2019 Benefits Guide 2019 Guía de Beneficios - The Claremont

2019 Benefits Guide 2019 Guía de Beneficios - The Claremont

2019 Benefits Guide 2019 Guía de Beneficios English Español

2019 Benefits Guide 2019 Guía de Beneficios - The Claremont
2019 Benefits Guide Forms Notices Who to Contact Your Benefits Who’s Eligible Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan LAST VIEWED HOME BACK NEXT Welcome! This guide provides information about your benefits with The Claremont Colleges. Use this guide as your go-to source when you are first enrolling for your benefits, when changing your benefits at Open Enrollment, or throughout the year as a benefits resource. Your Benefits Guide Your benefits are an important part of your overall compensation. The Claremont Colleges are pleased to offer a comprehensive array of benefits to protect your health, your family and your way of life, including:
  • Health care coverage, including medical, dental, and vision benefits
  • Financial protection for you and your family, including disability, life, and accident insurance coverage
  • Retirement savings opportunities
  • Work-life resources through the Employee Assistance Program (EAP)
  • Other voluntary benefits, including Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), long-term care insurance, pet insurance, identity protection insurance, legal services, and other financial benefits. This guide provides general benefit plan and enrollment information only. For specific details, conditions, and exclusions, please refer to the official summary plan descriptions (SPDs). If there is a discrepancy between this guide and an official SPD or Collective Bargaining Agreement, the official document will govern.
2019 Benefits Guide 2019 Guía de Beneficios - The Claremont

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Medical Benefits Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Benefits The following benefit programs are available to you. Click the benefit plan below for more information.

  • Medical Benefits – – Kaiser Permanente HMO – – Anthem Blue Cross HMO – – Anthem Act Wise HDHP
  • PNC Bank Health Savings Account
  • Dental Benefits – – Cigna Dental Care Access (DHMO) – – Cigna Dental DPPO
  • Vision Benefits – – Anthem Core Plan – – Anthem Buy-Up Plan
  • Employee Assistance Program
  • FSAs – – Health Care FSA – – Limited Scope Health Care FSA – – Dependent Care FSA
  • Long-Term Disability
  • Life Insurance – – Basic Life Insurance – – Supplemental Life Insurance
  • Accidental Death & Dismemberment Insurance (AD&D)
  • Long-Term Care
  • Pet Insurance
  • Legal Assistance Insurance
  • Identity Protection Insurance
  • Retirement Plan
2019 Benefits Guide 2019 Guía de Beneficios - The Claremont
2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits Your Medical Benefits The Claremont Colleges offers three medical plans for you to choose from. Click the plan name for more detail:
  • Kaiser Permanente HMO
  • Anthem Blue Cross (CaliforniaCare) HMO
  • Anthem Act Wise HDHP Kaiser Permanente HMO and Anthem Blue Cross (CaliforniaCare) HMO Plans The HMO plans offer affordable health care for you and your family through a network of health care providers. When you enroll in an HMO plan, you (and each enrolled family member) will be asked to select a primary care physician (PCP) from the network. The PCP you choose will help you manage all aspects of your health care. Anthem members: The PCP you select has to be within 15 miles or a 30-minute drive from your home or work. Kaiser members: You have the right to designate any primary care provider who participates in the plan’s network and who is available to accept you or your family members.

Plan Features: 1. You must select and use a primary care physician (PCP) from the HMO network to coordinate your care. 2. HMOs do not have deductibles or coinsurance. Instead, you pay a copay when you visit your PCP or a specialist whom you have been referred to by your PCP. 3. If you use doctors, hospitals, labs, pharmacies or other health care facilities outside the HMO, you are responsible for paying the full cost (except in an emergency). 4. There are no claim forms to file. CONTINUED

2019 Benefits Guide 2019 Guía de Beneficios - The Claremont

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits Kaiser Permanente HMO and Anthem Blue Cross (CaliforniaCare) HMO Plans (Continued) Here’s what you need to know about receiving care from the HMO plans: Kaiser Permanente HMO You have the option of going to any Kaiser Permanente facility to receive your care.

Care received from a non-Kaiser facility will not be covered (except for emergency care).

How to Find a Kaiser Permanente Provider 1. Go to www.kp.org/newmember. 2. Click “Find Doctors & Locations.” 3. Select “California-Southern.” 4. Enter your location and other key words, such as a doctor’s name or specialty. (Or you may select your physician on the My Doctor portal.) Once you have selected a primary care physician (PCP), you can use Kaiser Permanente’s My Doctor portal at www.kp.org/mydoctor to email your doctor and access health care tools OR you can download and use the KP Mobile App for your Android or Apple smartphone.

There’s an App for That Download the KP Mobile App for Android or Apple smartphone. You can:

  • Find a local doctor, network, or facility and make an appointment
  • View, refill, and check the status of a prescription
  • Check your latest test results
  • Email your doctor. CONTINUED

2019 Benefits Guide 2019 Guía de Beneficios - The Claremont

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits Kaiser Permanente HMO and Anthem Blue Cross (CaliforniaCare) HMO Plans (Continued) Anthem Blue Cross (CaliforniaCare) HMO You must receive all of your non-emergency care from doctors and hospitals in the Anthem Blue Cross (CaliforniaCare) HMO network, and the care must be under your PCP’s direction or the plan will not pay benefits.

Women may go directly to a gynecologist in their PCP’s medical group or practice association without a referral from their PCP. Care received from an out-of-network provider will not be covered (except for emergency care).

How to Find an In-Network Anthem Provider 1. Go to anthem.com/ca. 2. Scroll down and click “Find a Doctor.” 3. Scroll down under “Search as a Guest,” click “Search by Selecting a Plan/Network.” 4. On the next screen, select the type of care (for example “Medical”), and the state from the drop-down list. 5. Under “Select a plan/network,” you can enter the name of your plan/network under the “Medical (Employer Sponsored)” heading, or select it from the drop-down list then choose “Select and Continue.” – – The HMO plan name is “Blue Cross HMO (CA Care)-large group.” 6. Using the drop-down boxes, select what type of doctor and the location you’re looking for, then select SEARCH.

7. For more info about a provider (like skills and training), just select that name in the directory. There’s an App for That You can also download Anthem’s mobile app to search for an in-network provider. Download the Anthem Blue Cross app for Android or Apple smartphone. 15-Mile or 30-Minute Requirement If you are enrolled in the Anthem Blue Cross HMO (CaliforniaCare) plan, you must elect a primary care physician or medical group within 15 miles or 30 minutes of where you live or work to receive care.

If you attempt to elect a doctor who is outside of these limits, the plan may prevent you from electing that doctor, even if he or she is accepting new patients, or the medical group may disenroll you from their medical group facility.

To find out whether your primary care physician meets this requirement, contact Anthem customer service. CONTINUED

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits Anthem Act Wise HDHP With the Anthem Act Wise High Deductible Health Plan (HDHP), you have the flexibility to choose any doctor or facility and receive benefits.

However, if you go to Anthem Act Wise HDHP network doctors and facilities, you will pay less because Anthem Act Wise HDHP network providers have agreed to charge lower, negotiated rates.

Plan Features: 1. Flexibility to go to in-network and out-of-network providers 2. Lower out-of-pocket expenses when you see in-network providers 3. 100% coverage for preventive care with in-network providers 4. Coinsurance for most services once you meet the plan’s deductible A Note About Reasonable And Customary Charges When you use in-network providers, the coinsurance percentage is lower due to negotiated rates. If you use out-of-network providers, the coinsurance percentage is higher and is based on reasonable and customary (R&C) charges. You must also pay any amount over the R&C limit.

5. Out-of-pocket maximum(s) to help protect you from the expense of a possible catastrophic illness or injury 6. A tax-advantaged Health Savings Account (HSA). Go to Health Savings Account (HSA) for more information about this unique savings account. Need More Detail?

Click here to review Your Guide to the Anthem Act Wise HDHP. This guide has more detail about how the Anthem Act Wise HDHP works, and how to make the most of the tax-advantaged Health Savings Account (HSA). Research Your Health Care Costs Want to know how much a particular procedure or treatment may cost? Use the Healthcare Bluebook to look up average medications, treatments, procedures, and more! This website will help you find the fairest price for your care, plus information on how to save money. Think About Participating in the Limited Scope Health Care FSA/Health Savings Account (HSA) If you enroll in the Anthem Act Wise HDHP and Health Savings Account (HSA), a Limited Scope Health Care FSA is also available to you.

The Limited Scope Health Care FSA allows you to pay for eligible dental and vision expenses (i.e., deductibles, copays, coinsurance). You also can use the Limited Scope Health Care FSA to pay for medical expenses and prescription drugs AFTER you’ve met your plan’s deductible. For more details, review Using the Limited Scope Health Care FSA & HSA Together.

CONTINUED

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits Anthem Act Wise HDHP (continued) How to Find an In-Network Anthem Provider 1.

Go to anthem.com/ca.

2. Scroll down and click “Find a Doctor.” 3. On the right-hand side, under “Search as a Guest,” click “Search by Selecting a Plan/Network.” 4. On the next screen, select the type of care (for example “Medical”), and the state from the drop-down list. 5. Under “Select a plan/network,” you can enter the name of your plan/network under the “Medical (Employer Sponsored)” heading, or select it from the drop-down list then choose “Select and Continue.” – – The Act Wise HDHP plan name is “Blue Cross PPO (Prudent Buyer) – Large Group” 6. Using the drop-down boxes, select what type of doctor and the location you’re looking for, then select SEARCH.

7. For more info about a provider (like skills and training), just select that name in the directory. There’s an App for That You can also download Anthem’s mobile app to search for an in-network provider. Download the Anthem Blue Cross app for Android or Apple smartphone. › CONTINUED

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits PREVENTIVE CARE—FREE ANNUAL DEDUCTIBLE OUT-OF-POCKET MAXIMUM COINSURANCE How the Anthem Act Wise HDHP Works How does an HDHP work? Let us tell you.

1. Your annual out-of-pocket maximum for in-network usage caps your expenses. Once you reach the annual out-of-pocket maximum for in-network usage, the plan pays 100% of your costs for the rest of the year. Please note: your out-of-pocket expenses could exceed your maximums when using out-of-network providers and facilities. 2. Comprehensive coverage with coinsurance paid by you and the medical plan. Once you meet the deductible, the plan pays a percentage of the cost and you pay the rest. You can pay for your portion with the tax-free money you contribute to your HSA.

3. Your contribution to your deductible. You will pay for your health care expenses until you meet your annual deductible. You can use the tax-free money that you contribute to your HSA to cover this amount. 4. Preventive care is the plan’s foundation, covered at 100% by the medical plan. This is the point from which you grow your most valuable health knowledge and healthy habits. Most appropriate preventive care received in-network is free to you and your family. Facts About Your HSA If you enroll in the Anthem Act Wise HDHP, you will automatically be enrolled in a Health Savings Account (HSA) with PNC Bank.

An HSA is a special account that lets you pay eligible expenses—like deductibles, coinsurance and prescription drugs—with tax-free dollars. An HSA can be offered only with a medical plan that meets the IRS high deductible health plan requirements—like the Anthem Act Wise HDHP. Go to the Health Savings Account (HSA) section to learn more about the HSA and how it works.

Please note: If there is no activity on your HSA within three months, your account may be closed.

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits Health Savings Account (HSA) If you choose to enroll in the Anthem Act Wise HDHP you will automatically be enrolled in a Health Savings Account (HSA)1 .

An HSA is a personal savings account created from pre-tax employee contributions to be used for qualified medical expenses. Federal regulations limit HSAs to plans with a high deductible, like the Anthem Act Wise HDHP.

An HSA can also be used as an investment tool because your account balance can roll over from year to year. And, the HSA is completely portable—you can take it with you if you change jobs or retire. You can then use this tax-free money to pay for eligible medical expenses for you or your eligible dependents (consult with a tax professional about the eligibility of your dependents age 19–24). When you enroll in an HSA, you will receive a welcome kit from the HSA administrator, PNC Bank, with more information about using your HSA.

Learn more about the HSA in Your Guide to the Anthem Act Wise HDHP. For information about the fees and rate schedule for your HSA account, please visit PNC Bank online at www.anthem.com/ca, or call 844-860-3535. 1 Enrollment in Medicare Parts A and/or B makes you ineligible for an HSA. HSA Basics Funding You can contribute to your HSA directly from your salary on a pre-tax basis if you select PNC Bank as your HSA provider. You can also contribute to another financial institution’s HSA using post-tax dollars up to the IRS limit:
  • The maximum annual contribution is $3,500 per individual.*
  • The maximum annual contribution is $7,000 per family.*
  • If you are 55 years of age or older, there is a catch-up contribution option in the amount of $1,000.
  • You are not eligible for the HSA if you are enrolled in Medicare Parts A and/or B. *
  • These amounts include any employer contributions. Only non-highly compensated participants (employees who had an annual compensation of less than $120,000 in 2018) are eligible for the employer contribution. Qualified Expenses The money that you put into the HSA can be used to pay for qualified medical expenses, including the Anthem Act Wise HDHP’s deductible or coinsurance, and other out-of-pocket health care expenses like dentist visits and eye exams. Additionally, the money that you roll over can be used for future eligible expenses, including long-term care. There may be restrictions on who the plan will cover, for more details see Your Guide to the Anthem Act Wise HDHP.

FSA Participation If you enroll in an HSA, you will only be eligible for the Limited Scope Health Care FSA, due to IRS regulations. Limited Scope Health Care FSA reimbursements are for non-medical expenses that you choose not to use your HSA to reimburse, such as dental or vision copays or coinsurance payments. Refer to Using the Limited Scope Health Care FSA & HSA Together for more information. CONTINUED

  • 2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits Medical Benefits at a Glance The chart below provides an overview of the most commonly used benefits. Benefit Kaiser HMO Anthem Blue Cross (CaliforniaCare) HMO Anthem Act Wise HDHP Kaiser Permanente Network Anthem Blue Cross Providers In-Network Out-of-Network HSA Contributions Employee only N/A N/A $4501 Family N/A N/A $9001 Employee HSA Contribution Maximum (including the employer contribution) N/A N/A $3,500 (employee only)/$7,000 (family) Employee HSA Catch-Up Contribution (ages 55 and over) N/A N/A $1,000 Calendar-Year Deductible Employee only None None $1,500 $2,500 Family None None $3,0002 $5,0002 Out-of-Pocket Maximum (per calendar year; some benefits do not apply toward the out-of-pocket maximum) Employee Only $1,500 $1,500 $3,000 $6,000 Family $3,000 $3,000 (two party)/ $4,500 (family) $6,0003 $12,0003 Lifetime Maximum Unlimited Unlimited Unlimited Inpatient Services Inpatient Hospital $200 copay per admission $300 copay per admission Plan pays 80% after deductible Plan pays 60% after deductible Pre-Admission Testing Plan pays 100% Plan pays 100% Plan pays 80% after deductible Plan pays 60% after deductible 1 For employees who earned less than $120,000 in 2018, when opened through PNC Bank. 2
  • Includes insured employee and one or more members of the employee’s family. An individual with family coverage can incur $2,700 in covered expenses, at which point the plan will pay benefits for that individual.
  • An individual with family coverage can have out-of-pocket expenses totaling $3,000 in-network or $6,000 out-of-network, at which point the plan will pay 100% of that individual’s covered expenses for the remainder of the year.

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits Benefit Kaiser HMO Anthem Blue Cross (CaliforniaCare) HMO Anthem Act Wise HDHP Kaiser Permanente Network Anthem Blue Cross Providers In-Network Out-of-Network Inpatient Services (Continued) Drugs, Medicine, Casts, Dressings, Special Duty Nursing (when prescribed and medically necessary) Plan pays 100% Plan pays 100% Plan pays 80% after deductible Plan pays 60% after deductible X-ray, Laboratory Plan pays 100% Plan pays 100% Plan pays 80% after deductible Plan pays 60% after deductible Cost of Administering Blood Transfusions Plan pays 100% Plan pays 100% Plan pays 80% after deductible Plan pays 60% after deductible Whole Blood Plasma No charge if replaced Plan pays 100% Plan pays 80% after deductible Plan pays 60% after deductible Hospice Care Plan pays 100% Plan pays 100% Plan pays 80% after deductible Plan pays 60% after deductible Skilled Nursing Facility Plan pays 100% (limit 100 days per calendar year) Plan pays 100% (limit 100 days per calendar year) Plan pays 80% after deductible (limit 100 days per calendar year) Plan pays 60% after deductible (limit 100 days per calendar year) Outpatient Services Office Visits You pay a $20 copay (PCP), or You pay a $30 copay (specialist) You pay a $25 copay (PCP), or You pay a $40 copay (specialist) Plan pays 80% after deductible Plan pays 60% after deductible X-rays, Laboratory Tests Plan pays 100% Plan pays 100% Plan pays 80% after deductible Plan pays 60% after deductible Routine Exams Plan pays 100% Plan pays 100% Plan pays 80% after deductible Plan pays 60% after deductible Routine Immunization Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 60% after deductible Preventive Care Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 60% after deductible Outpatient Surgery (at a plan facility) You pay a $30 copay You pay a $100 copay Plan pays 80% after deductible Plan pays 60% after deductible Medical Benefits at a Glance (Continued)

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits Benefit Kaiser HMO Anthem Blue Cross (CaliforniaCare) HMO Anthem Act Wise HDHP Kaiser Permanente Network Anthem Blue Cross Providers In-Network Out-of-Network Short-Term Rehabilitation (physical, occupational, or speech therapy) You pay a $20 copay per visit; benefits are limited to medically necessary therapy authorized by a plan physician.

The plan pays 100% if you receive rehabilitation care in a hospital or facility affiliated with a hospital. Plan pays 80% after deductible (maximum 24 visits for both in-network and out-of-network providers) Plan pays 60% after deductible (maximum 24 visits for both in-network and out-of-network providers) Chiropractic Care Not covered $25 per visit, short term (referral from PCP required) Plan pays 80% after deductible (limited to 12 visits per calendar year) Plan pays 60% after deductible (limited to 12 visits per calendar year) Acupuncture You pay a $30 copay per visit You pay a $25 copay per visit Cardiac/Pulmonary Rehabilitation You pay a $20 copay per visit You pay a $40 copay per visit Plan pays 80% after deductible Plan pays 60% after deductible Home Health Care Plan pays 100% (limited to 100 2-hour visits per calendar year) You pay a $25 copay per visit (limited to 100 visits per calendar year) Plan pays 80% after deductible (limited to 100 visits) Plan pays 60% after deductible (limited to 100 visits) Emergency Services Emergency Room Services and Supplies You pay a $100 copay; waived if admitted You pay a $150 copay; waived if admitted Plan pays 80% after deductible Plan pays 80% after deductible Ambulance You pay a $50 copay per trip Plan pays 100% Plan pays 80% after deductible Plan pays 80% after deductible Maternity Care Office Visits (for mother) Plan pays 100% You pay a $25 copay per visit Plan pays 80% after deductible Plan pays 60% after deductible Hospital (for mother) You pay a $200 copay per admission You pay a $300 copay per admission Plan pays 80% after deductible Plan pays 60% after deductible Office Visits (for baby) Plan pays 100% for well baby visits Plan pays 100% for well baby visits Plan pays 100% for well baby visits Plan pays 60% after deductible Medical Benefits at a Glance (Continued)

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits Benefit Kaiser HMO Anthem Blue Cross (CaliforniaCare) HMO Anthem Act Wise HDHP Kaiser Permanente Network Anthem Blue Cross Providers In-Network Out-of-Network Outpatient Family Planning Elective Interrupted Pregnancy You pay a $30 copay Plan pays 100% Plan pays 80% after deductible Plan pays 60% after deductible Tubal Ligation You pay a $30 copay Plan pays 100% Plan pays 100% Plan pays 60% after deductible Vasectomy You pay a $30 copay You pay a $100 copay Plan pays 100% Plan pays 60% after deductible Counseling & Consultation Plan pays 100% You pay a $25 copay Plan pays 80% after deductible Plan pays 60% after deductible Medical Equipment Durable Medical Equipment (DME) Plan pays 80%; in accordance with DME formulary and prescribed by a Kaiser physician Plan pays 100% Plan pays 80% after deductible Plan pays 60% after deductible Mental Health Inpatient Care You pay $200 per admission You pay $300 per admission Plan pays 80% after deductible Plan pays 60% after deductible Outpatient Care You pay a $20 copay per visit (individual therapy) You pay a $10 copay per visit (group therapy) You pay a $25 copay per visit Plan pays 80% after deductible Plan pays 60% after deductible Substance Abuse Inpatient Care You pay a $200 copay per admission You pay a $300 copay per admission Plan pays 80% after deductible Plan pays 60% after deductible Outpatient Care You pay a $20 copay per visit for individual therapy You pay a $5 copay per visit for group therapy You pay a $25 copay per visit Plan pays 80% after deductible Plan pays 60% after deductible Medical Benefits at a Glance (Continued)

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Dental Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Medical Benefits Benefit Kaiser HMO Anthem Blue Cross (CaliforniaCare) HMO Anthem Act Wise HDHP Kaiser Permanente Network Anthem Blue Cross Providers In-Network Out-of-Network Prescription Drugs—Preventive Preventive N/A N/A Plan pays 100% Prescription Drugs—Retail (up to a 30-day supply) Generic You pay a $10 copay You pay a $10 copay Plan pays 80% after deductible Plan pays 60% after deductible Brand Formulary You pay a $25 copay You pay a $30 copay Plan pays 80% after deductible Plan pays 60% after deductible Brand Non-formulary You pay a $25 copay1 You pay a $50 copay Plan pays 80% after deductible Plan pays 60% after deductible Prescription Drugs—Mail Order Mail-Order Supply Up to a 100-day supply Up to a 60-day supply Up to a 90-day supply Not covered Generic You pay a $20 copay You pay a $10 copay Plan pays 80% after deductible Brand Formulary You pay a $50 copay You pay a $60 copay Plan pays 80% after deductible Brand Non-formulary You pay a $50 copay1 You pay a $100 copay Plan pays 80% after deductible 1 On exception and if approved by a plan physician Medical Benefits at a Glance (Continued)

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Medical Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Dental Benefits Your Dental Benefits Dental coverage is key to your overall health. Eligible employees are offered a choice of two dental plans:
  • Cigna Dental Care Access (DHMO)
  • Cigna Dental DPPO Use In-Network Providers 1. Go to Cigna.com, click on “Find a Doctor” at the top of the screen. 2. Then, choose a Directory by clicking on the “For Plans Offered through Work or School” option.
  • 3. Next, click on “Find a...Dentist.” 4. Enter SEARCH LOCATION — city, state or zip code. 5. ELECT A PLAN by clicking on the Pick drop-down icon and selecting “Cigna Dental PPO” or “Cigna Dental Care Access” under the Dental Plans section. Then press SEARCH. Need Help? Call Cigna at 800-244-6224. Quick Guide to Dental Services:
  • Preventive services include: semiannual checkups (including x-rays), cleanings, and fluoride treatments (for children)
  • Basic services include: diagnostic x-rays, fillings, and extractions
  • Major services include: bridges, crowns, implants, and dentures CONTINUED

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Medical Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Dental Benefits Cigna Dental DHMO The Cigna Dental DHMO plan works much like a medical HMO plan. When you enroll in a DHMO plan, you (and each enrolled family member) will be asked to select a primary care dentist (PCD) from the Cigna Total Network.

Plan Features: 1. You must select and use a PCD from the Cigna network to coordinate your care, including referrals to specialists within the network. 2. There are no deductibles or annual dental maximums. 3. First two cleanings per year, sealants and space maintainers are covered at 100%.

4. Preventive and basic services are covered at 100%. 5. General services such as fillings and simple extractions are subject to copays. 6. Major dental services, such as crowns, inlays and dentures, require a copay. 7. If you use a dentist outside the DHMO network, you are responsible for paying the full cost (except in an emergency). To view the Cigna Dental DHMO copayment schedule, click here. How the Plans Compare Cigna Dental DHMO Cigna Dental DPPO Plan Rates Less expensive More expensive Providers You must visit a dentist within the network You can visit any dentist Deductible No deductible You pay a deductible first before the plan begins to pay benefits, except for annual exams/cleanings Preventive Services Most preventive services covered 100% Costs for Dental Services You pay a copay You pay coinsurance after you meet the deductible Find a Cigna Primary Care Dentist (PCD) 1.

Go to www.Cigna.com and click on “Find a Doctor” at the top of the screen.

2. Then, choose a Directory by clicking on “Plans through your employer or school” option. 3. ELECT A PLAN by clicking on the Pick drop-down icon and selecting “Cigna Dental PPO” or Cigna Dental Care Access” under the Dental Plan section. Click CHOOSE. 4. Enter SEARCH LOCATION—city, state or ZIP code. Then press SEARCH. Need help? Call Cigna at 800-244-6224 CONTINUED

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Medical Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Dental Benefits Cigna Dental DPPO With the Cigna Dental DPPO Plan, you have the flexibility to choose any dentist and receive some benefits.

However, if you go to a Cigna network dentist in the DPPO or DPPO Advantage Network, you will pay less because Cigna dentists have agreed to charge lower, negotiated rates. You will likely achieve higher savings with the DPPO Advantage Network.

Plan Features: 1. You can choose any dentist, but will pay less if you choose a Cigna dentist. 2. Preventive services are covered at 100% for in-network or out-of-network expenses (out-of-network paid up to the maximum amount allowed by the plan) and aren’t subject to the deductible. 3. You pay the first $50 in eligible expenses per person ($150 maximum per family) each year, then the plan pays benefits. 4. Basic services are covered at 80%, and major services are covered at 50%, after you’ve met the deductible.

5. The Cigna Dental DPPO Plan covers up to $2,000 of eligible dental expenses per covered family member each calendar year.

Diagnostic and preventive benefits are not counted toward the annual maximum. If you get preventive care, your maximum dental benefit will be higher next year! 6. The Cigna Dental DPPO Plan has a lifetime maximum of $2,500 per covered family member for orthodontia services. Out-of-network provider charges are reimbursed only up to a maximum amount allowed by the plan. Since rates are not negotiated, it is likely their charges will be higher and you will pay more.

See Dental Benefits at a Glance for more details. How the Dental DPPO Works See any PPO network provider See a provider outside the PPO network Pay a deductible and any applicable coinsurance, and you will pay less because rates are negotiated Flexibility of choosing any dentist, but rates are not negotiated, so you may be charged more Before You Get Treatment ... When your dentist recommends treatment, you should contact Cigna before you get the work done so that they can authorize the expense and the plan will pay benefits. Follow this procedure to protect yourself from unexpected expenses.

CONTINUED

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Medical Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Dental Benefits Get Rewards for Dental Wellness1 Each year that a covered person gets regular preventive dental care, his or her maximum annual dental benefit for the following year will be increased by $200.

For example, if you get preventive dental care in 2019, your maximum dental benefit in 2020 will increase from $2,000 to $2,200. For each year that you receive preventive dental care, your maximum annual dental benefit will increase by another $200, until you reach a maximum of $2,600 in annual dental benefits. This incentive is applied on an individual basis. So, if you have family coverage and you are the only one to receive preventive care, yours is the only maximum that will increase for the next year. If everyone in your family gets preventive care, the annual maximum benefit for each person will increase the following year.

1 Rewards for Dental Wellness applies to DPPO only. How the Dental Wellness Feature Works Jeff gets preventive care each year and receives a $200 increase in his maximum dental benefits each following year, until reaching the maximum of $2,600. Karen gets preventive care in year one and receives a $200 increase in her maximum dental benefit for the following year. Karen does not get preventive care afterward, so her maximum dental benefit remains at $2,200. Arthur does not get preventive care, so his maximum dental benefit remains at $2,000.

Year 1 Year 2 Year 3 Year 4 Year 5 Jeff Karen Arthur $2,600 $2,400 $2,200 $2,000 CONTINUED

  • 2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Medical Benefits Your Vision Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Dental Benefits Dental Benefits at a Glance The chart below provides an overview of the most commonly used dental benefits. Benefit Cigna Dental DHMO Cigna Dental DPPO In-Network In-Network Out-of-Network Calendar-Year Deductible1 None Individual: $50/Family: $150 Individual: $50/Family: $150 Calendar-Year Maximum Benefit1 Unlimited Plan pays up to $2,000 per person/year2 Plan pays up to $2,000 per person/year2 Preventive/Diagnostic1 Routine Examination: Cleaning, Fluoride Treatment (including bitewing x-rays) Two cleanings per year You pay $0 Three cleanings per year Plan pays 100%; deductible does not apply Three cleanings per year Plan pays 100% of maximum allowed amount; deductible does not apply Office Visits You pay $0 Plan pays 80% after deductible Plan pays 80% of maximum allowed amount after deductible General Services (Restorative) Fillings: Amalgam Composite/ Resin You pay a $0 – $40 copay (depending on number of surfaces) Plan pays 80% after deductible Plan pays 80% of maximum allowed amount after deductible Simple Extractions You pay a $5 copay Plan pays 80% after deductible Plan pays 80% of maximum allowed amount after deductible Major Services Caps, Crowns, Dentures, Implants Copays as listed in the schedule of covered services and copays Plan pays 50% after deductible Plan pays 50% of maximum allowed amount after deductible Orthodontia Adults You pay a $0 – $1,488 copay depending on the service performed Plan pays 50% up to $2,500 lifetime maximum benefit; deductible does not apply Dependent Children (to age 19) You pay a $0 – $984 copay depending on the service performed Retention $250 copay 1
  • Calendar-year deductible and maximum benefit is not applicable to preventive or diagnostic services. 2
  • If you receive preventive dental care during a plan year, your calendar-year maximum benefit for the next year will increase by $200, until you reach a maximum dental benefit of $2,600.

CONTINUED

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Medical Benefits Your Dental Benefits Employee Assistance Program Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Your Vision Benefits Vision Benefits Eligible employees are automatically enrolled in the core vision coverage through Anthem (EyeMed) at no cost.

This plan includes coverage for eye exams and eyeglasses or contact lenses. You receive a higher level of coverage when you use network providers; however, you can use this claim form to file claims with Anthem if you visit a provider outside Anthem’s EyeMed network. Anthem uses a network of nationwide providers, including national retailers like Target and LensCrafters.

  • Increased coverage is available for purchase through the Buy-Up Plan. Vision Benefits at a Glance The chart below provides an overview of the most commonly used vision benefits. Benefit Core Plan Buy-Up Plan In-Network In-Network Out-of-Network Eye Exam (Once every 12 months) Plan pays 100% after a $10 copay You pay $79 out-of-network Plan pays 100% after a $10 copay Plan pays up to $79 Frames (Once every 12 months) You receive a 35% discount No out-of-network coverage Plan pays up to a $130 allowance; you receive a 20% discount on amounts over allowance Plan pays up to $100 Lenses* (Once every 12 months) Single Vision Lined Bifocal Lined Trifocal You pay $50 You pay $70 You pay $105 No out-of-network coverage Plan pays 100% after a $15 copay Plan pays up to $36 Plan pays up to $60 Plan pays up to $79 Contact Lenses (Once every 12 months, in lieu of glasses) You receive a 15% discount No out-of-network coverage Plan pays up to a $130 allowance; you receive a 15% discount on doctors’ professional fees. Materials are paid at usual & customary rates Plan pays up to $115 *
  • Special materials or coatings are subject to additional copays. Find the right Anthem eye doctor for you at www.anthem.com/ca.
2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Medical Benefits Your Dental Benefits Your Vision Benefits Flexible Spending Accounts Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Employee Assistance Program Employee Assistance Program (EAP) Confidential advice and counseling are available at no cost to you through the Employee Assistance Program (EAP). When you contact the EAP you can speak confidentially to a counselor or other professional who can help with issues, such as:
  • Parenting issues
  • Loss or grieving issues
  • Relationship problems
  • Substance abuse issues
  • Self-improvement
  • Mental health issues
  • Financial concerns
  • Legal-referral assistance. Employees and their legal spouse, domestic partner, and eligible dependents receive up to five counseling sessions with a licensed/certified therapist by phone or in person per family member, per issue, each calendar year. Call 800-234-5465 or log on to www.liveandworkwell.com (use access code: claremontcolleges) to get started.

You can also receive support for everyday tasks through the EAP’s WorkLife Services. Get referrals and consultations for such concerns as childcare and eldercare, household care and services, and personal services (such as shopping, translators, or even dog walkers). Read this WorkLife Services flyer for more information. Access to the EAP is available 24/7 year-round. All records, including medical information, referrals and evaluations, are kept strictly confidential in accordance with federal and state laws.

More information is available in the EAP Brochure. Did You Know? The EAP is 100% paid for by The Claremont Colleges!

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Medical Benefits Your Dental Benefits Your Vision Benefits Employee Assistance Program Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Flexible Spending Accounts Flexible Spending Accounts (FSAs) FSAs help you make your money go further by letting you set aside pre-tax dollars to pay for certain out-of-pocket eligible expenses and dependent care costs. Here’s how they work:
  • You make contributions from your pay on a pre-tax basis. Contributions and eligible reimbursed expenses aren’t subject to federal income tax, Social Security tax, and, in most cases, state income tax.
  • The tax savings help offset the cost of eligible health care and dependent care expenses.
  • You are not taxed on reimbursements from your FSAs. The Claremont Colleges offers three types of FSAs:
  • Health Care FSA—To pay for eligible medical, dental, and vision expenses
  • Limited Scope Health Care FSA—To pay for eligible dental and vision expenses if you participate in an HSA
  • Dependent Care FSA—To pay for eligible childcare and eldercare expenses Making FSA Contributions The annual amount you contribute to your FSA is deducted from your paychecks in equal installments, on a pre-tax basis, from January through December 31, 2019, and credited to your FSA account(s).

Incurring Claims You can incur claims for eligible expenses from January 1, 2019 through March 15, 2020, so you have until March 15, 2020 to use your 2019 funds. You will have until June 30, 2020 to submit claims for reimbursement. › CONTINUED

2019 Benefits Guide Forms Notices Who to Contact LAST VIEWED HOME BACK NEXT Your Benefits Who’s Eligible Your Medical Benefits Your Dental Benefits Your Vision Benefits Employee Assistance Program Life Insurance Benefit Evidence of Insurability Long-Term Disability Accidental Death & Dismemberment (AD&D) Insurance Long-Term Care Pet Insurance Legal Assistance Insurance Identity Protection Insurance Enrolling for Benefits 2019 Plan Rates Wellness Resources Retirement Plan Flexible Spending Accounts Health Care FSA You can use the funds in your Health Care FSA to pay for eligible expenses like deductibles, copays, and coinsurance for you and your eligible dependents.

You can contribute a minimum of $300 and a maximum of $2,650 per plan year, before tax. You don’t have to have medical, dental, or vision coverage through The Claremont Colleges to enroll in the Health Care FSA. The full annual election is available immediately (or January 1).

Limited Scope Health Care FSA If you participate in an HSA or if you are enrolled in Medicare Parts A and/or B, you can participate in a Limited Scope Health Care FSA. You can contribute a minimum of $300 and a maximum of $2,650 for eligible expenses. The Limited Scope Health Care FSA offers limited scope reimbursements for eligible non-medical expenses, such as dental and vision plan deductibles, copays and coinsurance. Additionally, once you’ve met your medical plan’s deductible, you can use the Limited Scope Health Care FSA to cover medical expenses and prescription drug costs.

Keep in mind that you cannot use a Limited Scope Health Care FSA for any of the expenses that are not eligible for reimbursement from a regular Health Care FSA. The Limited Scope Health Care FSA is a great option if you want to save the money in your HSA for future health care expenses (because HSA funds roll over each year). To learn more about how a Limited Scope Health Care FSA works with an HSA, check out Using the Limited Scope Health Care FSA & HSA Together. When using your FSA for dental claims ... If you use your Health Care FSA or Limited Scope Health Care FSA to pay for dental expenses before your insurance has processed the expense, the claim may result in requests for additional information. See the tip sheet, Substantiating Claims for Your Health Care Flexible Spending Account (FSA), for more information about Dental Claim substantiation. CONTINUED Eligible/Ineligible expenses Here are a few common examples of expenses you can reimburse from your Health Care FSA:
  • Ambulance services
  • Artificial teeth/limbs
  • Copays
  • Chiropractic care
  • Contact lenses
  • Crutches
  • Deductibles and coinsurance
  • Hearing aids
  • Insulin
  • Laser eye surgery
  • Long-term care expenses (but not insurance premiums)
  • Stop-smoking programs Below are some examples of ineligible expenses:
  • Cosmetic surgery (if not medically necessary)
  • Teeth bleaching
  • Health insurance premiums
  • Over-the-counter medications For a full list of eligible and ineligible expenses, go to www.payflex.com.
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