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2020 University of Richmond Benefits Guide
2020 University of RichmondBenefits Guide
The following descriptions of available benefit elections options, are purely informational and have been provided to you for illustrative purposes only. Payment of benefits will vary from claim to claim within a particular benefit option and will be paid at the sole discretion of the applicable insurance provider for each benefit option. The terms and conditions of each applicable policy or certificate of coverage will provide specific details and will govern in all matters relating to each particular benefit option described in this summary. In no case will any information in this summary amend, modify, expand, enhance, improve or otherwise change any term, condition or element of the policies or certificates of coverage that govern the benefit options described in this summary.
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TABLE OF CONTENTS
Presented by:
Your Benefits Checklist 3Benefits Eligibility 4Medical Plans 5HSA Information 7Cigna One Guide 9Healthy Pregnancy, Healthy Baby 10Cigna Lifestyle Management 11FSA Information 12Dental Plan 13Vision Plan 14Voluntary Life Insurance 15Voluntary Accident/Hospital 17Employer Paid Benefits 19Additional Benefits 20Carriers, Vendors & Contacts 26Glossary of Terms 27Notices 28Confidentiality Notice 37
YOUR BENEFITS CHECKLIST
q Read your materials and visit https://hr.richmond.edu/benefits/index.html and make sure you understand all of the options available.
q Before enrolling your dependents, please make sure that they meet all eligibility requirements on page 4.
q Important documents and notices regarding the University of Richmond Employee Welfare Benefits Plan (the “Plan”), including the Summary of Benefits and Coverage for group health plan benefits, are available in this guide and at https://hr.richmond.edu/benefits/insurance/medical-plans/index.html. The documents and notices provide information about your enrollment opportunities, benefits coverage, rights, and obligations under the Plan. Because the documents are in PDF format, you may need to download Adobe Reader in order to be able to read the documents. You have the right to request a paper copy of the documents, free of charge, by contacting [email protected].
q Meet ALEX, your personal enrollment guide, who will help you select the plans that are right for you at https://www.myalex.com/University-of-Richmond/2020
q Learn about additional benefits, including: • A High Deductible Health Plan (HDHP) to
receive contributions from the University to a Health Savings Account (HSA)
• Voluntary insurance policies, including hospital, accident, dental, and vision coverage
Decide
q You must complete the Benefit Enrollment Form at https://hr.richmond.edu/forms/benefit-change-form.pdf
q You may need to complete additional enrollment forms for the following:
• Health Savings Account: Complete the application at https://hr.richmond.edu/benefits/common/hsa-enrollment-form.pdf
• Voluntary Life Insurance: Complete the application at https://hr.richmond.edu/benefits/common/insurance-application.pdf. If enrolling for an amount above the Guaranteed Issue, you must also complete the Evidence of Insurability application at: https://hr.richmond.edu/benefits/insurance/life/voluntary.html.
• Legal Resources: Register on Legal Resource’s website at https://www.legalresources.com/enroll_nowThe login credentials are:
Company ID: 264Password: uorlegal
• HSA: If enrolling in a HDHP, be sure to enroll in a HSA and fill out the Enrollment form at https://hr.richmond.edu/benefits/common/hsa-enrollment-form.pdf
q If you are covering a spouse on your health insurance, complete the Spousal Surcharge Affirmation (page 3 of the Benefits Enrollment form).
q Enroll in a Medical or Dependent Care FSA if applicable.
q If you would like to begin making contributions to your retirement plan, please see the instructions on page 20.
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Act
BENEFITS ELIGIBILITY
Change in StatusGenerally, you may enroll in the plan, or make changes to your benefits, when you are first eligible or during Open Enrollment. However, you can make changes to who you cover during the plan year if you experience a change in status. You must submit your paperwork within 31 days of the change or you will be considered a late enrollee.
Examples of Changes in Status
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Offering a comprehensive and competitive benefits package is one way in which we recognize your contribution to the success of the University and work towards our goal of helping you and your family to be healthy, feel secure and maintain work/life balance. This benefits guide has been designed to provide you with information about the benefit choices available to you. Remember, this is your only opportunity to make changes to your elections until Open Enrollment, unless you or your family members experience an eligible "change in status.“ As a new enrollee, you must submit your initial enrollment paperwork within 31 days or you will be considered a late enrollee.
Eligible Dependents Ineligible
• Legally married spouse• Natural or adopted children*• Children under your legal guardianship*• Stepchildren*• Children under a qualified medical child
support order*• Disabled children 19 years or older*• Children placed in your physical custody
for adoption*• Foster children**See specific plan document for age details.
• Divorced or legally separated spouse• Common law spouse, even if recognized by
your state • Sisters, brothers, parents or in-laws,
grandchildren, etc.
Changes in… May Include
Marital Status Marriage, divorce, legal separation, death of a spouse
Number of Children Birth, adoption, placement of a child, or removal of a child due to death or age limitations
Employment Status Change in the employment status of the employee, spouse, or dependent children
Age Limitations for Coverage Ages at which employees and/or dependents age out of varying University benefits
MEDICAL PLANSFor this plan year, you can choose from the following medical options. Refer to the carrier benefits summaries for the exact benefit levels associated with your plan choice.
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases.
In Network BenefitsCigna
High Deductible Health Plan $4000
CignaHigh Deductible Health Plan
$1750*
CignaTraditional Plan
Annual Deductible$4,000 individual/
$8,000 family$1,750 individual/
$3,500 family $1,000 individual/$2,000 family
Maximum Out-of-Pocket $6,000 individual/$12,000 family
$4,000 individual/$8,000 family
$5,000 individual/$10,000 family
Pharmacy Out-of PocketMaximum N/A N/A $3,100 individual/$6,200 family
Preventive Care Covered 100% Covered 100% Covered 100%
Physician’s Office Visits PCP: 20% after deductibleSpecialist: 20% after deductible
PCP: 20% after deductibleSpecialist: 20% after deductible
PCP: $25 copaySpecialist: $50 copay
Urgent Care 20% after deductible 20% after deductible 30% after deductible
Emergency Room 20% after deductible 20% after deductible 30% after deductible
Inpatient Services 20% after deductible 20% after deductible 30% after deductible
Outpatient Services 20% after deductible 20% after deductible 30% after deductible
Diagnostic X-ray Services 20% after deductible 20% after deductible Covered at copays if services rendered with PCP/Specialist
Advanced Diagnostic Services 20% after deductible 20% after deductible Covered at copays if services rendered with
PCP/Specialist
Once Annual Eye Exam $15 copay $15 copay $15 copay
Pharmacy Deductible N/A N/A $150 individual/$300 family
Pharmacy Prescription Drugs
(Tier 1/Tier 2/Tier 3/Tier 4)
After plan deductible$15/$40/> of $70
or 20% up to $300 per RxGeneric mandated
After plan deductible$15/$40/> of $70
or 20% up to $300 per RxGeneric mandated
After Rx deductible$15/$40/> of $70
or 20% up to $300 per RxGeneric mandated
Mail Order Prescription Drugs
(Tier 1/Tier 2/Tier 3)
After plan deductible$30/$80/> of $140
or 20% up to $600 per RxGeneric mandated
After plan deductible$30/$80/> of $140
or 20% up to $600 per RxGeneric mandated
After Rx deductible$30/$80/> of $140
or 20% up to $600 per RxGeneric mandated
Out of Network BenefitsCigna
High Deductible Health Plan $4000
CignaHigh Deductible Health Plan
$1750
CignaTraditional Plan
Annual Deductible $5,000 individual/$10,000 family
$3,000 individual/$6,000 family
$2,000 individual/$4,000 family
Maximum Out-of-Pocket$10,000 individual/
$20,000 family$5,000 individual/
$10,000 family$6,500 individual/
$13,000 familyCo-Insurance 40% after deductible 40% after deductible 50% after deductible
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* The way the deductible and the out of pocket maximum work is important if you cover anyone other than yourself.
• With the Traditional Plan and the HDHP - $4,000, after each eligible family member meets his or her individual deductible and individual out of pocket maximum, covered expenses for that family member will be paid based on the coinsurance level specified by the plan. Or, after the family deductible has been met, covered expenses for each eligible family member will be paid based on the coinsurance level specified by the plan.
• With the HDHP - $1750, all eligible family members contribute towards the aggregate family plan deductible and out of pocket maximum. The family deductible and the family out of pocket maximum must be met before the plan will pay each eligible family member's covered expenses based on the coinsurance level specified by the plan.
MEDICAL EMPLOYEE PREMIUMSUniversity of Richmond contributes to the cost of the medical plan for you and your family. Below are your per pay period costs for each of the Cigna medical plan options.
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases.
Coverage Tier Employee Monthly Cost Employee Per Pay (24 Pays) Cost
High Deductible Health Plan $4000Employee Only $23.66 $11.83Employee/Minor $141.98 $70.99Employee/Spouse $208.70 $104.35Employee/Spouse w/surcharge* $308.70* $154.35*Employee/Children $229.06 $114.53Employee/Family $352.56 $176.28Employee/Family w/surcharge* $452.56* $226.28*
Coverage Tier Employee Monthly Cost Employee Per Pay (24 Pays) Cost
High Deductible Health Plan $1750Employee Only $59.00 $29.50Employee/Minor $177.00 $88.50Employee/Spouse $260.18 $130.09
Employee/Spouse w/surcharge* $360.18* $180.09*Employee/Children $285.56 $142.78
Employee/Family $439.52 $219.76
Employee/Family w/surcharge* $539.52* $269.76*
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Coverage Tier Employee Monthly Cost Employee Per Pay (24 Pays) Cost
Traditional Health PlanEmployee Only $90.52 $45.26Employee/Minor $199.16 $99.58Employee/Spouse $329.52 $164.76
Employee/Spouse w/surcharge* $429.52* $214.76*Employee/Children $345.20 $172.60Employee/Family $518.74 $259.37Employee/Family w/surcharge* $618.74* $309.37*
MEDICAL INSURANCE WAIVER An employee may choose to waive his or her enrollment in the University's health insurance plans and receive 5 vacation days or $500 taxable cash benefit. These amounts are annual benefits which will be pro-rated for any portion of a year. Employees who are married and both work full-time for the University are not eligible for the 5 vacation days or $500 benefit.*SPOUSAL SURCHARGEYou are eligible to elect medical coverage for your spouse; however, if your spouse is eligible for an employer-sponsored medical coverage or an employer-sponsored retirement plan and still chooses to enroll in University of Richmond’s medical coverage, you will be assessed the monthly surcharge. If your spouse does not have access to medical coverage through their employer, you will not be assessed the $100 monthly surcharge.
If covering a spouse, please sign the benefit affirmation form. The affirmation form is on page 3 of the Benefit Enrollment form which can be found by clicking here https://hr.richmond.edu/forms/benefit-change-form.pdf. It must be returned to HR before your benefits become effective.
HEALTH SAVINGS ACCOUNT (HSA)AVAILABLE TO HIGH DEDUCTIBLE HEALTH PLAN (HDHP) PARTICIPANTS
Employees who choose one of the HDHP plans have the option of opening a Health Savings Account (HSA). The HSA-eligible plan provides a way to save money to use for health care expenses throughout the year or in future years. Your account is administered by Health Savings Administrators. You can create an online account at https://healthsavings.com.
• In 2020 individuals can contribute up to $3,550 and families can contribute up to $7,100 to their HSA (these totals represent the total of employee and employer contributions). For 2020, if you are 55 or older, you can make a $1,000 catch-up contribution.
• Money deposited in the HSA fund is done so on a pre-tax basis, and funds within the HSA grow without incurring taxes. Funds are withdrawn tax-free for healthcare related needs without having to file receipts, although you should keep your receipts in case you are ever audited.
• Money deposited in the HSA by the employee AND employer immediately become the employee’s asset and is portable.
• The University contributes to eligible employees’ HSAs annually. See below for the University contribution amounts. These amounts count towards the annual maximum contribution limits.
• Administrative fees are paid entirely by the University• If you are enrolling in the HSA for the first time, you must complete an application
(https://hr.richmond.edu/benefits/common/hsa-enrollment-form.pdf). This contribution will be madeon your first paycheck in January of 2020. You may receive notification from Health Savings Administrators requesting additional information required to established your account.
• To verify if you are eligible to open a Health Savings Account (HSA), refer to the information below and visit http://hr.richmond.edu/benefits/insurance/medical-plans/hdhp/health-savings-account.html
Pre-Tax Plan What is this account and how does it work?
Maximum Contribution Allowed
Can money in accounts be “rolled over”?
Health Savings Account
(HSA)
An HSA account can be funded with pre-tax dollars by you,
your employer or both to help pay for eligible medical
expenses.
Employee only coverage: $3,550 (2020)
Family coverage: $7,100 (2020)
Catch up contribution (55 year of age or older):
$1,000
Yes, amounts left in your HSA account can be rolled over year to year and are
portable if your employment with the
company ends.
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HSA ELIGIBILTY GUIDELINESTo be eligible for a Health Savings Account you must meet the following criteria:• You must select the HDHP Plan offered• Cannot be enrolled in Medicare Part A and/or Part B (usually 65+) and contribute funds to the account• Cannot be covered by another health insurance plan• Cannot be enrolled in TriCare, or have had VA benefits in the last 90 days• Cannot be eligible to be claimed as a dependent on another’s tax return (does not apply to joint filing)• Cannot be enrolled in a medical Flexible Spending Account (you or spouse) and put funds in an HSA
University Contributions to Employee HSAs
Income ≥ $40,000 on 1/1/2020 Income < $40,000 on 1/1/2020
High Deductible Health Plan $4000 Individual: $1,000Family: $2,000
Individual: $1,500Family: $3,000
High Deductible Health Plan $1750 Individual: $ 500Family: $1,000
Individual: $ 500Family: $1,000
How long will this take?
ALEX® is an online tool that will help you select the best benefit plan for you and your family. When you talk to ALEX he’ll ask you a few questions about your health care needs, crunch some numbers, and point out what makes the most sense for you. Anything you tell ALEX remains anonymous.
How does ALEX know what plan is best for me?
Most users spend about 7 minutes with ALEX, but it really just depends how much guidance you’d like.
ALEX takes the amount each plan would cost you out of your paycheck (your premium) and adds that to the amount it would cost for the services you said you might use. Then he’ll recommend a plan for your needs.
How should I prepare?
Can I use ALEX on my phone?
You don’t need to do much of anything.ALEX will ask you to estimate what type of medical care you might need next year (doctors visits, surgeries, ER visits, prescriptions, etc.), so you may want to tally those up and talk to your family about their needs, but ALEX can also help you come up with some estimates.
Alex will also assist you with information about all of your other benefits, including amounts you may want to contribute to your Health Savings Account (HSA).
Oh yeah. ALEX is optimized for any device you’ve got.
Can I trust ALEX with my secrets?Yes! Your ALEX experience is totally private. He doesn’t maintain personal info or submit it back to your employer (or anyone else), so it’s completely anonymous.
How Works
Meet ALEX athttps://www.myalex.com/University-of-Richmond/2020
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CIGNA ONE GUIDE
Cigna One Guide service can help you make smarter, informed choices and get the most from your medical plan. It’s our highest level of support that combines the ease of a powerful app with the personal touch of live service. One Guide personal support, tools and reminders can help you stay healthy and save money.
Your Cigna One Guide team is just a call or click away to help you:
1. Understand your plan› Know your coverage and how it works› Get answers to all your health care or plan questions
2. Save and earn› Maximize your benefits and earn incentives › Get cost estimates and service comparisons to avoid surprise› Enhanced Cigna customer service at no additional cost
3. Get care› Find an in-network doctor, lab or urgent care center› Connect to health coaches, pharmacists and more› Stay on track with appointments and preventive care› Take advantage of dedicated one-on-one support for complex health situations
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Cigna’s One Guide team is here to help you 24/7!• Call 1-800-244-6224 • Visit myCigna.com to chat directly with an agent• Download the myCigna app
CIGNA’S HEALTHY PREGNANCIES, HEALTHY BABIES PROGRAM
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CIGNA’S LIFESTYLE MANAGEMENT BENEFITS
Whether your goal is to lose weight, quit tobacco or lower your stress levels, you have the power to make it happen. Cigna Lifestyle Management Programs can help – and all at no additional cost to you. Each program is easy to use and available where and when you need it.
Weight Management
Reach your goal of maintaining a healthy weight – all without the fad diets. Create a personal healthy-living plan that will help you build your confidence, be more active and eat healthier. And, you’ll get the support your need to stick with it.
Tobacco Cessation
Get the help you need to finally quit tobacco. Create a person quit plan with a realistic quite date. And, get the support you need to kick the habit for good. You’ll even get free over-the-counter nicotine replacement therapy (patch or gum).
Stress Management
Get help lowering your stress levels and raising your happiness levels. Learn what causes you stress in your life and develop a personal stress management plan. And, get the support you need to help you cope with stressful situations – both on and off the job.
Take the first step:Call 1-855-246-1873 or visit www.mycigna.com
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FLEXIBLE SPENDING ACCOUNTS (FSA)
Flexible Spending PlansThere are two separate reimbursement accounts available to you.
The University will roll-over up to $500 of unused funds each year. You may not have an HSA and an FSA at the same time, and you may not have an HSA if you are enrolled in a High Deductible Health Plan.
Coverage• Dependent Care Reimbursement: Covers eligible dependent care expenses up to a limit of
$5,000 annually. More information is available here: https://hr.richmond.edu/benefits/work-life/flexible-spending/dependent-care.html
• Medical Reimbursement: Covers eligible out of pocket medical expenses up to an annual limit of $2,750 for 2020. The Medical Reimbursement Account is available for qualifying medical, dental, and vision expenses incurred by you and your eligible dependents. More information is available here: https://hr.richmond.edu/benefits/work-life/flexible-spending/medical-reimbursement.html
CostAdministrative fees are paid entirely by the University.
EnrollmentA full-time employee is eligible to participate beginning as early as his or her start date or the date the enrollment form is signed, whichever is later. In order to participate, an employee must submit a completed enrollment application to Human Resources within thirty-one (31) days of the hire date.
Unless a qualifying condition is met, enrollment in this plan cannot be changed during the calendar year in which the election is made.
The University has an open enrollment period each year. Current employees must re-enroll in this plan every year during open enrollment. If an application is received during open enrollment, then the plan will be effective on January 1 of the next calendar year.
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VOLUNTARY DENTAL INSURANCESee Anthem detailed benefits sheets for additional information: http://hr.richmond.edu/benefits/insurance/pdf/dental-summary.pdf
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide,
the underlying insurance documents will govern in all cases.
2020 Rates
Anthem Dental
Deductible In Network Out of Network
Individual - Calendar Year $25 $50
Family - Calendar Year $75 $150
Plan Maximums
Calendar Year Max $1,250 $1,250
Ortho Lifetime Max $1,000 $1,000
Services In Network Out of Network
Preventive 100% 100%
Basic Services 80% after deductible 50% after deductible
Major Services 50% after deductible 50% after deductible
Orthodontia*Dependent Children Only 50% after deductible 50% after deductible
Coverage Tier Employee Monthly Cost
EmployeeBi-Weekly
(24 Pays) Cost
Employee Only $27.82 $13.91
Employee/Spouse $50.38 $25.19
Employee/Minor $50.38 $25.19
Family $86.28 $43.14
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VOLUNTARY VISION INSURANCESee the UniCare detailed benefits sheets for additional information: http://hr.richmond.edu/benefits/common/uniview-vision-summary.pdf
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of
insurance described in this guide, the underlying insurance documents will govern in all cases.
2020 Rates
Unicare
Network UniView Vision
Exam In Network Out of Network
Copay $15 copay Reimbursed up to $35
Frequency 12 Months
Lenses
Frequency 12 Months
Single $25 copay Reimbursed to $25
Bifocal $25 copay Reimbursed to $40
Trifocal $25 copay Reimbursed to $55
Contacts Elective $140 Allowance Reimbursed to $105
Contacts Medically Necessary Covered In Full Reimbursed to $210
Frames
Frequency 24 Months
Frames $140 Allowance Reimbursed to $45
Coverage Tier Employee Monthly Cost
Employee Bi-Weekly (24 Pays)
Cost
Employee Only $5.52 $2.76
Employee/Spouseor Employee/Child $9.66 $4.83
Employee/Children $11.04 $5.52
Family $16.06 $8.03
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VOLUNTARY LIFE BENEFITS
The University offers employees the ability to purchase voluntary life insurance for themselves and their eligible dependents.
If you wish to enroll during your new hire eligibility, you can elect up to the Guaranteed Issue amounts without having to complete Evidence of Insurability forms. If you elect any amount above the Guaranteed Issue amount, you will be required to complete the Evidence of Insurability form and those amounts above the Guaranteed Issue will not be effective until you are approved by Cigna. You must complete an enrollment application https://hr.richmond.edu/benefits/common/insurance-application.pdfand return to HR.
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide,
the underlying insurance documents will govern in all cases.
Cigna Voluntary Life
Employee Life Benefit Increments of $10,000 to Lesser of 5x Annual Salary or $500,000 Max
Guaranteed Issue Amount Employee: Lesser of 2x Salary or $200,000;
Dependent Life Benefit
Spouse: Increments of $10,000 to $50,000 Max
Dependent Child(ren):Increments of $2,000 to $10,000 Max
Dependent Under 6 Months: $500 Max
You must enroll in employee Life coverage to enroll dependents
Guaranteed Issue Amount Spouse: $30,000
Age Reduction Benefits
Reduces To:65% at Age 6545% at Age 7030% at Age 7520% at Age 80
Accelerated Benefits Yes
Conversion Privilege Yes
Waiver of Premium Yes
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VOLUNTARY LIFE RATES
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide,
the underlying insurance documents will govern in all cases.
Monthly Life Rates
Age Band EmployeePer $10,000 Benefit
SpousePer $10,000 Benefit
Child(ren) Per $2,000 Benefit
Under 30 $0.600 $0.600 $0.212
30-34 $0.800 $0.800 ---
35-39 $0.900 $0.900 ---
40-44 $1.200 $1.200 ---
45-49 $2.000 $2.000 ---
50-54 $3.200 $3.200 ---
55-59 $5.400 $5.400 --
60-64 $8.300 $8.300 ---
65-69 $14.100 $14.100 ---
70-74 $22.000 --- ---
75 & Over $33.300 --- ---
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VOLUNTARY ACCIDENT INSURANCE
If enrolled in the Cigna Voluntary Accident plan you receive a benefit paid directly to you to help pay for costs associated with a covered accident or injury. The benefit can be used to pay for anything not covered by your medical or other insurance such as deductibles, copayments and even living expenses.
The full list of covered services is outlined in the Cigna summary at https://hr.richmond.edu/benefits/insurance/medical-plans/pdf/SBC-accidental-injury-insurance.pdf, but the following includes examples of the benefits under the University plan:
Benefit Type Benefit Amount
Hospital AdmissionHospital Stay
$1,000, limited to 1 admit per accident$200 per day to a max of 365 days, 1 stay per accident
Follow up Physician Office visit $75 per visit, maximum of 10 visits
Fracture Benefits range from $100 to $8,000 based on the location and type of fracture
Dislocations Benefits range from $100 to $6,000 based on the location and type of dislocation
Other benefits There are benefits for transportation and travel if you are over 100 miles away from home for care.
This is a small illustration of the benefits paid by the Cigna Voluntary Accident Insurance. Refer to the full benefit summary for the entire list of benefits.
Monthly Rates Bi-Weekly Rates
Employee $10.29 $5.15
Employee/Spouse $16.32 $8.16
Employee/Child(ren) $20.28 $10.14
Family $26.31 $13.16
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VOLUNTARY HOSPITAL INSURANCE
Benefit Type Benefit Amount
Hospital Admission $1,000 per day – maximum of 1 day, 1 benefit every 90 days
Hospital Stay $100 per day – maximum of 30 days, 1 benefit every 90 days
Hospital Intensive Care Unit Stay $200 per day – maximum of 30 days, 1 benefit every 90 days
Hospital Observation Stay $100 per day – 24 hour elimination period, limited to 72 hours
If enrolled in the Cigna Voluntary Hospital plan you receive a benefit paid directly to you to help pay for costs associated with a hospital or intensive care hospital stay. You can use the money to pay for anything not covered by your medical or other insurance such as deductibles, copayments and even living expenses.
The full list of covered services is in the Cigna summary at https://hr.richmond.edu/benefits/insurance/medical-plans/pdf/SBC-hospital-care-coverage.pdf, but the following includes examples of the benefits under the University plan:
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Monthly Rates Bi-Weekly Rates
Employee $18.91 $9.46
Employee/Spouse $38.52 $19.26
Employee/Child(ren) $30.96 $15.48
Family $50.57 $25.29
EMPLOYER-PAID BENEFITS
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide,
the underlying insurance documents will govern in all cases.
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BASIC TERM LIFE AND AD&D
Employee Life/AD&D Benefit 2X Annual Compensation rounded to the next higher $1,000 if not already a multiple, to a maximum of $100,000
Benefit Reduction Schedule Benefits will reduce to 65% at age 65, 45% at age 70 , 30% at age 75 and 20% at age 80
Be sure your Beneficiary information is up to date
LONG-TERM DISABILTY
Benefit Begins After 180 days of disability andapproval from Cigna
Percentage of Income Replaced 66 2/3% of pre-disability earnings
Maximum Benefit Up to a maximum benefit of $10,000/month
Duration of BenefitsAge 68.5 or under = The Employee’s 70th birthday
Age 68.5 or older = The date the 12th Monthly Benefit is payable
EDUCATION
The University of Richmond offers tuition remission, covering both credit and non-credit courses for eligible employees and their dependents. The University is a member of two tuition exchange programs, making it possible for a full-time employee's dependent child(ren) to attend participating colleges or universities through a competitive scholarship program.
Ø Education EligibilityØ Tuition RemissionØ Tuition Exchange
For more information, visit: https://hr.richmond.edu/benefits/education
SHORT-TERM DISABILTYBenefit Begins After 14 days of disability and approval from Cigna
Percentage of Income Replaced Staff: 66 2/3% of pre-disability earningsFaculty: 100% of pre-disability earnings
Duration of Benefits Up to the end of the 24th week benefit period, or until you no longer quality for benefits, whichever occurs first.
The University of Richmond Retirement Plan is a defined contribution program governed by Sections 403(b) and 403(b)(7) of the Internal Revenue Code.
TIAA is the sole record keeper for the University's retirement plan.
CoverageThe Plan allows all employees to make pre- and/or post-tax contributions out of their pay. In addition, the University makes certain types of employer contributions under the Plan for employees who meet specified eligibility requirements. Employees who participate in the Plan are permitted to elect how these contributions will be invested. The Plan allows employees to invest these contributions in one or more funds provided by the fund sponsors available under the Plan.
To make voluntary salary reduction contributions, you must complete both:• A salary reduction agreement: Authorizes the University to take money out of
your pay and contribute them directly to the Plan. You determine how you would like those contributions invested. You may find the form here http://hr.richmond.edu/forms/salary-reduction-agreement-form.pdf.
• Online enrollment: Read the instructions at “How to Enroll Online” at http://hr.richmond.edu/benefits/common/retirement/employee-benefits-retirement/enroll-online.pdf
For more information, visit: https://hr.richmond.edu/benefits/retirement/
403(b) Retirement Plan
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WORK/LIFE BALANCE
The University of Richmond recognizes that balancing busy work lives and home lives is complex; the University works to provide resources and tools for success in all areas of the employee’s life. The resources provided on this page are intended to help employees intersect the challenges of work, family, and life responsibilities.
Ø Employee Assistance Program (EAP)Ø Employee Perks & DiscountsØ Flexible Spending AccountØ Flexible Work ArrangementØ Health AdvocateØ Child and Elder CareØ Long Term CareØ Legal Services PlanØ TransportationØ Lactation SupportØ Joyner Fine PropertiesØ Virginia Credit UnionØ Savi Student Debt AssistanceØ Summer Youth Programs
For more information, visit: hr.richmond.edu/benefits/work-life
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The information for this benefit has been provided by University of Richmond. OneDigital is not responsible for the content on this page.
LEGAL SERVICES PLAN
Legal Resources provides a variety of legal services to University of Richmond full-time employees with the cost of the attorney fees fully covered by the employee's monthly premium.
The cost is $18.00 per month for you, your spouse, and children up to age 26 for a 12-month commitment. There are no additional fees for the following basic covered services:
• Identity theft• Unlimited consultation and advice• Wills and estate planning• Traffic court• Real estate• Family law• Elder law
For more information, go to:https://hr.richmond.edu/benefits/work-life/Master%20Plan%20Contract%201.13.pdf
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EMPLOYEE ASSISTANCE PROGRAM (EAP)
As a UR employee, you have access to the valuable Cigna EAP at no cost to you. EAP personal advocates will work with you and your household family members to help you resolve issues you may be facing, connect you with the right mental health professionals, direct you to a variety of helpful resources in your community, and more.
Cigna EAP services include:• Face-to-face counseling: 4 sessions with a counselor in your area.• Legal assistance: 30-minute consultation with an attorney face-to-face or by phone.• Financial: 30-minute telephone consultation with a qualified specialist on topics, such as
debt counseling or planning for retirement.• Parenting: Resources and referrals for childcare providers, before and after school
programs, camps, adoption organizations, child development, prenatal care, and more.• Eldercare: Resources and referrals for home health agencies, assisted living facilities,
social and recreational programs and long-distance caregiving.• Pet care: Resources and referrals for pet sitting, obedience training, and veterinarian and
pet stores.• Identity theft: 60-minute consultation with a fraud resolution specialist.For more information, visit https://hr.richmond.edu/benefits/work-life/employee-assistance/index.html
The information for this benefit has been provided by University of Richmond. OneDigital is not responsible for the content on this page.
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HEALTH ADVOCATEEligibilityHealth Advocate is a free service available to all full-time employees, their spouses, dependent children up to age 23, parents, and parents-in-law.
ServicesHealth Advocate can provide no-charge assistance in solving your healthcare-related issues. You will be assigned a Personal Health Advocate (PHA) who will work with you one-on-one to find solutions to time-consuming issues such as billing concerns, scheduling specialized treatments, transferring medical records, finding eldercare, Social Security questions, and more.
How to EnrollTo take advantage of this service, call Health Advocate directly at 1-866-695-8622 or visithttps://members.healthadvocate.com/Account/OrganizationSearch
UR WELL/EMPLOYEE WELLNESS
Human Resources and Health Promotion have partnered to make employee wellness a top campus priority for faculty and staff at the University of Richmond. Our goal is to provide resources for the whole person while focusing on the eight dimensions of wellness: emotional, environmental, financial, intellectual, occupational, physical, social, and spiritual.
For more information, visit: employeewellness.richmond.edu
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The information for this benefit has been provided by University of Richmond. OneDigital is not responsible for the content on this page.
WORKING ON WELLNESS (W.O.W.) PROGRAMThis program is available to all full-time new hires within the first year of employment. You will receive:Ø 3 Free sessionswitha certified personal trainer to discuss wellness and goal
setting (nutrition,exercise,etc.)Ø Follow-up sessions throughout the year as an accountability partner to
reach wellness goals developed during first 3 sessions
Ø Trainer willwork with your schedule for appointments
Ø To register, fill out the questionnaire at https://employeewellness.richmond.edu/common/working-on-wellness-questionnaire.pdf and return it to the Health Promotion department.
MotivateMe is an incentive program that helps improve your health while rewarding you for the healthy actions you take. Full-time employees, regardless of medical coverage, may participate in programs and activities to help you reach your wellness goals, while earning up to $120 in gift cards to a wide range of stores.
View your incentives information by downloading the myCigna Mobile App or by going to www.mycigna.com to find a list of available healthy actions and goals and instructions on how to earn and redeem rewards For more information, visit http://employeewellness.richmond.edu/incentive-program.
URWell EMPLOYEE INCENTIVE PROGRAM
LEAVE
Eligible employees enjoy generous leave benefits, including 14 paid holidays. Most new staff members also accrue 12 vacation days and 12 sick days in their first year. In addition, the University offers a variety of leave options to accommodate individual needs, including parental leave, bereavement leave, personal leave, and more.
• Holidays• Personal• Vacation• Sick• Family Medical Leave Act (FMLA)• Parental• Bereavement• Jury Duty• Leave of Absence• Military• Voting
For more information, visit: hr.richmond.edu/benefits/leave
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The information for this benefit has been provided by University of Richmond. OneDigital is not responsible for the content on this page.
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CARRIERS, VENDORS AND CONTACTS - KNOW WHERE TO GO!Calling a vendor is the best way to resolve an issue quickly. If you are not sure who to call, what to ask, or have other questions about benefits or your employment, contact the HR Solution Center at [email protected] or 289-8747 (URHR). Our friendly team of HR Representatives will make sure you get to the right place.
Program Vendor Contact Information
Medical/Rx/One Guide Customer Service
CIGNA 1-800-244-6224www.cigna.com
Employee Assistance Program (EAP)
CIGNA 1-877-622-4327www.cigna.com
Dental Anthem 1-866-956-8607www.anthem.com
Vision Unicare 1-888-884-8428www.unicare.com
Flexible Spending Account (FSA) Flores 1-800-532-3327www.flores247.com
Health Savings Account (HSA) Health Savings Administrators
1-888-354-0697www.healthsavings.com
Group Life, Short Term Disability, and Long Term DisabilityVoluntary Life
CIGNA 1-800-238-2125www.cigna.com
Legal Services Plan Legal Resources 1-800-728-5768www.legalresources.com
Voluntary Accident Insurance and Voluntary Hospital Insurance
CIGNA 1-800-754-3207www.cigna.com
Health Advocate Health Advocate 1-866-799-2655www.healthadvocate.com
403(b) Retirement Plan TIAA 1-800-842-2776https://www.tiaa.org/public/tcm/richmond
The HR Solution Center University of Richmond
https://hr.richmond.edu/benefits/
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Glossary of Terms
Co-insurance. A percentage of a health care cost—such as 20 percent—that the covered employee pays after meeting the deductible.
Co-payment. The fixed dollar amount—such as $25 for each doctor visit—that the covered employee pays for medical services.
Deductible. A fixed dollar amount that the covered employee must pay out of pocket each calendar year before the plan will begin reimbursing for non-preventative health expenses. Plans usually require separate limits per person and per family.
Formulary. A list of prescription drugs covered by the health plan, often structured in tiers that subsidize low-cost generics at a higher percentage than more expensive brand-name or specialty drugs.
High-deductible health plan (HDHP). An HDHP features higher annual deductibles than traditional health plans. With the exception of preventive care, covered employees must meet the annual deductible before the plan pays benefits. HDHPs, however, may have significantly lower premiums than traditional plans. An additional benefit is the ability to participate in a health savings account.
Health savings account (HSA). HSAs may be opened by employees who enroll in a high-deductible health plan. Employees can put money in an HSA up to an annual limit set by the , using pre-tax dollars. Employers may also contribute funds to these accounts within the prescribed limit. HSA funds may be used to pay for medical expenses whether or not the deductible has been met, and no tax is owed on funds withdrawn from an HSA to pay for medical expenses. HSAs are individually owned and the account remains with an employee after employment ends.
In-network. Doctors, clinics, hospitals and other providers with whom the health plan has an agreement to care for its members. Health plans cover a greater share of the cost for in-network health providers than for providers who are out-of-network.
Out-of-network. A health plan will cover treatment for doctors, clinics, hospitals and other providers who are out-of-network, but covered employees will pay more out-of-pocket to use out-of-network providers than for in-network providers.
Out-of-pocket limit. The most an employee could pay during a coverage period (usually one year) for his or her share of the costs of covered services, including co-payments and co-insurance.
Premium. The amount that must be paid for a health insurance plan by covered employees, by their employer, or shared by both. A covered employee's share of the annual premium is generally paid periodically, such as monthly, and deducted from his or her paycheck.
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Women’s Health andCancer Rights ActIn October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully. As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a covered mastectomy is also entitled to the following benefits: 1. All stages of reconstruction of the breast on which the mastectomy has been performed: 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and 3. Prostheses and treatment of physical complications of the mastectomy , including lymphedemas. Health plans must provide coverage of mastectomy related benefits in a manner to determine in consultation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to deductibles and insurance amounts that are consistent with those that apply to other benefits under the plan.
Newborn and Mothers’Health Protection ActGroup health plans and health insurance issuers generally may not, under federal law restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization from the plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
REQUIRED NOTICES
Medicare Part D Creditable Coverage University of Richmond has determined that the prescription drug coverage offered by the University of Richmond is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
Special Enrollment Notice If 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 the appropriate time period that applies under the plan after you 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 the appropriate time period that applies under the plan after the marriage, birth, adoption, or placement for adoption. To request special enrollment or obtain more information, contact the appropriate plan representative.For additional information on your employer’s privacy policy, please contact your HR department.
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REQUIRED NOTICES Health Care Reform Exchange Notice
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You can access the full notice for University of Richmond at:https://hr.richmond.edu/benefits/insurance/pdf/healthcare-reform-exchange-notice.pdf
NOTICE OF PRIVACY PRACTICESOF THE GROUP HEALTH PLANS SPONSORED BY
THE UNIVERSITY OF RICHMOND
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOWYOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Introduction. Effective April 14, 2004, many health plans became subject to new federal privacy regulations under theHealth Insurance Portability and Accountability Act of 1996 (“HIPAA”). The HIPAA privacy regulations do not, as a generalmatter, regulate employers or non-health benefit plans such as workers compensation, disability, life insurance, dependentcare, financial planning, business travel, or other non-health benefits plans. However, employers can be subject to certainrequirements of the HIPAA privacy rules, as described in greater detail below.
You can find the HIPAA privacy regulations at 45 Code of Federal Regulations, Parts 160 and 164.
This notice applies to you if you are covered as an employee, former employee or dependent under a group health plansponsored by the University of Richmond (the “University”). It is the policy of the group health plans sponsored by theUniversity to maintain the privacy of your health information in accordance with the HIPAA privacy rules. The group healthplans covered by this notice include the University’s group health plan, dental plan, health flexible spending account planand the employee assistance program plan. The group health plans sponsored by the University are considered anorganized health care arrangement under the HIPAA privacy rules, which permits them to jointly issue this Notice of PrivacyPractices. Thus, this notice will refer to the University’s various group health plans as the “Plan.”
The state in which you live may also impose restrictions on the use or disclosure of your health information that are morestringent than the HIPAA privacy rules. While these state laws generally do not apply to employer-sponsored group healthplans, they often apply to doctors, hospitals, health insurance companies, and HMOs. The Health Privacy Project of theInstitute for Health Care Research and Policy maintains information on state health privacy laws at its website,www.healthprivacy.org, which you may find helpful in protecting the privacy of your health information and in gaining accessto your health records.
Protected Health Information. The HIPAA privacy rules regulate the use and disclosure by the Plan of “protected healthinformation” (commonly referred to as “PHI”). PHI is any “individually identifiable health information” maintained ortransmitted by the Plan (in any form or medium). Individually identifiable health information is health information thatidentifies you or creates a reasonable basis to believe that it could be used to identify you, including information relating toyour health condition or receipt of health care. In addition, health information that is merely in summary form and that doesnot identify you as its subject is not PHI and may be used or disclosed by the Plan without restriction under the HIPAAprivacy rules. For example, the University may use aggregated data regarding claims paid for all Plan participants to helpproject benefit costs for the next year. With respect to PHI, however, the HIPAA privacy rules prevent the Plan from usingyour PHI or disclosing it to the University or anyone else except as permitted by the HIPAA privacy rules, as authorized byyou, or as required by law.
Uses and Disclosure of Protected Health Information for Treatment, Payment, and Health Care Operations. TheHIPAA privacy rules permit the Plan to use or disclose your PHI without your authorization for purposes of treatment,payment, and health care operations. This is necessary in order to provide you with quality health care. The Plan’s businessassociates may also use or disclose your PHI for treatment, payment, or health care operations on the Plan’s behalf.Business associates include the Plan’s third party administrators, as well as brokers, service providers, lawyers,accountants, consultants, and other appropriate persons who help to ensure that the Plan is run properly and that youreceive any benefits to which you are entitled. PHI may also be shared among the University’s various group health plansthat make up the Plan for purposes of treatment, payment, or health care operations. The terms “treatment,” “payment,”and “health care operations” are explained below:
• “Treatment” means generally the provision, coordination, or management of health care and related services by oneor more health care providers. For example, the Plan may disclose your PHI to your doctor and his staff, the Plan’sthird party administrators and their staffs, and other appropriate persons to help provide you with proper medicaltreatment.
• “Payment” means any action undertaken by the Plan to obtain premiums, to determine responsibility for providingcoverage, or to obtain or provide reimbursement for the health care services you receive. This includes, but is notlimited to, eligibility and coverage determinations, billing, subrogation, claims management and processing, planreimbursement, reviews for medical necessity, appropriateness of care, utilization review, and pre-authorization fortreatment. For example, the Plan may disclose to your doctor and her staff, the Plan’s third party administrators andtheir staffs, and other appropriate persons information concerning a particular medical
procedure that you have had performed to determine whether the procedure is covered by thePlan.
• “Health care operations” means all the activities involved in the administration of the Plan. This includes, but is notlimited to, quality assessment and improvement, evaluating competence or qualification of providers, underwritingand other activities relating to obtaining or amending insurance contracts, disease management, cost management,legal, and other general administrative activities. For example, the Plan may use PHI about you to refer you to adisease management program, to evaluate the quality of care you are receiving from your providers, or to projectbenefit costs and determine premiums.
• If PHI is used or disclosed for underwriting purposes, the Plan is prohibited from using or disclosing any of your PHI that is genetic information for such purposes.
Other Uses and Disclosures Permitted Without Authorization. The Plan may disclose the Plan’s enrollment anddisenrollment information to the University without your authorization. This information merely indicates whether you areenrolled in the Plan and shows your specific Plan benefit options. The University requires such information for payrollwithholding and other purposes. The Plan may also disclose your PHI to the University or its business associates withoutyour authorization so that the University may obtain bids for services or make decisions about modifying or terminating thePlan. Information provided to the University for these purposes will be in summary form. This means that the informationwill be limited to claims history, claims expenses, or types of claims experienced, with your name and certain types of otheridentifying information removed. The Plan may use or disclose your PHI at any time without your authorization as requiredby the HIPAA privacy rules or other applicable law.
In addition, the HIPAA privacy rules permit the Plan to use or disclose your PHI without your authorization to the following:(1) a public health authority authorized by law to collect or receive such information for the purpose of preventing orcontrolling disease, injury, or disability; (2) a public health or other governmental authority authorized by law to receivereports of child abuse or neglect; (3) a person subject to the jurisdiction of the Food and Drug Administration with respect toan FDA-regulated product or activity for which that person has responsibility, for the purpose of activities related to thequality, safety, or effectiveness of such FDA-regulated product or activity; (4) a person who may have been exposed to acommunicable disease or may otherwise be at risk of contracting or spreading the disease or condition, if the plan isauthorized by law to notify such person as necessary in the conduct of a public health intervention or investigation; (5) ahealth oversight agency for certain purposes (e.g., audits, investigations, disciplinary actions, government benefit eligibility,civil rights law compliance); (6) a court or other party in connection with a judicial or administrative proceeding;(7) law enforcement officials for law enforcement purposes; (8) coroners and medical examiners for the purpose ofidentifying a deceased person, determining cause of death, or other duties authorized by law; (9) funeral directors, asnecessary to carry out their duties with respect to a decedent (consistent with applicable law); (10) organ procurementorganizations (and related organizations); (11) a researcher or research organization, subject to detailed requirements;(12) a person or other entity to avert a serious threat to the health or safety of a person or the public; (13) an appropriatemilitary authority in connection with military and veterans activities; (14) federal officials in connection with certain nationalsecurity activities; (15) correctional institutions and other law enforcement custodial situations in relation to an inmate; and(16) an individual or other entity as authorized by, and to the extent necessary to comply with, laws related to workers’compensation and other similar programs established by law that provide benefits for work-related injuries or illnesseswithout regard to fault. It is generally the policy of the Plan to disclose PHI under these circumstances only as required bythe HIPAA privacy rules or other applicable law.
Disclosure of Your PHI to University Personnel Without Authorization. In connection with the disclosures described inthe previous two sections of this notice, the Plan may disclose your PHI to University personnel who are involved in theadministration of the Plan. These disclosures will be made in connection with the University’s role as the sponsor of thePlan, and will be made to enable University personnel to carry out their duties in administering the Plan. In manycircumstances, it will be appropriate for such personnel to share your PHI with the Plan’s business associates outside of theUniversity. The University has amended the Plan documents to protect your PHI as required by the HIPAA privacy rules. Inaddition, the University has instituted policies and procedures to help ensure that your PHI is made available only to thoseindividuals who need it to perform important Plan functions. Such individuals have received training in the proper handling ofPHI and have been informed of the sensitivity of this information. It is the policy of the University that PHI received from thePlan is not to be used for employment-related purposes or other purposes not related to the University’s sponsorship oradministration of the Plan.
Uses and Disclosures Requiring That You Receive an Opportunity to Agree or Object. Certain circumstances mightarise where the Plan needs to disclose your PHI to family members and other appropriate persons in order to ensure thatyou are receiving appropriate care and to notify certain persons of your medical condition or your location. The Plan will
make such disclosures only if you have agreed (or have not objected) to the disclosure. Specifically, the Plan may discloseyour PHI to your family member, relative, close personal friend, or another person designated by you, but only to the extentthe information is directly relevant to the family member’s or friend’s involvement with your care or payment for care. ThePlan may also disclose your PHI to notify or assist in notifying your family member, personal representative, or other personresponsible for your care of details regarding your location, your general condition or your death. In such cases, you will begiven an opportunity to agree or object to the disclosure, and the disclosure will be made only if you either affirmativelyagree or you do not object to the disclosure when given the opportunity. If you are unavailable or you are incapacitated, thePlan may disclose your PHI to such individuals without providing you with an opportunity to agree or object, if the Plandetermines that to do so is in your best interests under the circumstances.
Fundraising.In the case of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.
Uses and Disclosures Requiring Your Written Authorization. Where use or disclosure is not otherwise permitted underthe HIPAA privacy rules, the Plan is required to obtain your written authorization before using or disclosing your PHI. Inaddition, the Plan is generally required to ask for your written authorization before using or disclosing notes about youobtained from your psychotherapist. Psychotherapy notes are separately filed notes about your conversations with youmental health professional during a counseling session. They do not include summary information about your mentalhealth treatment. The Plan may use and disclose such notes when needed by the Plan to defend against litigation filed byyou. In addition, your written authorization will be obtained for uses and disclosures of PHI for marketing purposes anddisclosures that constitute a sale of PHI but we never market or sell personal health care information. If you choose tosign an authorization to disclose information, you can later revoke that authorization to stop future uses and disclosures,except to the extent the Plan has acted in reliance upon your authorization. In some cases, the Plan (including Universitypersonnel and business associates acting on behalf of the Plan) may ask you to sign a written authorization regarding theuse and disclosure of your PHI even when one is not clearly required under the HIPAA privacy rules. This is to protect yourprivacy rights and to ensure that representatives of the University, the Plan, and its business associates are fully authorizedto communicate with each other regarding your situation in order to provide you with the best possible health care benefits.
Incidental Uses and Disclosures. The HIPAA privacy rules permit incidental uses and disclosures that occur as a by-product of a permissible or required use or disclosure. An incidental use or disclosure is a secondary use or disclosure thatcannot reasonably be prevented, is limited in nature, and that occurs as a result of another use or disclosure that ispermitted by the HIPAA privacy rules. The Plan has instituted reasonable safeguards to protect against uses anddisclosures not permitted by the HIPAA privacy rules and to limit incidental uses or disclosures. However, those safeguardscannot totally guarantee the privacy of your PHI. In implementing safeguards, the Plan has considered the nature of the PHIheld, the potential risks to privacy, the potential effects on patient care, and the financial and administrative burden ofparticular safeguards. The Plan is not required to obtain your authorization or notify you if an incidental disclosure occurs.
Reservation of the Plan’s and University’s Rights. Generally, it is the Plan’s policy to avoid the use and disclosure ofyour PHI whenever possible. Therefore, the Plan will not normally use or disclose your PHI, except when necessary fortreatment, payment, or health care operations or to comply with the HIPAA privacy rules or other applicable law. However,the Plan reserves the right to use or disclose your PHI in any manner permitted by the HIPAA privacy rules. The Universityis also committed to the protection of your PHI and generally seeks to avoid the use and disclosure of your PHI wheneverpossible. However, the University reserves the right to use or disclose your PHI received from the Plan in any mannerpermitted by the HIPAA privacy rules. Please remember that health information maintained by the University as part of youremployment records or through a benefit plan of the University that is not part of the Plan, such as a short- or long-termdisability plan, is not subject to the HIPAA privacy rules and may be used or disclosed in accordance with the University’sstandard policies (subject to applicable law).
Your Rights. You have the right to review and receive copies of your PHI maintained by the Plan in a designated recordset or used by the Plan to make decisions about your coverage or benefits. The term “designated record set” means theenrollment, payment, claims adjudication, and case or medical management records maintained by the Plan. If you requestcopies of this information, you may be charged a reasonable, cost-based fee for the copies. Your request should be madein writing to the address listed at the end of this notice, and the Plan will comply with the request within 30 days of yourrequest (60 days if the information is maintained offsite), subject to a possible 30-day extension. If your request is denied,you will receive a written explanation of the reasons for the denial. Please remember that the Plan is only responsible forproviding you with information contained in its records. Hospital records and other records not maintained by the Plan mustbe procured directly from the individual or institution that maintains those records.
You have the right to receive a list of instances where the Plan or the University disclosed your PHI to third parties after theeffective date of this notice for reasons other than treatment, payment, or health care operations, except in cases
where you have authorized the disclosure, the disclosure was merely incidental to a disclosure that is otherwise permittedunder this privacy policy, or the disclosure was required for law enforcement or national security purposes. You mayrequest one such accounting at no charge every 12 months. For any additional requests, you may be charged areasonable, cost-based fee for the copies.
Uses and disclosures not listed in the Privacy Notice will be made only with individual authorization.
If you believe that information in your record is incorrect or if important information is missing, you have the right to requestthat the Plan correct existing information or add missing information. Your request should be made in writing to the addresslisted at the end of this notice and should state reasons supporting your request for a correction or addition. The Plan has60 days to respond to your request, subject to a possible 30-day extension. If your request is denied, you will receive awritten explanation of the reasons for the denial.
You have the right under HIPAA to request restrictions on the Plan’s use or disclosure of your PHI for treatment, paymentand health care operations. You may also request restrictions on disclosures to your family members or other individualswho are involved in your care or payment for your care. The Plan will consider your request, but is not required to agree tosuch restrictions. Any restriction agreed to by the Plan will not apply if the use or disclosure is necessary to provide you withemergency treatment or if the disclosure is required by law. If you wish to request a restriction on disclosures of your PHI,you should send your request in writing to the address listed at the end of this notice. If the Plan accepts your request, youwill receive written notification that your request has been accepted. The Plan will also accommodate reasonable requestsfor you to receive communications of your PHI at alternate locations or by alternate methods, if the normal method ofcommunication could endanger you.
You may exercise your rights through a personal representative, provided that such individual produces evidence of his orher authority to act on your behalf. The Plan will only accept the following as evidence of such authority: (1) a power ofattorney for health care purposes notarized by a notary public; (2) a court order appointing the individual as yourconservator or guardian; or (3) proof that such individual is your parent (if you are a minor). Your personal representativewill be treated as you would with respect to access to your PHI and your other rights under the HIPAA privacy rules.However, the Plan retains the discretion to deny your personal representative access to your PHI if the Plan finds evidencethat such denial is necessary to protect you from abuse or neglect.
You may request a paper copy of this notice at any time by contacting the person or office listed at the end of this notice.
The Plan’s Legal Duties. The HIPAA privacy rules require the Plan to maintain the privacy of your PHI, to provide thisnotice about its information practices, and to follow the practices described in this notice. The Plan may change its privacypolicies at any time, and changes may apply to all PHI held by the Plan at the time of the change. When the Plan makes asignificant change in policy, a revised Notice of Privacy Practices will be distributed to all current Plan participants within 60days of the effective date of the change.
This notice and the privacy policies of the Plan and the University do not create any legal rights, contractual orotherwise, under state or federal law, but simply give you notice of the Plan’s obligations, and your rights, underthe HIPAA privacy rules.
Complaints. If you are concerned that the Plan has violated your rights under the HIPAA privacy rules, or if you disagreewith a decision made about access to or amendment of your health records, you may contact the person or office listedbelow. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services,Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201, or you may file your complaint withthe appropriate regional office listed at http://www.hhs.gov/ocr/filing-with-ocr/index.html. Neither the Plan nor the Universitywill retaliate against you in any way for exercising your right to file a complaint.
You may contact the following for more information on the Plan’s privacy practices:
Laura S. DietrickDirector, Compensation and Benefits, Privacy OfficerUniversity of Richmond Human Resources Weinstein HallUniversity of Richmond, Virginia 23173 (804) 289-8747
Revised: January 9, 2020Approved: April 14, 2004
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REQUIRED CHIP NOTICE Premium Assistance Under Medicaid and the Children’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 – Medicaid FLORIDA – Medicaid
Website: http://myalhipp.com/Phone: 1-855-692-5447
Website: http://flmedicaidtplrecovery.com/hipp/Phone: 1-877-357-3268
ALASKA – Medicaid GEORGIA – Medicaid
The AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com/Phone: 1-866-251-4861Email: [email protected] Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
Website: https://medicaid.georgia.gov/health-insurance-premium-payment-program-hippPhone: 678-564-1162 ext 2131
ARKANSAS – Medicaid INDIANA – Medicaid
Website: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)
Healthy 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
35
REQUIRED CHIP NOTICE (CONT)COLORADO – Health First Colorado (Colorado’s Medicaid
Program) & Child Health Plan Plus (CHP+)IOWA – Medicaid
Health First Colorado Website: https://www.healthfirstcolorado.com/Health First Colorado Member Contact Center: 1-800-221-3943/ State Relay 711CHP+: https://www.colorado.gov/pacific/hcpf/child-health-plan-plusCHP+ Customer Service: 1-800-359-1991/ State Relay 711
Website: http://dhs.iowa.gov/HawkiPhone: 1-800-257-8563
KANSAS – Medicaid NEW HAMPSHIRE – Medicaid
Website: http://www.kdheks.gov/hcf/Phone: 1-785-296-3512
Website: https://www.dhhs.nh.gov/oii/hipp.htmPhone: 603-271-5218Toll free number for the HIPP program: 1-800-852-3345, ext5218
KENTUCKY – Medicaid NEW JERSEY – Medicaid and CHIP
Website: https://chfs.ky.govPhone: 1-800-635-2570
Medicaid 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
LOUISIANA – Medicaid NEW YORK – Medicaid
Website: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331Phone: 1-888-695-2447
Website: https://www.health.ny.gov/health_care/medicaid/Phone: 1-800-541-2831
MAINE – Medicaid NORTH CAROLINA – Medicaid
Website: http://www.maine.gov/dhhs/ofi/public-assistance/index.htmlPhone: 1-800-442-6003TTY: Maine relay 711
Website: https://medicaid.ncdhhs.gov/Phone: 919-855-4100
MASSACHUSETTS – Medicaid and CHIP NORTH DAKOTA – Medicaid
Website: http://www.mass.gov/eohhs/gov/departments/masshealth/Phone: 1-800-862-4840
Website: http://www.nd.gov/dhs/services/medicalserv/medicaid/Phone: 1-844-854-4825
MINNESOTA – Medicaid OKLAHOMA – Medicaid and CHIPWebsite: https://mn.gov/dhs/people-we-serve/seniors/health-care/health-care-programs/programs-and-services/other-insurance.jspPhone: 1-800-657-3739
Website: http://www.insureoklahoma.orgPhone: 1-888-365-3742
MISSOURI – Medicaid OREGON – Medicaid
Website: http://www.dss.mo.gov/mhd/participants/pages/hipp.htmPhone: 573-751-2005
Website: http://healthcare.oregon.gov/Pages/index.aspxhttp://www.oregonhealthcare.gov/index-es.htmlPhone: 1-800-699-9075
MONTANA – Medicaid PENNSYLVANIA – Medicaid
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084
Website: http://www.dhs.pa.gov/provider/medicalassistance/healthinsurancepremiumpaymenthippprogram/index.htmPhone: 1-800-692-7462
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REQUIRED CHIP NOTICE (CONT)
NEBRASKA – Medicaid RHODE ISLAND – Medicaid and CHIPWebsite: http://www.ACCESSNebraska.ne.govPhone: (855) 632-7633Lincoln: (402) 473-7000Omaha: (402) 595-1178
Website: http://www.eohhs.ri.gov/Phone: 855-697-4347, or 401-462-0311 (Direct RIte Share Line)
NEVADA – MedicaidSOUTH CAROLINA – Medicaid
Medicaid Website: https://dhcfp.nv.govMedicaid Phone: 1-800-992-0900
Website: https://www.scdhhs.govPhone: 1-888-549-0820
SOUTH DAKOTA - Medicaid WASHINGTON – MedicaidWebsite: http://dss.sd.govPhone: 1-888-828-0059
Website: https://www.hca.wa.gov/Phone: 1-800-562-3022 ext. 15473
TEXAS - Medicaid WEST VIRGINIA - MedicaidWebsite: http://gethipptexas.com/Phone: 1-800-440-0493
Website: http://mywvhipp.com/Toll-free phone: 1-855-MyWVHIPP (1-855-699-8447)
UTAH - Medicaid and CHIP WISCONSIN - Medicaid and CHIPMedicaid Website: https://medicaid.utah.gov/CHIP Website: http://health.utah.gov/chipPhone: 1-877-543-7669
Website: https://www.dhs.wisconsin.gov/publications/p1/p10095.pdfPhone: 1-800-362-3002
VERMONT - Medicaid WYOMING - MedicaidWebsite: http://www.greenmountaincare.org/Phone: 1-800-250-8427
Website: https://health.wyo.gov/healthcarefin/medicaid/Phone: 307-777-7531
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
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:
Paperwork Reduction Act StatementAccording 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 BenefitsSecurity Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., RoomN-5718, Washington, DC 20210 or email [email protected] and reference the OMB Control Number 1210-0137.
OMB Control Number 1210-0137 (expires 12/31/2019)
U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov1-877-267-2323, Menu Option 4, Ext. 61565
U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/agencies/ebsa1-866-444-EBSA (3272)
37
CONFIDENTIALITY NOTICE
OneDigital Health and Benefits, a division of Digital Insurance, LLC does not sell or share any information we learn about our clients and understands you may have to answer sensitive questions about your medical history, physical condition and personal health habits as required by our insurance carrier partners.
We collect nonpublic personal information from the following sources:• Information from you, including data provided on applications or other forms, such as name, address,
telephone number, date of birth and Social Security number• Information from your transactions with us and/or our partners such as policy coverage, premium, claim,
and payment history.
OneDigital Health and Benefits recognizes the importance of safeguarding the privacy of our clients and prospective clients, and we pledge to protect the confidential nature of your personal information. We understand our ability to provide access to affordable health insurance to businesses and individuals can only succeed with an environment of complete trust.
In the course of business, we may disclose all or part of your customer information without your permission to the following persons or entities for the following reasons:• To an insurance carrier, agent or credit reporting agency to detect, prevent or prosecute actual or
potential criminal activity, fraud, misrepresentation, unauthorized transactions, claims or other liabilities in connection with an insurance transaction.
• To a medical care institution or medical professional to verify coverage or benefits, to inform you of a medical problem of which you may or may not be aware or to conduct an audit that would enable us to verify treatment.
• To an insurance regulatory authority, law enforcement or other governmental authority to protect our interests in detecting, preventing or prosecuting actual or potential criminal activity, fraud, misrepresentation, unauthorized transactions, claims or other liabilities in connection with an insurance transaction.
• To a third party, for any other disclosures required or permitted by law. We may disclose all of the information that we collect about you, as described above.
Our practices regarding information confidentiality and security: We restrict access to your customer information only to those individuals who need it to provide you with products or services, or to otherwise service your account. In addition, we have security measures in place to protect against the loss, misuse and/or unauthorized alternation of the customer information under our control, including physical, electronic and procedural safeguards that meet or exceed applicable federal and state standards.
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NOTES
