HARVARD UNIVERSITY 2015 BENEFITS OPEN ENROLLMENT GUIDE NOVEMBER 5-19, 2014
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Harvard University 2015 Benefits Open Enrollment GUIDE November 5–19, 2014 This publication is for Harvard Faculty, Administrative and Professional Staff, and Other Nonunion Staff
My Notes: My To Do’s:
Table of Contents Page
During Benefits Open Enrollment
You Can…
Benefits Open Enrollment Calendar
4
of Events
• Change, elect, or drop medical, dental, and/or
A Message from Marilyn Hausammann 5 vision coverage.
• Update your medical, dental, and/or vision
Background Behind the Changes 6 coverage to add or remove a dependent.
• Elect a Health Care Flexible Spending Account
Health Care Choices and Changes in 2015 7 (FSA) or Limited-Purpose FSA (if you enroll
in the new High-Deductible Health Plan, or
HDHP), and/or Dependent Care Flexible FSA.
Introducing the High-Deductible Health If you want to participate in any FSA for
Plan (HDHP) with Health Savings Account 14 2015, you must enroll—2014 coverage does
(HSA) and a Limited-Purpose FSA not carry over to 2015.
• Elect to contribute to a Health Savings Account
Programs That Can Reduce Your Out-of- (HSA), if you enroll in the new HDHP in 2015.
18
Pocket Expenses • Elect Long-Term Disability Insurance.
• Elect or increase Supplemental Life
Medical Plan Comparison Chart 20 Insurance coverage.
To make your elections, go to the PeopleSoft
Other Resources and Information 22 Benefits Enrollment system on HARVie from
November 5–19, 2014. Once in PeopleSoft,
under Benefits and Payroll Quick Links, select
How to Review Current Coverage, Enroll in, Benefits Enrollment.
23
or Make Changes to Your 2015 Benefits
Benefits Eligibility Guidelines
Then you are eligible for, and affected by, 2015 changes to the…
If you are benefits-eligible… HMO Plans POS/PPO Plans New HDHP* Dental Plan
• Administrative/professional staff
• Nonunion staff
• Faculty
• Internal post-doc
External (“stipendee”) postdoc with
Harvard research
Coaching assistant, teaching assistant,
intern, visiting fellow
*High-Deductible Health Plan (HDHP) with Health Savings Account (HSA) and Limited-Purpose Flexible Spending Account (FSA) options.
Note: If you are a member of one of these groups but are currently on Long-Term Disability (LTD), you are not eligible to participate in the HSA
or the new Reimbursement Program. 3
Benefits Open Enrollment Calendar of Events
Each year, Benefits Open Enrollment affords you the If you do not make an election, your 2014 elections
opportunity to enroll in and make changes to your medical, will carry over to 2015 except for your participation in an FSA.
dental, vision, flexible spending accounts (FSAs), long- However, please note that there are significant changes in the
term disability insurance, and life insurance plans. plans for 2015, so be sure to read this guide and review the
This year, Benefits Open Enrollment for 2015 will information on HARVie before making any decisions about
take place online in PeopleSoft between 8:00 a.m. ET your elections for 2015.
November 5 and 8:00 p.m. ET November 19, 2014.
Here are some important dates to keep in mind:
October November December January
Late October to January 1, 2015
Mid-November
Beginning date for 2015
Online and on-campus coverages. Vendors for
educational sessions. two important Harvard
benefits change:
• Pharmacy benefits
management moves
November 5 November 19 to Catamaran (from
Express Scripts).
First day to enroll in or make Last day to enroll in or make • FSAs and other
changes to your 2015 benefits. changes to your 2015 benefits. reimbursement
programs move to
Benefit Strategies
(from Crosby).
By December 31 Begin using new 2015
medical, pharmacy, and
You will receive your new
HSA/FSA debit cards.
2015 prescription drug ID
card, new FSA/HSA debit Harvard HSA funding
card, and other applicable available January 2, 2015.
health care ID cards.
2014 FSA debit card will
be deactivated. (See transition
details on page 19.)
4
A Message from Marilyn Hausammann
Vice President for Human Resources
Dear Colleague,
Benefits Open Enrollment is here, giving you the opportunity to review and make changes to your
health and welfare benefits elections for 2015. These include medical, dental, vision, flexible spending
accounts, long-term disability, and life insurance. As described in the Preview Brochure and the Harvard
Benefits: What’s New in 2015 multimedia presentation, which were made available to you earlier this fall,
we have made some important changes to our benefits for 2015.
Harvard is proud of the strong package of total rewards that we offer and remains committed to
providing high-quality, affordable health care. This guide will provide you with additional information
on the changes, how they may affect you, and programs and benefits that can help you manage
additional costs. Being an informed consumer is the best way to get the health care you need and
the most value from your Harvard benefits.
Many of the benefits changes for 2015 were laid out in the Preview Brochure and the multimedia presentation, but we recognize
the importance of continuing to help members of the Harvard community better understand their benefits. There are many
opportunities to learn more at online and in-person information sessions being held in late October and early November.
Among the changes this year, some may pay more for some kinds of services (e.g., surgery, hospitalization, advanced diagnostic
testing) through the introduction of deductibles and coinsurance. At the same time, Harvard is taking steps to help limit or
offset these additional costs—such as lowering monthly premiums and annual out-of-pocket maximums for in-network care, and
creating a new Reimbursement Program for those with an annual full-time equivalent (FTE) salary of $95,000 or less. Preventive
care will continue to be provided at no charge, with office visits and prescriptions provided for only a copayment. And there are
steps you can take to help reduce the costs you pay, such as enrolling in a tax-advantaged Flexible Spending Account or a Health
Savings Account.
This guide is designed to help you make fully informed decisions about your 2015 benefits. You can find these resources and more
on HARVie (harvie.harvard.edu) as well as our external HR website (hr.harvard.edu). It is important that you understand these
changes and the impact they will have on you, so you can make the choices that best meet your needs and those of your family.
Sincerely,
October 2014 5
Background Behind the Changes
Harvard, like most employers, must respond to the
national trend of rising health care costs, including some
driven by health care reform. Even with the changes we
have made over the past several years, health care costs Did you know?
continue to be a challenge, growing at a pace that threatens Harvard spends over a half billion dollars a year
our ability to make necessary investments in Harvard’s for benefits.
mission, sustain our benefits, and pay competitive salaries.
To ensure that high-quality health care remains affordable
and sustainable for the University and its faculty and staff,
we are changing the way we share in the cost of care for
some kinds of medical services.
As the University Benefits Committee* and our senior
leaders developed the changes that will take effect on The Impact of Health Care Reform
January 1, 2015, they did so with the intent to preserve the The Affordable Care Act (ACA, also known as
health plans on which you and your family rely. Harvard health care reform) has brought new benefits and
remains committed to these guiding principles: opportunities to many people, but with added
• Access to health care, and to top-rated doctors, costs to plan sponsors like Harvard. Some of the
providers, and networks in Boston’s quality-rich area. additional costs for Harvard are in the areas of:
• Choice of both proven and innovative plan designs. • Extending coverage for children up to the
age of 26.
• Affordability for all of our people.
• Preventive care—which is fully paid by the
• Fairness in cost-sharing between the University and its University.
faculty and staff, and among health plan participants.
• Additional taxes and fees that began in 2012,
• Transparency so that we can all become more aware and are ongoing.
of how much health care actually costs and the cost
differences between providers. • A potential 40% excise tax on the value of health
insurance benefits exceeding certain thresholds,
*Read more about the thinking and deliberations of the University which is scheduled to go into effect in 2018.
Benefits Committee at: news.harvard.edu/gazette/
story/2014/09/changes-to-harvard-health-care.
6
Health Care Choices and Changes in 2015
HMO, POS, and PPO Medical Plans
In 2015, for the HMO, POS, and PPO plans, the monthly premiums will decrease. The plans will now include deductibles and
coinsurance for some kinds of non-preventive care. It’s important to understand what each term used in this guide means:
• Deductible: The amount you must pay for health care services before the health plan begins to pay.
• Coinsurance: Your share of the cost of health care services, after the deductible.
• Out-of-Pocket Maximum: The maximum amount you will be required to pay during a calendar year for covered health
care, excluding premiums, after which your medical plan will pay 100% of covered health care costs. Please note: Because
Harvard is instituting a “global” out-of-pocket maximum, virtually all eligible out-of-pocket medical costs, including copayments for office visits
and prescriptions, deductibles, and coinsurance will count toward your out-of-pocket maximum.
Important: The deductibles and coinsurance do not apply to in-network preventive services (such as annual physicals and
well-baby visits, immunizations, and preventive testing and screening), which continue to be covered at 100%. In addition, the
deductibles and coinsurance will not apply to in-network office visits for care of sickness or injury, outpatient mental health,
or prescription drugs; these will continue to have the same copayments as they do today. Please see Services and Charges at a
Glance on page 8 for more detailed information.
New cost structure for certain kinds* of non-preventive care in the HMO, POS, and PPO plans
HMO POS and PPO
Plan Feature
What you pay… What you pay…
In-Network Out-of-Network In-Network Out-of-Network
$250 per person, $250 per person, $750 per person,
Deductible* up to a maximum up to a maximum up to a maximum
of $750 per family Services of $750 per family of $2,500 per family
received from an
Coinsurance* 10% out-of-network 10% 30%
provider are not
Out-of-Pocket Maximum $1,500 per person, covered by the $1,500 per person, $2,500 per person,
(includes deductible, coinsurance, up to a maximum HMO plans. up to a maximum up to a maximum
and copayments) of $4,500 per family of $4,500 per family of $7,500 per family
Here’s how the new cost structure works for certain kinds* of non-preventive medical expenses:
You pay for the full You and Harvard, Once you reach
1st cost of your care 2nd through coinsurance, 3nd the out-of-pocket
for certain medical each pay for a portion maximum for
expenses until you of these covered each individual,
reach your deductible. health care services. Harvard pays 100%
of eligible costs.
You will not pay more for covered health care services than the out-of-pocket maximum in a given year. If your annual FTE
salary is $95,000 or less, Harvard offers a program that can help reduce your overall out-of-pocket expenses by providing
reimbursement for eligible expenses. See page 19 for additional information.
*Deductibles and coinsurance do not apply to in-network preventive care or to services where copayments apply, such as office visits. Please
see Services and Charges at a Glance on page 8 for more details.
7
How does this translate into costs in 2015?
For the HPHC and HUGHP HMO, POS, and PPO plans, you will pay a deductible and coinsurance, up to the annual out-of-
pocket maximum, for certain medical services, including:
• Hospitalization Please note that out-of-network services in the POS and
• Surgery PPO plans have separate deductibles, coinsurance, and
• Advanced diagnostic testing out-of-pocket maximums.
Services and Charges at a Glance
This chart summarizes the kinds of care that are provided by the HMO, POS, and PPO plans (in-network) without charge,
those that are subject only to a copayment, and those that are subject to an annual deductible and coinsurance—up to the
annual out-of-pocket maximums.
Copayment Annual deductible,
only then 10% coinsurance
No
Type of care charge Up to out-of-pocket maximum
Routine examinations for preventive care, including
immunizations and routine vision exams
Office visits for non-preventive care of sickness and injury, authorized
office visits for consultations/evaluations with specialists
Rehabilitation, speech, occupational, chiropractic, and physical therapy
Prescriptions
Outpatient mental health services including group
and individual therapy, detoxification
Emergency room care (copayment is waived
if admitted directly to the hospital)
Inpatient hospitalization (e.g., acute care,
maternity, rehabilitation, mental health)
Intermediate mental health care services (e.g., acute residential
treatment including detoxification, intensive outpatient
programs, partial hospitalization, and day treatment)
Hospice, skilled nursing, home health care
Non-preventive laboratory and radiology services (including
advanced radiology such as CT and PET scans)
Surgery—inpatient and outpatient (including
colonoscopy, endoscopy, and sigmoidoscopy)
8 This is a summary of services and charges only and not a complete listing of plan coverage, provisions, or limitations.
How the family deductibles and out-of-pocket maximums work for two-, three-, and four-person-plus families
Two-person family Three-person family Four-person-plus family
If you cover yourself and one If you cover yourself and two The in-network deductible and out-of-
dependent under family coverage, dependents, your in-network deductible pocket maximum are capped at $750
your in-network deductible will be will be $750 for the family ($250 and $4,500 per family, respectively.
$500 ($250 per person), and your per person), and your in-network If you cover yourself and three or more
in-network out-of-pocket maximum out-of-pocket maximum will be dependents, your in-network deductible will
will be $3,000 ($1,500 per person). $4,500 ($1,500 per person). be $750 for the family, and your in-network
out-of-pocket maximum will be $4,500.
Important note: For a family HMO, POS, or PPO plan, Harvard’s 90% coinsurance begins for each covered individual after the annual
in-network individual deductible ($250) is met for that person, and moves to 100% when the in-network out-of-pocket maximum ($1,500)
is met for that person.
Example: Emily is enrolled in individual coverage through
the HUGHP HMO medical* plan. She needs minor surgery
that will cost $2,000. Emily is using an in-network provider.
Her annual in-network deductible is $250. Programs That Can Reduce Your
Out-of-Pocket Expenses
Before the plan starts to pay,
Tax-Favored Programs
1st Emily will need to reach her
Flexible Spending Account (FSA): Participate in, or
annual $250 deductible.
increase your contribution to, an FSA in 2015. By
Once Emily pays her $250 doing so, you lower your taxable income and can use
deductible, the remaining cost the money you contribute toward out-of-pocket health
for her surgery is $1,750. care costs in an HMO, POS, or PPO plan in 2015.
Now, coinsurance begins… Reimbursement Program
Emily pays 10% of the If your annual full-time equivalent (FTE)* salary
remaining $1,750, which is $95,000 or less and you enroll in an HMO, POS,
2nd is $175. or PPO plan, you can take advantage of Harvard’s
Reimbursement Program. You will be reimbursed for
The plan pays 90% of the any eligible in-network out-of-pocket costs you incur
remaining $1,750, which over the 2015 thresholds.
is $1,575.
Learn more on page 18.
Emily’s total cost for this surgery is $425; her deductible is
*Your annual full-time equivalent (FTE) salary is the salary
$250 and her coinsurance is $175. Both count toward her
you earn if you work full-time, or if you work part-time, it is the
out-of-pocket maximum.
salary you would earn working full-time at the same rate of pay.
For any remaining 2015 in-network medical services that
are subject to coinsurance, Emily will pay 10% of the cost,
up to the plan’s out-of-pocket maximum of $1,500 (any
other out-of-pocket expenses, such as copays, will also
count toward this maximum).
This example is provided for illustrative purposes only. Individual Did you know?
situations may differ. 2015 health plan premiums will decrease, so less
is taken from your paycheck. You can see the
*Please note, HPHC and HUGHP HMO, POS, and PPO plans premiums in the 2015 Rates and Plan Comparison
work similarly in this example; the costs are different for the new Chart, enclosed in this package.
High-Deductible Health Plan. See page 15 for more information.
9
Examples of the Cost of Care under the New HMO, POS, and PPO Plans
It’s important to understand how these changes could affect you. Take a look at some examples of how costs—yours and
Harvard’s—may work under the new cost structure for the HMO, POS, and PPO plans.
These examples are provided for illustrative purposes. Individual situations may differ.
Example from Real Life: Having A Baby
Sarah has a routine pregnancy and delivers a healthy baby by C-section
Treatment Typical Costs Sarah Would Pay Why?
Initial office visit $200 $20 Office visit copayment
Initial lab work $83 $83 Diagnostic testing; $83 paid toward
annual $250 deductible
Initial ultrasound $325 $183 Diagnostic testing; $167 paid to meet annual
deductible; $16 is 10% coinsurance on the balance
Maternity office visits (7) $1,400 $0 Preventive care, no charge
Lab work, pre-delivery $497 $50 Diagnostic testing; 10% coinsurance
Ultrasounds, pre-delivery (7) $2,275 $228 Diagnostic testing; 10% coinsurance
Inpatient C-section delivery $15,000 $936 10% coinsurance up to $1,500 annual
out-of-pocket maximum
Breast pump—durable $220 $0 Covered at no charge
medical equipment
Newborn care $2,500 $0 Annual out-of-pocket (OOP) maximum met
Total $22,500 $1,500* $20 copayment, $250 deductible,
$1,230 coinsurance
See FAQs on the HARVie 2015 Open Enrollment page for more details about maternity and parental benefits.
Assumptions: All services are provided in-network. Sarah has family HMO coverage in a 2015 (faculty and nonunion staff) plan.
*These predictable medical costs could be reduced through the use of a tax-favored flexible spending account (FSA). At a 20% tax savings,
the net cost to Sarah’s family for the delivery would be $300 less.
10Example from Real Life: Serious Illness
Jane is receiving treatment for breast cancer
Treatment Typical Costs Jane Would Pay Why?
Annual mammography
$300 $0 Preventive care, no charge
screening
$250 to meet annual deductible, plus 10%
Biopsy $2,600 $485
coinsurance ($235) on the balance for the procedure
Pre-surgical office visit $215 $20 In-office care subject to only a copayment
10% coinsurance, up to $1,500 annual
Outpatient surgery $11,000 $995
out-of-pocket maximum
Post-surgical office visit $215 $0 Annual out-of-pocket (OOP) maximum has been met
Lab work/testing $10,000 $0 Annual out-of-pocket (OOP) maximum has been met
Chemotherapy/radiation $44,000 $0 Annual out-of-pocket (OOP) maximum has been met
Post-treatment office
$2,369 $0 Annual out-of-pocket (OOP) maximum has been met
visits for follow-up (11)
$250 deductible, $1,230
Total $70,699 $1,500*
coinsurance, $20 copayment
Assumptions: All services provided are outpatient and in-network. Jane has individual HMO coverage in a 2015 (faculty and nonunion staff) plan.
Example from Real Life: Serious Mental Illness
Tom needs care for major depression
Treatment Typical Costs Tom Would Pay Why?
$250 to meet deductible and 10% coinsurance
Inpatient hospitalization $18,000 $1,500 ($1,250) on the balance, up to $1,500
annual out-of-pocket maximum
Outpatient counseling
$3,500 $0 Annual out-of-pocket (OOP) maximum has been met
(35 visits)
Generic medication
$280 $0 Annual out-of-pocket (OOP) maximum has been met
(14 prescriptions)
Total $21,780 $1,500* $250 deductible, $1,250 coinsurance
Assumptions: All services are provided in-network. Tom has individual HMO coverage in a 2015 (faculty and nonunion staff) plan.
*For both Jane and Tom, if they have an annual FTE salary of less than $70,000 they would each be eligible for a $600 reimbursement of these
out-of-pocket costs. If they have an annual FTE salary of $70,000 to $95,000, they would each be eligible for a reimbursement of $250 for these
out-of-pocket costs. See page 19 for more details.
11Dental Plan
We are providing enhanced dental coverage through an innovative collaboration with Delta Dental. This change will give
participants greater financial protection against exceptionally high dental expenses by providing additional benefits beyond
the current annual benefit of $3,000. This enhanced benefit replaces the rollover maximum feature, which will be discontinued
as of December 31, 2014.
Here’s How It Works Once you reach the Level 1 annual maximum benefit
Dental coverage remains the same with Level 1 benefits: of $3,000, Level 2 benefits begin. This coverage will apply
automatically—there is no need to enroll and it is included
• For preventive services, you pay no deductible, and in the premium you pay.
the service is covered at 100%.
• For preventive and diagnostic services, you pay no
• For basic, restorative, and major services, you pay deductible, and the service is covered at 100%.
a deductible, and the service is covered at 75%, up
to $3,000. • For basic, restorative, and major services, you pay an
additional deductible of $500 per individual (there is no
• Orthodontic* services are covered at 50% (with no family deductible), and the service is covered at 75%,
deductible) for children under age 19, with a lifetime with no annual plan maximum.*
benefit of $1,500 per person.
This additional level of coverage can provide you with
valuable insurance protection that doesn’t exist today.
2015 Dental Plan
Plan Feature Level 1 Benefit Level 2 Benefit
$50 Per Individual $500 Per Individual
Annual Deductible
$150 Family Maximum (No family deductible)
Preventive and
100%, no deductible Reach $3,000 100%, no deductible
Diagnostic Services
Maximum
Basic Services 75%, after deductible 75%, after deductible
Major Services 75%, after deductible 75%, after deductible
Annual Plan Maximum $3,000 Unlimited
*Orthodontic services are not included in the Level 2 benefit.
In-Network Out-of-Network
The percentages described above apply when using When using an out-of-network dentist your costs may be
a dentist in the Delta Dental network. Participating higher. You may be “balance billed” for any difference
dentists cannot bill you for fees beyond those approved between the plan’s approved cost and the dentist’s charge.
by Delta Dental (a practice called “balance billing”).
12Pharmacy Benefits medication, you will need to get a new prescription from
your physician and submit it to Catamaran. Once they
Prescription drug coverage is included with all HPHC and
receive the prescription, the mail-order process can take
HUGHP medical plans (HMO, POS, PPO, and HDHP).
up to 14 days to resume;
Prescription drug coverage has three copayment tiers, with
generic medications having the lowest copayments. You • subject to prior authorization requirements or exceeds
can save even more on medications you take regularly, typical quantity limits.
sometimes called maintenance medications, by using Harvard faculty and staff can contact Catamaran’s
mail order. Customer Service Center at 844-265-1224 beginning
Prescription drugs are not subject to a deductible under October 27, 2014 with any questions. To learn more
the HMO, POS, and PPO plans—just copayments. Under about the 2015 Formulary, visit Catamaran’s Open
the new HDHP, you must meet the plan deductible before Enrollment online portal, which can be accessed via
the plan covers prescription drug costs; once you meet HARVie (select Compensation & Benefits > 2015 Open
the deductible, the same copayment structure applies. Enrollment) or at hr.harvard.edu, under Total Rewards.
See HARVie or the enclosed 2015 Plan Comparison Chart All employees will receive new pharmacy ID cards before
for costs. January 1, 2015. Once you receive your new ID card,
For 2015, Harvard has chosen Catamaran, which is it is very important to present it when filling any
expected to offer enhanced customer service, as our new prescriptions on or after January 1, 2015. You will also
pharmacy benefits administrator. Catamaran is one of the receive a Welcome Kit with more information.
largest pharmacy benefits administrators in the U.S. and Other Benefits to Consider
provides a number of online tools to help you manage
your prescription benefits (see the enclosed FAQs for Vision Plan
more information). It is recommended that you have on Davis Vision provides you and your covered dependents
hand a three-week supply of your medication during with coverage for in-network vision exams, eyewear, and
the transition. There are no changes to the copayment contact lenses (with copayments), and discounts for out-
structure for prescription drugs in 2015, which remains: of-network services and laser surgery. Davis Vision has a
broad, nationwide network of participating providers. To
Mail- find one near you, call Davis Vision at 800-448-8245, or
Retail Order visit davisvision.com and enter Client Code 2556. See
(30-day (90-day HARVie or the enclosed 2015 Plan Comparison Chart
What you pay for... supply) supply) for costs.
Generic Drugs $7 $14
Long-Term Disability (LTD) Insurance
Preferred Brand-Name Drugs $20 $50 Optional LTD insurance protects your financial security
Non-Preferred if you become unable to work due to illness or disability.
$45 $110 If you elect LTD insurance, you must provide evidence
Brand-Name Drugs
of insurability (EOI) by completing a Medical History
While the copayments themselves are not changing, Statement, available on the PeopleSoft Open Enrollment
you may see adjustments to where your medication falls page. Final approval comes from The Standard. See
(and how much it will cost) on the plan’s preferred drug HARVie or the enclosed 2015 Rates and Plan Comparison
list, also called a Formulary. You will receive personal Chart for costs.
communication from Catamaran beginning in November
if your prescription is: Supplemental Life Insurance
• expected to change cost “tiers”—so that you may Supplemental Life Insurance coverage is available at 1 to 5
explore a generic or preferred brand-name alternative times your annual salary (up to a maximum of $1.25
with your doctor if one is available and you so desire; million). If you need to complete a Statement of Health
• a mail-order prescription transferring from Express form, it will be mailed to you in December. Final approval
Scripts—in this case, you will need to provide new comes from MetLife. A medical statement will be sent
shipping and payment information to Catamaran; to you at the mailing address Harvard has on file. See
HARVie or the enclosed 2015 Rates and Plan Comparison
• a mail-order prescription that will not transfer from Chart for costs.
Express Scripts. This may happen if there are no refills
remaining on it, it is a controlled substance, the “refill
by” date has expired, it is being held for a future fill date,
or it is a compound medication. If you still need the 13Introducing the High-Deductible Health Plan (HDHP)
with Health Savings Account (HSA) and a Limited-Purpose FSA
The High-Deductible Health Plan with HSA is a different
approach to how you pay for today’s health care and save
for your future. It is a lower-premium, high-deductible
health insurance plan, which means you pay less out of Did you know?
your paycheck for premiums and more out of pocket at Two-thirds of U.S. employers with 1,000 or more
the point of care—before the plan pays for services that employees offer a high-deductible health plan.
are not considered preventive. Harvard’s new HDHP
meets the federal requirements that allow an enrollee to
also qualify for a tax-advantaged HSA.
There Are Several Features of the HDHP with HSA
Health Plan A Pre-Tax Savings Plan Debit Card
The HDHP provides you the (Health Savings Account) With your HSA, you receive a
flexibility to receive care from both If eligible, you can contribute via debit card that you can use for
in-network and out-of-network payroll deduction on a pre-tax basis easy access to your account (once
providers (you’ll pay more for to a Health Savings Account (HSA) funds are accumulated) to pay for
out-of-network providers). to pay for out-of-pocket medical out-of-pocket medical expenses,
In-network preventive care services expenses, including deductibles, including your copays, prescriptions,
are covered at 100%—meaning coinsurance, and copayments. and other health care costs.
you do not pay for this type of The HSA is a fully employee-owned If you decide to also enroll in the
service (as defined by the plan). account. Funds roll over from year to Limited-Purpose FSA—which
For all other services, you are year. There is no “use it or lose it” rule. reimburses you for eligible dental
responsible for paying the full cost Once the balance in your savings and vision expenses only—your FSA
of care until you reach the plan’s account reaches $2,100, you can dollars will be loaded onto the
deductible. You are then responsible select from a choice of investment same debit card. See pages 18-19 to
for a portion of the cost of care options, in $100 increments. learn more about FSA coverage.
(your coinsurance), until you reach For 2015, Harvard will make
the plan’s out-of-pocket maximum. a tax-free contribution to your
See the HDHP with HSA Summary account—you must open an HSA,
Chart on page 15 for details. through Harvard’s third-party
You can also see a side-by-side administrator, Benefit Strategies,
comparison of all plans on in order to receive this funding:
pages 20–21. • $500 for individual coverage
• $1,000 for family coverage
14HDHP Summary Chart
Plan Feature In-Network Out-of-Network
Preventive Care Covered at 100% Deductible, then 35% coinsurance
$1,500 (individual)|$3,000 (family)
Deductible* For family coverage, the full family deductible must be met
before plan (Harvard) coverage begins.
Coinsurance (once deductible is met) 15% coinsurance 35% coinsurance
$3,000 (individual)| $6,000 (individual)|
$6,000 (family) $12,000 (family)
Out-of-Pocket Maximum (includes
For family coverage, the full For family coverage, the full
deductible, coinsurance, and
family out-of-pocket maximum family out-of-pocket maximum
prescription drug costs)
must be met before 100% plan must be met before 100% plan
(Harvard) coverage begins. (Harvard) coverage begins.
Emergency Room Deductible, then 15% coinsurance
All other covered non-preventive care
such as: PCP/Specialist Office Visits;
Hospital Admission; Outpatient Deductible, then 15% coinsurance Deductible, then 35% coinsurance
Surgery; In-patient Surgery; Advanced
Diagnostic Testing; Lab/X-Rays
Prescription Drugs (Retail/Mail-Order)
• Generic $7/$14, after deductible
• Preferred Brand-Name $20/$50, after deductible
• Non-Preferred Brand-Name $45/$110, after deductible
*The deductible applies to all non-preventive health care expenses. Amounts paid for covered in-network and out-of-network care are combined
to satisfy the deductible.
15Features of a Health Savings Account (HSA)
An HSA provides you with flexibility in how you pay for • Save for Tomorrow: If you save more money than you
medical services today and in the future. spend on health care expenses in the plan year, you can
• Tax Advantages: Your contributions to your HSA come use that money in the future. Any money remaining
out of your paycheck before taxes are withheld, so every in this account at the end of the plan year rolls over
dollar that goes toward your HSA reduces your taxable into the next year—and, even if you leave Harvard, the
income. Participants can also make contributions to the money remains yours.
HSA with after-tax dollars. (Because this is a tax-favored • Invest for Your Future…Tax-Free: Once the balance in your
account, there are IRS limits on annual contributions; HSA reaches $2,100, your funds will be automatically
see chart below for details.) directed into the investment you select—helping you
• Use It Today: Pay for regular health care expenses, build savings for your future. When used to pay for
including deductibles, coinsurance, copayments, and qualified medical expenses, distributions from your HSA
prescription drugs, with an easy-to-use debit card. are tax-free.
• Catch-up Contributions: Employees 55 years of age or older
can contribute additional dollars to their HSA. See the
chart below for details.
2015 HSA Maximum Contributions
Coverage Level HSA Contribution HSA Contribution for Age 55+
$3,350 $4,350
(Total includes: $2,850 employee contribution plus (Total includes: $2,850 employee contribution plus
Individual
$500 Harvard contribution) $1,000 age 55+ catch-up contribution plus
$500 Harvard contribution)
$6,650 $7,650
(Total includes: $5,650 employee contribution plus (Total includes: $5,650 employee contribution plus
Family
$1,000 Harvard contribution) $1,000 age 55+ catch-up contribution plus
$1,000 Harvard contribution)
16What You May Want to Consider
As with any benefit choice, there are things you should
carefully consider prior to enrolling. As you think about HSA Requirements
your health care needs, be sure you understand how the
medical plan works. Here are some things to keep in mind • You cannot be covered under another non-
as you review the HDHP with HSA plan compared to HDHP medical plan or Health Care FSA (such
Harvard’s other options: as your spouse’s plan/FSA) and contribute, or
receive Harvard’s contribution, to the HSA.
• Lower Premium: You pay less out of your paycheck for
coverage. • HSA contributions must be in your account
before you can use them to pay for eligible
• Higher Out-of-Pocket Costs: You pay 100% of any medical expenses or receive reimbursement.
non-preventive expenses until you meet your deductible Please note that Harvard’s funding will be
before the plan pays for services. deposited on January 2, 2015.
– Deductible: If you’re enrolled in family coverage, you • You must be under age 65 and not enrolled in
must meet the entire family deductible before the plan pays— Medicare to contribute, or to receive Harvard’s
unlike the HMO, POS, and PPO plans. contribution, to the HSA.
– Out-of-Pocket Maximum: If you’re enrolled in
family coverage, you must meet the entire family out-of-pocket
maximum before the plan pays 100%—there is no per-
person maximum like there is in the HMO, POS, and
PPO plans.
If you enroll in the HDHP for 2015 and currently
• Access to the Same Doctors and Networks: The
have a 2014 Health Care FSA, you must have a
HDHP with HSA is offered through Harvard Pilgrim
$0 balance in your FSA by December 31, 2014
Health Care and HUGHP Blue Cross Blue Shield of
to be eligible for an HSA in January 2015.
MA, so you will continue to have access to doctors and
networks that are currently part of these health plans. If you have a balance remaining in your Health Care
Additionally, HUGHP HDHP members will have access FSA as of January 1, 2015, you will not be eligible to
to an expanded network of Blue Cross Blue Shield of enroll in the HSA or receive Harvard’s contribution
MA providers that includes Harvard University Health until April 1, 2015.
Services (HUHS) providers. If this occurs, you will not be able to use HSA funds
• Limited-Purpose Flexible Spending Account: to get reimbursed for medical costs incurred before
According to federal regulations, HSA participants April 1.
are not eligible to participate in a regular Health Care
Flexible Spending Account (FSA). However, HSA
participants can participate in the Limited-Purpose FSA,
which provides a tax-free way to save and pay for dental
and vision expenses not covered by your health plan.
All other Health Care FSA rules and features apply to
the Limited-Purpose FSA—same maximum, same use-
it-or-lose-it rule, same claim-filing deadline, and if you
enroll, you will receive a debit card to pay for eligible
dental and vision expenses. If you elect an HSA, you will
receive one combined debit card.
17Programs That Can Reduce Your Out-of-Pocket Expenses
Save on Eligible Expenses with • Dependent Care FSA: You can use this account to
a Flexible Spending Account (FSA) contribute up to $5,000 on a pre-tax basis to be used
Participating in an FSA can help you lower your taxable to reimburse eligible dependent day care expenses.
income while paying for eligible health care and/or Covered dependents include a dependent child under
dependent day care expenses. You contribute to your FSA age 13, a disabled spouse, or a disabled dependent of
before taxes are withheld from your paycheck, meaning any age. Your health plan enrollment has no impact on
that every dollar that goes toward your FSA reduces your your eligibility for the Dependent Care FSA.
taxable income. Let’s take a look at this example: • Limited-Purpose FSA: You can use this account to
contribute up to $2,500 on a pre-tax basis to be used to
No FSA FSA reimburse out-of-pocket dental and vision expenses.
Assumptions Contribution Contribution Important: Per federal regulations, if you enroll in a
Your income $75,000 $75,000 qualified HDHP with an HSA, such as the one being
introduced at Harvard in 2015, you are only eligible to
You contribute $0 $2,000 enroll in a Limited-Purpose FSA.
Taxable income $75,000 $73,000 You must enroll annually during Open Enrollment
Taxes you pay in order to have an FSA for the following year—your
(based on 22.65% election in an FSA does not carry over from year to
$16,988 $16,535 year. If you enroll in any of the FSA plans for 2015, you
federal income and
FICA tax rate) will receive a debit card that can be used to pay eligible
expenses from participating providers and merchants.
This example is provided for illustrative purposes only. Individual
situations may differ, and tax savings will depend upon your tax rate.
By using an FSA, you can save $453 in taxes and use the Remember: Use It or Lose It
$2,000 you saved pre-tax to pay for eligible, out-of-pocket Any money left in your FSA(s) at the end of the
health care expenses. plan year is forfeited.
If you know that you will have out-of-pocket costs for Grace Period Reminder: You may incur expenses
health care or dependent care during the year, enrolling in until March 15, 2016 for reimbursement from
an FSA might be the right choice for you. But remember— your 2015 FSA(s). All claims for reimbursement
FSA funds do not roll over from year to year. Unused must be postmarked by March 31, 2016.
funds in your FSA are forfeited. So estimate carefully—
you will need to use it or lose it!
The debit card makes it easier to manage your cash flow—
FSAs Available to You you don’t need to pay and then file for reimbursement.
You are eligible to enroll in one of the following FSAs However, you may be asked to submit receipts after using
whether or not you are enrolled in a Harvard-sponsored your debit card—you must save receipts/documentation for all
health plan. purchases made with an FSA debit card.
• Health Care FSA: You can use this account to With the Health Care and Limited-Purpose FSA, your
contribute up to $2,500 on a pre-tax basis to be used to entire elected amount is available as of January 1—you
reimburse out-of-pocket medical, dental, and vision don’t need to wait until all your contributions have been
expenses. Important: A Health Care FSA can also aid in made. So, if you need money for a bigger expense early in
managing the costs of the copayments, deductibles, and the year, the funds are there. For the Dependent Care FSA,
coinsurance in the Harvard-sponsored HMO, POS, and you may only be reimbursed up to the amount in your account as of
PPO plans. the date you request reimbursement.
If you want to participate in an FSA for 2015, you must
elect this coverage by going to PeopleSoft during Open
Enrollment. The deadline to elect 2015 participation is
8:00 p.m. ET, Wednesday, November 19, 2014. The
18 2015 FSA plan year begins January 1, 2015.of costs and reflect the 2015 plan changes. The program
New FSA Administrator for 2015
is not available to HDHP participants. You do not need to
We are moving to a new FSA administrator—Benefit enroll in this program. However, you will need to submit a
Strategies. In addition to high marks in the area of claim for reimbursement, if eligible.
customer service, Benefit Strategies offers additional
online tools to help you manage your account. What’s Changing?
When you enroll for 2015, if you wish to be reimbursed • New Program Administrator. Benefit Strategies will be
through direct deposit, you’ll need to establish a new direct the administrator for our 2015 Reimbursement Program.
deposit account with Benefit Strategies. You’ll also receive • Broader Eligibility for Reimbursable Expenses.
a new debit card from them. Any eligible out-of-pocket, in-network medical expenses
And, new for 2015, if you enroll in the Dependent Care that you pay above the thresholds shown below can
FSA, you will receive a debit card that can be used to pay be reimbursed through the Reimbursement Program.
for eligible dependent care expenses (where accepted). Eligible expenses include amounts that you pay toward
your deductible and your coinsurance, along with
copayments for emergency room visits, office visits, and
prescription drugs. (Ineligible expenses include monthly
premiums and out-of-network costs.)
Transition: If you have an FSA for 2014, you will
• New Thresholds. You will be eligible to receive
need to submit any claims for your 2014 expenses
reimbursement for any out-of-pocket, in-network costs
through the current administrator, Crosby Benefits
that exceed these new thresholds.
Systems. Please note: Your 2014 FSA debit cards
will be deactivated as of December 31, 2014. You
Annual FTE
may request reimbursement either online or via paper
Salary of
submission. You can find reimbursement request
Covered
forms on HARVie (harvie.harvard.edu): select the
Harvard 2015 Individual 2015 Family
link to “Forms” at the top of the page and click FSA.
Employee Threshold Threshold
You have until March 15, 2015 to incur expenses
and until March 31, 2015 to submit expenses to Under $70,000 $900 $2,250
Crosby for reimbursement from your 2014 FSA. $70,000–$95,000 $1,250 $3,125
Be sure to use up any 2014 funds before spending
2015 funds. You may not be reimbursed for the same expenses through
the Reimbursement Program and the Health Care FSA.
However, you may cover expenses up to the thresholds
shown above with money saved in your FSA without
affecting your eligibility for the Reimbursement Program.
FSA Direct Deposit
For 2015, if you wish to be reimbursed via direct
deposit, you will need to establish a new direct Did you know?
deposit account with Benefit Strategies (even
if you currently have this set up with Crosby The Reimbursement Program is available to
Benefits Systems). you if your annual FTE salary is $95,000 or less
and you are enrolled in a 2015 HMO, POS,
or PPO plan.
Manage Your Health Care Costs
To learn more about the Reimbursement Program,
with Our Reimbursement Program including deadlines and information on filing a claim
Harvard’s new Reimbursement Program provides an through our program administrator, Benefit Strategies,
important financial protection for those earning an annual please visit the HARVie 2015 Open Enrollment page.
full-time equivalent (FTE) salary of $95,000 or less who
are enrolled in the 2015 HMO, POS, or PPO health plans.
The Reimbursement Program will cover a broader range
19Medical Plan Comparison Chart
There is a lot for you to consider to make well-informed benefits choices and get the most value from them. Take the
time to review this Medical Plan Comparison Chart to help you choose the plan that is right for you and your family.
Plan Comparison Chart
Plan Feature HMO
In-Network Out-of-Network
Preventive Care
Covered at 100%
Non-Preventive Care Services
• Office Visit: PCP/Specialist $20
• Emergency Room Visit $100
• Other Medical Services
Deductible,
(for example, hospitalization, surgery, advanced
then 10% coinsurance
diagnostic testing)
Prescription Drugs: Retail (30-day supply)/Mail-Order (90-day supply)
• Generic $7/$14
• Preferred Brand $20/$50
• Non-Preferred Brand $45/$110 Services
received from an
Deductible out-of-network
provider are not
$250 per person, up to a covered by the
maximum of $750 per family HMO plans.
Coinsurance
10%
Out-of-Pocket Maximums**
Individual and Family $1,500 per person, up to a
(includes deductible, coinsurance, and copayments) maximum of $4,500 per family
Programs That Can Reduce Your Out-of-Pocket Expenses
• Health Care FSA (medical, dental, and vision) Yes
• Limited-Purpose FSA (dental and vision only) No
• Health Savings Account (HSA) No
• Reimbursement Program if Annual Yes
FTE Salary is $95,000 or less
*Amounts for both in-network and out-of-network care can be combined to satisfy this deductible in the HDHP. However, for family coverage, the
entire family deductible must be met before the plan begins to share costs for any individual family member.
**There are two separate out-of-pocket maximums—one for in-network care and one for out-of-network care. They accrue separately, which means
that neither counts toward the other.
20Programs to Help You Manage Out-of-Pocket Expenses
Harvard understands that you may be paying more at the point of care in 2015. That’s why we have developed
programs that can help with these additional costs. Most faculty and staff are eligible to participate in a flexible
spending account (FSA), which helps you pay for expenses in a tax-effective way that will save you money.
And, if you have an annual FTE salary of $95,000 or less, you can recoup a portion of your eligible out-of-pocket
HMO, POS, or PPO medical expenses through Harvard’s Reimbursement Program.
Learn more about “Programs That Can Reduce Your Out-of-Pocket Expenses” on page 18.
POS and PPO HDHP
In-Network Out-of-Network In-Network Out-of-Network
Deductible, Deductible,
Covered at 100% Covered at 100%
then 30% coinsurance then 35% coinsurance
Deductible, Deductible, Deductible,
$20
then 30% coinsurance then 15% coinsurance then 35% coinsurance
$100 $100 Deductible, then 15% coinsurance
Deductible, Deductible, Deductible, Deductible,
then 10% coinsurance then 30% coinsurance then 15% coinsurance then 35% coinsurance
$7/$14 $7/$14, after deductible
$20/$50 $20/$50, after deductible
$45/$110 $45/$110, after deductible
$250 per person, up to a $750 per person, up to a
maximum of $750 per family maximum of $2,500 per family $1,500 for individual coverage
Does not count toward Does not count toward $3,000 for family coverage*
out-of-network deductible. in-network deductible.
10% 30% 15% 35%
$1,500 per person, up to a $2,500 per person, up to a $3,000 for individual coverage $6,000 for individual coverage
maximum of $4,500 per family maximum of $7,500 per family $6,000 for family coverage $12,000 for family coverage
Yes Yes No No
No No Yes Yes
No No Yes Yes
Yes No No No
(only in-network costs are eligible)
21Other Resources and Information
These changes represent new opportunities and – This Benefits Open Enrollment Guide is available
responsibilities for you. It’s important that you take the online so you can access the information at any time.
time to review the information available—and be sure to • Attend the Online and On-Campus Information
include members of your family in the process. There are Sessions available to you in late October through
several resources available to help you make the decision mid-November. Dates, times, and locations will be
that best fits your personal situation. posted on the 2015 Open Enrollment page on HARVie
• Within Harvard, go to HARVie; or explore Harvard’s (harvie.harvard.edu).
new external human resources website, hr.harvard.edu.
Both websites provide you access to the following
educational resources:
– The multimedia Harvard Benefits: What’s New in
2015 presentation guides you through the changes and
Important Contact Information
what to expect in 2015. It also provides information Harvard Pilgrim Health Care Total Assist line:
on how FSAs and HSAs can save you money. And 1-866-874-0817
don’t forget to take the self-assessment, whose answers
HUGHP Member Services: 1-617-495-2008
can help you focus in on the plan option(s) that may
be best for you. Harvard Benefits at: 1-617-496-4001 or
– The Preview Brochure sent to your home in September benefits@harvard.edu
is available online so you can access it at any time.
Dependents/Beneficiaries
To comply with federal regulations, we will begin collecting the Social Security numbers of dependents covered by Harvard-
provided health plans. To update this information, go to PeopleSoft > Self Service > Benefits > Dependent/Beneficiary Info
and select the name of the dependent whose information you’d like to update.
Your life insurance, retirement plan, and tax-deferred annuity provide a benefit to your designated beneficiary(ies) in the event
of your death. It is important to ensure that your beneficiaries on file are up to date, especially if you have had family changes.
You can review and update your beneficiaries by contacting:
Benefit To Review Your Beneficiaries To Update/Change
Forms section on HARVie
• Basic and Supplemental Contact Harvard Benefits
(harvie.harvard.edu), provides a Life
Life Insurance at benefits@harvard.edu
Insurance Beneficiary Form
Contact your investment vendor
directly (Fidelity, TIAA-CREF, and/
• Faculty Retirement Plan
or Vanguard); contact information Contact your investment
• 2001 Staff Retirement Plan
can be found on HARVie under vendor directly
• TDA
Compensation & Benefits > Retirement
Benefits > Retirement Plans
• Grandfathered retirement benefit
Contact Harvard Benefits Contact Harvard Benefits
(staff employed prior to 2001)
at benefits@harvard.edu at benefits@harvard.edu
• 1995 Retirement Plan
Harvard University Health Services (HUHS)
Harvard University Health Services offers a wide variety of services and benefits for the Harvard community, including both
Harvard University Group Health Plan (HUGHP) members and employees who select another health plan option. To find out
more about these services and benefits, visit huhs.harvard.edu.
22How to Review Current Coverage, Enroll in, or Make Changes
to Your 2015 Benefits
Benefits Open Enrollment is available online via
PeopleSoft from 8:00 a.m. ET on Wednesday,
November 5 through 8:00 p.m. ET on Wednesday,
November 19, 2014. (Due to nightly data processing, it
is best to make your elections between 6:00 a.m. and Review Your Current Coverage
9:00 p.m.) You can view your current coverage
in PeopleSoft.
Select the PeopleSoft link at the top of any page on
HARVie (harvie.harvard.edu) or from the new external • Under Benefits and Payroll Quick Links, select
Benefits Enrollment.
Harvard HR website (hr.harvard.edu). Log in using your
HUID as your user name and your Harvard personal • Then select Benefits Summary to review
identification number (PIN) as your password. your current 2014 coverage.
• Here you can verify and update your spouse
and dependent information:
– To update dependent information, select
edit next to the benefit plan in question.
Don’t Have a PIN/Password? If you are adding a dependent, you
If you do not have a PIN/password to log in to will need to submit documentation to
HARVie or PeopleSoft, you can: Benefits showing that your dependent
is eligible for Harvard’s plans.
• Follow the instructions at pin.harvard.edu;
if you have trouble with the online system, call
617-496-9001.
• Go to the Campus Service Center in Holyoke
Center 807; be sure to bring a government- Enroll or Make Changes
issued photo ID. During Benefits Open Enrollment, you
can make changes to your benefits directly in
PeopleSoft. If you do not have Internet access,
please call Benefits at 617-496-4001 so that
enrollment arrangements can be made for you.
Elections will be effective as of January 1, 2015.
System Requirements • Under Benefits and Payroll Quick Links, select
Benefits Enrollment.
Please note that PeopleSoft Self Service is
• At the Benefits Enrollment page, click the
compatible with: Select button. You will see your benefit
• Internet Explorer 8.0 and higher elections effective January 1, 2015, if you make
no changes.
• Chrome and Firefox 17 and higher on Windows
• If you do not want to change elections, click
• Safari 5 and higher Submit until you reach the Submit Benefit
• Firefox 17 and higher on a Mac Choices page. (Remember: FSA elections do
not carry over from year to year.)
• Remember, your elections are not complete
until you hit the Submit button on the Submit
Benefit Choices page.
23Confirmation of Your 2015 Elections
After Open Enrollment, you will receive a confirmation
of elections by mail in December from Harvard, even if Questions? Need Special Assistance?
you made no changes. Please open and review immediately,
Please call Benefits at 617-496-4001 between 9:00 a.m.
as all requested corrections must be postmarked by
and 5:00 p.m. ET, Monday through Friday, with
December 19, 2014. No changes, including FSA
any questions or email benefits@Harvard.edu.
elections, will be accepted after this date.
If you are out of the country without online
Health Care ID Cards access or will not otherwise be able to complete
your changes online during the Benefits Open
All employees enrolled in a Harvard-sponsored medical Enrollment period, call as soon as possible so
plan will receive a new health plan ID card for 2015. They that other arrangements can be made.
will also receive a new prescription drug ID card from our
incoming prescription drug administrator, Catamaran.
If you are newly enrolled in, or made changes to,
your medical, dental, or vision coverages during Open
Enrollment, you will receive a new plan ID card(s). If you
elect an HSA or FSA during Open Enrollment, you will
receive a debit card to use with these accounts.
If you make your elections by November 19, 2014, you
will receive new ID cards in late December. If you correct
your benefit elections after November 19, 2014, you may
see a delay in receiving your new plan ID cards and/or
your HSA or FSA debit card.
If you don’t take action during Open Enrollment…
Unless you have a qualifying life event (as defined by the Internal Revenue Service) during the year, Open
Enrollment is your once-a-year opportunity to update your coverage. If you do not log in to PeopleSoft during
Open Enrollment to make elections, your 2014 medical, dental, vision, life insurance, and long-term disability
coverages will automatically carry over to 2015.
However, please note that there are changes in the health and dental plans for 2015, so be sure to read this
guide before making any decisions about your elections for 2015.
If you are currently enrolled in a Health Care and/or Dependent Care Flexible Spending Account (FSA) and do
not re-enroll for 2015, you will not have an FSA in 2015.
This brochure has been designed to acquaint you with the features of the 2015 benefit plans, and every attempt has been made to summarize
them accurately. The actual provisions of each plan will govern if there is any inconsistency between this brochure and Harvard’s formal plans
and contracts.You can also read
