Ivy Tech Community College

Limited Medical Insurance Plans

Ivy Tech Community College currently offers two limited medical insurance plans to adjunct faculty members who do not also have a full-time appointment with Ivy Tech, or part-time (less than 60%) hourly or administrative employees who are not eligible for the full-time Ivy Tech benefit plan. Eligible employees may purchase one of the plans to cover you, your spouse and eligible dependent children.

The two limited medical insurance plans offered include:Basic Medical PlanEnhanced Medical Plan

PLAN INFORMATION

Plan comparison at a glance

BASIC PLAN ENHANCED PLAN Maximum Per Occurrence or Sickness

$2,500 $5,000

Deductible (per illness or injury)

$200 $150

Prescription Drug Benefit

At pharmacy, there is a point of sale discount.

After paying for prescription, receipt

should be sent to American Sentinel for 50% reimbursement

At pharmacy, there is a point of sale discount.

After paying for prescription, receipt

should be sent to American Sentinel for 50% reimbursement

Office Visit Copay $20.00 $15.00 Hospital Care

60% after deductible 80% after deductible

Physician Services Lab/X-ray/Diagnostic Care Surgery Other Covered Medical Services Additional Inpatient Benefit

$400 per day $500 per day

Emergency Room/Ambulance

60% 80%

PLAN SUMMARY COMPARISON

MultiPlan Network

Office Visit Benefit $20 co-pay

Rx Benefit (name brands and generics) Covered at 50% up to $750 per Calendar Year

Hospital Care (inpatient and outpatient) 60% after per occurrence deductible

Physician Services 60% after per occurrence deductible

Additional In-patient Benefit $400 Per Day30 Days Per Calendar Year

Lab/X-ray/Diagnostic Care 60% up to $750 per occurrence

BASIC MEDICAL PLAN SUMMARY

MultiPlan Network

Emergency Room/Ambulance Covered at 60%($350 per visit Emergency Room Deductible – waived if due to an accident or results in hospital admission)

Surgery (inpatient and outpatient) 60% after per occurrence deductible

Other Covered Medical Services (home health, hospice, physical therapy) 60% after per occurrence deductible

Deductible Per Accident or Sickness $200

Maximum Benefit Per Accident/Sickness $2,500 Per Occurrence

BASIC MEDICAL PLAN SUMMARY (continued)

MultiPlan Network

Office Visit Benefit $15 co-pay

Rx Benefit (name brands and generics) Covered at 50% up to $1,000 per Calendar Year

Hospital Care (inpatient and outpatient) 80% after per occurrence deductible

Physician Services 80% after per occurrence deductible

Additional In-patient Benefit $500 Per Day30 Days Per Calendar Year

Lab/X-ray/Diagnostic Care 80% up to $1,000 per occurrence

ENHANCED MEDICAL PLAN SUMMARY

MultiPlan Network

Emergency Room/Ambulance Covered at 80%($350 per visit Emergency Room Deductible – waived if due to an accident or results in hospital admission)

Surgery (inpatient and outpatient) 80% after per occurrence deductible

Other Covered Medical Services (home health, hospice, physical therapy) 80% after per occurrence deductible

Deductible Per Accident or Sickness $150

Maximum Benefit Per Accident/Sickness $5,000 Per Occurrence

ENHANCED MEDICAL PLAN SUMMARY (cont.)

90% of claims incurred are between $1 and $3,500 Both plans cover all State Mandates $10,000 Accidental Death Coverage No Medical Underwriting – Guarantee Issue Vision Discount Program – National Vision Administrators Prescription Benefits Available

• Express Scripts is the discount prescription vendor on both plans.

Pre-existing condition clause does not apply to Pregnancy Plan policies are underwritten by American Sentinel Insurance Co. $100 Wellness Benefit Included

COVERAGE BASICS

Monthly Premiums Basic Plan Enhanced Plan

Employee Only $111.24 per month $180.12 per month

Employee + 1 $213.20 per month $355.30 per month

Family $313.14 per month $511.46 per month

Premiums are direct billed to the employee. Payments can be made through debit card, credit card or ACH Debit monthly.

PREMIUM INFORMATION

Why are there dollar limits on this plan?The American Sentinel Plan was not designed to replace a traditional health insurance plan, only to offer affordable coverage to individuals who otherwise wouldn’t be able to buy coverage.

Can an employee be turned down for coverage?No, an eligible person cannot be turned down.

Can dependents be covered?Yes. Due to changes with Health Care Reform, dependents can now be covered to age 26, if the dependent is not eligible for another employer-sponsored health plan.

FREQUENTLY ASKED QUESTIONS

Is there a pre-existing condition clause?Yes, a pre-existing condition is an injury or illness for which you have received medical advice, treatment, or incurred expenses within 6 months prior to your enrollment date. Pre-existing conditions are covered after 12 continuous months from your enrollment date or after 6 continuous months of receiving no treatment and incurring no expenses for the condition. These periods may be reduced by any creditable coverage that you may have had with a previous employer-sponsored or individual insurance plan. No pre-existing limitation will be applied to pregnancy. Lastly, due to changes with Health Care Reform, the pre-existing clause will not apply to any enrollee that is under the age of 19.

Who do I contact with questions?Contact American Sentinel customer service at 1-800-692-7338 or you can email questions to mebner@aegisfirst.com.

FREQUENTLY ASKED QUESTIONS (continued)

To Enroll in one of the Plans: Complete the Enrollment Packet. Packets are located in the

Employee Services and Faculty Tabs of Campus Connect. You may also obtain an Enrollment Packet from your Regional Human Resources Department.

Once the Enrollment Packet is complete, submit the completed forms to your Regional Human Resources Department within 31 days from your date of hire.

Coverage becomes effective on the first day of the month following your completion and return to your Regional Human Resources Department of the appropriate paperwork, and the Regional Human Resources Department’s verification of eligibility. Employees must have an active assignment on the effective date of coverage.

ENROLLMENT INFORMATION

CHANGE & TERMINATION INFORMATION

To make changes to your Plan: Complete the Change Form located in the Employee

Services tab on Campus Connect under College Benefits Website via Adjunct Faculty/Part-Time Employees Forms & Resources link. You may also obtain an Change Form from your Regional Human Resources Department.

Once the Change Form is complete, submit the completed form to your Regional Human Resources Department.

To Terminate your Plan: To cancel your coverage please notify

Christine Butler by sending an email to cconner5@ivytech.edu.

Your coverage will end at the end of the month coverage is cancelled.

OPEN ENROLLMENT

An Open Enrollment period will be conducted September 4 – September 14, 2012.

Effective date of coverage for the Open Enrollment period will be October 1, 2012.

Check with your local Human Resources Department for information on meeting dates and times.

UPCOMING OPEN ENROLLMENT PERIOD