Orange County Community College 2009 Option Transfer and Open Enrollment October 1, 2008 - October 31, 2008 This Question and Answer format has been designed to provide brief answers to frequently asked questions. If you have specific questions, please do not hesitate to contact the Human Resource Department, for answers. 1. Q. What is Option Transfer? 1. A. Option Transfer is the College�s open enrollment period, during which you can make changes to your benefits without any special reasons, or �qualifying events�. These employer-sponsored benefits include: Medical Dental Vision Flexible spending plans (Health FSA and Dependent Care) Medical Buy Out Determine the coverage you (and all your eligible family members) will need for the new plan year, and request those changes during October. All approved requests will become effective January 1st of the coming year. (New enrollees: do not use your cards or benefits until that date.) 2. Q. What changes can I make during Option Transfer? 2. A. You can: Enroll in coverage if you are not already enrolled Remove some of your dependents from your Family coverage Remove all dependents from your Family coverage and downgrade to Individual Add additional dependents to your existing Family coverage Upgrade your Individual coverage to Family by adding dependents Remember: You can voluntarily remove eligible dependents but you must remove all ineligible dependents, as of the date each dependent lost eligibility. 3. Q. Who are my eligible dependents? 3. A. Your spouse to whom you are legally married Your unmarried children under 19 years of age: natural child legally adopted child stepchild who depends on you for financial support (supporting documentation may be required) a child for whom you have legal custody (requires additional documentation) Your financially dependent full-time student dependent age 19 to 25 (proof required) Your disabled dependent child (requires additional documentation) 4. Q. Can I cover my spouse if we are separated? 4. A. A separated spouse can be an eligible dependent if you choose to enroll him/her. 5. Q. Can I cover my ex-spouse if I am required to continue health benefits after the divorce? 5. A. Under no circumstance can you keep an ex-spouse on your coverage following a divorce. Continuation coverage under COBRA, or other alternate coverage must be at your or your ex-spouse�s expense. 6. Q. Will these changes I�m requesting cost me more money? 6. A. The cost of your medical health coverage (your Employee contribution) is determined by the bargaining unit under which you work. You should consult your contract or contact the Human Resource Department. The cost of Family Dental and Family Vision can be found on page 12 of this brochure. 7. Q. Could my request for changes be rejected during Option Transfer? 7. A. All requests for changes to your benefits, along with all supporting documentation, must be reviewed to determine the eligibility of each dependent. Only persons who meet the College�s dependent definition can be covered, and all dependents must submit proof of that relationship. If you can�t provide the supporting documents � marriage certificate, Social Security card, birth certificate, or other required proof of eligibility your request could be delayed or denied. In addition, if you are under a court order to provide your dependent with medical, dental and vision coverage, you can not request to remove the dependent unless you can provide proof that the order has been lifted, or the dependent no longer fits the college�s dependent definition. 8. Q. What if I don�t submit any applications during the open enrollment period? 8. A. Here is what will happen: Health, Dental, Vision - If you submit no requests for changes to your health, dental, or vision coverage, the coverage you now have will continue for next year. Flexible Spending Accounts - If you do not submit a request for the New Plan year, your current enrollment in either the Health Flexible Spending Account or the Dependent Care Account, or both, will end December 31st of this year. You must submit a new enrollment form if you want to continue in one or both of these flexible spending accounts. Medical Buy-Out - The Medical Buy Out election terminates December 31. You must submit a new Medical Buy-Out enrollment form to continue in the Buy-Out program, or you must be enrolled in the Empire Plan. 9. Q. What will I need to submit to make changes during this open enrollment? 9. A. For each plan you want to enroll in, or make changes to, you must submit a completed, signed and dated form. Originals please; no faxes or photocopies will be accepted. If you want to remove an otherwise eligible dependent or dependents for January 1, you will list his/her name on the form. If you need to remove an ineligible dependent to update your record, you will list the name, and the Date the dependent was last eligible (for example, a child who last attended school in March 2008). If you are adding a dependent to your coverage, you must submit the required documents along with your completed, signed and dated application. One set of documents is all that is required for any number of changes. If these documents are already on file at Risk, you do not need to submit them again. If you are not certain, you can call the Human Resource Department. 10. Q. How do I get the forms I need to make changes? 10. A. Health, dental and vision transaction forms as well as Section 125 enrollment forms can be accessed by going to the college�s website using the following link: www.sunyorange.edu/hr/forms Changes to your Empire Plan health coverage? Use the Empire Transaction Form (a two-sided form) Changes to your Dental coverage? Use the Dental Transaction Form Changes to your Vision coverage? Use the Vision Transaction Form Want to enroll in the Medical Flexible Spending or Dependent Care Account? Use the Section 125 Enrollment Form (2009) (a two-sided form) Want to enroll in the Medical Health Insurance Buyout for 2009? Use the Request to Decline and Waive Medical Health Insurance 2009 form 11. Q. What happens if my HMO costs more than the Empire Plan? 11. A. In the event that the cost of GHI HMO exceeds the cost of the Empire Plan, you will be required to pay your employee contribution, if any, in addition to the difference between the cost of the two plans (the excess premium). 12. Q. Why can�t I change my benefits anytime I want? 12. A. During a Plan Year (January 1-December 31), your benefits cannot be changed at will. There are numerous laws, rules, and regulations that govern how benefits are administered. If you cannot document a qualifying event that would permit a change or addition in your coverage, you cannot make changes during a Plan Year. However, certain life events may allow you to add new dependents, while other events REQUIRE you to delete dependents that are no longer eligible. 13. Q. What are some �qualifying events� that would allow me to add a dependent mid- year? 13. A. Some qualifying events would be: marriage, birth or adoption of a child, obtaining legal guardianship of a child, or a return to full-time student status of your 19 to 25 year old dependent. 14. Q. Can I add a new dependent at any time after he or she becomes eligible? 14. A. There are rules and regulations that require you to promptly notify the Benefits Unit if you want to add newly acquired dependents following a marriage, birth or adoption, return to student status, or involuntary loss of other coverage. All requests for coverage must be made within 30 days of the event. Failure to request coverage within this 30 day period may delay or prevent your request from being processed until the next annual open enrollment. 15. Q. How do I remove an ineligible dependent? 15. A. All requests to remove ineligible dependents, whether non-students ages 19 to 25, step-children who you are no longer supporting, or an ex-spouse, must be submitted on signed and dated change forms (health, dental, vision, as the case may be). For loss of student status: The date your dependent last attended school is required. (You can request a 3 month extension for your graduating student under the Empire Plan; contact the Benefits Unit for instructions.) For a divorce: You must supply a photocopy of the first and last page of the decree to verify names, the document filing date, and the ex-spouse�s current or last known address. 16. Q. What can happen if I don�t report a loss of a dependent�s eligibility? 16. A. There can be consequences to you, your dependent and your Department. For your dependent - your enrolled dependents have certain rights under COBRA and HIPAA laws. The date of the event dictates the date an ineligible dependent must be terminated from your coverage. If your dependent loses eligibility, as in the case of divorce or non-student dependents over age 19, you should contact this office within 30 days. If you wait more than 60 days, the dependent loses his/her right to COBRA coverage. For you - In addition, if the dependent uses your card after eligibility ends, you could be billed for all expenses incurred after that date. Use of a membership card after eligibility ends is considered fraud. For your Department - You may, or may not, contribute toward the cost of medical, family dental and family vision coverage, but it is important to keep in mind that when you no longer have any eligible dependents (spouse and/or children) neither you, nor your Department, should be paying for Family coverage. However, as long as one dependent�s name appears on your enrollment records, the coverage being purchased is Family coverage, regardless of that dependent�s actual eligibility. When you do not report the loss of your last dependent, your Department is paying thousands of dollars for coverage that cannot be used. 17. Q. How do I get a new or additional Empire Plan card? 17. A. You must complete a Request for Empire Plan Card, sign and date the form and return it to Risk Management. This form can be obtained from the college�s website www.sunyorange.edu/hr/forms or the Human Resources office. 18. Q. How do I get a new or additional GHI HMO card? 18. A. You must request your card from GHI HMO directly. 19. Q. Why don�t I receive all the brochures and literature that my co-workers receive from our insurance companies? 19. A. If your address is not kept current, you may not receive all the information that you need from your insurer. You must change your address through Human Resources; once the Benefits Unit is notified of the new address, your health and dental/vision providers are notified. Visit www.sunyorange.edu/hr/forms for an address change form. 20. Q. Why is my child, who graduated from college a couple of years ago, still listed as my dependent? 20. A. It is your responsibility to notify the Benefits Unit, in writing, when any dependent loses eligibility for your coverage. Each year, the Empire Plan sends out Benefits updates listing all dependents on your record. If you failed to update and send back that form, or did not submit a transaction form removing the dependent, or did not respond to any questionnaires from Risk Management, then the ineligible dependent�s name will remain on your record. 21. Q. I�ve had family coverage for years, and all of a sudden I am being asked to provide this or that information on my dependents. Why now? 21. A. The Benefits Unit has been preparing its records for conversion to the new Oracle system. When it is discovered that records do not have complete information regarding dependents, we have been contacting employees in order to obtain it. Please respond promptly to our inquiries. 22. Q. Is there anything I need to know or do if I�ll soon be retiring with my health benefits? 22. A. If neither you nor your dependent is currently Medicare eligible, you will notice few, if any, differences in the way the Empire Plan pays claims when you first leave active employment. However, if you are already eligible for Medicare, or if your spouse, either by age or disability, is already eligible for Medicare, you must make sure to enroll in Medicare Parts A and B and have it in effect for the month following your retirement. If you have a Medicare eligible dependent based on disability rather than age, you should contact Human Resources, to notify us of this fact. If you have specific questions, please feel free to contact the Benefits Coordinator at Risk Management, 615-3600. 23. Q. What is a Section 125 Flexible Benefit Plan 23. A. Orange County Community College offers a Section 125 Plan. Enrollment questions should be addressed Human Resources. Orange County Community College Section 125 Flexible Benefit Plan (for Active Orange County Community College benefits eligible employees only) This plan was established under Section 125 of the Internal Revenue Code, to help you pay for certain expenses using pre-tax dollars. Pre-tax contributions are not subject to federal, FICA, state and local taxes. (If you live in Pennsylvania, however, state and local taxes may not be excluded.) These pre-tax contributions do not affect New York State Retirement System benefits. Under the Plan, all employee contributions for health, family dental and family vision are taken on a pre-tax basis unless you instruct the Human Resource department that you do not want to participate. Your current election will continue unless a change form is filed during this open enrollment period. The regulations that govern cafeteria plans are very technical and complex, and many special rules under COBRA and HIPAA must also be considered. If, during the plan year, you think you have experienced a qualifying event that would allow a change in your benefits elections, and therefore your pre-tax contributions, please contact Human Resources to discuss your status change. (Claims filing deadline for a plan year is March 31 of the following calendar year.) Refer to pages 9- 12 for information on available medical, dental and vision benefits. 24. Q. What is a Health Flexible Spending Account? 24. A. The Health Flexible Spending Account, also known as Health FSA or Med Flex, is a medical reimbursement plan funded by your tax-free contributions. Enrolling in the Health FSA allows you to set aside money on a pre-tax basis to pay for medical, dental and vision expenses that cannot be reimbursed through insurance or any other arrangement. Examples of Health FSA expenses are deductibles, eyeglasses and orthodontics. This is a voluntary program. You can enroll for a minimum of $300, up to a maximum of $3,000 per year. During this open enrollment period, you should think about the out of pocket expenses you will have for yourself and your eligible dependents for the coming year. After your Health FSA becomes effective January 1, you cannot make changes in your account unless you have a qualifying change in status that would allow a corresponding and consistent change to occur. There are specific reasons for which a change can be allowed. You will be requested to complete a Change in Circumstance Form, and provide acceptable documentation of the change in circumstances. This is an IRS rule that must be followed. PLAN WISELY and do not over pledge. You must use this money during the Plan Year or you will lose it. You cannot get it back, and you cannot roll it over to the next year. This �Use it or Lose it� rule is part of the Plan design. Technical questions can be answered by calling Fitzharris, our third party claims administrator, at 1-800-635-5651, ext. 140. The Flexible Spending Accounts Enrollment Form is available on the college�s website www.sunyorange.edu/hr/forms, or in the Human Resource Office Your current FSA enrollment, if any, terminates December 31st. This benefit is not automatically renewed. You must apply for the new Plan Year. Please complete the Section 125 Flexible Benefit Plan Return the completed form to Human Resources before the deadline. Claims filing deadline for a plan year is March 31 of the following year. 25. Q. What is the Dependent Care Assistance Program � DCAP? 25. A. The Dependent Care Assistance Program, or DCAP, is another voluntary flexible spending account funded by your pre-tax salary contributions. This account helps you reduce taxes and increase your disposable income by paying dependent care expenses with pre-tax dollars. This program is available to employees who have dependents under age 13, handicapped children, or adult parents who need care to allow you and your spouse to continue working. Like the Health FSA, the DCAP Plan Year is January 1st - December 31st. The DCAP only reimburses expenses that have been incurred during the coverage period. Unlike the health FSA, you must put the money in before getting it out. You must have sufficient contributions in your account to cover the amount you are requesting for reimbursement. There must be adequate claims substantiation (the employee must provide the name, address of the caregiver, caregiver�s tax ID, or Social Security number for an individual.) You cannot carry over any unused contribution. The same �Use it or Lose it� rule applies to the DCAP, in accordance with federal regulations and Plan design. The annual minimum contribution is $300. There is a statutory limit on the amount of expenses that can be paid pre-tax under a DCAP. The maximum contribution, set by the IRS, is $5,000 (or $2,500 if married and filing separate returns). You will need to decide whether you will claim the Dependent Care Tax Credit for eligible dependent care expenses. You may want to talk to your tax preparer to assist you with this decision. This benefit is not automatically renewed. If you are currently enrolled in the Dependent Care Assistance Program (DCAP) it will terminate December 31st. You must apply for the coming Plan Year. To enroll in one, or both of the flexible spending accounts, (Health FSA or DCAP), complete the Flexible Spending Account Enrollment Form, and return to Human Resources before the deadline. All of the components of the Section 125 Flexible Benefit Plan operate under Internal Revenue Service rules. Therefore, once you have elected participation, you may not change your deduction(s) during the Plan Year unless you experience a qualifying event, as allowed by IRS regulations. You must contact Human Resources to discuss mid-year changes. You will be required to complete a Change of Status form and provide acceptable proof of the qualifying event. If you experience a change of status, contact the Benefits Unit with your questions and for further instructions. 26. Q. What are my health plan options? 26. A. GHI HMO and the Empire Plan will continue to be offered for the coming year. Consult the applicable union contract to determine your bi-weekly contribution for medical coverage enrollment. Keep in mind that if the cost of a health maintenance organization, GHI HMO, exceeds that of the Empire Plan, the difference will be the responsibility of the enrollee. GHI HMO This plan is GHI HMO Value Plan $20. There are no co-pays for well baby and well child care visits. The adult primary care co-pay is $20. The prescription benefits plan costs $10 for generic, $20 for preferred brand, and $30 for non-preferred brand. If you want to enroll in GHI HMO, you must select a doctor for yourself and each of your eligible dependents from the GHI HMO list of participating providers, and include that information on your GHI enrollment application. Your visits to participating specialists are by referrals. GHI HMO will not be mailing open enrollment information to prospective enrollees. If you are interested in reviewing the GHI co-payment schedule, call Human Resources. If you are interested in enrolling in GHI, contact Human Resources for an enrollment packet and application. The Empire Plan, NYSHIP (New York State Health Insurance Program) The Empire Plan is a specially designed health insurance program available only to public employees. The Empire Plan is not an Empire Blue Cross Blue Shield Plan. However, the Empire Plan contracts with other insurance carriers to pay claims. The following claims are paid by: Hospital claims are paid by Blue Cross Blue Shield. Doctors visits and lab charges are paid by United HealthCare. Mental health and substance abuse claims are paid by Value Options. Prescriptions are paid by MEDCO. The Empire Plan does not mail information to prospective enrollees during Option Transfer. For general information, copies of the current The Empire Plan At A Glance are available through Human Resources. The brochure helps explain the Empire Plan payer components. You may also look on the NYSHIP web site www.cs.state.ny.us (Employee Benefits, Employees and Retirees of Participating Agencies (PA), Core Plus). If you are thinking of leaving your HMO and enrolling in the Empire Plan, please contact the Benefits Unit with any questions, since there are differences in the way an HMO and the Empire Plan work. When you choose doctors or providers of services that participate with the Empire Plan, you will only have to pay the co-pay(s), and the doctor accepts what the Empire Plan pays as payment in full. You can also choose to go to non-participating providers. When you use a non-participating provider, you must meet deductibles. If you have questions about how this works, please contact the Benefits Unit at Risk Management. The Benefits Unit has not yet received information regarding any changes that might be made for 2009. As soon as this information is made available to us, we will pass it along. 27. Q. What is the Medical Health Insurance Buy-Out option? 27. A. It is a cash payment you request when you have an alternate source of medical coverage and do not want College sponsored medical health benefits. Employees who are eligible for medical coverage and are actively employed at work are eligible for the Medical Health Buy-Out Option. How do I enroll in the Medical Health Insurance Buy Out? The Medical Health Insurance Buy Out option is effective from January 1 through December 31 of each year. You must apply for this Buy Out Option by completing the Request to Decline and Waive Medical Health Insurance Coverage. You must provide detailed information regarding the alternate coverage under which you will be covered during the buyout period. (The alternate coverage cannot be health coverage provided by government assistance programs.) If you are enrolled in College provided medical coverage, Human Resources will terminate your current coverage at the end of the calendar year. How do I continue the Medical Health Plan Buy-Out for the next year? The Buy-Out option must be renewed during each Option Transfer. It is not renewed for you. If you want to continue the Buy-Out option for the coming year, complete the Request to Decline and Waive Medical Health Insurance Coverage that has been mailed to your home address; return to Human Resources before the deadline. How do I leave the Buy Out and enroll in medical coverage? If you want to enroll in medical coverage, complete an enrollment form for either GHI HMO or the Empire Plan, and return it to Human Resources before the deadline. (Please remember to include any supporting documents that are required to verify eligibility of your dependents, if enrolling.) What if I need to get out of the Buy Out during the Plan Year? You will not be able to re-enter a medical health plan during the year unless you experience a qualifying event. (It would not be a qualifying event if you find that your alternate coverage is not as good as the coverage you instructed this office to terminate. However, if your spouse loses his/her job and health coverage, that loss would be a qualifying event which would allow you to enroll in coverage for yourself and your dependents.) If you experience an involuntary loss of coverage during the period of the Buy-Out, you must contact the Human Resources immediately to discuss health plan options, and to complete the required Request to Resume Medical Health Insurance Coverage. (You must also be able to supply acceptable documentation of the loss of coverage.) If you want the Buy-Out option but are also planning to retire during the coming year, contact Human Resources to discuss your particular situation. Buy-Out payments are issued by the Payroll Department in the month following the end of each quarter. Orange County Self-Insured Dental and Vision Plans You can enroll or make changes to your dental and vision coverage by using separate dental and vision transaction forms. Make sure you complete the form(s) accurately; list all eligible dependents you want covered, with proper names, dates of birth and Social Security numbers. Remember, if you are adding dependents for the first time, (or if documents for dependents are not currently on file at Risk Management) you must supply required proofs of eligibility. Plan brochures and claim forms can be found on the Intranet. Dental provider lists are available by contacting Risk Management. The deadline for submitting claims for a Plan Year is March 31st of the following calendar year. 28. Q. Can you tell me about our dental coverage? 28. A. The Orange County Self-Insured Dental Plan is free to full-time eligible employees. Family coverage for Groups 718 OCCOBA and 755 OCDSPBA will cost $16.55 per payroll. Family coverage for Groups 723 CSEA/Management Plan, 768 Superior Officers, 719 OCCC Faculty and 722 OCCC Staff and Chair will cost $17.07 per payroll. If you do not submit a change form, your dental coverage will remain the same as it is now. 29. Q. Can you tell me about our vision coverage? 29. A. The Orange County Self-Insured Vision Plan is free to full-time eligible employees. Family coverage will cost you $1.96 per payroll. If you do not submit a change form, your vision coverage will remain the same as it is now. 30. Q. Who or what is Fitzharris? 30. A. Fitzharris and Company, Inc., is the claims administrator for the County�s dental and vision programs. Fitzharris works for Orange County; it is not the insurer. Fitzharris pays claims based on the scheduled of benefits allowances. Fitzharris is also the claims administrator for Orange County Community College�s Section 125 Flexible Benefit plans. If you have questions regarding a claim, you should call the toll free number at 1-800-321-1336. OPTION TRANSFER ENDS AT 5PM ON FRIDAY, OCTOBER 31, 2008 6 9