2016 Oklahoma State University Benefits

This publication contains important information about your employee

benefit programs.

Please read thoroughly.

2016 OSU

BENEFITS

2

Oklahoma State University

Eligibility .............................................................. 3

Health Savings Account ........................................ 4

Flexible Spending Accounts ................................... 5

2016 Medical/Rx Benefit Summary ........................ 6

Dental ................................................................. 8

Vision .................................................................10

Voluntary Benefits ...............................................11

Resources ...........................................................13

Table of Contents

ImportantChange of Status EventYou cannot change your insurance

coverage during the year except in the

case of a qualified change of status.

You have 30 days from the date of a

qualifying change of status event to

notify OSU Benefits and change your

insurance selections. Most changes

are effective the first of the month

following notification. If you do not

make your changes during the 30-day

status-change period, your changes

cannot be made until the next OSU

Benefits Enrollment period in October.

Financial hardship and provider

network changes are not considered

qualifying events.

Here are some common examples of

qualified change of status events:

� Marriage, divorce, legal

separation, or spouse’s death

� Birth, adoption, medical child

support order, or dependent’s

death

� Change in residence if the change

affects your or your dependents’

current plan eligibility

� Gain or loss of other group

coverage, starting or returning

from leave of absence, or change

of job status (e.g., changing from

part-time to full-time)

Questions?E-mail: [email protected] or

call OSU Benefits 405.744.5449

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2016 OSU Benefits

EligibilityIf you are appointed to work at least a six month assignment and have an FTE greater than 0.75 in an eligible staff or faculty employee position, you may participate in the University’s insurance plans.

All spouses recognized under applicable law are eligible for University benefits in accordance with the University’s plan documents. For questions about eligibility, please contact OSU Benefits, [email protected] or 405.744.5449

For OSU medical insurance and dental and vision benefits, your eligible dependents are as follows.

� Your spouse

� Your child under the age of 26; may be married or unmarried

� Does not need to be enrolled as a student; and/or may have a separate residence from you

� May be employed, but the employer must not offer group medical coverage to your child

� Your married or unmarried child of any age who is medically certified as disabled and dependent upon you for support and maintenance

Employees should carefully review the dependents they are covering on medical, dental, and/or vision insurance. During OSU Benefits Enrollment, employees should drop coverage for anyone who does not meet the criteria listed above for an eligible dependent. If covering eligible dependents, supporting documentation will be required to add them to the plan (e.g., marriage license, tax return, birth certificate).

Enrollment

OSU Benefits Enrollment

Annual enrollment occurs in October. During this time, you may review coverage and make changes to your insurance and add or remove dependents from coverage using the online enrollment system, Web For Employees (http://webemp.okstate.edu). Changes you make during OSU Benefits Enrollment will start January 1.

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Employees have the opportunity to contribute pre-tax dollars to an account to use for qualified medical expenses.

Employees who wish to participate in a HSA must be enrolled in a high deductible health plan, such as BlueEdge High Deductible, cannot be enrolled in Medicare, cannot be claimed as a dependent on another person’s tax return, and cannot be enrolled in any other non-qualified medical plan.

HSA’s are not use-it-or-lose-it plans. The contributions you make to the account rollover year to year and are yours to take with you if you leave the University. The HSA is not pre-funded. You use what is available in the account after it has been deposited. HSA participants can use the funds beyond medical expenses for such items as COBRA premiums, long-term care insurance and Medicare insurance premiums including A, B, C, and D products.

Health Savings Account

Management of your HSA is your responsibility. You must first open your account before funds may be deposited (including any employer contributions) or withdrawn to pay for qualified medical expenses.

You will receive a Welcome Kit in the mail or a link to open your account electronically. For either method, there are a few forms requiring personal information; this information is required by federal banking regulations under the Patriot Act, just as it would be required to open a traditional banking account. Look for the form titled “Master Signature Card” in your kit or online. Even if you electronically provide your signature to open your account, you should mail in this card. It gives you the ability to designate a beneficiary for your account. You can use your debit card, administered by BenefitWallet (https://mybenefitwallet.com/index.html), to pay for eligible expenses or you can reimburse yourself by writing a check from the account.

There are fees associated with your HSA account. When you access your account online, you will be directed to your homepage which includes forms and resources, including a fee schedule. Please review the fee schedule associated with your account.

For the 2016 tax year, the maximum contribution is $3,350 for individuals and $6,750 for family. You may also have an opportunity to make a $1,000 catch up contribution if you are age 55 or older.

Health Savings Accounts (HSA)

Flexible Spending Account (FSA)—HealthcareThe Flexible Spending Account for healthcare is administered by Chard-Snyder.

A healthcare FSA allows you to set aside a portion of your earnings to pay for qualified healthcare expenses as established by the IRS. Money deducted from your paycheck into the healthcare FSA account is not subject to payroll taxes, resulting in a substantial payroll tax savings to you. The annual plan maximum per participating employee for 2016 is $2,550.

� If you are in BlueEdge and do not have a Health Savings Account you can elect the healthcare FSA account.

� Under the Affordable Care Act, the Internal Revenue Service has set an annual limit on the maximum an employer can contribute to a health FSA; the 2016 limit is $500; therefore your monthly employer contribution to the health FSA will be $41.67 ($500 annual maximum).

You may use the FSA for the following expenses:

� Deductibles, coinsurance, and copayments

� Other qualified expenses which are allowable for a medical tax deduction

Please note expenses must be incurred in 2016 while you are a covered participant in the plan and elections cannot be stopped or changed during the year unless a qualified family status change occurs (as defined by the IRS) (see page 3).

Flexible Spending Account (FSA)—Dependent CareThe Dependent Care FSA lets you use pretax dollars towards qualified dependent care. The maximum amount you may contribute to the Dependent Care FSA is $5,000 per household (or $2,500 if married and filing separately) per calendar year.

Flexible Spending Accounts

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2016 OSU Benefits

2016 Medical/Rx Benefit SummaryMaking a ChoiceTo determine the best plan for you, we have provided a side-by-side comparison of your choices in the following chart.

BlueOptions BlueEdge (HSA)

Benefits Blue Preferred Network

Blue Choice Network Out-of-Network Blue Choice

Network Out-of-Network

Calendar year deductible

Individual $750 $750 $750 $2,600 $2,600

Family $2,250 $2,250 $2,250 $5,200 $5,200

Out-of-pocket maximum includes deductibles

Individual $4,250 $4,250 $4,750 $6,550 $6,550

Family $12,700 $12,700 $12,700 $13,100 $13,100

Physician office visits

Primary care $30 $30 50% after deductible

20% after deductible


Specialist $50 $50 50% after deductible



Preventive care

No charge for mammograms, child immunizations, or certain diagnostic tests in-or-out-of-network

100% 100% 30% after deductible

100% 30% after deductible

Immunizations-well child and adult



Routine lab 100% 100% 30% after deductible


Routine bone density testing



Women’s preventive care benefits



Colorectal exam 100% 100% 30% after deductible


PSA (Prostate Specific Antigen) Test



X-ray and lab services

Diagnostic test (X-ray,blood work)




Imaging (CT/PET scans, MRIs)






Urgent care 20% after deductible





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BlueOptions BlueEdge (HSA)

Benefits Blue Preferred Network

Blue Choice Network Out-of-Network Blue Choice

Network Out-of-Network

Hospital services

Inpatient 20% after deductible





Outpatient 20% after deductible





Emergency room(BlueOptions only: $100 copay per occurrence deductible; waived if admitted )






Mental health/substance abuse






Outpatient $30 copay or 20% after deductible

$50 copay or 30% after deductible




Substance abuse






Outpatient $30 copay or 20% after deductible

$50 copay or 30% after deductible




Skilled nursing care 20% after deductible





Home healthcare 20% after deductible





Hospice care 20% after deductible





Durable medical equipment






Prescription drugs

Generic $4 copay $4 copay $75 copay 20% after deductible


Preferred brand $50 copay $50 copay $125 copay 20% after deductible


Non-preferred brand $100 copay $100 copay $125 copay 20% after deductible


Specialty drugs $150 copay $150 copay $200 copay 20% after deductible


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2016 OSU Benefits

DentalMaintaining healthy teeth and gums and seeking professional treatment when dental problems arise is important to your overall health. Employees and their families should maintain good dental habits and seek professional dental care.

OSU Offers Four Dental Plans � Healthchoice

� Delta Dental PPO

� Delta Dental Premier

� Delta Dental PPO-Choice

Please review the comparison grid below and choose the plan which best fits you and your dependents.

Your Costs for Network Services HealthChoice Dental

Delta Dental PPO In-Network and Out-of-

Network

Delta Dental Premier In-Network and Out-Of-

Network

Delta Dental PPO-Choice

Annual deductible Network: $25 basic and major services combined

Non-network: $25 preventive, basic, and

major services combined plus amounts above

allowed charges

$25 Per person, per year, applies to basic and

major care

$50 Per person, per year, applies to diagnostic, preventive, basic, and

major care

$100 Per person, per year, applies to major

care only (level 4)

Diagnostic and preventive care (e.g., cleanings, routine oral exams) allowed charges apply

Network: $0Non-network: $0 of

allowed charges after deductible

$0 of allowable amounts no deductible applies

$0 of allowable amounts after deductible

Schedule of covered services and copays

Basic care (e.g., extractions, oral surgery) allowed charges apply

Network: 15%Non-network: 30% plus amounts above allowed

charges deductible applies

15% of allowable amounts after deductible



Major care (e.g., dentures, bridge work) allowed charges apply

Network: 40%Non-network: 50% plus amounts above allowed

charges deductible applies




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Your Costs for Network Services HealthChoice Dental

Delta Dental PPO In-Network and Out-of-

Network

Delta Dental Premier In-Network and Out-Of-

Network

Delta Dental PPO-Choice

Orthodontic careAllowed charges apply

Network: 50%Non-network: 50% plus amounts above allowed charges No lifetime maximum covered for members under age 19 and members age 19 and older with TMD

40% of allowableamounts, up to lifetime maximum of $2,000 no deductibleNo waiting period Orthodontic benefits are available to employee and their lawful spouse and eligible dependent children

40% of allowable amounts, up to lifetime maximum of $2,000No deductibleNo waiting period Orthodontic benefits are available to employee and their lawful spouse and eligible dependent children

You pay amounts in excess of $50 per month lifetime maximum up to $1,800No deductibleNo waiting periodOrthodontic benefits are available to employee and their lawful spouse and eligible dependent children

Plan year maximum Network and non-network $2,500 per person per year

$2,500 per person, per year



Filing claims Network: no claims to fileNon-network: you file claims

Claims are filed by participating dentists



Note: After the deductible is satisfied, your cost shares will be the percentage shown on the grid.

This is only a sample of the services covered by each plan. For services not listed in this comparison chart, contact each plan or review online at http://hr.okstate.edu/benefits/dental.

Dental Monthly Premiums

Employee only EE + Spouse EE+ Child EE + Children EE + Spouse + Child Family

HealthChoice Dental $32.00 $64.00 $59.40 $100.20 $91.40 $132.20

Delta Dental PPO $33.64 $67.26 $62.90 $107.68 $96.52 $141.30

Delta Dental Premier $44.52 $89.04 $83.30 $142.58 $127.82 $187.10

Delta Dental-Choice $15.06 $49.24 $49.50 $98.66 $83.68 $132.64

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2016 OSU Benefits

VisionMonthly Premiums

Monthly Vision Contributions

EE $9.50

EE and spouse $15.86

EE and child $15.62

EE and children $23.22

EE and spouse and child $21.98

Family $29.58

Vision benefits are essential towards maintaining your overall health and well-being, which is why we are proud to offer vision coverage through Vision Service Plan (VSP). VSP offers maximum value if you visit an in-network provider. For a complete listing of network providers, please visit www.vsp.com. Please review the outline of the plan below before electing coverage.

Covered Services In-Network Out-of-Network

Eye exam $10 copay $10 copay plan pays up to $35

Lenses per pair $25 copay $25 copay up to $80

Frames $25 copay $25 copay up to $45

Contact lenses $25 copay $0 copay plan pays up to $105

Laser vision correction 15% discount No benefit

After the copays above, the participant has a $120 credit towards glasses or contacts per year, and then a 20 percent discount on the remaining balance.

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Group Basic Life and AD&DOSU provides basic life and accidental death and dismemberment coverage to continuous, regular benefits eligible employees who work at least 30 hours a week (0.75 FTE.) Plus, OSU offers you the opportunity to purchase additional insurance for yourself and your family. Voya Employee Benefits provides the life insurance coverage, which is underwritten by ReliaStar Life Insurance Company.

Coverage Provided by OSU

Employees have basic life coverage provided by the OSU/A&M system of two-times annualized salary up to $200,000, with accidental death and dismemberment coverage. The Voya Employee Benefits plan includes:

� Accidental death and dismemberment coverage equal to basic life insurance coverage

� Accelerated death benefit which allows terminally ill employees to receive benefits while living

� Automatic reduction of coverage when reaching age 65

� $6,000 life insurance when you retire from OSU; must meet OSU retirement criteria

Voluntary Supplemental Coverage OpportunitiesEmployees may purchase additional coverage on themselves, spouse, and children. For more detailed information, please visit hr.okstate.edu/benefits/life or call 405.744.5449.

� No proof of good health is required if enrolled within 30 days of hire; limit of 2X’s salary for employee only and 1X’s employee salary for spouse

� Cost is based on age of employee and spouse

� Children coverage is based on coverage units, rather than age

� Proof of good health required if coverage is increased more than $5,000 each year or coverage exceeds two times annualized salary

� Portability is available to continue supplemental employee coverage upon separation and uses the same age-based cost available to active employees

� Employees can port supplemental life on their spouse and children if the employee ports supplemental life on theirself

� Even higher coverage limits are available at any time during the year by providing proof of good health satisfactory to ReliaStar Life Insurance Company—contact your Human Resources Office for assistance

If you are interested in applying for additional supplemental life insurance coverage, please complete the Life Insurance-Beneficiary Change Form and the Life Insurance-Evidence of Insurability forms and submit them to your Human Resources office for processing. You will receive notification from Voya, via your mailing address, regarding the status of your request. Voya also offers other services included in your life insurance policy; Funeral Planning and Concierge and Travel assistance services.

Voluntary Benefits

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2016 OSU Benefits

Voluntary Benefits

Cancer Protection

OSU offers a Cancer Protection Insurance Policy through American Fidelity Assurance (AFA) Company. If you are diagnosed with cancer, AFA’s Limited Benefit Cancer Insurance Plan pays benefits directly to you. This money may be used however you need, allowing you to protect yourself from financial hardship.

How would you pay for these out-of-pocket medical expenses?

� Lost income

� Utilities

� Spouse’s lost income

� Meals and lodging

� Transportation costs

� Special diets

� Housekeeping expenses

� House/mortgage payments

Contact Kacey Boothe, Executive Account Specialist for enrollment 800.933.1853.

Long Term DisabilityOSU offers a Long Term Disability (LTD) policy through American Fidelity Assurance Company. This is a voluntary plan and premiums will be deducted from your paycheck as an after tax deduction.

No one plans to be disabled, but are you prepared if it were to happen to you? Disability can cause financial hardship. A disability plan is a great source for providing the income protection you need. It basically works as insurance on your income: when you are unable to work due to a disability, you would receive benefits to help pay for life’s necessities. Employees can apply for a LTD policy at any-time during the year. If you are within your first 30 days of hire, you are guaranteed issue of this policy.

Coverage Options and Costs50 percent at $0.26/$100 of covered monthly salary with $50,000 additional AD&D Life Insurance—$6,000 maximum.

60 percent at $0.62/$100 of covered monthly salary—$6,000 maximum.

Example for 60 percent LTD cost: $29,000/12 = $2,417/100 = $24.17 * 0.62 = $14.99 per month.

Questions?Contact the Human

Resources/Benefits office at

your OSU branch campus

or OSU Benefits, 106

Whitehurst, 405.744.5449, or

email osu-benefits@okstate.

edu. Forms and additional

information are posted on the

Human Resources website

at http://hr.okstate.edu/

benefits.

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Medical and PharmacyBlue Cross Blue Shield

877.258.6781

www.bcbsok.com/osu

PO Box 3283

Tulsa, OK 74102-3283

VisionVision Service Plan

800.877.7195

www.vsp.com

DentalHealth Choice

800.782.5218

www.healthchoiceok.com

Delta Dental

800.522.0188

www.deltadentalok.org

Basic/Supplemental LifeVoya

hr.okstate.edu/benefits/life

800.955.6965

Oklahoma Teachers Retirement System (OTRS)

trs.state.ok.us

877.738.6365

Health Savings Accountwww.mybenefitwallet.com

877.472.4200

Long Term Disability/CancerAmerican Fidelity Assurance

800.662.1113

Flexible Spending AccountChard-Snyder

800.982.7715

www.chard-snyder.com

Alternate Retirement Plan (ARP) Voluntary 403(b) & 457(b)

TIAA-CREF

www.tiaa-cref.org/okstate

800.842.2776

Employee Assistance ProgramComPysch

www.guidanceresources.com

855.850.2397

CancerAmerican Fidelity Assurance

800.933.1853

ResourcesFor any other questions, please feel free to contact the Oklahoma State University Benefits Department at 405.744.5449 or email [email protected]. We will be happy to help.

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2016 OSU Benefits

Notes

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Notes

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2016 OSU Benefits

© 2015 Lockton, Inc. All rights reserved. [Rev 09/29/15] Memphis\EB\OSUCE01\EE Comm\Enroll Guide\2016\16OE 454.pdf

This Employee Benefits Newsletter is

only intended to highlight some of the

major benefit provisions of the Company

plan and should not be relied upon

as a complete detailed representation

of the plan. Please refer to the plan’s

Summary Plan Descriptions for further

detail. Should this newsletter differ from

the Summary Plan Descriptions, the

Summary Plan Descriptions prevail.

2016 Oklahoma State University Benefits

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