2023 Benefits Enrollment Guide - Stephens College
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2023 Benefits
Enrollment Guide
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. © 2014-2022 USI Insurance Services. All rights reserved.
Benefit Items
Stephens College provides benefits for eligible employees and their family
members including same-sex or opposite-sex domestic partners. Benefit eligible is
defined as working ¾ time or 1560 hours per year. Eligible dependents include all
dependents up to age 26 or longer, if they are disabled.
The open enrollment elections you make will be effective January 1, 2023 through
December 31, 2023. You may only change coverage if you experience a qualifying
life event.
You may change your benefit elections during the year if you experience an event
such as:
Marriage
Divorce or legal separation
Birth of your child or your domestic partner’s child
Death of your spouse or dependent child
Adoption of or placement for adoption of your child
Change in employment status of employee, spouse/domestic partner or
dependent child
Qualification by the Plan Administrator of a child support order for medical
coverage
Entitlement to Medicare or Medicaid
You must notify Human Resources within 30 days of a qualifying life event, and
they will guide you through the change of benefit(s) process.
What is new for 2023?
Stephens college will be adding an additional High Deductible Health Plan
(HDHP). This plan has a $5,000 deductible for singles, and a $10,000
deductible for family. Please refer to the table on page 4 for more details.
Your FSA and HSA administrator will be Paylocity beginning January 1.
All other plan options remain the same.
Benefits Guide | 2
© 2014-2022 USI Insurance Services. All rights reserved.
Have Questions? Need Help?
Stephens 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 8:00am to 5:00pm Eastern & Central Standard 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.
Toll Free: 855-874-0829
BRCMidwest@usi.com
Carrier Policy Numbers Contact Information
Cigna Medical PPO 800-997-1654
Delta Dental of Missouri Dental PPO / 0119-0901 800-392-1167
EyeMed Vision / 1019575 866-939-3633
SunLife Life and AD&D / 246728 800-247-6875
SunLife Long Term Disability (LTD) / 246728 800-247-6875
SunLife Voluntary Life / 246728 800-247-6875
AFLAC Worksite Benefits 877-950-8415
Benefits Guide | 3
© 2014-2022 USI Insurance Services. All rights reserved.
Medical Plan
Your medical carrier is Cigna for 2023. Medical coverage is available for all benefit
eligible employees. It is very important to verify that your doctors and facilities are
in the Cigna Open Access Plus network. The following chart summarizes the plan
options that will take effect January 1, 2023.
PPO HDHP - $3,000 NEW PLAN HDHP - $5,000
Out-of- Out-of-
Plan Provision In-Network In-Network Out-of-Network In-Network
Network Network
Preventive Care 100% 50% 100% 70% after ded 100% 70% after ded
Primary Physician
$30 copay 50% 100% after ded 70% after ded 100% after ded 70% after ded
Office Visit
Specialist Office
$50 copay 50% 100% after ded 70% after ded 100% after ded 70% after ded
Visit
Outpatient Lab &
Ded, 100% 50% 100% after ded 70% after ded 100% after ded 70% after ded
X-Ray
Urgent Care $50 copay 50% 100% after ded 70% after ded 100% after ded 70% after ded
$0 copay after $0 copay after
Virtual Care $30 copay N/A N/A N/A
ded ded
Emergency Room
$300 copay $300 copay 100% after ded 100% after ded 100% after ded 100% after ded
Care
Annual Deductible $1,200 / $3,000 / $10,000 /
$3,000 / 6,000 $5,000 / $10,000 $5,000 / $10,000
(per calendar year) $2,400 $6,000 $20,000
Inpatient &
Outpatient 80% / 80% 50% / 50% 100% after ded 70% after ded 100% after ded 70% after ded
Hospital Services
Retail Rx Drugs
Ded, $10
Generic copay
$10 copay $10 copay Ded, $10 copay Ded, $10 copay Ded, $10 copay
Formulary Ded, $35
$35 copay $35 copay Ded, $35 copay Ded, $35 copay Ded, $35 copay
copay
Non-Formulary
$70 copay $70 copay Ded, $60 copay Ded, $60 copay Ded, $60 copay
Ded, $60
copay
$2,400 / $6,000 / $3,500 / $20,000 /
Out-of-Pocket $4,800 $12,000 $7,000 $5,500 / 11,000 $40,000
$10,000 / $20,000
Maximum Once out-of- Once out-of- Once out-of- Once out-of- Once out-of-
Once out-of-pocket
(includes pocket max is pocket max pocket max is pocket max is pocket max is
max is met, 100% on
deductible and all met, 100% on is met, 100% met, 100% on met, 100% on met, 100% on
covered expenses
copays) covered on covered covered covered expenses covered
expenses expenses expenses expenses
Benefits Guide | 4
© 2014-2022 USI Insurance Services. All rights reserved.
Medical Rates
Biweekly
Monthly
(26 Pay Periods)
Employee HDHP - HDHP - HDHP - HDHP -
PPO PPO
Premiums $3000 $5000 $3000 $5000
Employee Only $113.95 $57.53 $47.67 $246.90 124.64 $103.28
Employee +
$443.62 $330.76 $293.54 $961.17 $716.66 $636.01
Spouse
Employee +
$350.22 $251.52 $223.22 $758.80 $544.96 $483.65
Child(ren)
Family $609.97 $454.80 $403.62 $1,321.60 $985.39 $874.51
Benefits Guide | 5
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Cigna Virtual Care
Benefits Guide | 6
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Benefits Guide | 7 © 2014-2022 USI Insurance Services. All rights reserved.
Health Savings Account (HSA)
What is a Health Savings Account (HSA)?
An HSA is a tax-sheltered bank account that you own for the purpose of paying eligible health
care expenses for you and/or your eligible dependents for current or future healthcare
expenses. The Health Savings Account (HSA) is yours to keep, even if you change jobs or
medical plans. There is no “use it or lose it” rule; your balance carries over year to year.
Health Savings Account (HSA)
Your HSA savings account will be through Paylocity for 2023. Although everyone can enroll in
the Qualified High Deductible Health Plan, not everyone is eligible to open and contribute to
an HSA. If you do not meet these requirements, you cannot open an HSA.
You must not be covered by another non-QHDHP health plan, such as a spouse’s
PPO plan.
You are not enrolled in Medicare.
You are not in the TRICARE or TRICARE for Life military benefits program.
You have not received Veterans Administration (VA) benefits within the past three
months.
You are not claimed as a dependent on another person’s tax return.
You are not covered by a traditional health care flexible spending account (FSA).
This includes your spouse’s FSA.
2023 HSA Contributions
You can contribute to your Health Savings Account on a pre-tax basis through payroll
deductions up to the IRS statutory maximums.
FOR THE 2023 TAX YEAR:
• $3,850 Individual (employee + employer)
• $7,750 Family (employee + employer)
If you are age 55 and over, you may contribute an extra $1,000 catch up contribution.
Stephens College will contribute $750 to help offset the high deductible. For new
employees, the contribution amount will be prorated based on the insurance effective
date. Contributions will be made month beginning the effective date of insurance as long
as the HSA has been established.
How do I get reimbursed for my eligible expenses?
The easiest way to use your HSA dollars is by using your HSA Debit Card at the time you
incur an eligible expense. Keep your receipts! You must be able to prove that you were
reimbursing yourself for an eligible expense in the event that you are audited. If you use
your HSA funds for non-eligible expenses, you will be charged a 20% penalty tax (if under
age 65) as well as federal income taxes.
Benefits Guide | 8
© 2014-2022 USI Insurance Services. All rights reserved.
Flexible Spending Account (FSA)
Stephens College provides you the opportunity to pay for out-of-pocket medical,
dental, vision and dependent care expenses with pre-tax dollars through Flexible
Spending Accounts with Paylocity for the 2023 plan year. You must enroll/re-enroll
in the plan to participate for the plan year January 1 to December 31, 2023. You can
save approximately 25% of each dollar spent on these expenses when you participate
in an FSA.
A health care FSA is used to reimburse out-of-pocket medical expenses incurred by
you and your dependents. After you submit your receipt and explanation of benefits A dependent care
(EOB), reimbursements will be made through Paylocity. You can submit your claim FSA is used to
Paylocity.com reimburse expenses
related to care of
Contributions to your FSA come out of your paycheck before any taxes are taken out. eligible dependents
This means that you don’t pay federal income tax, Social Security taxes, or state and while you and your
local income taxes on the portion of your paycheck you contribute to your FSA. You
spouse work.
should contribute the amount of money you expect to pay out of pocket for eligible
expenses for the plan year. If you do not use the full contribution, it will not be
refunded to you. You may carry forward up to $500 to the future plan year. The rest The maximum that
is subject to the use-it-or-lose-it rule. you can contribute
to the Dependent
The maximum that you can contribute to the Health Care Flexible Spending Account Care Flexible
(FSA) is $2,750 annually. If you are enrolled in a high deductible health plan (HDHP) Spending Account is
you may only use the FSA for dental and vision expenses. $5,000 if you are a
single employee or
The following example shows how you can save money with a flexible spending married filing
account.
jointly, or $2,500 if
Bob and Jane’s combined gross income is $30,000. They have two children and file
you are married
their income taxes jointly. Since Bob and Jane expect to spend $2,000 in adult and filing
orthodontia and $3,300 for day care next plan year, they decide to direct a total of separately.
$5,300 into their FSAs.
Without FSAs With FSAs
Gross income: $30,000 $30,000
FSA contributions: 0 -5,300
Gross income: 30,000 24,700
Estimated taxes:
Federal -2,550* -1,755*
State -900** -741**
FICA -2,295 -1,890
After-tax earnings: 24,255 20,314
Eligible out-of-pocket
Medical and dependent care expenses: -5,300 0
Remaining spendable income: $18,955 $20,314
Spendable income increase: $1,359
*Assumes standard deductions and four exemption
Benefits Guide | 9
© 2014-2022 USI Insurance Services. All rights reserved.
Your Dental Coverage
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. Stephens College
offers you a dental plan through Delta Dental of Missouri.
Visit deltadentalmo.com to look up in-network dentists.
Delta Dental of
PPO Network Premier Network Out of Network
Missouri
Annual Deductible Regular dental exams
$0 $0 $0 can help you prevent
(per calendar year)
Annual Maximum most tooth decay and
$1,000 $1,000 $1,000
(per calendar year) periodontal disease and
Diagnostic and is an important part of
Preventive maintaining your
100% 100% 100%
(includes exams, medical health.
cleanings & x-rays)
Basic Services
(includes fillings, simple
90% 80% 80% Under this dental plan,
extractions & oral
surgery) you may choose to go to
Major Services any dentist. If you use a
(root canals, dentist in the PPO or
periodontia, crowns, 60% 50% 50% Premier network, you
inlays/onlays & will be guaranteed no
dentures) balance billing. If you
choose to see a dentist
This is a summary of your coverage only. Please refer to your summary plan description for the full outside of the network,
scope of coverage.
you may be balance
billed.
Employee Premium Biweekly
Deductions 26 Pay Periods
Monthly
The Delta Dental PPO
Employee $15.98 $34.62 Network will give you
Employee & Spouse
the best discounts.
$32.68 $70.81
Employee & Child(ren) $32.44 $70.28 The Delta Dental
Premier Network will
Employee & Spouse & give you the most
Child(ren) (Family) $52.11 $112.90
options of in-network
providers, however the
discounts could be less.
Benefits Guide | 10
© 2014-2022 USI Insurance Services. All rights reserved.Your Vision Coverage
Stephens College offers a vision plan through EyeMed. Vision plans provide
coverage for routine eye exams and pay for all or a portion of the cost of glasses
or contact lenses if you need them.
Visit www.eyemed.com to find a provider near you.
Reminder: You are in the Insight Network.
Provisions In-Network Out-of-Network
Exam – 12 months $10 Copay $40 Reimbursement
$0 Copay, $130 allowance,
Frames – 24 months $91 Reimbursement
20% off balance over $130
Single: $25 copay Single: $30 Reimbursement
Lenses– once every calendar
Bifocal: $25 copay Bifocal: $50 Reimbursement
year
Trifocal: $25 copay Trifocal: $70 Reimbursement
In Lieu of Eyeglass Lenses – 12 months
Contact Lenses
$130 Conventional
Elective Conventional
$0 Copay, $130 allowance, $130 Disposable
Elective Disposable
15% off balance over $130 $210 Medically Necessary
Non-Elective
Employee Premium Deductions Biweekly Monthly
26 Pay Periods
Employee Only $3.17 $6.87
Employee + Spouse $6.02 $13.04
Employee + Child(ren) $6.34 $13.73
Family $9.31 $20.18
Benefits Guide | 11
© 2014-2022 USI Insurance Services. All rights reserved.Life Insurance
Life and Accidental Death & Dismemberment (AD&D)
Stephens College provides benefit eligible employees with the following life and
accidental death and dismemberment (AD&D) insurance through Sun Life.
• Life and AD&D: 1.5 X salary up to a maximum of $250,000
This benefit is 100% paid by the employer after one year of employment.
Contact Human Resources if you need additional details or if you need to
update your beneficiary.
Beneficiary
Voluntary Life and Accidental Death & Dismemberment (AD&D)
Stephens College provides employees the opportunity to purchase additional Remember to keep
Life/AD&D insurance if you need additional coverage. Your contributions will your beneficiary
depend on your age and the amount of coverage you elect. updated which can
be done anytime
• Employees: Increments of $10,000 up to a maximum of $300,000 with a through the year. If
guarantee issue of $150,000 available with no medical underwriting. you are married
and living in a
• Spouses: Increments of $5,000 but not more than 50% of employee amount community
up to a maximum of $150,000 with a guarantee issue of $50,000.
property state,
• Children: Increments of $1,000 to a max of $10,000. your insurance
carrier may require
Important Things to Consider that you designate
You will need to provide evidence of insurability for insurance if: your spouse (or in
• You elect to initially enroll in an amount over the guarantee issue amount some cases a
• You elect to increase your current amount in excess of the guaranteed issue registered domestic
amount partner) for at
• You declined voluntary life during your initial eligibility period and would like to least 50% of the
enroll this year benefit unless you
have a waiver
Employee /Spouse
Age notice on file from
(per $1,000 of benefit) your spouse.
Under 20 - 34 $0.05 Consult your legal
or tax advisor for
35 - 39 $0.08
further guidance on
40 - 44 $0.13 this issue.
45 - 49 $0.21
50 - 54 $0.32
55 - 59 $0.52
60 - 64 $0.86
65+ $1.45
Child(ren) Rate .289 per $1,000 of benefit
EE/SP AD&D Rate .030 per $1,000 of benefit
Child AD&D Rate .030 per $1,000 of benefit
Benefits Guide | 12
© 2014-2022 USI Insurance Services. All rights reserved.Disability Insurance
Disability Insurance Coverage
Stephens College will continue to provide benefit eligible employees with Long
Term Disability income benefits through Sun Life. 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. This benefit is provided after one year
of employment.
Coverage Benefit
Benfit Percentage - 60%
Long Term Disability Maximum Monthly Benefit - $4,000
Elimination Period - 180 day
Benefits Guide | 13
© 2014-2022 USI Insurance Services. All rights reserved.Aflac Plans
Aflac Worksite Benefit
Stephen’s College offers you options to purchase supplemental Insurance through
Aflac. Please contact Human Resources for more information.
Short Term Disability Insurance
Aflac STD helps in an event where you become disabled and are unable to work.
This plan is a source for monthly income you may need to help take care of your
bills while you take care of yourself.
Hospital Indemnity Insurance
Hospital Indemnity Insurance helps with out-of-pocket costs associated with
a covered hospital stay, including benefits for hospital admission,
confinement, and Intensive care.
Critical Care Protection
Aflac’s critical care protection policy helps provide financial peace of mind if
you experience a serious health event, such as a heart attack or a stroke.
You will receive a lump sum benefit upon diagnosis of a covered event with
additional benefits to be paid for things such as hospital confinement,
intensive care unit confinement, ambulance, transportation, lodging, and
therapy.
Cancer Insurance
Aflac’s Cancer plan helps cover costs associated with a cancer diagnosis such
as, treatments, copays, lost work time, and even travel. This plan will pay
cash benefits directly to you.
Accident Insurance
Most major medical insurance plans only pay a portion of this bills. This policy
can help pick up where other insurance leaves off and provide cash to cover
expenses. Your accident insurance provides protection for a wide range of
covered benefits Injured employees and their dependents may use the cash
benefits however they want – to satisfy deductibles, pay out of pocket medical
expenses, or pay household bills.
Benefits Guide | 14
© 2014-2022 USI Insurance Services. All rights reserved.Employee Assistance Program from Cigna
Benefits Guide | 15
© 2014-2022 USI Insurance Services. All rights reserved.SunLife EAP
Benefits Guide | 16
© 2014-2022 USI Insurance Services. All rights reserved.Glossary
Brand Name Drugs: Drugs that have Mail Order Pharmacy: Mail order
trade names and are protected by pharmacies generally provide a 90-day
patents. Brand name drugs are generally supply of a prescription medication for
the costliest choice. the same cost as a 60-day supply at a
retail pharmacy. Plus, mail order
Coinsurance: The percentage of a pharmacies offer the convenience of
covered charge paid by the plan. shipping directly to your door.
Copayment (Copay): A flat dollar Inpatient: Services provided to an
amount you pay for medical or individual during an overnight hospital
prescription drug services regardless of stay.
the actual amount charged by your
doctor or health care provider. Outpatient: Services provided to an
individual at a hospital facility without
Deductible: The annual amount you and an overnight hospital stay.
your family must pay each year before
the plan pays benefits. Out-of-Pocket Maximum: The
maximum amount you and your family
Generic Drugs: Generic drugs are less must pay for eligible expenses each
expensive versions of brand name drugs plan year. Once your expenses reach
that have the same intended use, the out-of-pocket maximum, the plan
dosage, effects, risks, safety and pays benefits at 100% of eligible
strength. The strength and purity of expenses for the remainder of the year.
generic medications are strictly
regulated by the Federal Food and Drug Primary Care Physician (PCP):
Administration. physician (generally a family
practitioner, internist or pediatrician)
In-Network: Use of a health care who provides ongoing medical care. A
provider that participates in the plan’s primary care physician treats a wide
network. When you use providers in the variety of health-related conditions and
network, you lower your out-of-pocket refers patients to specialists as
expenses because the plan pays a higher necessary.
percentage of covered expenses.
Specialist: A physician who has
Out-of-Network: Use of a health care specialized training in a specific branch
provider that does not participate in a of medicine (e.g., a surgeon,
plan’s network gastroenterologist or neurologist).
This brochure summarizes the benefit plans that are available to Stephens College’s
eligible employees and their dependents. Official plan documents, policies and
certificates of insurance contain the details, conditions, maximum benefit levels
and restrictions on benefits. These documents govern your benefits program. If
there is any conflict, the official documents prevail. These documents are available
upon request through the Human Resources Department. Information provided in
this brochure is not a guarantee of benefits.
Benefits Guide | 17
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