BENEFITS ENROLLMENT GUIDE FOR 2019

ST. JOHN FISHER COLLEGE

Benefits Enrollment Guide – St. John Fisher College

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TABLE OF CONTENTS

TOPIC PAGE # AN OVERVIEW OF YOUR BENEFIT CHOICES 3 ENROLLMENT PROCEDURES – HOW TO ELECT YOUR BENEFITS ONLINE 6 BENEFITS CHANGES DURING THE YEAR/QUALIFYING LIFE EVENTS 8

SUMMARIES OF YOUR BENEFIT OPTIONS 11 MEDICAL AND FLEXIBLE BENEFITS 11

MEDICAL COVERAGE 11 HEALTH SAVINGS ACCOUNTS 12 FLEXIBLE SPENDING ACCOUNTS 13

DENTAL COVERAGE 15 vISION COVERAGE 15 LIFE INSURANCE 15 ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (AD&D) 16

ELIGIBILITY FOR BENEFITS 17 RESOURCES FOR YOUR BENEFITS AND ENROLLMENT QUESTIONS 18

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AN OVERVIEW OF YOUR BENEFIT CHOICES

Please refer to the section entitled SUMMARIES OF YOUR BENEFIT OPTIONS for additional details.

Health Coverage

You may choose one of three Excellus Blue Cross Blue Shield plan options, or you can waive medical coverage:

Excellus BlueEPO (EPO J)

Excellus Healthy Blue Hybrid Excellus BluePPO (HDHP) Waive Medical Coverage

Not Enrolling in Medical Coverage

Employees who can attest to having other group health insurance may elect to opt out of St. John Fisher College’s Medical. Employees who elect to opt out will receive $1,700 annually.

Health Savings Accounts (HSA) For participants in BluePPO (HDHP), the College will contribute to your Health Savings Account (HSA) as follows: $500 for individual coverage $1000 for two person, employee and child(ren) and family coverage

You may also choose to contribute to your HSA. You can change the amount of your contribution during the year.

Flexible Spending Accounts

You may choose to contribute to either, both or none of the following. If you enroll in BluePPO (HDHP) you will not be eligible for Medical Flexible Spending Account:

Medical Flexible Spending Account contribution of up to $2,700; or Dependent Care Flexible Spending Account contribution of up to $5,000

Dental Coverage

You may choose one of two Excellus Blue Cross Blue Shield plan options or you can decline dental coverage:

Dental Blue Low (no orthodontia) Dental Blue High (with orthodontia), or Waive Dental Coverage

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Vision Coverage

You may choose VSP vision or you can decline vision coverage: VSP vision plan Waive vision coverage

Supplemental Life Insurance

You may choose (additional) Supplemental Life Insurance equal to:

1, 2 or 3 times annual base salary to a maximum of $300,000; or No additional Supplemental Life Insurance coverage

If you are increasing your coverage or electing coverage for the first time after your initial New Hire eligibility during the annual enrollment, you will need to submit Evidence of Insurability (EOI). If you elect and are approved for Supplemental Life Insurance for yourself, you may choose Dependent/Spouse Life Insurance equal to:

Spouse $4,000/Children $2,000, or Spouse $10,000/Children $4,000

Please note that age 70, the amount of this benefit will be reduced by 50%.

Accidental Death and Dismemberment Insurance (AD&D) You may choose (additional) Supplemental AD&D:

Supplemental AD&D ‐ Employee Only Supplemental AD&D ‐ Employee & Family No Supplemental AD&D Insurance coverage

Eligible employees can purchase Supplemental AD&D Insurance in increments of $10,000 up to the lesser of 10 times your annual salary or $500,000. At age 70, this benefit will be subject to reduction. Domestic Partners are not eligible for this benefit.

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Other Benefits

The following benefits are provided by the College to all full time benefits‐eligible employees:

Basic Life Insurance: equal to one times your annual salary to a maximum of $160,000, at no cost to

you. Basic Accidental Death and Dismemberment Insurance: equal to one times your annual salary to a

maximum of $160,000, at no cost to you. Long Term Disability (LTD) Insurance, provided at no cost to you. LTD provides you with benefits

equal to 60% of your pre‐disability salary, not to exceed $7,500 monthly, after a 180‐day waiting period. In addition, if you are actively contributing to the retirement plan prior to the date of your disability, the insurance carrier will provide you with a retirement contribution, up to the limits specified in the policy.

Healthy Rewards (for adult medical plan participants): an online incentive program where you can earn up to $500 per individual or $1,000 per family each year for doing healthy activities.

Employee Assistance Program (EAP): A free, confidential counseling and referral service to help you and your family resolve problems that affect you personally. Note: This service is available to all employees.

Part-time Employees The Affordable Care Act (ACA), also called Health Care Reform, includes requirements for employers to offer medical coverage, to employees who work an average of 130 hours or more per month during a 12-month measurement period, or are hired to work at least 30 hours per week. Employees who meet this requirement will be contacted by Human Resources and will be provided the opportunity to enroll in one of the College’s health care plans.

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ENROLLMENT PROCEDURES – HOW TO ELECT YOUR BENEFITS ONLINE

To enroll in your benefits, you can access the benefits enrollment system directly through my.sjfc.edu – you will not need a separate login or password. Once you are logged in to my.sjfc.edu, just click on “Benefits Enrollment” from your Launchpad. Below is a sample of Launchpad with the Benefits Enrollment link highlighted. You will be able to access the system the same way from home.

LAUNCHPAD

LAUNCHPAD

Banner 8

Banner 9

Benefits Enrollment

Blackboard

Faculty/Staff Email

FisherLink

Fish R Net

FisherSync

Handshake

Hoonuit

Google Apps

Lavery Library

Qualtrics

Rave Alert

RiskTool

Smarthinking (Online Tutoring)

uAchieve

COMMUNITIES

EMAIL MANAGEMENT

ACADEMICS

PEOPLE AND SERVICES

BANNER 9

APPLICATIONS

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The online enrollment system has a time‐out feature to protect your information. If you leave the system “idle” for more than 15 minutes, you may be logged out and any data not saved will need to be reentered. Also, do not use your browser’s back button in the online enrollment system. If you have already completed your enrollment but would like to make changes, you may do so by logging into the enrollment system again, following the above instructions. You can make changes until the end of your enrollment eligibility period; or generally 30 days after your date of hire, the date you attain new benefits eligibility, or experience a qualifying/family event.

Once you complete your enrollment online, you will be able to print a summary of your benefit elections. It is very important for you to review and confirm your elections.

Have information for you and your dependents and/or beneficiaries available including: 1) Full name, including middle initial, 2) Date of birth 3) Social Security Number 4) Address, and 5) Phone Number

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Enrollment Status – Cost Summary Your cost summary will always be seen on the right hand side.

The cost summary shows your approximate cost of your per pay period benefit elections.

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BENEFITS CHANGES DURING THE YEAR/QUALIFYING LIFE EVENTS

The elections you make when you enroll during annual enrollment or at initial eligibility (e.g., when you are hired) will be in effect for the entire calendar year unless you experience a qualifying life event. A qualifying life event includes: marriage, birth, divorce, death, or employment change that affects benefits coverage. You may change your enrollment elections during the year if you have a qualifying life event and make your new elections online within 30 days of the date of the qualifying event. Human Resources will require you to provide documentation to support a qualifying life event. The documentation to support the qualifying event must be provided to Human Resources within 30 days of the event date.

Please note that even with a qualifying event you cannot change medical or dental plans (e.g., change from the Excellus BlueEPO (EPO J) to the Excellus Healthy Blue Hybrid) during the calendar year.

To make changes in the system for a Qualifying Life Event, follow the new hire instructions to access the

system. Once you login to the system, first click on the “Life Events” link on the top left side of your screen.

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You will then need to select the Life Event from the drop-down menu and enter the Life Event Date.

If you are adding a new dependent such as a birth or marriage, you will need to add your family member’s information in the “Add Family Member Screen.”

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You will then be asked to confirm your information to save and start the life event enrollment.

Then you will need to update your benefits based on the Life Event you have triggered. Click on each benefit plan and make changes. You must save each election and hit “Continue” at the bottom of the page once your elections are saved.

You will need to provide supporting documentation to HR stating the reason for, and date of your Qualifying Life Event. For more information, please contact Human Resources at 585.385.8048.

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SUMMARIES OF YOUR BENEFIT OPTIONS Summaries of Benefit Coverages and per-pay period costs for medical, dental and vision can be found on the 2019 Online Annual Open Enrollment Website and on the SJFC HR webpage.

MEDICAL AND FLEXIBLE BENEFITS

MEDICAL COVERAGE

The College offers a choice of three Excellus BCBS medical plans:

Excellus BlueEPO (EPO J)

Excellus Healthy Blue Hybrid Excellus BluePPO (HDHP)

Your medical coverage contributions

Your base annual salary as of your date of hire is used to determine your cost for the medical insurance you elect for the current year. The annual salary does not include overtime, stipends, supplemental pay, or reimbursements. In future years, your annual salary as of December 31 of the prior year is used to determine your cost.

Contributions are based upon four salary “tiers”:

Less Than $30,000

Greater Than or Equal to $30,000 and Less Than $50,000 Greater Than or Equal to $50,000 and Less Than $90,000

Greater Than or Equal to $90,000

Not Enrolling in Medical Coverage

Employees who can attest to having other group health insurance may elect to opt out of St. John Fisher College’s Medical. Employees who elect to opt out will receive $1,700 annually. The amount of $70.83 will be credited to 24 paychecks as taxable income over the plan year. You need to waive medical coverage in the benefits enrollment system in order to receive the $1,700 annual opt-out. Other Medical Coverage

If your spouse or domestic partner has other medical coverage (and/or Medicare) in addition to your College insurance, you will need to complete a Coordination of Benefits (COB) form. Excellus will send you the COB form, and you will need to complete it and return it to the address on the form.

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HEALTH SAVINGS ACCOUNT (HSA) A Health Savings Account (HSA) provides a way for you to designate pre-tax dollars to pay for certain medical expenses. You must be enrolled in BluePPO (HDHP) to be eligible for the HSA. Eligible employees who elect employee only BluePPO (HDHP) coverage will receive an annual College contribution of $500; employees who elect employee/child(ren) or family coverage will receive an annual contribution of $1,000. Employees may contribute pre-tax dollars up to $3,000 for single coverage and $6,000 for employee/child(ren), or family coverage (in addition to the amount contributed by the College). Employees age 55 and over also may contribute up to an additional $1,000 as a catch-up provision. If you are age 65 or older and enrolled in Medicare Part A or B, you cannot contribute to an HSA. If you have selected the Healthy Blue Hybrid or BlueEPO (EPO J), you are not eligible for this benefit. Additional HSA Information:

If you are electing BluePPO (HDHP) for the first time, an HSA account will be set up for you with HSA Bank. Once created you will receive your debit card and additional information from HSA Bank.

If you have questions on your HSA, please contact HSA Bank at 800-357-6246.

The College contribution to your HSA account will be provided the first payroll in January. For new hires a prorated College contribution will be made to your HSA account in the first payroll after the account has been created.

If you currently contributing to your HSA you will not have to change your HSA election each year. Your current amount will continue to rollover each plan year.

You can change your HSA amount any time during the year. Please contact Human Resources if you wish you change your HSA during the year.

Domestic Partners are not eligible for this benefit.

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MEDICAL FLEXIBLE SPENDING ACCOUNT

A Flexible Spending Account (FSA) provides a way for you to designate pre-tax dollars to pay for certain medical expenses. If you enroll in the BluePPO (HDHP), you are not eligible for the Medical FSA. Domestic Partners are not eligible for this benefit. The limit on the annual amount of reduction permitted for medical expense reimbursement cannot exceed the lesser of your earned income or $2,700 (per household). Any claim submitted for an eligible medical expense cannot exceed the amount allocated for the plan year. The annual amount you enter will be divided by the annual number of pay periods in which health care deductions are taken. If you are electing mid-year the annual amount will be divided by the remaining number of pay periods for the year.

DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT

The Dependent Care Flexible Spending Account Plan allows you to pay for dependent care expenses for children under the age of 13 or an older dependent who is physically and/or mentally incapable of self-care.

The limit on the annual amount of reduction permitted for dependent care expenses cannot be more than $5,000 ($2,500 if married filing separately) per household, or if your spouse is a student for more than 5 months of the year, the lesser of your spouse’s earned income or $5,000. Any claim submitted for an eligible dependent care expense cannot exceed the total amount currently available in your account at the time the claim is filed. Domestic Partners are not eligible for this benefit. The Dependent Care Flexible Spending Account is separate from the Medical Spending Account and can be used for non-medical expenses related to your dependents (Example: day care expenses for children under 13). The annual amount you enter will be divided by the annual number of pay periods in which health care deductions are taken. If you are electing mid-year the annual amount will be divided by the remaining number of pay periods for the year.

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Our FSA administrator is Discovery Benefits. Their contact information follows:

Participant Services Hours of Operation 7:00 am to 7:00 pm Central (M‐F)

Participant Services Number 866‐451‐3399

Claims Address Discovery Benefits PO Box 2926 Fargo, ND 58108

Website www.discoverybenefits.com

Fax Number 866‐451‐3245

Participant Services Email Address customerservice@discoverybenefits.com

You will be able to file claims in the following ways: 1. Submit your claims online via Discovery’s website (link above) – print a confirmation page, scan and

email. 2. Scan your paper form and receipts and send via E‐mail. 3. Fax your paper form and copies of receipts (or mail in the receipts). 4. Complete a paper form and send via mail (including copies of receipts and/or Explanation of

Benefits).

To obtain account information (balance, claims status, printable forms, more information, etc.), you will need to log on to the Discovery Benefits website. You will receive a welcome letter via email or at your home address if an email address was not provided. This welcome letter will include instructions on how to access your online account; or you can call Participant Services at the number listed above for this information.

Discovery Benefits will also offer a debit card option for medical and dependent care FSA purchases. With a debit card, you will not need to submit documentation to Discovery Benefits for any purchases made at certain retailers. A list of compliant vendors can be found on the Discovery Benefits website (Inventory Information Approval System Merchants) at the following link: http://www.discoverybenefits.com/uploads/IIASMerchantList.pdf. These merchants will approve eligible expenses at the point of purchase. When using your card at these merchants, you will swipe your card for the entire purchase. Those items that are eligible expenses will be “auto‐substantiated” as eligible FSA expenses, and the merchant will then ask for a secondary form of payment for the ineligible items.

Claims for eligible medical/dependent care FSA expenses must be filed within 90 days following the close of the plan year (i.e., March 31, 2020) or 90 days following termination of employment, if earlier. Eligible claims must be incurred while you are a participant in a FSA. Any balance remaining in either the medical or dependent care expense accounts after these periods will be forfeited under the Internal Revenue Service (IRS) guidelines.

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DENTAL COVERAGE

The College offers a choice of two Excellus BCBS dental plans:

Dental Blue High (with orthodontia), or

Dental Blue Low (no orthodontia)

Please note that orthodontia benefit under the Dental Blue High option is limited to $1,000 lifetime per child under age 19, and only half of the orthodontia benefit is payable in one calendar year.

Your dental coverage contributions

You pay the full cost for your dental insurance coverage. You can determine your per‐pay period dental contributions using the table.

VISION COVERAGE

The College offers a VSP vision plan.

Your vision coverage contributions

You pay the full cost for your vision insurance coverage. You can determine your per‐pay period vision contributions using the table.

BASIC LIFE INSURANCE

The College provides one times base salary of term life insurance to all eligible employees, up to maximum of $160,000.

You do not need to elect this coverage and employees do not contribute to the cost.

SUPPLEMENTAL LIFE INSURANCE

You may elect to purchase supplemental life insurance in increments of 1, 2, or 3 times your base annual salary, to a maximum of $300,000. The total Basic and Supplemental Life Insurance benefit cannot exceed $460,000. Life Insurance amounts are reduced at age 70. If you are increasing your coverage or electing coverage for the first time after your initial New Hire eligibility during the annual enrollment, you will need to submit Evidence of Insurability (EOI). You will be able to access the Evidence of Insurability form in the enrollment system. Your new coverage amount will not go into effect until approved by the carrier. If you elect supplemental life insurance for yourself, you will be eligible to pick up life insurance for a spouse/dependent.

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SUPPLEMENTAL SPOUSE/DEPENDENT LIFE INSURANCE

If you elect supplemental life insurance for yourself, you will be eligible to elect life insurance for a spouse/dependent. If you elect coverage, eligible children are automatically covered up to age 21, or to age 25 if a full-time student. Domestic partners are not eligible for this benefit.

You may elect one of two levels of coverage:

$2,000 dependent/$4,000 spouse

$4,000 dependent/$10,000 spouse

BASIC ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE

(AD&D)

Accidental Death and Dismemberment Insurance (AD&D) pays your beneficiary a death benefit if you die due to a covered accident while you are insured. It also pays you a benefit for certain accidental injuries. AD&D covers losses that occur away from work or at work.

You do not need to elect this coverage and employees do not contribute to the cost.

SUPPLEMENTAL ACCIDENTAL DEATH AND DISMEMBERMENT

INSURANCE (AD&D)

Supplemental AD&D can be purchased in $10,000 increments on an after-tax basis. You may elect to purchase up to a maximum of 10 times your annual compensation to a maximum of $500,000 in benefit coverage. The amount reduces at age 70. Employees may purchase the insurance for themselves and their family members. You may not cover your dependent if the dependent is covered as an employee under the policy. No person can be insured as a dependent of more than one employee under the policy. Your benefit will reduce on the January 1st after you turn age 70. Domestic partners are not eligible for this benefit.

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ELIGIBILITY FOR BENEFITS

(Spouse and Dependent)

If you are eligible for and elect College benefits, you may also elect certain coverage for eligible individuals. These may include your:

Spouse: Your current legal spouse as recognized by federal law and the State of New York.

Common Law Spouse: Your current common law spouse as recognized by the State of New York. Domestic Partner: In order to be a qualified domestic partner, you and the individual must:

Be engaged in an exclusive committed relationship for mutual support and benefit to the same extent as married individuals. You are each other’s sole Domestic Partner and intend to remain so indefinitely.

Be sharing a residence with you currently and have done so for at least the previous twelve consecutive months;

Be jointly responsible with you for basic living expenses; Not be married to any other person; Not be related to you by blood to a degree of closeness that would prohibit marriage; You must be financially interdependent and jointly responsible for the common welfare and

financial obligations of the household (or one of you is chiefly dependent upon the other for care and financial assistance).

Be both at least eighteen (18) years of age and legally competent to contract.

Son or daughter who is not yet age 26: For medical, dental and vision coverage, the term “child”

includes your biological child, adopted child or stepchild. It also includes a child for whom you are

legal guardian under the laws of the state in which the child resides. Your child does not need to

live with you, be financially dependent upon you, or be a student, or unmarried in order to be

covered. Coverage ends at the end of the month in which the child attains age 26. Contact Excellus

at 1‐800‐499‐1275 or https://www.excellusbcbs.com/wps/portal/xl to request information

regarding continuing coverage for an over‐age dependent.

Enrollment in Benefit Plans (except Retirement Benefits) You will be able to review your benefit options by logging onto http://www.myfisherbenefits.bswift.com

St. John Fisher College Human Resources Department For questions regarding benefits you may also contact the Human Resources office at 585.385.8048.

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RESOURCES FOR YOUR BENEFITS AND ENROLLMENT QUESTIONS

Benefit Supplier Name Telephone Number

Website or Other Contact Information

Medical Excellus BlueCross BlueShield

800.499.1275 www.excellusbcbs.com

Health Savings Accounts (HSA)

HSA Bank 800.357.6246 www.hsabank.com

Flexible Spending Accounts

Discovery Benefits

866.451.3399 www.discoverybenefits.com

Dental Excellus BlueCross BlueShield

800.724.1675 www.excellusbcbs.com

Vision VSP 800-877-7195 www.vsp.com

Life Insurance, Accidental Death and Dismemberment Insurance (AD&D)

The Hartford 800.523.2233 The Hartford Group Benefits Division, Customer Service

P.O. Box 2999 Hartford, CT 06104‐2999

Basic Term Life, Supplemental Dependent Life,

Supplemental Term Life, Basic Accidental Death and

Dismemberment Policy Number: GL‐377473

Supplemental (and Supplemental

Dependents') Accidental Death and Dismemberment Insurance Supplemental

Accidental Death and Dismemberment Insurance

Policy Number: ADD‐S06266 Employee Assistance Program (EAP)

Strong EAP 585.475.0432 www.urmc.rochester.edu/eap

Healthy Rewards

Excellus BlueCross BlueShield

866.238.4216 https://www.excellusbcbs.com/wps/portal/xl/mbr/hnw/healthyrewards

This notice is provided for information purposes only for eligible faculty and staff, and does not constitute a legal contract. St. John Fisher College reserves the right to amend or terminate any of the plans or programs described in this notice at any time. Further, there may be certain coverage limitations or features based on carrier contract and/or College policy. In cases where discrepancies occur, the Plan Document or other relevant plan materials will be the ruling and binding instrument.