriptions.
Specialty Drug NoteSpecialty medications represent one of the fastest-growing areas of medical costs. BriovaRx is now Optum Specialty Pharmacy, OptumRx’s mail-order specialty drug pharmacy, helps patients requiring specialty medications to manage their costs.
Everyone enrolled in a Notre Dame medical plan automatically receives prescription drug coverage. The University’s prescription plan administrator is OptumRx.
Keeping You Well.To learn more, visit
hr.nd.edu/benefits
Online ordering, status tracking, prescription history: optumrx.com
PRESCRIPTION RATES
Note: If you enroll in the Anthem HSA plan, you must meet your deductible before prescription copays apply.
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WELLNESS CENTER
Notre Dame Wellness CenterThe Wellness Center is a great option for basic healthcare and is open to all benefit-eligible faculty and staff, their spouses and dependents on our plans. Those enrolled in the PPO or HRA plans can access services at the Wellness Center for a $15 flat fee. Those enrolled in the HSA plan can schedule an office visit for just $30.
Wellness Center Services• Primary and Preventive Care• Immediate “Walk-in” Care• Lab Services• Physical Therapy• Wellness Coaching • Chronic Condition Management• Biometric Screenings
Who Can Use the Wellness Center?• All full-time, benefit-eligible faculty
and staff, spouses and dependents may visit the Notre Dame Wellness Center. Benefit-eligible faculty and staff who waive University healthcare coverage may still use the Wellness Center.
• Privacy promise: The Notre Dame Wellness Center is operated by Premise Health, which assures privacy of all interactions and healthcare services at the Wellness Center. The University of Notre Dame has no access to personal health information obtained by the Notre Dame Wellness Center.
Awarded the Medical Home status from the Accreditation Association for Ambulatory Health Care, the Wellness Center has been recognized a first-choice provider of primary care services, including the care and management of chronic illnesses.
Reaching for Well-being.
To learn more, visit hr.nd.edu/benefits
For a full list of services, visit: notredamewellnesscenter.com
ANTHEM HSA PPO HDHP WITH HRA
Office Visit $30 $15 $15
Physical Therapy $30 $15 $15
Labs Deductible/coinsurance $0 $0
Prescription Deductible/copay Copay Copay
Wellness Coaching $0 $0 $0
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Directory and list of covered services: deltadentalin.com
Eligibility claims or reimbursements: toolkitsonline.com
DELTA PREMIER* DELTA PPO POS*
Individual $16.74 $21.36
Individual + 1 $31.88 $40.48
Family $56.78 $74.48
DENTAL PLANS
DENTAL PLAN RATES
The University offers two dental plan options through Delta Dental. Both plans allow you to choose any licensed dentist for your care.
A Reason To Smile.
Premier Plan• Lower monthly premiums in exchange for
lower coverage and a lower annual maximum
PPO POS Plan• Higher percentage of basic services,
with a higher annual maximum
Choice of providers:
• If you choose a dentist in the Delta Dental network, you will pay only your deductible (waived for preventive care and orthodontia) and coinsurance for covered services.
• If you choose an out-of-network dentist, Delta will reimburse you for the amount that would be paid to a participating dentist. You are responsible for any difference.
To learn more, visit hr.nd.edu/benefits
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*If you enroll in a Delta Dental plan, you must remain enrolled for two years. You may switch between the two plans during open enrollment or when you have a qualifying event, such as a birth or marriage.
PLAN COMPARISON
DELTA PREMIER* DELTA PPO POS*
Participating Dentist Non-Participating Dentist**
Participating Dentist Non-Participating Dentist**
Network Delta Premier Other Dentists Delta PPO POS Delta Premier/Other Dentists
Deductibles $50 individual/$150 family $50 individual/$150 family
Diagnostic and Preventive Services 100% 100% of usual
and customary 100% 100% of usual and customary
Basic Services 50% (after deductible)
50% of usual and customary (after
deductible)
80% (after deductible)
50% of usual and customary
(after deductible)
Major Services 50% (after deductible)
50% of usual and customary
(after deductible)
50% (after deductible)
50% of usual and customary
(after deductible)
Annual Benefit $1,000 per person, per year $1,500 per person, per year
Orthodontic Services 50% maximum lifetime benefit of $1,500
50% maximum lifetime benefit of $1,500
Periodontics Services 50% 50% 80% 50%
Endodontic Services 50% 50% 80% 50%
Paid at usual and customary: A usual and customary fee is the amount that your dental plan determines is the normal range of payment for a specific service within a given geographic area.
**When using a non-participating dentist, Delta Dental will reimburse you and not the dentist. This document is intended as a supplement to your Dental Care Certificate and Summary of Dental Plan Benefits. Please refer to your certificate and summary for policy exclusions and limitations.
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Individual $9.90
Individual + 1 $18.72
Family $27.42
Summary of benefits: hr.nd.edu/ benefits
EyeMed directory: eyemedvisioncare.com
VISION PLAN
VISION PLAN RATES
The University’s vision benefit program is provided by EyeMed. The program offers significant savings on eye exams, frames, corrective lenses and laser vision correction.
Your Vision Is Our Focus.
Choice of providersYou can see the vision provider of your choice, however, you’ll receive discounted pricing from optometrists and opticians in the EyeMed network.These include:
• Independent optometrists, ophthalmologists and opticians
• Retail providers like LensCrafters, Pearle Vision, Target, Sears and JCPenney Optical
Note: Claim forms are not required for services from participating providers, but may be submitted for reimbursement (up to plan maximum) for some services received from non-participating providers.
To learn more, visit hr.nd.edu/benefits
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MEMBER COST OUT-OF-NETWORK ALLOWANCE
Exam with Dilation $0 Up to $35
Frames $0 copay, plus 20% off balance over $150 Up to $65
Standard Plastic Lenses
Single $10 copay Up to $25
Bifocal $10 copay Up to $40
Trifocal $10 copay Up to $55
Progressive Lens (Standard) $75 copay Up to $40
Contact Lenses
Fit and Follow-up (Standard) Up to $40 N/A
Fit and Follow-up (Premium) 10% off retail price N/A
Conventional $0 copay, plus 15% off balance over $130 Up to $104
Disposables $0 copay, plus balance over $130 Up to $104
Frequency
Exams, Frames, Lenses or Contact Lenses Once every calendar year
*The vision plan covers either glasses or contacts annually, but not both.
Are you a contact user? As a reminder, EyeMed plan participants can apply their in-network contact lens allowance online at contactsdirect.com.
PLAN HIGHLIGHTS
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Your Age
Amount of Insurance as a Percentage of Amount Before 65
65-69 65% of pre-65 amount
70-74 50% of pre-65 amount
75+ 25% of pre-65 amount
Securian Financial: securian.com
Evidence of Insurability Form: hr.nd.edu/benefits
LIFE INSURANCE
In 2020, life insurance will be offered at reduced premiums, providing you with a cost-savings. Plan and coverage options will remain the same–with the added bonus of being even more affordable
Planning for Tomorrow … Today.
Base Life Insurance• Coverage of $25,000 to all benefit-eligible,
full-time faculty and staff• Provided free by the University• No enrollment is required• Check or update your beneficiaries
Supplemental Life Insurance• Supplement to University-provided base
coverage • 1 to 10 times your salary, up to $1.5M• Evidence of Insurability may be required• Enrollment required• At age 65+, coverage amount becomes
percentage of the amount of prior coverage Evidence of Insurability
Evidence of Insurability (EOI) certifies the insured’s health status and discloses prior conditions or hospitalizations. EOI may be required if you increase coverage above a certain amount, are electing coverage for the first time, or had previously canceled coverage.
Dependent Life Insurance • Coverage for your spouse and dependent
children (under age 26)• Evidence of Insurability may be required• Enrollment required
To learn more, visit hr.nd.edu/benefits
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DEPENDENT LIFE INSURANCE
Monthly Rate
Spouse $12,500 $5.64
Spouse $25,000 $11.30
Child(ren) $5,000 $0.76
Child(ren) $10,000 $1.50
SUPPLEMENTAL LIFE INSURANCE
Your AgeMonthly Rate per
$1,000 of Coverage
<25 $0.032
25-29 $0.036
30-34 $0.048
35-39 $0.054
40-44 $0.060
45-49 $0.097
50-54 $0.140
55-59 $0.257
60-64 $0.395
65-69 $0.875
70+ $1.234
LIFE INSURANCE RATESAll benefit-eligible faculty and staff receive $25,000 base life coverage at no cost. You may supplement your own coverage or cover your dependents.
NOTE: All life insurance premiums are an after-tax deduction.
Supplemental life: Evidence of Insurability will be required for a first-time election; an increase of more than 1x salary; an increase to more than $750,000 of total coverage; or if you have previously canceled supplemental coverage.
When both spouses work at Notre DameA spouse, also employed at the University and eligible for base and supplemental life insurance, is not eligible for coverage under dependent life. Additionally, either one, but not both, may insure their children.
NEW! Lower premiums for 2020.
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2019 Monthly Rate
NEW! 2020 Monthly Rate
Individual $6.88 $5.52
Individual + 1 $12.04 $8.68
Family $16.46 $15.84
PLAN RATES
Benefits reductions to AD&D coverage: 25% at age 65; 50% at age 70.
Securian Financial: securian.com
Summary of benefits:hr.nd.edu/benefits
ACCIDENT INSURANCE
The premiums for accident insurance will decrease significantly in 2020. Accident insurance now will be provided by Securian Financial and is available to all benefit-eligible faculty and staff.
Invest in Peace of Mind.
NEW VENDOR: Securian Financial• Payment directly to you if you or a covered
family member dies or suffers a serious injury in an accident
• Covers out-of-pocket expenses, such as hospital/emergency room care, injuries requiring surgery, ambulance fees, physical therapy, recovery, income and family lodging
What is covered?
Benefits are paid when an accident causes fractures, dislocations, loss of limbs, burns, hospital and ambulance expenses, accident-related disabilities or death. The amount you receive is based on the type of injury and care you receive.
To learn more, visit hr.nd.edu/benefits
NEW! Lower premiums for 2020. If you want this benefit in 2020, you must enroll during open enrollment.
Individual coverage is included at no cost with Anthem HSA and HDHP/HRA plan enrollment.
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BENEFIT PAYOUT
Daily Hospital Limit $100 per day (non-ICU); $200 per day (ICU)
Emergency Room Treatment Up to $50
Ambulance (Ground/Air) $200/$750
Appliance Up to $250
Physical Therapy $100 per day (inpatient); $300 lump sum (outpatient)
Fractures• Varies based on type of fracture • Up to $3,000 (surgical); up to $1,500 (non-surgical) • Chip fractures: up to $375
Dislocations • Varies based on type of dislocation • Up to $3,000 (surgical; up to $1,500 (non-surgical)
AD&D (employee) • Up to $25,000 • 3 times for death on common carrier
Other Benefits
Blood, plasma, platelets; emergency dental; burns, skin graft, lacerations; coma; concussion; eye injury; hospital rehabilitation; inpatient surgery; lodging; medical testing; pain management; prosthetic device; tendon, ligament, rotator cuff, ruptured disc; therapy services; torn knee cartilage; transportation
PLAN HIGHLIGHTS
When both spouses work at Notre DameIf both you and your spouse are benefit-eligible University employees, either one of you (not both) may choose individual +1 or family coverage. Additionally, only one of you may cover dependent children.
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INITIAL BENEFIT RECURRENCE BENEFIT
Full Benefit Cancer 100% of initial benefit 50% of initial benefit
Partial Benefit Cancer 25% of initial benefit 25% of initial benefit
Heart Attack 100% of initial benefit 50% of initial benefit
Stroke 100% of initial benefit 50% of initial benefit
Coronary Artery Disease Needing Surgery 100% of initial benefit 50% of initial benefit
Kidney Failure 100% of initial benefit Not applicable
Alzheimer’s Disease 100% of initial benefit Not applicable
Major Organ Failure 100% of initial benefit 50% of initial benefit
Additional Covered Illnesses* 25% of initial benefit Not applicable
*Additional covered illnesses include: Addison’s disease; ALS (Lou Gehrig’s disease); benign brain tumor; cerebrospinal meningitis (bacterial); cerebral palsy; Creutzefeldt-Jacob Disease; cystic fibrosis; encephalitis; Legionnaire’s disease; multiple sclerosis (definitive diagnosis); muscular dystrophy; myasthenia gravis; necrotizing fascilitis; occupational HIV; osteomyelitis; poliomyelitis; rabies; sickle cell anemia (excluding sickle cell trait); systemic lupus erythematous (SLE); and systemic sclerosis (scleroderma).
Securian Financial: securian.com
Summary of benefits: hr.nd.edu/benefits
CRITICAL ILLNESS
In 2020, critical illness insurance will be available at reduced rates. Additionally, through our new provider, Securian Financial, you will have even more coverage options for critical illness.
Serious Medicine, Extra Care.
NEW VENDOR: Securian Financial• Lump-sum payment when diagnosed with
critical illnesses like heart attack, stroke, organ failure, cancer, Alzheimer’s disease, etc.
• Payment may be used for medical expenses or other living expenses (child care, transportation, special medical equipment, etc.)
• New issue age being used in 2020 to secure rates going forward; due to lower prices, no one will pay more than current rates
To learn more, visit hr.nd.edu/benefits
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INDIVIDUAL* INDIVIDUAL + 1 FAMILY
Your Age:** $10,000 $10,000 (Individual) +$5,000 (+1)
$10,000 (Individual) +$5,000 (Per dependent)
<25 $1.94 $3.22 $3.90
25-29 $2.74 $4.40 $5.14
30-34 $4.22 $6.50 $7.36
35-39 $6.70 $10.02 $11.06
40-44 $9.92 $14.70 $16.00
45-49 $14.24 $21.06 $22.72
50-54 $19.60 $28.94 $31.04
55-59 $26.44 $38.30 $40.86
60-64 $31.68 $45.32 $48.18
65-69 $34.66 $48.88 $51.84
70+ $42.32 $58.58 $61.90
Your Age:** $20,000 $20,000 (Individual) +$10,000 (+1)
$20,000 (Individual) +$10,000 (Per dependent)
<25 $3.00 $4.86 $6.10
25-29 $4.62 $7.22 $8.60
30-34 $7.58 $11.44 $13.02
35-39 $12.52 $18.48 $20.42
40-44 $18.96 $27.82 $30.30
45-49 $27.60 $40.52 $43.72
50-54 $38.34 $56.30 $60.36
55-59 $52.02 $75.02 $80.00
60-64 $62.52 $89.06 $94.66
65-69 $68.46 $96.16 $101.96
70+ $83.78 $115.58 $122.10
*$5,000 of individual coverage is included at no cost with Anthem HSA or HDHP/HRA plan enrollment. **Age of individual Notre Dame faculty/staff member. Initial rate locked upon enrollment on or after January 1, 2020, as long as you maintain the coverage. Benefits reductions: 25% at age 65; 50% at age 70.
When both spouses work at Notre DameIf both you and your spouse are benefit-eligible University employees, either one of you (not both) may choose individual +1 or family coverage. Additionally, only one of you may cover dependent children.
NEW! Lower premiums for 2020. If you want this benefit in 2020, you must enroll during open enrollment.
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Get Informed! You can attend an information session, a help session or the Irish Health Benefits and Wellness Fair. And don’t forget to use AskAlex.
Medical Plan: Which plan best suits your needs: Anthem HSA, Anthem PPO or Anthem HDHP/HRA?
HSA: Should you contribute tax-free dollars for healthcare expenses? If so, how much?
Dental: Do you want basic or more comprehensive coverage?
Vision: Would you like coverage for eye care or corrective lenses?
Flexible Spending or Limited Purpose Flexible Spending Accounts: Do you want to set aside tax-free dollars for healthcare, dental, vision or dependent care expenses? If so, how much?
Life Insurance: Would you like more than the base coverage provided?
Voluntary Benefits: Are there any optional benefits like accident or critical illness insurance that you want?
Your netID, password
Full legal name, date of birth and Social Security number of dependents
Name and address of your life insurance beneficiaries
Enroll anytime between October 15 and November 1, 2019 .
1. DECIDE WHAT BENEFITS YOU WANT
2. GATHER YOUR INFORMATION
3. ENROLL ONLINE AT MYBENEFITS.ND.EDU
HOW TO ENROLL
Open enrollment is October 15 to November 1, 2019. Unlike in the past, benefit selections will not roll forward. You must complete online enrollment by the deadline to receive benefits in 2020.
Easy as 1-2-3.To learn more, visit
hr.nd.edu/benefits
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KEY DATES BENEFITS ACTIVITY
Now – November 8, 2019 Health screenings available on campus, the Notre Dame Wellness Center or Beacon Health and Fitness
October 15 – November 1, 2019 at 11:59 p.m.
Open enrollment via MyBenefits.nd.edu
October 22 & 23, 2019• Irish Health Benefits and Wellness Fair
• St. Joseph’s Mobile Mammogram Unit
November 1, 2019 Last day of open enrollment
November 8, 2019 Health screening deadline for premium credits
November 18, 2019Confirmation statements available at MyBenefits.nd.edu
November 27, 2019Last day to submit enrollment corrections to [email protected]
December 6, 2019Last day to submit eligibility documentation for newly enrolled spouse or dependents in MyBenefits.nd.edu
January 1, 2020 2020 benefit elections take effect
ENROLLING NEW DEPENDENTSIf you are adding a spouse or new dependent, you are required to provide documentation to verify the dependent’s relationship to you. You must submit the documentation via MyBenefits.nd.edu no later than December 6. Scans or legible photos of the documents are acceptable.
IMPORTANT: If documentation is not provided by the deadline, the spouse or dependent will not be enrolled. See hr.nd.edu/benefits/verify for more information on the required documentation.
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What is MyBenefits.nd.edu?MyBenefits.nd.edu is the online platform for selecting your benefits and managing your life insurance beneficiaries. The site is available 24/7 and includes easy access to plan information that can help users make informed benefits decisions.
What will I need to enroll? You will need your University netID and password as well as your notes on the benefit elections you wish to make. If you are enrolling new dependents, you will need their full legal name, date of birth and Social Security number.
Can I change my benefits during open enrollment? Yes, MyBenefits.nd.edu is available 24 hours, 7 days a week from October 15 to November 1, 2019. You may log in anytime during this period to enroll in your benefits.
Can I change my benefits any other time? After your initial enrollment at hire, your opportunities to change benefits remain limited to two circumstances:
• During the annual open enrollment period• Within 30 days of a qualifying event
When can I review my elections in MyBenefits? Your current elections are in the system and you can view them at any time. Your 2020 elections and your confirmation statement will be available for your review beginning late November.
Will I need to re-enroll my children, spouse or other dependents? Your dependents who are currently enrolled will appear in the MyBenefits system. You will not need to re-enter them or re-verify their eligibility (though you should double-check the accuracy of their information). If you wish to add any new dependents, you will need to enter their information.
What if I am enrolling new dependents?If you are adding a spouse or dependent, you are required to provide documentation to verify the dependent’s relationship to you. You must submit the documentation via MyBenefits.nd.edu no later than December 6. Scans or legible photos of the documents are acceptable.
Enroll between October 15 and November 1: MyBenefits.nd.eduFAQS
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CONTACT INFORMATION
Medical Anthem 833-835-2717 anthem.com
Prescription Drug OptumRX 866-270-0234 optumrx. com/mycatamaranrx
Dental Delta Dental 800-524-0149 deltadentalin.com
Vision EyeMed 866-800-5457 eyemedvisioncare.com
Life Insurance / Accident Insurance / Critical Illness Insurance
Securian Financial 800-843-8358 securian.com
Flexible Spending Accounts Anthem 833-835-2717 anthem.com
Health Advocate Health Advocate 866-695-8622 healthadvocate.com
Wellness Center Wellness Center 574-634-WELL wellnesscenter.nd.edu
What if I need help understanding benefits or enrolling?You can get help in several ways:
• Enrollment tutorial booklet: hr.nd.edu/benefits • On-campus help sessions: Find the schedule at hr.nd.edu/benefits • Irish Health: Computers and benefits team members will be on hand
(October 22–23)• askHR customer service center: 574-631-5900 or [email protected]• Ask ALEX: myalex.com/NotreDame/2020
What is a qualifying event?Certain life events may require changes to your benefits, such as marriage, divorce or loss of a dependent’s eligibility. If you experience an event that qualifies, then you may submit changes to your benefits in MyBenefits within 30 days from the date of the event. See a full list of qualifying events at hr.nd.edu/benefits.
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SPECIAL ENROLLMENT NOTICEIf you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
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 yourself and your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
PREMIUM ASSISTANCE UNDER MEDICAID AND THECHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1- 877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2019. Contact your State for more information on eligibility –
ALABAMA – MedicaidWebsite: http://myalhipp.com/ Phone: 1-855-692-5447
ALASKA – MedicaidThe AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com/ Phone: 1-866-251-4861 Email: [email protected] Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
ARKANSAS – MedicaidWebsite: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)
COLORADO – Health First Colorado Colorado’s Medicaid Program & Child Health Plan Plus (CHP+)Website: http:// www.healthfirstcolorado.com/Health First Colorado Member Contact Center:1-800-221-3943/ State Relay 711CHP+: http:// Colorado.gov/HCPF/Child-Health-Plan-PlusCHP+ Customer Service: 1-800-359-1991/State Relay 711
FLORIDA – MedicaidWebsite: http://flmedicaidtplrecovery.com/hipp/ Phone: 1-877-357-3268
GEORGIA – MedicaidWebsite: http://dch.georgia.gov/medicaid- Click on Health Insurance Premium Payment (HIPP)Phone: 404-656-4507
INDIANA – MedicaidHealthy Indiana Plan for low-income adults 19-64Website: http://www.in.gov/fssa/hip/Phone: 1-877-438-4479All other MedicaidWebsite: http://www.indianamedicaid.comPhone 1-800-403-0864
IOWA – MedicaidWebsite: http://dhs.iowa.gov/hawk-iPhone: 1-800-257-8563
KANSAS – MedicaidWebsite: http://www.kdheks.gov/hcf/Phone: 1-785-296-3512
KENTUCKY – MedicaidWebsite: https://chfs.ky.govPhone: 1-800-635-2570
LOUISIANA – MedicaidWebsite: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331Phone: 1-888-695-2447
MAINE – MedicaidWebsite: http://www.maine.gov/dhhs/ofi/public-assistance/index.htmlPhone: 1-800-442-6003TTY: Maine relay 711
MASSACHUSETTS – Medicaid and CHIPWebsite: http://www.mass.gov/eohhs/gov/departments/masshealth/Phone: 1-800-862-4840MINNESOTA – MedicaidWebsite: https://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/other-insurance.jspPhone: 1-800-657-3739
MISSOURI – MedicaidWebsite: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 573-751-2005
MONTANA – MedicaidWebsite: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084
NEBRASKA – MedicaidWebsite: http://www.ACCESSNebraska.ne.govPhone: (855) 632-7633Lincoln: (402) 473-7000Omaha: (402) 595-1178
Enroll between October 15 and November 1: MyBenefits.nd.eduNOTICES
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NEVADA – MedicaidMedicaid Website: http://dhcfp.nv.govMedicaid Phone: 1-800-992-0900
NEW HAMPSHIRE – MedicaidWebsite: https://www.dhhs.nh.gov/ombp/nhhpp/Phone: 603-271-5218Hotline: NH Medicaid Service Center at 1-888-901-4999
NEW JERSEY – Medicaid and CHIPMedicaid Website: http://www.state.nj.us/humanservices/dmahs/clients/medicaid/Medicaid Phone: 609-631-2392CHIP Website: http://www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710
NEW YORK – MedicaidWebsite: https://www.health.ny.gov/health_care/medicaid/Phone: 1-800-541-2831
NORTH CAROLINA – MedicaidWebsite: https://dma.ncdhhs.gov/Phone: 919-855-4100
NORTH DAKOTA – MedicaidWebsite: http://www.nd.gov/dhs/services/medicalserv/medicaid/Phone: 1-844-854-4825
OKLAHOMA – Medicaid and CHIPWebsite: http://www.insureoklahoma.orgPhone: 1-888-365-3742
OREGON – MedicaidWebsite: http://healthcare.oregon.gov/Pages/index.aspxhttp://www.oregonhealthcare.gov/index-es.htmlPhone: 1-800-699-9075
PENNSYLVANIA – MedicaidWebsite: http://www.dhs.pa.gov/provider/medicalassistance/healthinsurance premiumpaymenthippprogram/index.htm
Phone: 1-800-692-7462
RHODE ISLAND – MedicaidWebsite: http://www.eohhs.ri.gov/Phone: 855-697-4347
SOUTH CAROLINA – MedicaidWebsite: https://www.scdhhs.govPhone: 1-888-549-0820
SOUTH DAKOTA - MedicaidWebsite: http://dss.sd.govPhone: 1-888-828-0059
TEXAS – MedicaidWebsite: http://gethipptexas.com/Phone: 1-800-440-0493
UTAH – Medicaid and CHIPMedicaid Website: https://medicaid.utah.gov/CHIP Website: http://health.utah.gov/chipPhone: 1-877-543-7669
VERMONT– MedicaidWebsite: http://www.greenmountaincare.org/Phone: 1-800-250-8427
VIRGINIA – Medicaid and CHIPMedicaid Website: http://www.coverva.org/programs_premium_assistance.cfmMedicaid Phone: 1-800-432-5924CHIP Website: http://www.coverva.org/programs_premium_assistance.cfmCHIP Phone: 1-855-242-8282
WASHINGTON – MedicaidWebsite: http://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-programPhone: 1-800-562-3022 ext. 15473
WEST VIRGINIA – MedicaidWebsite: http://mywvhipp.com/Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
WISCONSIN – Medicaid and CHIPWebsite: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdfPhone: 1-800-362-3002
WYOMING – MedicaidWebsite: https://wyequalitycare.acs-inc.com/Phone: 307-777-7531
To see if any other states have added a premium assistance program since July 31, 2019, or for more information on special enrollment rights, contact either:
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa1-866-444-EBSA (3272)
U.S. Department of Health and Human ServicesCenters for Medicare & Medicaid Serviceswww.cms.hhs.gov1-877-267-2323, Menu Option 4, Ext. 61565
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email [email protected] and reference the OMB Control Number 1210-0137.
NEW HEALTH INSURANCE MARKETPLACE COVERAGE OPTIONS AND YOUR HEALTH COVERAGEPart A: General Information
When key parts of the health care law took effect in 2014, a new way to buy health insurance was developed: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer.
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What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes, if you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain costsharing if your employer does not offer coverage to you at all, or does not offer coverage that meets certain standards. If the cost of a plan from our employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, of if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit.1
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution – as well as your employee contribution to employer-offered coverage – is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your summary plan description or contact: askHR (574) 631-5900. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.1. An employer-sponsored health plan meets the “minimum value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60% of such costs.
Part B: Information About Your Health Coverage Offered by Your Employer
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.3. Employer Name: University of Notre Dame du Lac4. Employer Identification Number (EIN): 35-08681885. Employer Address: 200 Grace Hall6. Employer Phone Number: (574) 631-59007. City: Notre Dame8. State: IN9. Zip code: 4655610. Who can we contact about employee health coverage at this job? askHR11. Phone number (if different from above): NA
12. Email address: [email protected]
Here is some basic information about health coverage offered by this employer:
As your employer, we offer a health plan to:
All employees
Eligible employees (Eligible employees are defined in the Summary Plan Description which can be found on the Office of Human Resources website at hr.nd.edu)
With respect to dependents:
We do offer coverage. (Eligible dependents are all dependents of employees as defined by Indiana law.)
We do not offer coverage.
If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.
** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee, or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount.
If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process.
Enroll between October 15 and November 1: MyBenefits.nd.eduNOTICES
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NOTICE REGARDING WELLNESS SCREENINGThe Notre Dame Health Screening is a voluntary wellness program available to all full time employees. The program is administered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate you must complete a biometric screening, which will include a blood test for the markers of diabetes and hypertension. You are not required to participate in the screening.
However, employees who choose to participate in the screening will receive an incentive in the form of a medical plan premium reduction of $180 spread out over the course of a year, and an employee whose spouse completes the screening will receive a reduction of an additional $96 in medical plan premium over the year.
The results from your biometric screening will be used to provide you with information to help you understand your current health and potential risks, and may also be used to offer you services through the wellness program, such as no cost visits with a Wellness Coach or Chronic Condition Nurse. You also are encouraged to share your results or concerns with your own doctor.
Protections from Disclosure of Medical Information
We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program and The University of Notre Dame may use aggregate information it collects to design a program based on identified health risks in the workplace, the administrators of the screening will never disclose any of your personal information either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you that is provided in connection with the wellness program will not be provided to your supervisors or managers and may never be used to make decisions regarding your employment.
Your health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness program, and you will not be asked or required to waive the confidentiality of your health information as a condition of participating in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. The only individual(s) who will receive your personally identifiable health information are the staff of the Notre Dame Wellness Center, administered by the third party, Premise Health, in order to provide you with services under the wellness program.
In addition, all medical information obtained through the wellness program will be maintained separate from your personnel records, information stored electronically will be encrypted, and no information you provide as part of the wellness program will be used in making any employment decision. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness program, we will notify you immediately.
You may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness program, nor may you be subjected to retaliation if you choose not to participate.
If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact the askHR helpdesk at (574) 631-5900.
WOMEN’S HEALTH & CANCER RIGHTS ACT ENROLLMENT NOTICEIf you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:
• All stages of reconstruction of the breast on which the mastectomy was performed
• Surgery and reconstruction of the other breast to produce a symmetrical appearance
• Prostheses; and
• Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and co-insurance applicable to other medical and surgical benefits provided under this plan.
NOTICE OF AVAILABILITY OF HIPAA NOTICE OF PRIVACY PRACTICESThe Privacy Rule under The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires health plans to remind covered participants of the availability of the Privacy Notice and how they can obtain it.
The Notice of Privacy Practices for the University of Notre Dame’s Group Benefits Plan describes the uses and disclosures of your protected health information and your rights regarding them.
A copy of The Notice of Privacy Practices for the University of Notre Dame’s Group Benefits Plan can be obtained by:
• Visiting the Human Resources website at: hr.nd.edu/nd-faculty-staff/fed/
• Contacting askHR at: 574-631-5900
• Emailing askHR at: [email protected]
• Visiting the Office of Human Resources, Grace Hall, Second floor
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MyBenefits.nd.edu
Enroll October 15 – November 1, [email protected] • 574-631-5900
hr.nd.edu/benefits • 200 Grace Hall
