2021 Benefits Enrollment Guide - Plan year 9/1/2021 8/31/2022 - Cowley College
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
2021 Benefits Enrollment Guide
Plan year 9/1/2021 – 8/31/2022
CONFIDENTIAL AND PROPRIETARY: This document and the information contained herein is confidential and proprietary information of USI Insurance
Services, LLC ("USI"). Recipient agrees not to copy, reproduce or distribute this document, in whole or in part, without the prior written consent of USI.
Estimates are illustrative given data limitation, may not be cumulative and are subject to change based on carrier underwriting. © 2014-2021 USI
Insurance Services. All rights reserved.
WELCOME TO YOUR 2021-2022 BENEFIT GUIDE! At Cowley College, we value each and every employee. Our commitment to our employees is to provide an enriching environment where employees are engaged and are proud to be part of the Cowley College family. The cost of health care and other benefits continue to rise year after year. Each year, we analyze our costs and try to manage increases by reviewing our plans and benefit providers. We are conscious of the fact that changing health insurance plans is often difficult for our employees, so whenever possible, we work with our benefit providers to create solutions that will work financially and will be less disruptive. Employers across the country are all facing the same challenge. But the fact is that 70 percent of health care costs are due to preventable conditions that cost the U.S. health care system about $100 billion every year. Smoking, obesity, and high blood pressure are all preventable or treatable conditions that, left untreated, can lead to such illnesses as cancer, Type II Diabetes, or heart failure. Cowley College continues to promote a culture of health and wellness, establishing a work environment that promotes healthy lifestyles, decreases the risk of disease, and enhances your quality of life. As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare your options. This benefit summary has been prepared to help you review the key factors that are associated with our benefit plans. This summary does not provide all of the contractual provisions, limitations or exclusions included in our policies and should be considered only as a summary of our current benefits. If any differences exist between this summary and the official contracts, the contracts shall prevail. WHAT’S INSIDE THIS GUIDE? Welcome................................................................................... 2 Get More Value From Your Plans.............................................. 3 Important Information.............................................................. 4 Tips How To Control Cost......................................................... 5 Medical Plans........................................................................... 6 Telemedicine Information........................................................ 7 Flexible Spending Accounts...................................................... 8 Health Savings Account…………………………………………………………. 9 Dental Plan............................................................................... 10 Vision Plan................................................................................ 11 Life Insurance....…..................................................................... 12 Short-Term Disability................................................................ 13 Voluntary Benefit..…................................................................. 14 Employee Assistance Program.................................................. 15 403(B) Retirement Plan.............................................. .............. 16 Benefit Resource Center...…....................................................... 17 USI Mobile App.......................................................................... 18 Contact Informaton................................................................... 19 Required Notices. ..................................................................... 20 2|Page © 2014-2021 USI Insurance Services. All rights reserved.
GET MORE VALUE FROM YOUR PLANS
Here are a few key points to help you get the most value out of your health plan:
You will always save more money using providers in your medical plan's network. To
Minimize your out-of- find an in-network provider go to www.bcbsks.com/blueaccess
pocket expenses
What are your options? You may want to consider the following the next time you need
care:
For a Life Threatening Emergency
In a true medical emergency – such as an apparent heart attack, serious injury, or other
Use the Emergency life-threatening situation – always call 911 or your local emergency number right away!
Room ONLY for For Less Critical Issues, if the emergency is NOT life threatening
emergencies • Call your physician’s office (even after hours, someone is typically on call to
answer questions). Your doctor will know you and your medical history and
may be able to schedule you for a visit the same (or next) day.
• If your condition starts or worsens on the weekend, or after your doctor’s
office has closed for the day, you may want to consider a visit to an Urgent
Care facility. These clinics are not affiliated with hospitals, but they do have
doctors and nurses on staff and are open in the evenings and on weekends.
If You are Travelling and You Need Urgent Care
Your medical plan covers urgent care. An urgent condition is one that requires
immediate care but isn’t life-threatening. If you seek urgent care while traveling, you or
someone acting on your behalf should notify your doctor within 48 hours of the onset
of the urgent condition.
Take advantage of the fact the Medical plan covers 100% of scheduled annual physical
Annual physical exams exams and cancer screening tests related to the physical exam when you use an in-
and cancer screening network provider. Keep in mind that if your physician orders a test that isn’t part of the
scheduled preventative care exam/test, those procedures may result in some out-of-
tests are 100% covered! pocket expense for you. It’s always a good idea to check with your doctor’s office
before your visit, to see what tests or exams are planned. Then, call your health plan to
make sure you understand if and how those tests will be covered.
Your dental plan is designed to provide the dental coverage you need with the features
Preventive dental care is you want. Take advantage of what this plan has to offer without compromising what
covered 100%! matters most - including the freedom to visit the dentist of you and your dependents
choice – an “in-network” dentist or an “out-of-network” dentist. To find an in-network
provider go to www.deltadentalks.com
For those medical, dental or vision care expenses (copays, deductibles, etc) that you do
Save tax dollars and pay for out-of-pocket, don’t forget to take advantage of the Flexible Spending Account.
enroll in a Flexible You can set aside up to $2,750 a year on a before-tax basis and then reimburse yourself
for eligible expense
Spending Account
3|Page
© 2014-2021 USI Insurance Services. All rights reserved.
IMPORTANT INFORMATION
Open Enrollment
Open enrollment is the one time a year where benefits-eligible employees can enroll in or make changes to their
benefits. It’s important to take time to review your current situation and determine what benefits you and your
immediate family may need for the 12 months.
Mid-Year Changes
After open enrollment, you cannot make changes to your coverage during the next 12 months unless you
experience a change in family status. A change in family status is a change in your personal life that may impact your
eligibility or dependent’s eligibility for benefits. Examples of some family status changes include:
• Change of legal marital status (i.e. marriage, divorce, death of spouse, legal separation)
• Change in number of dependents (i.e. birth, adoption, death of dependent, ineligibility due to age)
• Change in employment or job status (spouse loses job, etc.)
If such a change occurs, you must make the changes to your benefits within 60 days of the event date.
Documentation may be required to verify your change of status. Failure to request a change of status within 60 days
of the event may result in you having to wait until the next open enrollment period to make your change.
Who is Eligible for Benefits?
You may enroll in the Employee Benefits if you are a Full-Time or working at least 30 hours or more per week. The
waiting period for new hires is 30 days after the date of hire and coverage will begin on the first of the month
following the waiting period.
4|Page
© 2014-2021 USI Insurance Services. All rights reserved.
TIPS ON HOW TO CONTROL COST
Go Generic – if you are using a brand medication, consider asking your doctor for a generic
alternative. More and more generic medications are available each year and usually cost less .
Know what’s Free – Preventive care services are free of charge when you see an in-network
provider. Check out a full list of covered services at www.healthcare.gov.
Emergency vs Urgent Care – Knowing which option to use in a given situation can help you save a
lot of money. Emergency room visits can cost far more than urgent care visits. Urgent care visits are
good for minor illness, or injuries. If your condition is life-threatening always go to the ER.
Telemedicine – Instead of the emergency room or urgent care facility you may consider telemedicine
visit. A telemedicine visit entails of talking to a doctor online, instead of going to an in-person
appointment. This could save you time and keep you out of the waiting room.
Stay In-Network – Most medical plans offer in and out of network benefits. You will pay more when
you see out of network providers or going to an out of network facility. You can find a list of in-
network providers by going to www.bcbsks.com/blueaccess
Use your Health Savings Account (HSA) or Flexible Spending Account (FSA) – Using these
accounts can save you money because the contributions are made in a pre-tax basis.
Stay Healthy – Finding ways to improve your overall health and wellness can lower your out-of-
pocket health care costs.
4 simple actions you can take to live a healthier lifestyle:
1. Less Sugar More Water
2. Sit Less More Movement
3. Get enough Rest
4. Wash your hands frequently!
5|Page
© 2014-2021 USI Insurance Services. All rights reserved.
MEDICAL PLANS
Everyone has different medical benefit needs. Cowley College offers medical benefits through Blue Cross and Blue
Shield of Kansas. New employees are eligible for benefits first of month following 30 days of full-time employment.
Description High Option Low Option HDHP
Deductible $1,000 $1,500 $3,500
Preventive Care Covered at 100%
Telehealth Visits $30 copay Approximately $59 Approximately $59
Primary Physician Office Visit
$30 copay 80% after deductible 100% after Deductible
(includes Eye Exam)
Specialist / Urgent Care $50 copay 80% after deductible 100% after Deductible
Emergency Room $100 copay then Deductible / Coinsurance 100% after Deductible
Hospital Services 80% after Deductible 100% after Deductible
Plan Year Deductible
Individual / Family $1,000 / $ 3,000 $1,500 / $4,500 $3,500 / $$7,000
Coinsurance 80% to $1,000 / $3,000 80% to $1,000 / $3,000 100%
Out of Pocket Maximum (includes deductible, copays, & coins)
Individual / Family $6,350 / $12,700 $6,350 / $12,700 $3,500 / $7,000
Diagnostic Services
X-ray and Lab Tests 100% to $300 then Ded. & Coins 80% after Deductible 100% after Deductible
Retail Prescriptions (34-day Supply)
$20 copay or 30% coins up to
Generic 80% after Deductible 100% after Deductible
$200 Maximum
$40 copay or 30% coins up to
Preferred Brand 80% after Deductible 100% after Deductible
$200 Maximum
$60 copay or 30% coins up to
Non-Preferred Brand 80% after Deductible 100% after Deductible
$200 Maximum
Specialty Medications
30% up to a max of $1,000 80% after Deductible 100% after Deductible
Copay assistance available
Mail Order Prescriptions (90-day Supply)
$50 copay or 30% coins up to
Generic 80% after Deductible 100% after Deductible
$500 Maximum
$90 copay or 30% coins up to
Preferred Brand 80% after Deductible 100% after Deductible
$500 Maximum
$150 copay or 30% coins up to
Non-Preferred Brand 80% after Deductible 100% after Deductible
$500 Maximum
Employee Contributions (Monthly)
COWLEY COLLEGE PROVIDES EACH EMPLOYEE WITH $640 PER MONTH TOWARDS THE MEDICAL COST
Employee (- $74.92) (- $133.12) (- $182.85)
Employee + Spouse $83.31 $8.71 (- 55.14)
Employee + Child(ren) $9.84 (- $56.84) (- 114.47)
Family $139.81 $59.57 (- 9.37)
6|Page
© 2014-2021 USI Insurance Services. All rights reserved.
TELEMEDICINE
Get Care 24/7
Telemedicine services allow you to get care whenever you need it. With Amwell, you can have
virtual doctor’s visit from your computer, tablet, or phone.
You can see a doctor from the comfort of your home – safe and secure!
Benefits!!
• Less time away from work
• No travel expenses or time
• Easier if you have a child or elder in your care
• Privacy
• No exposure to other potentially contagious patients
When can I use it?
• Cold or flu
• Fever
• Rash
• Sinus Infection
• Pink Eye
• Ear Infection
3 ways to register: Behavioral Health Services
• Download the Amwell app on any mobile device. Licensed therapists can provide
• Visit bcbsks.com/telemed advice and counseling for
• Call 844-733-3627 depression, anxiety, stress,
relationship issues and more.
Private appointment available
7 days a week, 6:00 a.m. to
10:00 p.m. cst.
7|Page
© 2014-2021 USI Insurance Services. All rights reserved.
FLEXIBLE SPENDING ACCOUNTS
The internal Revenue Code Section 125 allows an employer to establish a salary-reducing agreement or Cafeteria
Plan for the benefit of employees. Since flexible spending dollars are paid before taxes, the employee’s taxable
income is reduced, and the employee saves money.
Dependent Care Reimbursement Account
Allows you to be reimbursed for dependent care expenses with “tax-free” dollars. The minimum amount you may elect
to put aside is $300 and maximum amount is $5,000 per plan year. Eligible expenses include wages paid to a daycare
provider for services during regular working hours. Babysitting costs for social events are not eligible.
Medical Reimbursement Account – Eligible if NOT in Option 3 HDHP
Allows you to pay for eligible medical and dental expenses with “tax-free” dollars. You never pay taxes on
earnings you convert to this “tax-free” benefit. You estimate the amount of eligible expenses you and your
dependents will likely incur from September 1 through August 31 each year. You determine how much you
would like to convert to a non-taxable benefit from a minimum of $300 per year to a maximum of $2,750 per
year. Eligible medical, dental and vision expenses must be incurred from September 1 through August 31
each year. The plan offers a grace period of 2 ½ months following the end of the plan year in which eligible
expenses can be incurred. The expenses your medical, dental and vision insurance plan does not pay, such as
copays, deductibles and coinsurance are eligible. Other examples of eligible expenses are shown on this page.
Flex Accounts are spending accounts, NOT savings accounts.
Qualifying Healthcare Expenses
Debit Card Acupuncture Lead-Based Paint Removal
Allows you to pay for eligible expenses directly from your Alcoholism Learning Disability
Flex Spending Account, eliminating the hassle of claim Ambulance Lifetime Care Payments
Annual Physical Exam Long-Term Care
forms, reimbursement checks, and in most cases, the need Artificial Limb Medical Conferences
to submit receipts. Artificial Teeth Medical Information Plan
Bandages Nursing Home
Birth Control Nursing Services
Flex Made Easy Login Information Body Scan Optometrist
To set up your online Flexible Spending Account: Go to Braille Books & Magazines Organ Donors
flexmadeeasy.com Breast Pumps & Supplies Osteopath
Breast Reconstruction Oxygen
Capital Expenses Physical Examination
If you experience any difficulty signing into Flex Made Easy Car (special hand controls) Pregnancy Test Kit
site, please call Customer Service at (855) 615-3679 or via Chiropractor Prescription Medicines
Christian Science (Practitioner) Prosthesis
email: info@FlexMadeEasy.com Contact Lenses Psychiatric Care
Crutches Psychoanalysis
Dental Treatment Psychologist
Diagnostic Devices Sterilization
Disabled Dependent Care Stop-Smoking Programs
Drug Addiction Surgery
Eyeglasses Telephone (Hearing Impaired)
Eye Surgery Therapy
Fertility Enhancement Transportation (Medical)
Guide Dog Vasectomy
Hearing Aids Vision Correction Surgery
Home Care Weight Loss (Program Fees)
Home Improvements Wheelchair
Hospital Services Wig (Hair Lost Due to Disease)
Laboratory Fees X-ray
Lactation Expenses
8|Page
© 2014-2021 USI Insurance Services. All rights reserved.
HEALTH SAVINGS ACCOUNT
If you are enrolled in the Medical HDHP, you can contribute funds into an HSA. HSA are tax sheltered
accounts that do not have a use-it-or-lose-it rule.
Cowley College offers employees enrolled in the High Deductible Health Plan (HDHP) the option of
participating in a Health Savings Account (HSA). The HSA is a tax-free bank account that allows you to
save money for healthcare expenses. As out-of-pocket healthcare expenses are incurred, you may
withdraw funds from your HSA to pay those expenses or reimburse yourself. Your money continues
to build year over year; there is no use it or lose it rule.
HSA Eligibility
• Qualified High Deductible Plan (HDHP) must be the employee’s only medical coverage and
cannot be covered on another non-HDHP.
• Spouse does not have a Flexible Spending Account (FSA)
• Not eligible in Medicare
• Not claimed as a dependent on another person’s tax return (except spouses)
HSA Contributions Limits for Calendar Year 2021
● Employee only coverage - $3,600
● Employee plus dependent coverages - $7,200
● Employees 55 years of age and older may contribute an additional catch-up amount of $1,000
● Any person – an eligible individual, an employer, a family member, or any other person - can
contribute towards your HSA; each contribution counts toward the maximum amount.
● You can change your pre-tax HSA account contributions at any time during the year, increase
or decrease as you need to!
● There is NO use it or lose it provision. Your unused dollars rollover to use for future healthcare
expenses.
● There are no substantiation requirements. You do not have to send in receipts! You should
always save receipts of your healthcare/HSA expenditures in care your regular tax return would
be subject to an IRS audit.
● HSAs are individual accounts, not employer accounts.
● If you use HSA funds for non-eligible expenses, you will be liable for penalties and excise tax
o Eligible expenses are same as FSA expenses, such as deductible, dental, and vision (not
cosmetic), etc.
9|Page
© 2014-2021 USI Insurance Services. All rights reserved.
DENTAL PLAN
Regular dental exams can help you and your dentist detect problems in the early stages when
treatment is more basic, and costs are much lower. Cowley College offers you a dental plan through
Delta Dental of Kansas.
BENEFITS DELTA DENTAL OF KS
Network In-Network
Deductible
Individual / Family $25 / $75
Maximum Benefit
Per Person $1,500
Preventive
Preventative
Unlimited cleanings, dental exams every 6 months, dental imaging, 100%
fluoride, prophylaxis, sealants, space maintainers.
Primary Services
Emergency treatment for pain, filings, inlays, simple extractions,
50% Payment
endodontics, repair of dentures, periodontics (non-surgical), oral
After Deductible
surgery
Major Services
Dental implant services, periodontal surgery, surgery of bony
structure supporting teeth. 50% Payment
Onlays (not part of bridge); dentures full or partial, bridges. After Deductible
EMPLOYEE COST MONTHLY DEDUCTIONS
Employee Only $38.05
Employee & Spouse $70.40
Employee & Child(ren) $68.49
Family $79.91
Helpful Tip: Ask your dentist for a pre-determination letter
prior to treatment and/or procedure. A treatment plan is Managing your Benefits:
usually submitted by a dentist for Delta Dental to review At DeltaDentalKS.com you can log in to your
and provide an estimate of benefits before treatment starts. member account to:
• Find a Dentist
This can help a member budget for dental procedures and
• Print Member ID Card
predict their out-of-pocket cost.
• Review eligibility and benefits
• View Claims and Coverage
PPO & PREMIER NETWORK • Estimate your Out-of-Pocket Costs
• Mobile App is also available
You may see a dental provider in either the Delta Dental
PPO or Delta Dental Premier network. You will see deeper
discounts when utilizing a PPO provider, but will have the same percentage of coverage with both networks.
10 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.VISION PLAN
The vision plan includes coverage for both an annual vision exam as well as vision hardware
benefits. Eligible employees have the option to elect vision coverage through Vision Care
Direct.
DESCRIPTION COMPLETE PLAN MATERIALS ONLY PLAN
EXAM – Every 12 Months $15 Not Covered
FRAMES – Every 24 Months $160 Allowance $160 Allowance
LENSES – Calendar Year
Single Vision $15 copay $15 copay
Bifocal $15 copay $15 copay
Trifocal $15 copay $15 copay
CONTACT LENSES
Contact lenses
Elective Conventional
$160 Allowance in Lieu of Glasses $160 Allowance in Lieu of Glasses
Elective Disposable
$250 Allowance $250 Allowance
Non-Elective
EMPLOYEE COST MONTHLY DEDUCTIONS MONTHLY DEDUCTIONS
Employee Only $13.48 $9.34
Employee + 1 $21.57 $14.94
Employee + Child(ren) $24.88 $17.24
Family $42.31 $29.30
To find a provider go to www.VisionCareDirect.com
Note: Medical plan options 1 & 2 include routine eye
exam with a $30 copay. Individuals enrolled in these
medical plans may consider the materials only vision
plan and receive an eye exam through medical
insurance.
If you are enrolled in option 3 (HDHP) eye exams are
subject to deductible with medical insurance.
11 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.LIFE INSURANCE
Voluntary Life Insurance Coverage
Cowley College provides employees the opportunity to purchase Life insurance if you need additional
coverage. Your contributions will depend on your age and the amount of coverage you elect.
• Vol Life: Increments of $5,000 not to exceed 5 x annual earnings up to a
maximum of $500,000 with up to $200,000 available with no medical
underwriting during your initial eligibility period.
• Spouse Vol Life: Increments of $5,000 but not more than 50% of
employee amount up to a maximum of $100,000 with up to $25,000
available with no medical underwriting during their initial eligibility
period.
• Child(ren) Vol Life: Increments of $10,000 up to a maximum of $100,000
with the full amount available with no medical underwriting during their
initial eligibility period.
Important Things to Consider
You will need to provide evidence of insurability for insurance if:
• You elect to initially enroll in an amount over the guaranteed issue amount.
• You elect to increase your current amount in excess of the guaranteed issue
amount.
• You declined voluntary life during your initial eligibility period and would like
to enroll this year.
The cost of Life Insurance will be determined based on your age and the amount of coverage you elect. Please review
your coverage options through the Paycom Enrollment Portal.
Optional Group Life Insurance with KPERS (OGLI)
As part of your KPERS benefits, your employer offers Optional Life Insurance, additional coverage
beyond KPERS basic life insurance. This is extra coverage to help you protect what matters most –
your family, including their financial security. With Optional Life, you decide how much you need and
pay your premiums through payroll deduction.
12 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.SHORT TERM DISABILITY
DISABILITY INSURANCE COVERAGE
Cowley College will provide a voluntary disability option to full-time employees with Short Term
Disability benefits with OneAmerica through Benefits Direct. In the event you become disabled from a
non-work-related injury or sickness, disability income benefits are provided as a source of income.
You are not eligible to receive disability benefits if you are receiving workers’ compensation benefits
and you may be subject to waiting periods for pre-existing conditions. Long Term Disability coverage
is provided through the Kansas Public Employees Retirement System. Long Term Disability begins
after 6 months of disability.
COVERAGE BENEFIT
Option 1: 0 days of injury/7 days sickness
Elimination Period Option 2: 14 days of injury/14 days of sickness
Option 3: 30 days of injury/30 days of sickness
Option 1: 26 weeks
Maximum Duration Option 2: 24 weeks
Option 3: 22 weeks
3 months/12 months
*Any condition you were treated for prior to your
Pre-Existing Limitations
effective date will not be covered for the first 12
months
The cost of Short-Term Disability Insurance will be determined based on your age and the amount of
coverage you elect. Please review your coverage options through the Paycom Enrollment Portal.
13 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.VOLUNTARY BENEFITS
Cowley College offers options for Accident and Cancer Insurance. These plans are designed to help
cover out-of-pocket expenses not covered by your health insurance as well as a pay-check protection
if you cannot work because of an injury or illness.
As a valued employee you are eligible to apply for supplemental insurance. Participation in these
benefit plans is voluntary; however, we feel it is very important for you to understand them any
advantages of the products we are making available to you:
▪ The ability to choose benefits to meet your individual needs.
▪ The convenience of premium payment through payroll deduction.
▪ The ability to take coverage with you if you change jobs or retire.
▪ The ability to provide coverage for you and your family, with most products.
Listed below are the plans for which you can apply. These cash benefits are paid directly to you unless
you specify otherwise, and most benefits are paid regardless of other coverage you may have with
other insurance companies.
ACCIDENT INSURANCE
Helps offset the unexpected medical expenses, such as deductible and copayments
that can result from a fracture, dislocation or other covered accidental injury.
CANCER INSURANCE
Helps offset the out-of-pocket medical and indirect non-medical expenses related to
cancer that most medical plans may not cover. This coverage also provides benefits
for specified cancer-screening tests.
It is important that you take a few minutes to learn about the advantages of supplemental insurance
and to determine if all of your insurance needs are currently being met. We strongly encourage you to
participate in this exciting opportunity!
14 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.EMPLOYEE ASSISTANCE PROGRAM (EAP)
Life does not always go smoothly. All of us experience times when a personal problem or crisis affects the way
we function at work or home. Your Employee Assistance Program (EAP) is a problem-solving resource available
to you and your household members. A professional counselor will assist you in assessing your situation, finding
options, making choices or locating further help. It’s free...Your employer covers the cost of initial assessment,
additional problem-solving sessions and referral services.
It’s confidential...Your EAP has been set up with EMPAC, an outside counseling resource to assure
confidentiality. No one at work will know you have chosen to seek help unless you choose to tell them.
NATIONAL TOLL-FREE 800 NUMBER Available 24 hours a day, 365 days a year, the EAP toll-free number is
answered by a master’s level experienced EAP specialist.
RESOURCES Assessment and Referral – in person or telephone
Short Term Counseling – certified, licensed
professionals available
Financial Consultation – access our network of attorneys and financial
counselors who can provide legal expertise and advice on a multitude of
challenges. Connect online or in person.
Health Resource Library – search a wide variety of topics including Addiction,
Financial, Health & Wellness, Legal, Mental Health, Parenting, Relationships
and more!
Weekly Tips – sign up for weekly tips and advice on how to work through
stress, parenting, being your best at work and other helpful material –
delivered right to your inbox.
ASSISTANCE AREAS The EAP can provide assistance for a variety of personal and professional matters,
including:
o Work/Life Balance
o Stress, Depression & Anxiety
o Financial Struggles
o Marital or Relationship Issues
o Grief and Loss
o Substance Abuse
o Work-related Concerns
o Life-changing Events
IF YOU NEED HELP 1-800-234-0630 or 316-265-9922 (24 hours a day, 7 days a week)
Login at www.empac-eap.com and enter Cowley’s login code:
COWLEY
15 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.RETIREMENT PLAN
Cowley’s 403(b) Savings Plan is a tax-deferred retirement plan
which allows you to contribute a percentage of your pay before
taxes and received a basic contribution and matching
contribution from Cowley College. Distributions generally are
only available when you reach age 59 ½. However, distributions
can also be available in the event of financial hardship, death or
disability.
You can contribute up to 100% of your compensation to this plan, up to the limit allowed
under the Internal Revenue Code which is $19,500 in 2021. If you are age 50 or older, you can
make a “catch-up” contribution of up to $6,500 in 2021. If you have 15 years of service with
Cowley College, you may be eligible to make additional contributions of up to $3,000 per year
(capped at $15,00 for all years).
Automatic payroll deduction withdraws your contribution directly from your paycheck after
you complete a Salary Deduction Agreement and return it to your financial representative. You
may commence making contributions or modify the amount of your current contribution at
any time.
You may choose the 403(b) custodial account or annuity contract you want from the list of
approved investment providers and 403(b) investment products located on the Bay Bridge
website. http://sfr.baybridgeadministrators.com
403(b) Provider Contact Information
Ameriprise Financial Security Benefit (800-888-2461) Voya Retirement Ins
Services Ginger Hamilton PO BOX 3015
70100 Ameriprise Financial Cntr (316) 670-0049 New York, NY 10116
Minneapolis, MN 55474 ginderhamilton@ofgfinancial.com (888) 410-9482
(800) 297-7378
Ian Lindstrom
Aspire Financial Services (316) 990-8923
4010 Boy Scout Blvd, Ste 500 ianlindstrom@ofgfinancial.com
Tampa, FL 33607
(866) 634-5873 Leasha Rutschman
(316) 461-5063
Leasharutschman@ofgfinancial.com
16 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.BENEFIT RESOURCE CENTER
Cowley College is excited to offer access to the USI Benefit Resource Center (BRC), which is
designed to provide you with a responsive, consistent, hands-on approach to benefit inquiries.
Benefit Specialists are available to research and solve elevated claims, unresolved eligibility
problems, and any other benefit issues with which you might need assistance. The Benefit
Specialists are experienced professionals, and their primary responsibility is to assist you.
The Specialists in the Benefit Resource Center are available Monday through Friday 8:00 AM to
8:00 PM (Local Time). If you need assistance outside of regular business hours, please leave a
message and one of the Benefit Specialists will promptly return your call or e-mail message by
the end of the following business day.
Call Toll Free 855-874-0742 Monday through Friday 8:00am to 8:00pm Central Standard Time
or email BRCMT@usi.com.
If you have any questions, please contact: Amy Tharp 620-441-5295
This guide is provided to you by Cowley College and USI
These pages summarize benefits of the plan(s). The Subscriber Certificate(s) and applicable riders define the terms and conditions of
these benefits in greater detail. Should any questions arise; the certificate(s) and riders will govern.
17 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.USI MOBILE APP
The Our mobile benefits app provides a quick and simple way for you and your benefit plan
participants to access benefit summaries and other important information about your group plans.
The app also offers the ability to take photos of ID cards to store on the phone, as well as a way to
easily locate carrier and HR contact information—all in one place—24/7 and on the go. Our app is
free, available for iPhone and Android and the benefits include:
• Staying Organized
The app gives employees access to all of their benefit
plan information and ID cards—all in one place.
• Lightening Wallets
The app allows you to take and access images.
of your ID cards. Images are stored on the phone itself.
no personal health information is transmitted or saved.
• Getting In Touch
The app provides you with a single location to
find contact information for your Human Resources
team and the Benefit Resource Center as well as insurance carriers
18 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.CONTACT NUMBERS & WEBSITES
We encourage all of our employees and their families to become familiar with and use the
resources offered.
Below is a list of websites and telephone numbers where you can obtain information about
your benefit plan coverage. In most cases, you can register to securely access your benefit
information online. This will enable you to review important information about your coverage,
locate a doctor, view your claims history and research various health related topics.
Customer Service Contacts
BCBS of KS
(800) 432-3990 www.bcbsks.com
Medical Plans
Telemedicine (844) 733-3627 www.bcbsks.com/telemed
Delta Dental of KS
(800) 733-5823 www.deltadentalks.com
Dental Plan
Vision Care Direct
(800) 399-9644 www.visioncaredirect.com
Vision Plan
Flex Made Easy
(877) 523-0176 www.flexmadeeasy.com
FSA & Dependent Care
USI Benefit Resource Center
(855) USI-0742 BRCMT@usi.com
Benefit & Claim Issues
Benefits Direct
(877) 523-0176 customerSupport@AmeriLife
Vol STD, Vol Life, Cancer &
Benefits.com
Accident Coverage
EMPAC
(800) 234-0630 www.Empac-EAP.com
Employee Assistance Program
19 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.REQUIRED NOTIFICATIONS
Important Legal Notices Affecting Your Health Plan Coverage
THE WOMEN’S HEALTH CANCER RIGHTS ACT OF 1998 (WHCRA)
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s
Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits,
coverage will be provided in a manner determined in consultation with the attending physician and the patient,
for:
▪ All stages of reconstruction of the breast on which the mastectomy was performed.
▪ Surgery and reconstruction of the other breast to produce a symmetrical appearance.
▪ Prostheses; and
▪ Treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical
and surgical benefits provided under this plan. Therefore, the following deductibles and coinsurance apply:
Please see your benefit summary for complete plan details.
NEWBORNS ACT DISCLOSURE - FEDERAL
Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any
hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours
following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law
generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from
discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans
and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the
insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).
NOTICE OF SPECIAL ENROLLMENT RIGHTS
If you are declining enrollment for yourself or your dependents (including your spouse) because of other health
insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if
you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your
or your dependents’ other coverage). However, you must request enrollment within 60 days after your or your
dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption,
you may be able to enroll yourself and your dependents. However, you must request enrollment within 60 days
after the marriage, birth, adoption, or placement for adoption.
Further, if you decline enrollment for yourself or eligible dependents (including your spouse) while Medicaid
coverage or coverage under a State CHIP program is in effect, you may be able to enroll yourself and your
dependents in this plan if:
coverage is lost under Medicaid or a State CHIP program; or
you or your dependents become eligible for a premium assistance subsidy from the State.
In either case, you must request enrollment within 60 days from the loss of coverage or the date you become
eligible for premium assistance.
To request special enrollment or obtain more information, contact person listed at the end of this summary.
STATEMENT OF ERISA RIGHTS
As a participant in the Plan you are entitled to certain rights and protections under the Employee Retirement
Income Security Act of 1974 (“ERISA”). ERISA provides that all participants shall be entitled to:
Receive Information about Your Plan and Benefits
20 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.▪ Examine, without charge, at the Plan Administrator’s office and at other specified locations, the Plan and
Plan documents, including the insurance contract and copies of all documents filed by the Plan with the
U.S. Department of Labor, if any, such as annual reports and Plan descriptions.
▪ Obtain copies of the Plan documents and other Plan information upon written request to the Plan
Administrator. The Plan Administrator may make a reasonable charge for the copies.
▪ Receive a summary of the Plan’s annual financial report, if required to be furnished under ERISA. The
Plan Administrator is required by law to furnish each participant with a copy of this summary annual
report, if any.
Continue Group Health Plan Coverage
If applicable, you may continue health care coverage for yourself, spouse or dependents if there is a loss of
coverage under the plan as a result of a qualifying event. You and your dependents may have to pay for such
coverage. Review the summary plan description and the documents governing the Plan for the rules on COBRA
continuation of coverage rights.
Prudent Actions by Plan Fiduciaries
In addition to creating rights for participants, ERISA imposes duties upon the people who are responsible for
operation of the Plan. These people, called “fiduciaries” of the Plan, have a duty to operate the Plan prudently
and in the interest of you and other Plan participants.
No one, including the Company or any other person, may fire you or discriminate against you in any way to
prevent you from obtaining welfare benefits or exercising your rights under ERISA.
Enforce your Rights
If your claim for a welfare benefit is denied in whole or in part, you must receive a written explanation of the
reason for the denial. You have a right to have the Plan review and reconsider your claim.
Under ERISA, there are steps you can take to enforce these rights. For instance, if you request materials from
the Plan Administrator and do not receive them within 30 days, you may file suit in federal court. In such a case,
the court may require the Plan Administrator to provide the materials and pay you up to $156 per day (up to a
$1,566 cap per request), until you receive the materials, unless the materials were not sent due to reasons
beyond the control of the Plan Administrator. If you have a claim for benefits which is denied or ignored, in whole
or in part, and you have exhausted the available claims procedures under the Plan, you may file suit in a state
or federal court. If it should happen that Plan fiduciaries misuse the Plan’s money, or if you are discriminated
against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file
suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the
court may order the person you have sued to pay these costs and fees. If you lose (for example, if the court finds
your claim is frivolous) the court may order you to pay these costs and fees.
Assistance with your Questions
If you have any questions about your Plan, this statement, or your rights under ERISA, you should contact the
nearest office of the Employee Benefits and Security Administration, U.S. Department of Labor, listed in your
telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits and Security
Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210.
CONTACT INFORMATION
CONTACT INFORMATION: Questions regarding any of this information can be directed to:
Amy Tharp Jenette Hanna
620-441-5295 OR 620-441-5214
Amy.tharp@cowley.edu Jenette.Hanna@cowley.edu
21 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
Your Information. Your Rights. Our Responsibilities.
Recipients of the notice are encouraged to read the entire notice. Contact information for questions or complaints is
available at the end of the notice.
Your Rights
You have the right to:
• Get a copy of your health and claims records
• Correct your health and claims records
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and share information as we:
• Answer coverage questions from your family and friends
• Provide disaster relief
• Market our services and sell your information
Our Uses and Disclosures
We may use and share your information as we:
• Help manage the health care treatment you receive
• Run our organization
• Pay for your health services
• Administer your health plan
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests and work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our
responsibilities to help you.
Get a copy of health and claims records
• You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us
how to do this.
• We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may
charge a reasonable, cost-based fee.
Ask us to correct health and claims records
• You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing, usually within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.
22 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations.
• We are not required to agree to your request.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for up to six years prior to the date you
ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain
other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a
reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide
you with a paper copy promptly.
Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your
rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to
200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting
www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share
your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in payment for your care
• Share information in a disaster relief situation
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if
we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat
to health or safety.
• In these cases we never share your information unless you give us written permission:
Marketing purposes
Sale of your information
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Help manage the health care treatment you receive
We can use your health information and share it with professionals who are treating you.
Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.
Pay for your health services
We can use and disclose your health information as we pay for your health services.
Example: We share information about you with your dental plan to coordinate payment for your dental work.
Administer your plan
We may disclose your health information to your health plan sponsor for plan administration.
23 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain
the premiums we charge.
Run our organization
• We can use and disclose your information to run our organization and contact you when necessary.
• We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage.
This does not apply to long term care plans.
Example: We use health information about you to develop better services for you.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as
public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
Do research
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services
if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests and work with a medical examiner or funeral director
• We can share health information about you with organ procurement organizations.
• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Our Responsibilities
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we
can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be
available upon request, on our web site (if applicable), and we will mail a copy to you.
Other Instructions for Notice
• 9/1/2021
• Amy Tharp (620) 441-5295
24 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.OMB 0938-0990
MODEL INDIVIDUAL CREDITABLE COVERAGE DISCLOSURE NOTICE LANGUAGE
FOR USE ON OR AFTER APRIL 1, 2011
If you are receiving this electronically, you are responsible for providing a copy of this notice to any Medicare
Part D-eligible dependents who are covered under the group health plan.
Important Notice from Cowley College About Your Prescription
Drug Coverage and Medicare
Please read this notice carefully and keep it where you can find it. This notice has information about your current
prescription drug coverage with Blue Cross Blue Shield of Kansas and about your options under Medicare’s
prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug
plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at
what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area.
Information about where you can get help to make decisions about your prescription drug coverage is at the end of
this notice.
There are two important things you need to know about your current coverage and Medicare’s prescription drug
coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this
coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or
PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of
coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Please read this notice carefully and keep it where you can find it. This notice has information about your
current prescription drug coverage with Blue Cross Blue Shield of Kansas and about your options under
Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join
a Medicare drug plan. If you are considering joining, you should compare your current coverage, including
which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription
drug coverage in your area. Information about where you can get help to make decisions about your
prescription drug coverage is at the end of this notice.
When Can You Join A Medicare Drug Plan?
You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15thto
December 7th.
However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be
eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.
CMS Form 10182-CC Updated April 1, 2011
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is 0938-0990. The time required to complete this information collection is
estimated to average 8 hours per response initially, including the time to review instructions, search existing data resources, gather the data needed,
and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving
this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
OMB 0938-0990
25 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.What Happens To Your Current Coverage If You Decide to Join A Medicare Drug
Plan?
If you decide to join a Medicare drug plan, your current Blue Cross Blue Shield coverage will not be affected. You can
keep this coverage and it will coordinate with Part D coverage.
If you do decide to join a Medicare drug plan and drop your current Blue Cross Blue Shield coverage, be aware that you
and your dependents will be able to get this coverage back (during open enrollment or in the case of a special
enrollment opportunity).
When Will You Pay A Higher Premium (Penalty) To Join a Medicare Drug Plan?
You should also know that if you drop or lose your current coverage with Blue Cross Blue Shield and don’t join a
Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a
penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up
by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that
coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at
least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as
long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to
join.
For More Information About This Notice Or Your Current Prescription Drug Coverage…
Contact the person listed below for further NOTE: You’ll get this notice each year. You will also get it
before the next period you can join a Medicare drug plan, and if this coverage Blue Cross Blue Shield
of Kansas changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage…
More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You”
handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly
by Medicare drug plans.
For more information about Medicare prescription drug coverage:
• Visit www.medicare.gov
• Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare &
You” handbook for their telephone number) for personalized help
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For
information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-
1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be
required to provide a copy of this notice when you join to show whether or not you have maintained creditable
coverage and, therefore, whether or not you are required to pay a higher premium (a penalty).
Date: 9-1-2021
Name of Entity/Sender: Cowley College
Contact--Position/Office: Jenette Hanna, Director of Human Resources
Address: 125 S Second St, Arkansas City, KS 67005
Phone Number: 620-441-5214
26 | P a g e
© 2014-2021 USI Insurance Services. All rights reserved.You can also read
