Postdoctoral Insurance Plan

Open Enrollment – Plan Year 2015November 10th through November 25th, 2014

Effective January 1, 2015

PennsylvaniaThe University of

“An investment in knowledge pays the best interest”

– Benjamin Franklin

AGENDA Review of benefit plan designs,

rates and changes for 2015

Explanation of the Open Enrollment

process

Q & A

The Postdoctoral

Insurance Plan

The University of Pennsylvania has partnered with Garnett-Powers & Associates to provide marketing, administrative services and customer service for this program. The University of Pennsylvania Postdoctoral Insurance Plan was implemented on March 1st, 2007, and is available to all Postdoctoral Scholars.

The program offers a package of benefits originally designed to closely match the benefits offered to the University of Pennsylvania faculty & staff.

Meet Your Postdoctoral Insurance Plan Representative!

Dane Pisano is a graduate of California State University, Fullerton, with a Bachelor’s degree in Communications, and a licensed insurance agent.

He has 4 years of experience as a Garnett-Powers & Associates University Services Account Manager, and is eager to assist you with any enrollment, benefits or billing questions you may have regarding the Postdoctoral Insurance Plan.

Benefits Offered Through ThePostdoctoral Insurance Plan

Plan Name Insurance Type Company

HMO*new for 2015*

Medical

PPO Medical

DMO Dental

DPPO Dental

PPO Vision

Life and AD&D Life

Benefit Plan/RateChanges for 2015

The Aetna medical POS plan will be changing to the Aetna Open Access HMO plan.

The HMO plan rates will be a 5% increase from the current POS plan rates.

If you are currently enrolled in the POS plan, you will be automatically enrolled in the new Open Access HMO Plan effective January 1st, 2015.

New ID cards will be sent to your home for all enrolling family members.

Change from Aetna Medical POS Planto

Aetna Medical HMO Plan

Benefit Plan/RateChanges for 2015, cont.

Aetna Medical PPO Plan Benefit Changes

The medical PPO plan’s benefits are being altered to bring them more in-line with the comparable faculty/staff plan to reduce the monthly premium cost.

There will be an 11.8% increase to the rates.

MEDICALAetna PPO (Current Plan) Aetna PPO - Downgrade Option

BENEFITS

    In-Network Out-of-Network In-Network  Physician Office Visit $20 Copay 30% $30 Copay 40%Specialist Office Visit $30 Copay 30% $40 Copay 40%Hospitalization:        

Inpatient - 10% after deductible 30% after deductible 20% after deductible 40% after deductible

Outpatient - 10% after deductible 30% after deductible 20% after deductible 40% after deductible

Maternity -   10% after deductible 30% after deductible 20% after deductible 40% after deductiblePrescription Drugs:     30% Plus   40% PlusGeneric   $10 Copay $10 Copay $20 Copay $20 CopayBrand Name $15 Copay $15 Copay $30 Copay $30 CopayNon Formulary $30 Copay $30 Copay $50 Copay $50 CopayDeductible:        Individual - $200 $500 $300 $800

Family   $600 $1,500 $900 $2,400

Benefit Plan/RateChanges for 2015, cont.

The dental DMO rates will be increasing by 4%.

The dental PPO and vision rates will remain

the same with no reduction in benefits.

MEDICALINSURANCE

Provided by

What is anOpen Access HMO plan?

A Health Maintenance Organization (HMO) plan typically

requires the selection of a Primary Care Physician (PCP) to act as your healthcare “gatekeeper”, referring you to specialists if necessary.

The ‘Open Access’ component of this HMO plan allows you to choose a PCP as you seek service, as well as self- refer to specialists, as long as those providers are in the HMO network. The Open Access HMO plan benefits mirror the rich, in- network benefits of the current POS plan, however there is no out-of-network benefit.

Unless it is a true emergency, any services rendered by an out-of-network provider will not be covered under the plan in any capacity.

There is minimal provider disruption between the POS and HMO networks.

Postdoctoral Insurance Plan AETNA Open Access HMO Medical Plan Medical Benefits In-Network

Postdoc Pays PCP Office Visit $20 Copay (no PCP selection required)Women’s Preventive Health $0Specialist Office Visit $30 Copay (members can self-refer to specialists)Hospitalization:

Inpatient $250 Copay Outpatient $100 CopayPregnancy $250 Copay

Prescription Drugs:Tier 1 $10 Copay Tier 2 $15 Copay Tier 3 $30 Copay

Emergency Room Visits $75 CopayUrgent Care $30 CopayRoutine Physical Exam $0Mental Health

Office Visit $30 Copay Inpatient $250 Copay Annual Maximum Out of Pocket $1,500 Individual

$3,000 FamilyDeductible:

Individual NoneFamily None

Lifetime Maximum Unlimited

For more detailed plan design information go to: www.garnett-powers.com/upenn

What is a PPO Plan?

The member does not have to choose a PCP.

The contractual agreement between the PPO Plan and the Provider is on a “discounted fee for service” basis.

At the time of service, the member has the ability to

seek care from a Specialist, without having to obtain a referral from a PCP.

The In-Network benefits will be greater than the Out-of- Network benefits.

There is an In-Network and Out-of-Network component.

Postdoctoral Insurance Plan AETNA PPO Medical Plan Medical Benefits In-Network Out-of-Network

Postdoc Pays Postdoc Pays Non-Specialist/Specialist Office Visit $30 ($20)/$40 ($30) Copay 40% (30%)*Women’s Preventive Health $0 40% (30%)*Hospitalization:

Inpatient 20% (10%)* 40% (30%)*Outpatient 20% (10%)* 40% (30%)*Pregnancy 20% (10%)* 40% (30%)*

Prescription Drugs:Tier 1 $20 ($10) Copay $20 ($10) Copay + 40%

Tier 2 $30 ($15) Copay $30 ($15) Copay + 40% Tier 3 $50 ($30) Copay $50 ($50) Copay + 40%Emergency Room Visits $150 ($50)Copay $150 ($50) Copay*Urgent Care $35 Copay 40% (30%)*Routine Physical Exam $0 40% (30%)*Mental Health:

Office Visit $40 ($30) Copay 40% (30%)* Inpatient 20% (10%)* 40% (30%)*Deductible:

Individual $300 ($200) $800 ($500)Family $900 ($600) $2,400 ($1,500)

Annual Maximum Out-of-Pocket $2,500 Individual** $3,000 Individual**Includes deductible, copays & pharmacy $7,500 Family** $9,000 FamilyLifetime Maximum Unlimited Unlimited

* Subject to Deductible For more detailed plan design information go to: www.garnett-powers.com/upenn

Summaries of Benefits and Coverage

The PPACA requires that you be notified that the Summaries of Benefits and Coverage for your medical plans will be available on our website.

You may also print a copy directly off of the GPA website.

You may request a paper copy at no charge by calling the toll-free number on your ID card.

The Summaries of Benefits and Coverage follow the recommended guidelines of PPACA in a standardized format to make them easier to read and comprehend to better serve you in making your plan selections.

Mail Order Pharmacy

You may fill your maintenance prescriptions through mail order, which offers a savings.

Up to 3 months worth of Rx

Mail Order Copay

(up to 3 month supply)

Regular Rx CoCopay

(3 month supply)

Generic Formulary

$20 $30

Brand Formulary $30 $45

Generic or Brand, Non-Formulary

$60 $90

Mail order forms and instructions are available on Aetna Navigator as well as the GPA website.

Aetna Wellness Programs

Beginning Right – A program to assist moms-to-be with materials on prenatal care, labor and delivery, as well as newborn care and pregnancy risk surveys to identify any potential problems.

Aetna Navigator’s secure member website provides numerous services as finding the cost for tests and procedures, reviewing your claim status details, ordering ID cards and a myriad of other services that can assist you in managing your healthcare.

To see all programs Aetna offers, visit www.aetna.com and register for Aetna Navigator.

Several programs may be viewed on the website at www.garnett-powers.com/upenn/wellness.htm.

GlobalFit – Save on fitness club memberships and exercise equipment, with preferred discounts within the GlobalFit network.

Urgent Care

The hospital emergency room should be used only if the situation is life or limb threatening.

There are 7 Urgent Care Centers within 10 miles of UPENN.

The copay is significantly less: PPO Plan, $150 copay for emergency room vs $35 for urgent care; HMO Plan, $75 for emergency room, vs $30 for urgent care.

Most Urgent Care Centers are open 24 hours and available to treat most non-life threatening emergencies, as broken bones (not multiple fractures), wounds not bleeding profusely, fevers and flu symptoms.

The Urgent Care Center should be used as often as possible to avoid additional charges.

Walk-In Clinics The Walk-In Clinic is an in-network, free-standing health care facility that is an alternative to a physician’s office for treatment of unscheduled, non-emergency illnesses and injuries and administration of certain immunizations.

There are 2 Walk-In Clinics within 5 miles of campus.

If you use a Walk-In Clinic on the Medical PPO plan, you will pay $25 in-network.

If you use a Walk-In Clinic on the Medical HMO plan, you will pay $20.

They are generally found in a retail location such as CVS or Walgreens.

They are not an alternative for the emergency room or the outpatient department of a hospital.

The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010.

Healthcare Reform

U.S. citizens and most legal residents are eligible for plans on the exchange.

Pennsylvania is using the federal exchange.

All states are required to offer a Health Care Exchange, either through the federal government, on their own or through a partnership between the state and the federal government.

The intent of the ACA is to make health care coverage

available to the millions that are uninsured in the U.S.

The ACA requires that most people that are either citizens or legal residents to have health insurance coverage, or to pay a tax beginning in 2014 if they do not.

There are differing levels of coverage and cost, as well as several insurance carriers offering the plans.

Healthcare Reform(continued)

The cost of the postdoc-only coverage exceeds 9.5% of the postdoc wage/stipend.

Certain poverty-level income conditions are met.

The employer offers coverage where the plan design does not meet the coverage requirements of the ACA.

In order to be eligible for the Premium Tax Credit, also known as a subsidy, a person must meet certain eligibility requirements:

Important ACA Information Specifically for Enrollees in the UPENN-PIP:

Healthcare Reform(continued)

For more information, please visit the federal exchange site at www.healthcare.gov.

It is highly unlikely that anyone enrolled in the UPENN postdoc plan’s medical coverage will be eligible for a subsidy through the exchange.

To the best of our knowledge, the cost of single coverage for the POS does not exceed 9.5% of an eligible postdoc’s wage/stipend.

All of the UPENN postdoc medical plans meet or exceed the legal requirements of the ACA.

DENTALINSURANCE

Provided by

Postdoctoral Insurance Plan AETNA DHMO Dental Plan Dental Benefits Postdoctoral Scholar Pays

Deductible None

Diagnostic and Preventative CareRoutine Oral Exams (2x per year) No chargeRoutine Teeth Cleanings (2 x per year) No chargeRoutine X-Rays No charge Basic ProceduresFillings Varies up to $75 copayOral Surgery Varies up to $117copay Endodontics Varies up to $380 copay Periodontics Varies up to $300 copay Major Procedures Crowns Varies up to $275 copayBridgework Varies up to $275 copayDentures Varies up to $350 copay OrthodonticsComprehensive Treatment- Child $1,945 copay plus start-up fees and retentionComprehensive Treatment- Adult $1,945 copay plus start-up fees and retention Annual Maximum UnlimitedFor more detailed plan design information go to: www.garnett-powers.com/upenn

Accessing Care Through The PENN Dental School

Accessing care through the PENN Dental School offers a number of valuable benefits:

Penn Dental Medicine ranks #1 of Top Dental Schools in U.S.A. for 2014

Direct supervision of care by faculty with national and international reputation

Convenient on-campus location – all dental specialties under one roof

In order to alleviate this issue, we have begun automatically assigning the PENN dental school as the PCD for all newly enrolled postdocs. Should you want to change to a different PCD, you may do so through Aetna member services.

A vast majority of postdocs are enrolled before they are able to choose a PCD, and if one is not chosen before accessing care for the first time, it can make the claims process difficult.

The DMO plan requires that you choose or be assigned a Primary Care Dentist (PCD) and access all care through this provider unless a specialist referral is necessary.

Accessing Care Through The PENN Dental School,

continued

Collaboration with HUP and CHOP – world renowned medical and pediatric care

Convenient evening clinic sessions – options for convenient appointments

24/7 access to professional care for dental emergencies

High quality dental care at a reasonable cost – maximize use of insurance benefits

Diverse international environment – over 40 languages spoken

State of the art care in a comfortable environment

Postdoctoral Insurance Plan AETNA DPPO Dental Plan

Annual Maximum $1,500In-Network Out-of-NetworkPostdoc Pays Postdoc Pays

Calendar Year Deductible $50 Ind/$150 Family $50 Ind/$150 Family (Applies to Basic and Major only)

Diagnostic and Preventative Care-Routine Exams No charge 20% of UCR-Teeth Cleanings-X-RaysBasic Procedures-Fillings 20% 50% of UCR-Endodontics-Periodontics-Oral SurgeryMajor Procedures-Crowns 50% 50% of UCR-Bridgework-DenturesOrthodontia (child only)-$1,500 Lifetime Maximum 50% 50% of UCR

For more detailed plan design information go to: www.garnett-powers.com/upenn

VISIONINSURANCE

Provided by

Postdoctoral Insurance Plan Aetna Vision Plan

In-Network Out-of-NetworkPostdoc Pays Postdoc Allowance

Exam with Dilation (if necessary): $10 Exam Copay Up to $40

Standard Lenses:-Single Vision $25 Up to $40-Bifocal Materials Up to $60-Trifocal Copay Up to $80-Lenticular Up to $80

Frames: $130 retail allowance for Up to $45any frame at a retail chain

Lens Options:-UV Coating N/A-Tint (solid and gradient) Available N/A-Standard Polycarbonate at a N/A-Standard Progressive discount N/A-Standard Anti-Reflection N/A

*Contact Lenses: $25 (up to 4 boxes) up to $210 Allowance

Frequency: Exam, Lenses, Contact Lenses & Frames – Once every 12 months

*Contact lenses may be chosen in lieu of eyeglasses.

For more detailed plan design information go to: www.garnett-powers.com/upenn

LIFE AND AD&DINSURANCE

Provided by

Postdoctoral Insurance PlanLife Insurance

andAccidental Death & Dismemberment (AD&D) Plan

The plan pays $50,000 in the event of death.

The plan already satisfies the new 2015 Department

of State requirements of $50,000 Medical Evacuation and $25,000 Repatriation of Remains coverage. These changes take effect on 5/1/15.

Accelerated Benefit Provision – Allows eligible members who are terminally ill to receive an early allocation of up to 75% of their group life insurance benefit.

The plan provides postdocs and their dependents the $10,000 Medical Evacuation and $7,500 Repatriation of Mortal Remains benefits necessary to satisfy the J1 & J2 Visa requirements for 2014.

The Open Enrollment Process

All currently enrolled Postdoctoral Scholars have the option of making changes during the Open Enrollment Period from November 10th – November 25th, 2014.

If you are not changing your current enrollment status, no action is necessary.

If you previously waived either yourself and/or your family members, you/they may be enrolled at this time.

If you are currently enrolled in the Dental HMO, you may switch to the Dental PPO, or vice versa.

All changes you make to your enrollment will be effective

as of January 1st, 2015.

If you are currently enrolled in the Medical POS, you may

switch to the Medical PPO.

If you are currently enrolled in the Medical PPO you may switch to the Medical HMO as long as you are in the Medical HMO service area. Please call GPA for assistance.

The Open Enrollment Process, (continued)

In order to make changes to your enrollment for Plan Year2015, please follow these steps. Please note that all changes made to your current enrollment will take effect January 1st, 2015.

Once the instructions are in hand, go directly to the “Open Enrollment Form”. You will need your Penn ID and previously created unique password to enter the site on the login page. Once you reach the Postdoc Dashboard, you may view your current enrollment and make the plan changes you desire online. Once complete, you may print a copy for your records.

Click on the “Open Enrollment Instructions” link and print them out for assistance with completing the Open Enrollment Form properly.

First, click on the “Enrollment” section of the website, then the sub-link “Open Enrollment”.

The Open Enrollment Process, (continued)

Once you access your online Open Enrollment Form you may do the following:

If you previously waived or are enrolling for the first time, and choose the dental HMO, you must choose a Primary Care Dentist for all participating family members.

Update your Life Insurance beneficiary information. If nothing has changed, you may leave this section as is.

Enroll yourself and/or your eligible dependents if you previously waived.

Make the changes mentioned earlier regarding switching to medical PPO and/or dental PPO if desired. Please

check all plans in which you wish to be enrolled for Plan Year 2015.

If you are currently enrolled, you may view your current

Benefit enrollment.

The Open Enrollment Process, (continued)

Provider directory links are available at the GPA website.

To obtain the form, click on “Dependent Contribution Worksheets” found in the Enrollment section on the website.

Please have your Business Administrator sign the form, then either fax or email it to Garnett-Powers & Associates.

All Postdoctoral Scholars making changes to their enrollment, whose dependent or PPO buy-up premiums are covered by their department, must complete the Dependent Contribution Worksheet.

The Open Enrollment Process, (continued)

An electronic version of the enrollment form will be

submitted to the Garnett-Powers & Associates’ secure website for data entry.

ID cards will be mailed to your home.

Please make sure the email address that appears on your enrollment form is correct.

An email will be sent no later than December 22nd confirming your new enrollment status.

Family Member Eligibility

Family member eligibility requirements are the same as the family member eligibility requirements for the Penn faculty/staff plans.

Spouse

The major family categories are:

Same-sex domestic partner. The required domestic partner affidavit (located on the GPA website) must be notarized and forwarded to Garnett-Powers & Associates.

Stepchildren may be included, if they live with the Postdoctoral Scholar, are supported by the Postdoctoral Scholar at more than 50% and claimed as a tax dependent.

Natural or adopted children to age 26 and unmarried (unless eligible to continue coverage because of disability).

INFORMATION SOURCES

For general inquiries and customer service regardingenrollment, benefit questions and ID cards, you shouldcontact:

Garnett-Powers & Associates Website:

www.garnett-powers.com/upenn

Toll Free Phone:800-319-9557

Fax #:949-583-2929

Email Address:pdinsplan@garnett-powers.com

Data Entry & Premium Payment Process

All UPENN Postdoctoral Scholars will automatically be enrolled in the Postdoctoral Insurance Plan (Medical, Dental, Vision and Life Insurance) as a single individual.

1. Salary Key “S”2. Active Code “A”3. Postdoc Indicator of:

- 217500 PD Researcher- 217503 PD Researcher- 217603 PD Fellow- 217703 PD NRSA Fellow

To be eligible and automatically enrolled in the program, Postdoctoral Scholars must be in the payroll system (minimum record okay) with the following codes to be eligible:

Data Entry & Premium Payment Process, cont.

A Dependent Contribution Worksheet must be submitted to GPA so the appropriate premium allocation is distributed between the department, grant and postdoc, ONLY when the Department or grant is paying for:

Please attempt to enter a phone number for the postdoc to assist with their enrollment success. All zeros will work when a phone number is not available.

We at GPA do not need the worksheet unless the department or grant is paying for the up-charge or dependent premiums.

The worksheet must be submitted, prior to the final payroll for the month, to avoid charges being assigned to the postdoc when they should not.

1. The up-charge for medical PPO or dental PPO2. The dependent premiums

Current Process to Confirm Appointment End Date/Re-Appointment

When a postdoc transfers to a faculty/staff position, we receive an ‘A’ for active and an ‘N’ for ineligible from the Penn eligibility file (for true terms, a ‘T’ is transmitted instead of the ‘A’).

If a postdoc is terminated per this process, a certified letter is mailed to their home address (taken from their Penn payroll record) advising them of the termination and why it occurred.

If a response is not received within 2 weeks, the postdoc is termed from all coverage per the appointment end date in our system.

An e-mail is sent to the BA, copying the postdoc, asking for confirmation of either reappointment or termination, and requiring the exact term date.

Thank you for joining us today!

Questions?