Benefits Guide - CSHL

Benefits Guide - CSHL

Your Employee Benefits at Cold Spring Harbor Laboratory (CSHL)

Constance Brukin, 2013/CSHL

• Definitions • Medical Benefits and Contributions • Dental Benefits and Contributions • Vision Benefits and Contributions • Life and AD&D Benefits and Rates • Other CSHL Benefits • Contacts

Effective January 1, 2021

Contents

Introduction

3

Benefit Eligibility

4

Definitions

4

Your Medical Benefits and Contributions

6

Your Dental Benefits and Contributions

8

Your Vision Benefits and Contributions

9

Your Life and AD&D Benefits

10

Optional Life and Voluntary AD&D Rates

11

Other CSHL Benefits

12

Key Contacts

16

Legal Notices

1 7

2

Introduction

This employee benefits guide highlights various benefit plans offered at Cold Spring Harbor Laboratory (CSHL). As you look to make decisions regarding medical benefits for you and your family, you should be aware that the available medical plans provide you access to one of the country’s largest provider networks, United Healthcare (UHC). You also have the freedom to select any provider in their network without obtaining a referral. The UHC network includes many top- tier specialist hospitals such as Memorial Sloan Kettering Cancer Center (MSK), St. Francis, and Hospital for Special Surgery. While CSHL remains committed to providing excellent health coverage for our employees, we need your help to control our escalating health care costs. With this in mind, the design of our in-network plan is to incent participants to use doctors designated by UHC as Tier 1 doctors (doctors practicing an excellent level of quality and cost-efficiency) and also to use a freestanding network facility, rather than a hospital, for outpatient services such as radiology and outpatient surgery. Virtual visits are also available as an option to connect with some doctors via live video instead of physically going to a doctor’s office. We have arranged with MSK to offer a benefit called MSK Direct – a program that offers guided access to exceptional cancer treatment for all our employees and their family members. Please refer to page 14. The UHC Choice Tiered Plan is an in-network only plan. This means that you and your covered family members must use in-network providers in order for the services to be covered. For the coming year the co-pays and reimbursements for outpatient services will remain the same. Your costs will be minimal as long as you utilize Tier 1 providers and free-standing network facilities, not a hospital, for lab work, radiologic services, and minor surgery. The UHC Choice Plus Plan gives you the freedom to utilize providers both in and out- of-network. However, with this plan you will experience higher copayments when utilizing in-network providers, and if you utilize out-of-network providers, your out-of-pocket medical costs will be higher. For 2021, we have increased the family deductibles and have increased the in-network member responsibility. We have increased the prescription drug copays for Tier 1 and Tier 3 drugs under both UHC plans. Please refer to page 6. As you look to decide which plan best meets your needs, please take the time to review the various plan details and research doctors on the UHC provider network on www.uhc.com. We have included the following definitions section to assist you in understanding the information throughout this guide.

3

Benefit Eligibility

Eligibility Information As an employee working 30 hours or more per week, you and your eligible dependents qualify for Medical, Dental, Vision, and Life/ AD&D Insurance benefits. If your spouse or domestic partner has access to group coverage through his or her own employer, they are not eligible for CSHL medical/vision and/or dental benefits. Special enrollment rules apply if you are married to another CSHL employee or graduate student. Making Changes During the Year Generally you can only change your benefit elections during the annual benefits Open Enrollment period. An exception is made for any Qualifying Life Event (QLE), such as marriage, divorce, birth, or adoption. You must notify Human Resources within 31 days of any QLE to make changes. Otherwise, you’ll have to wait until the next Open Enrollment period. Any changes you make to your benefit choices must be directly related to the QLE. Proof of the change will be requested (example: a marriage license or birth certificate). When Coverage Ends All benefits end on your last day of work. However, under certain circumstances, you may continue your health care benefits through COBRA Insurance. Definitions

United Healthcare (UHC) developed the United Health Premium designation program, which recognizes physicians that meet guidelines for providing quality and cost efficient care. These physicians are designated as Premium Tier 1 and are displayed publicly on myuhc.com and in UHC’s physician directory. The program uses national industry standards to evaluate for quality and local market benchmarks for cost efficiency across 25 specialties, including family practice, internal medicine, pediatrics, cardiology, and orthopedics. The fact that a doctor does not have a quality designation does not mean that the doctor does not provide quality health services. All doctors who are part of the UHC network must meet UHC’s standard credentialing requirements. Medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount was paid. A cost-sharing arrangement in which a covered person pays a specified charge for a specified service, such as $20 for an office visit. The covered person is responsible for payment at the time the health care is rendered. Our co-payments are fixed flat amounts for physician office visits, prescriptions, or hospital services for which the patient is responsible to pay. DED is a portion of the benefits, under a policy, that the employee and dependents must satisfy before any reimbursement occurs. This is called the individual deductible. A dental health maintenance organization (DHMO) is a structured type of dental plan. In this type of plan, a set group of dentists provides broad and affordable care at a low monthly pre- mium. The dentists who work with DHMOs receive a fixed fee each month. Most of the work is done at no cost or for a reduced price. You may need to make a copayment for some types of work. You will need to choose a primary dentist to work with and you must let Cigna know if you want to change your dentist. There are no waiting periods, calendar year maximums, deductibles, or claim forms when you have a DHMO plan. Your dependent child can remain covered under your health plan through the end of the month in which s/he turns 26 regardless of marital or student status or if they have access to an employer-sponsored plan. However, under the Dental Plan, your unmarried child can remain on the plan through the end of the month in which s/he turns 22 or through the end of the month in which s/he ceases being a full-time college student, up to age 26. Each year you will be required to provide supporting documentation that your unmarried child over age 22 is a full-time student each August.

Tier 1 Provider

Co-Insurance

Co-Payment

DED: Deductible

Dental Health Maintenance Organization (DHMO)

Dependent Child(ren)

4

Definitions continued

OOP is the portion of payments for covered health services required to be paid by the member, including co-payments, deductibles, and coinsurance. The OOP maximum is the maximum amount of co-payments, deductibles, and coinsurance that the member will have to pay each calendar year. Once the OOP maximum has been met, the plan will pay 100% of covered medical expenses for the remainder of the calendar year. A primary care physician or primary care provider (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. This can be a physician in general practice, family practice, pediatrics, internal medicine, or gynecology. This is a term used to refer to the commonly charged or prevailing fees for health services within a geographic area. A fee is considered to be reasonable if it falls within the parameters of the average or commonly charged fee for the particular service within that specific community. It creates a maximum that is allowed for a particular service based on the geographical area and the charges for the same service within that area. This >Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18-19 Page 20-21 Page 22-23 Page 24-25 Page 26-27 Page 28-29 Page 30-31 Page 32-33 Page 34-35 Page 36-37 Page 38-39 Page 40 Page 41

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